Portland State University report highlights best ways to support people experiencing homelessness

“What is the most effective way to support people experiencing homelessness?” That’s the question a new report called “The Pathways Study” tries to answer. Researchers at the Homelessness Research and Action Collaborative at Portland State University surveyed more than 500 people who are or have been homeless. The study focused on what people experiencing homelessness say they need most and what programs and services are helping them survive–and for some, get housing.

Kathleen Conte is the lead investigator of the study, and Cassie Marusa is a member of the 17-person Lived Experience Committee that helped produce it. They join us to share more about the study and their recommendations as Portland continues to grapple with how to provide housing to those without it.

Note: The following transcript was transcribed digitally and validated for accuracy, readability and formatting by an OPB volunteer.

Dave Miller: This is Think Out Loud on OPB. I’m Dave Miller. What is the most effective way to support people experiencing homelessness? That’s one of the questions at the heart of a report that came out earlier this month. Researchers at Portland State University partnered with people who’ve been homeless themselves to survey more than 500 people who are or have been homeless in Multnomah County. They focused on what people experiencing homelessness say they need to be able to meet their basic needs and to get into housing. Kathleen Conte is the lead investigator of the study. She is an assistant professor in the OHSU-PSU School of Public Health and a member of the Homelessness Research and Action Collaborative. Cassie Marusa is a member of the Lived Experience Committee that helped produce this new report. They both join me now. It’s great to have both of you on Think Out Loud.

Kathleen Conte:Thanks for having us.

Miller: Kathleen, first, what did you set out to learn in this survey?

Kathleen Conte: This study is funded by the Multnomah County Homelessness Services Department. They were interested in understanding how their services are working at a system level. So it’s not about any particular service, but about the whole system. How is it working to get people into housing? What are people’s goals? What do they want? And we kind of complicated that a little bit by asking questions that we were interested in, like what is actually helping people while they’re waiting to achieve those goals? While they’re currently and actively experiencing homelessness?

Miller: We’ve talked over the years and we’ve heard over the years about other surveys. What was different about this one?

Conte: This is the first time that the city and maybe even our state has actually invested in supporting people who have lived experience of homelessness as co-constructors of the research. So we have people with lived experience who are doing everything from collecting data to designing the study questions to even being involved in the analysis of the data.

And that’s very unique, not only for service delivery and service design, but in the field of research to open it up and have those folks be inside of the research making process.

Miller: Cassie, you were one of those folks. Why did you want to take part in this process?

Cassie Marusa: Being part of the Lived Experience Committee was something that came to me in an email from my administration. So seeing something that we can be involved in to directly impact research that is being done and giving a voice to people who have experienced homelessness like myself, I think that was the value of it.

I currently work with people who are experiencing housing instability and I understand their needs, and being someone with lived experience, I just wanted to help propagate that and make sure that the funding is going to the right places.

Miller: What did your work entail for this study, for this survey?

Marusa: The Lived Experience Committee was involved in all aspects of the study. We acted as co-researchers. We helped identify research priorities. We presented to media and in conferences. We developed messages to share with stakeholders. We created survey questions, we conducted the surveys, we did data analysis, and mostly we acted as advocates for our houseless community.

Miller: I’ll ask both of you this question, but Cassie, starting with you, what’s a concrete way that you know that this study was different because people like you were a part of every aspect of it? Another way to put it is, what would have been different if it had “just” been researchers like Kathleen – who don’t know what it’s like themselves to be homeless – if they’d been the sole people who did this?

Marusa: Well, I think the biggest difference is that this is a super trauma-informed project. This research is not being done on people with homelessness experience, but with people with homelessness experience. So, just being involved in every aspect, we’re able to add our value and add what we’ve gone through with our homelessness experience to every part of the research.

When creating the survey questions, that was a big part of making sure that they were trauma-informed, making sure that we weren’t going to elicit emotional responses that may have been negative. So, just, yeah, being all inclusive.

Miller: Kathleen, what about you? What’s a specific place where you know that this report is different because of the input, expertise, knowledge of people like Cassie?

Conte: The whole report is different from the research I would normally do. I would say that researchers are good at finding answers, but if we’re not asking the right questions we’re not going to get the right answers. And so the committee being involved and even just saying we need to understand people’s experiences while they’re homelessness, not just the services that they get, but what is it like to access those services and how is that helping them or not?

But the other thing I would point out is that the quality of the data in the study is tremendously important, because these folks were going out, our partners, our committee members were going out and meeting with people one on one and sharing their experiences and building trust. And the kinds of things that people told us were very personal and reflected the trauma that they had been through, and that wouldn’t have happened if it had been me out there asking those questions.

Miller: Cassie, you were one of the people who fanned out with the questionnaire. What was that experience like?

