S2E4: Street Medicine, Housing First, and Reaching the Unhoused | Cat Cruz & Dr. Craig Borne

Not everyone wants to live the life that you want to live.

Some people when offered, you know, shelter,

they're gonna like, go sit in a bando kind of thing.

They're gonna be like, nah, I'd rather stay up until.

Like, I've had a patient.

I knew he was, I knew he was living rough.

He told me, edically, he was doing fine.

And I asked him about his goals

and he was working at Walmart.

He was putting money into savings.

He was working to get a car.

He had engaged in different services

and he was just chose that life.

Welcome back to The Shield.

This is a place where we talk about the intersection

of substance use and mental health on all facets of life.

And at the same time, really elevate some awesome things

that are happening in Birmingham.

Thank you again to our sponsors, the Children's Trust Fund

for making this possible.

We could not do anything without that.

So thank you.

With me today are two guests.

And we are gonna talk about a new program

that program service coalition.

Coalition.

Yeah, a new initiative that is quite literally

hitting the streets of Birmingham

and we're so excited.

So I have cat crews from one roof

and I have Craig born from Kahaba Medical Care.

And today we are going to talk about care for our journey.

Welcome, y'all.

Thank you.

Okay, so what the heck is care for our journey?

So, how would you describe it, Craig, in like one sentence?

Or maybe two sentences?

Yeah, an interdisciplinary street medicine coalition.

An interdisciplinary street medicine coalition.

So, in case people still don't really know what that means.

In a nutshell, other cities have had programs

that are like street outreach, right?

With street medicine, street psychiatry,

there's a really cool one in Montgomery happening

that's street psych where physicians

and providers actually go into community.

So you're reducing barriers to access

and you're bringing the care to individuals.

And Birmingham didn't have one of those.

But we came together a lot of last year

and had a ton of meetings trying to figure out

like what this could look like.

And I think the cool part,

and we'll touch on this later,

is that it's not owned by any one particular agency.

There are several agencies that are all sort of

bringing different skill sets to the table

in an effort to create a program

that is unique and unlike any other program

that we've ever had here in Birmingham, certainly.

But in a lot of ways,

it's also different from what's happening across the country

because of the holistic approach.

So, when we were starting to pull in folks,

it was at the beginning,

it was a lot of folks from UAB trying to figure that out.

It was us at APC,

food for our journey because Kelly Green

is going into community.

She has 3D plus stops every day,

pulled her in recovery resource center,

one roof and kahaba.

And there were some others,

but those were the ones that kind of like kept coming back.

And so, Craig, I want to start with you,

like if what we needed to do,

street psych that was happening in Montgomery

was super important and it was filling a niche,

but we also knew that we wanted

more holistic medical care.

So, can you talk about what kahaba does sort of

all the time and then the role

that you're filling with this specific project?

Yeah, yeah, yeah.

So, yeah, kahaba medical care,

it's a set of clinics

that make up like a larger health center.

And so, we're from,

yeah, really up here in the West End,

all the way down through Centerville, Camden,

like the reaches far down there.

But a lot of the focus is like here in the West End,

Fairfield, Bessamer,

and then we have school-based clinics there out as well.

And so, we have this like larger clinic system

and we're also a federally qualified health center.

And what does that mean for people

that don't know what a FQHC is?

Yeah, and so an FQHC is a clinic that receives

funding from the government,

but that allows the clinic to see

a majority of medical and Medicaid,

as well as all of the insurances.

But we also get to have a sliding scale,

which allows people who are uninsured to receive care.

And so, that's based on their income level

and it will provide basic medical care,

labs, physical therapy, all the imaging

and that kind of stuff that we have,

which, yeah, we have x-ray ultrasound,

and then physical therapy, as well, at the clinic.

And so, yeah, and so,

with that, we have a built-in health center

that can absorb people that are unhoused if needed.

And then also, we are set up to engage in street medicine,

which is a brand of medicine or a type of medicine

that is bringing a full suite of clinical care

to people where they are,

which is super important because there's a lot

of socioeconomic and structural factors

that's in history that kind of keep

our friends on the street out of the classic clinical system.

And Kahaba in this particular,

I mean, this is what you do 24-7 anyway,

but in this particular initiative,

you are providing holistic care.

So it could be anything from care for somebody's diabetes

to, if they have wound helping with that,

it could be, talk a little bit about

kind of the spectrum of services that you can provide.

And it's you and Sarah, right, on this project.

What kinds of services are you all providing?

Yeah, and so, yeah.

On the street.

Yeah, on the street, yeah, yeah, yeah.

So I'm a, I'm a word certified family doctor,

which just, that means I practice full spectrum care

like you were saying.

I can see kids, adults, elderly people,

do prenatal care, those obstetrics as well.

And so, yeah, and so, and then into mental health

and substance use, suboxone,

and the different injectables and those kind of things.

And so, so able to take all of that

that I learned through the way you see a cart.

Is basically not, but is he pretty smart?

I mean, he likes to think so.

He tells us all.

So I would imagine though,

because you can sort of treat and do the,

I mean, you're doing the whole birth,

like the whole spectrum,

everything from preventative care all the way to,

like, holy cow, this person might even need to go

into the hospital, like everything in between.

Yeah.

Whoa.

Yeah, yeah.

Our residency training, which Sarah Bertrand

is one of our third year residents at Cobb Medical.

Awesome.

It's awesome.

It's a copy of a UAB family medicine residency,

which is where I graduated from.

Yeah, we do everything from the clinic

to we trained in the hospital as well.

So we are hospitalists,

where obstetricians and ER doctors,

or urgent care doctors,

we can kind of go everywhere,

which is the beauty of family medicine

and why I think a lot,

like if you like other street medicine programs

around the country and that kind of thing,

a lot of them are either going to be family doctors

or kind of med-peeds doctors,

which is that like broad spectra of care.

Yeah, not like super specialized,

like you can see, you can kind of,

you know the gamut.

Wow.

The other like piece besides medical

that was like a no-brainer as we were coming together,

thinking about how we needed to structure

this street medicine, street outreach,

whatever you wanted to call it,

the other component that was critical

besides medical was housing.

Like that's a no-brainer.

So Kat, can you talk in broad strokes about

what is, what does one roof do,

but then also what is the housing landscape

here in Birmingham?

Because I know we have some challenges.

Well, one roof is the hub of the continuum of care.

There are hubs in various places

and what we do, my boss is going to hate me

because I can't remember our,

we don't need official like mission statement,

Gordon, if you're listening, just smile.

What we do is we take data from folks

who are experiencing homelessness

in the Birmingham state clear and Shelby area

to see what housing resources they might be available for.

Or they might be eligible for.

And some of those may include

HUD funding, housing referrals based on HUD priorities.

But a lot of times not.

So we try and have a good idea of what all the resources

are and what all the pathways are

and help folks move towards those pathways.

And that's the case management piece.

So you're like helping them navigate.

Helping them navigate.

So that's one piece.

We also have a walk-in and call center.

So people can kind of get those same services

when they call or they walk in.

We are, you know, there are some,

maybe not so unique challenges.

And then you have, sorry, before you also have

street outreach.

Just street outreach, yes.

And I am part of street outreach.

And that's where you're like boots on the ground,

helping people that are currently experiencing homelessness,

try to find shelter, more stable housing,

respite, kind of everything.

Okay.

So I started, I mean, I started off as part of the regular

street outreach team as a four person street outreach team

that only does housing.

And then this came up.

And so this is more of a collaborative thing.

But yeah, as street outreach workers,

what we do is we go out and kind of get people

to a place where they're willing to engage

and willing to talk about your building trust.

About their needs, exactly, building trust.

And we're very careful about keeping that trust

and keeping everything anonymous.

That's a big part of what we do.

As trust is built, then someone might want to share

more of their information.

Sometimes people are in the HUD priority population,

wherein we can do an assessment,

we can get them into a pool of folks waiting

for HUD funded housing referrals.

But as I tell clients, often they're way more people in need

and eligible than there is out there.

So a lot of what we do is help people navigate pathways

that might already exist and just see what might already exist.

So maybe it is like connecting folks to an employment service

that might work for them.

Maybe it is helping connect folks to an agency

that can help them get an ID, which will help them get to work.

There's a lot of different things.

Maybe it's even interceding with friends or family member

to try and help people have a place.

There are a lot of different ways to get housed.

Right now, I have a few clients who ended up in the ER

and now we're in skilled nursing care.

And so I'm working them to figure out with them to figure out

if they're gonna stay in skilled nursing care

as permanent using their insurance

or if they're gonna be, of course, they're eligible

to still be in the pool of people waiting,

but are they going to be attractive to a housing project

who doesn't necessarily have that medical ability?

Right, right.

So that's sort of what I'm doing with them now.

So it's a little bit different with everyone

because not everyone is in situation.

And Birmingham, my understanding from talking with Gordon

is that Birmingham has a lot of housing

but not a lot of affordable housing.

Like what, okay, what does it,

what does affordable housing mean?

What does that mean?

Because when I moved here and I was looking for housing,

well, it wasn't very affordable

and I have a full-time job, you know?

I mean, it wasn't very affordable.

I mean, I don't know that there's,

there probably is an official definition of affordable housing,

but I think it depends on what agency you're talking to.

If you're talking to HUD, that's 30% of your income,

which doesn't really exist very much, right?

If you're talking to developers,

it's less than they would charge normally,

but really not affordable.