Marusa: That was really rewarding. To hear the emotional responses to the questions that we helped formulate was really powerful. We had lots of people give feedback that they were happy to be heard and happy to be given a voice and hadn’t been asked those questions before so it was really valuable.

Miller: On average, survey respondents said that they moved more than five times in the last six to twelve months, or – and we’ll get to this – were moved some number of times involuntarily. How much did you have to move around when you were homeless?

Marusa: Many times, over ten times within a few months, I would say. I primarily stayed at the Portland International Airport, myself. I was fleeing domestic violence, so I would stay there and I would look up flights on my phone so that if security came and asked me, I would have an excuse for why I was staying there. I stayed on the streets, I stayed in vehicles, at friends’ houses, couch surfed, so the only place I didn’t stay actually was a shelter.

Miller: Why not?

Marusa: It was a safety thing for me. I was a single woman, unsheltered, and I had heard stories so I felt safer in other places.

Miller: Kathleen, one of the ways that you all put the report together is to show, for all kinds of different questions, to show the demographic breakdown of how the answers to those questions depended based on gender, on ethnicity, on duration of that most recent homelessness experience. What kinds of themes stood out to you in terms of the diversity of experience based on people’s life circumstances?

Conte: I’m going to turn that back around a little bit because what’s most interesting and pressing is that those differences were there but they were very subtle, and they were hard to see because the overwhelming needs of people are just so clear. That people need affordable housing, that the main cause of homelessness is related to their ability to afford housing.

And what they want is simple and straightforward. They want a place where they can be safe and a place where they can be with their families. So when you get into more detailed specifics, like housing that accommodates women or families or that accommodates minority populations, well, they’re certainly playing an important role and people may be benefiting from them. If you put those up against just a roof over my head, people are choosing just a roof over my head. The need is that great.

Miller: I mentioned involuntary displacement. That’s the name in the report that you give to what we’ve often heard of and talked about as “sweeps.” What stood out to you in the survey responses about these involuntary displacements?

Conte: I think the thing that’s most pressing is that people are moving, they’re being displaced, and it looks like we are displacing the same people over and over again. And so what that raises to me is a question of how well is our system working overall?

When people are displaced, they lose access to key things that actually help them get into housing. So their cell phone, you need that to be able to be called by your caseworker, your ID and other paperwork. People said that they missed appointments with housing navigators that were helping them get into housing. So the displacements show that some of our actions are working at cross purposes. While people have invested in homelessness services, this investment in constantly moving people through involuntary displacements is working against that.

Miller: Over the years, we’ve had various conversations about these displacements, these sweeps, and we’ve heard from various policymakers, we do our best to, first of all, we give warning ahead of time, and second of all, as we’re moving people along in a place that we’ve told them that they can’t be here and we try to hook them up with services.

What would you like to see? Let’s say that sweeps of some kind still happen, that policy leaders say that this person, we’ve told them they cannot be in this place and so we’re going to move them along somewhere else. How would you like to see best practices in terms of those involuntary displacements if they’re still going to happen to some extent? What’s the least harmful way for them to happen?

Marusa: Yeah, I’ll answer that. I think one of the biggest things is being connected to services during the sweep. A lot of times people are just told to leave and their belongings are taken and they have nowhere to go. I think one of the responses mentioned, we can’t just not exist. So, having some type of support worker there, and doing it in a more trauma-informed way, I would say.

I’ve heard from a lot of participants that the way that they are moved is not trauma-informed, kind of rude, and that their items are not being handled carefully and that it is nearly impossible for them to retrieve their items once they are moved. So that’s been a common theme, just having an approach that connects people to services as opposed to just trying to clean up the area.

Miller: Kathleen, we’re gonna be talking with Mayor Wilson later this week about budget questions. He has focused his homelessness attention really squarely on shelters. What did people in the survey responses say about shelters?

Conte: Some of the things that Cassie brought up earlier in this interview, which is that people are worried about safety. They’re worried about security. Some people do find help through shelters and I think that’s important to note, that about a third of the population stayed in shelters most often, and two-thirds used some form of shelter.

But shelters aren’t supposed to be a long term place to stay. And a recent study by the Welcome Home Coalition also showed that people preferred staying in shelters as much as they preferred staying outside. So they’re seeing those things as equally bad, I would say.

Miller: We asked folks on Facebook what they think are the most effective support services for people experiencing homelessness. Candy Lopez wrote on Facebook: “Prevent homelessness in the first place. We need a lot more affordable housing to prevent people from being forced to spend 80% of their income on rent. Universal healthcare to prevent one bad medical bill from forcing people into bankruptcy. Better mental health care and addiction treatment services that are widely available and affordable.”