What we have is a lot of housing

that doesn't match the economy of the neighborhoods.

I mean, even here in Titusville,

the average income and the average housing price

prices don't match.

Right, right.

Which is what's for the certification, of course.

It makes it even harder.

And something even more challenging

that just sort of compounds on all of this,

and again, this wasn't just in Birmingham,

this was like nationwide, was the closing

of several mental health institutions and things like that

that forced a lot of people onto the streets.

And so the Care for Our Journey initiative

really sort of targets, aims,

attempts to provide services for those people

that are unhoused, correct?

And we're bringing the services to them.

Yes, one thing that made me feel really passionate

about this project is, yes, on the ground,

there are three different agencies.

There's Recovery Resource Cahaba and OneRoof

that are doing the work every day.

Yes, and we do three separate things,

but it's a collaborative initiative

because in HUD best practices are housing first.

That means housing before anything else,

but that does not mean that housing

is the most important thing.

Everything is the most important thing.

We can think of medical care as a housing need

or as housing as a medical need.

Or free coverage, right, right, right.

If we think of acting together as a coalition,

as opposed to different services in a silo,

given the fact that, you know,

beggars can't be choosers

and we don't have enough services,

it makes the most sense to act together

and think of ourselves as a team

as opposed to three separate services.

Absolutely, absolutely.

And that's what interests me about this so much,

the collaboration.

And it makes it more difficult, you know?

Oh sure.

We're all doing different things.

Oh sure, we're all different people.

We're all different agencies.

We have different boards.

We all need different data sets and all the things,

but when it comes down to it,

we can get more done for the client

and move them further, quicker, client patient,

whoever, if we work this way,

if someone is not ready to engage with me about housing,

they may engage with Chris Albright,

who is our recovery resource peer about recovery.

Yeah, they may engage with Craig about medical.

If they engage with Craig

and they also need to talk about housing,

he doesn't have to say,

here's the phone number call this person.

He can call me over.

And that I think really opens a lot of doors for us

in terms of trust with folks living on these streets.

Because that was something that was paramount

when we were all in the room talking

and this was something that Kelly Green was like,

so set on is it's all A, calling them friends,

building community, protecting trust.

We were very slow with the quote unquote rollout

because we wanted to be very intentional.

We wanted to keep showing up.

We sort of piggybacked off of food for our journey at first

because they are people who have the trust

in community and go out kind of day after day.

And so in terms of the mechanics of the program,

Kat, you mentioned a little bit about it.

So RRC Recovery Resource Center,

OneRoof and Kahaba,

they're you three are the boots on the ground.

So there's always a peer,

there's always a person from OneRoof to talk

at help with housing and navigation for shelter or whatever.

And there's always a medical person.

So well, most of the time.

Yes, and so how,

so can you talk,

I don't need like specific stops or anything like that,

but can you talk about,

and there's a reason for that, right?

So some people might be saying,

well, why can't I go and help out?

Well, it doesn't work like that because privacy.

Privacy, exactly.

We're going to people's home.

It's also why there aren't any of our friends

or clients on this podcast.

Like we want to be careful

and we are, we're going into people's homes,

we're meeting them where they are.

And just because their home doesn't look like our home

doesn't mean that, you know,

we all just get to show up, it's still their home.

Right.

So we're not talking specific stops,

but in general,

could you walk me through like,

maybe like a typical day,

doesn't have to be a particular stop,

although I will just say that correct me if I'm wrong.

But a lot of the work that's happening

is happening on the outskirts of downtown, correct?

Not, I feel like it's a good mix.

A good mix.

Okay, okay, okay.

We've built a, we've sort of,

we've been taking data since October.

Yeah.

And we've built out around,

we kind of started following food for our journey.

Because of the different services we provide,

it doesn't work perfectly.

It doesn't work perfectly.

And because of the time, you know,

we just, it's just timing.

Yeah.

So we're going pretty quick.

Yeah.

And whereas you might have somebody

in there with you for an hour.

Yeah.

I mean, a good clinic morning, like in the clinic,

like actual clinical setting where people are coming

to me with appointments and that kind of stuff,

I can see, you know, 12 to 15,

you know, on a good clinic morning.

Kelly serves up to, I mean,

averagely, I think talking to her,

she serves anywhere between like 180 to like 250 meals.

I mean, that's a great day.

Right.

So that's like where we started,

but then we had to, we had to adapt,

which is part of, and they're just different services.

And the beauty of it is all these services work well together,

but we need to respect that they,

we need to do things differently,

like time and management and all of those things.

So like, what's a day?

What's, what's a day look like?

Typical care for our journey day.

We get on the van at nine o'clock,

and we go out to our first stops.

Typically, there's two stops a day.

No, three, four.

Okay, okay, okay.

It depends, okay.