Brennan Swan wrote: “Affordable housing – actually affordable, not this model where 80% of the median income is considered affordable. No. Someone working full time on minimum wage should be able to afford rent.”

And Sue Gemmell said: “A secure place to sleep, clean up, store things, and get the support services that meet individual needs.”

Kathleen, I saw you nodding a little bit as you were hearing. What stands out to you in some of those comments?

Conte: It sounds like the main findings from the report. People who are experiencing homelessness know what they need to be successful in housing, and it’s those things that those listeners just said to you. They need affordability. They’re not asking for places that they can’t pay for themselves.

And actually, people might give up housing.

That was one of the deal breakers that people identified was that they would give up a house or a placement that wasn’t long-term, if it was just temporary, because they’re looking for that stability. Also, a large number of people are looking for employment opportunities and employment support. So people are wanting to work and they’re wanting to be in places that they can be successful.

Miller: Cassie, one of the pages that struck me was in the area where respondents were asked for the reasons for their loss of housing for the most recent time they became homeless. The top answers were lost or reduced income, some kind of trauma that they experienced or an eviction notice.

But what was most striking is that close to half of respondents cited at least four different reasons and as many as ten different reasons for becoming homeless at the most recent time. How does that increase the challenge of helping people if they’re saying it’s not one reason, it’s not four, it’s ten different things that they could point to on a list for why they were homeless.

Marusa: We’ve talked about kind of the perfect storm. It could be that just means that there’s way more issues to work on to get people stable into housing. So if mental health was involved, that’s an area that needs to be worked on, and affordability, and then they have an eviction on the record. It’s just those compiling pieces that make it a lot more difficult to get housing and then to remain in housing.

I’ve known people that have gone into housing that have not addressed their mental health needs and then have lost their housing as a result of that. I need to take a holistic approach and individualized approach to the housing for each person.

Miller: Do you think that the findings from this survey dispel any common myths about homelessness?

Marusa: I do. I think a lot of people see people using drugs on the streets, homeless people using drugs on the streets, and assume that everyone is using drugs, and that’s not what we found. So I think that’s important.

Also, over half of the survey participants were looking for employment, seeking employment. And I think another common perception is that they’re lazy, and that’s not what we found in the survey data.

Conte: And 98% of participants want permanent housing. So that’s another myth that people don’t want to move into housing and we found that’s wrong.

Miller: You mean there’s some sense among some people that people experiencing homelessness, that they want to be in a tent on the street?

Conte: Exactly.

Miller: And you’re saying 98% of people said we want permanent stable housing.

Conte: Exactly.

Miller: The report starts with this sentence: “As historical levels of funding to resolve and prevent homelessness draws down in Multnomah County, entities providing homelessness services want to know the most effective ways of supporting people experiencing homelessness.”

What does this report, this big survey suggest about the most effective uses of dwindling funding? I mean, what does it say should be prioritized if less money in the county is going to go towards homelessness in the coming years?

Conte: I mean, if that’s the case, we show that people are using and accessing services that just help them survive and that those are very important. So, access to food, access to a safe place to sleep, access to hygiene facilities, places to charge your phone so you can stay in communication.

Miller: Those are among the most used services and at the bottom of the most unmet services, because people are actually taking advantage of those.

Conte: And they’re helpful. Yes, that’s right, but the things that are actually helping people get into housing, and what we need more of are things like good case management and placements, places to have people go. Alternatives to shelter or trauma-informed shelter. Places where people can feel secure and safe while they’re navigating the homelessness space.

Miller: Cassie, how do you hope this report is going to be used? This is, in the end, one more survey put out by a group of very well-meaning people. What do you hope will follow from it?

Marusa: I really hope that there will be more effort in funding… in permanent housing and helping people find employment. So some employment support to help people fill their own life, get to a place where they want to be and not be on the streets anymore.

I feel like a lot of people aren’t staying in shelters. A lot of people who are homeless are not staying in shelters. So I think putting more funding into that is not necessarily helping the situation and not helping people get into permanent housing.

Miller: And Kathleen, finally, the report we’ve been talking about that came out this month is the first of two. How is the report that’s coming out later this summer going to be different?

Conte: We’re going to be looking at how people actually get connected to caseworkers, how they actually navigate that pathway through services to housing. I think there’s another myth that people have to go through shelter to get to housing and that’s not what we found in this survey. So some of those myths can be unpacked a bit more in the second report which is focused on in-depth interviews with people.

Miller: Kathleen Conte and Cassie Marusa, thanks very much.

Conte/Marusa: Thank you.

Miller: Kathleen Conte is an assistant professor in the OHSU-PSU School of Public Health and the lead investigator of the study put out by the Homelessness Research and Action Collaborative. Cassie Marusa is a Lived Experience Committee member.

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