Okay, so nine a.m.

You get on the van, what, what van?

Like paint a picture.

Okay, the one roof, yeah, we've a van at one roof,

and no one wants to drive at me,

so we get to drive it.

Sorry, miss me, beautiful.

Well, the short straw, that one, okay.

So we could love the soccer van, you know,

it's great, it's got the room for us.

We go to our first stop, and we just,

I mean, we just go to stops all day and see people,

and you're just chatting with people at this point.

It depends, we're doing what's needed.

We, at this point, folks know us,

they know where we're going.

We pull up.

They see you have like an established route, right?

So they know where you're going to be.

And it does change.

If we go to a place like two or three times,

and there's no one, we generally move on to something else.

When we do that, I'm able to talk to the regular outreach team

to make sure that they're continuing to check.

Got it, okay.

To make, you know, because people move around a lot.

Yeah, yeah, move.

People move around.

Yeah, yeah, yeah.

Because a lot of times they get kicked out of,

they have to move around, yeah.

They have to move, right?

Yeah.

The city does, the city has like their job

and their initiatives as well.

And sometimes, yeah, that runs kind of in friction

with our friends on the street.

And so yeah, and so we just continue to travel with them

as they go.

All right, so 9 a.m.

You pull up in the soccer mom van, okay?

And, you know, we get out, say we're at a park, right?

You get out, you know, one roof,

a hub, a recovery resource.

We kind of yell out, say who we are.

Sometimes people are there already.

And we just offer services, have conversations,

see what people might be interested in.

Sometimes people don't want anything

we get back in the van and go.

Sometimes we have people we know that we're seeing

because that has been set up beforehand by one of us,

by food for our journey.

And, you know, so at that point,

we just kind of offer whatever.

Sometimes it's me sitting down and having a conversation

about housing and doing an intake and assessment.

Sometimes it's Craig sitting down

and figuring out what the medical needs are.

Sometimes it's Chris sitting down and talking with them

about addiction and where they are

and what they might want to do around that.

Honestly, I think that's probably the hardest piece of it.

Because it's, you know, people do these things

to deal with a horrible life.

Yeah, to cope, right.

And it's, I think it's a really hard thing to sell, like,

hey, you know, stop doing that thing that's keeping you alive.

Yeah, yeah.

And, you know, it was critical for us to have,

not just somebody from Recovery Resource Center,

but also obviously APC wanted to be involved.

We help with wound care kits

and our community collaborative board sort of provides,

like, a little bit of oversight for lack of a better word,

but I don't even know if that's the right word.

Yeah, accountability.

But then also, it was important for us

to provide some medication for opioid use disorder

because some of the funding is coming from opioid settlement

grants from the Birmingham city, opioid settlement,

as well as Jefferson County as well.

And so can you talk a little bit about that kind of intersection,

like, let's say that, you know, there is somebody

that has been identified as struggling

and they want some help.

How do you get involved at that point then?

Yeah, and so, yeah, I think, yeah, like what Kat said,

like, we do go out and so, yeah, we're all on the van.

We kind of go out.

And it's like, it's like, it's like, yeah, we're all,

we're all, yeah, I'm calling out of the van, you know.

And you're not wearing your white coat, right?

Okay, good, okay, and that's intentional, right?

Okay, of course.

And so, yeah, and so it's, I mean, yeah, it's,

it's going to our friends with love, right?

And like, that's the kind of the point.

That's the point.

And so, and so, yeah, and so, but we're, yeah,

we are going to their home.

And they, and so the very, the key difference

between clinical medicine and street medicine

is that we are going to their home

and oftentimes it's uninvited to kind of thing.

And so, there's a, there's an ethos there.

There's a, there's an empathy there.

There's a, there's a, there's a, there's a,

difference in engagement.

And so you have to just reach out and be like, hey,

do you want to, do you want to talk today?

Do you now want to talk today?

It's totally okay.

How are we going to work today?

But then also there's, you have to,

you have to discuss what you can bring to the table well.

And so, you have to reach out and be like, hey, I'm a doctor,

right?

And so, if you want to talk about any medical needs,

I'd be happy to, if you have any questions,

like if you want to engage in any, like substance use

discussions, anything like that.

If you need medicine that you are supposed to have had,

hey, it was less time you went to the ER.

Do you have any questions since you were last at the ER?

Because like, everyone usually does, right?

And so, yeah, and then like, hey, I'm with OneRoof

and OneRoof is, you know, institution at Birmingham, right?

And so they know they and also has like housing.

And so a lot of people, a lot of our friends know kind of

what's what's going on there.

And then recovery resource as well.

And so, so yeah, and so when something's identified,

like a medical need, a medicine need,

or an addictions need, you just discuss the different options,

just like you wouldn't a clinical setting.

You say, hey, and in a lot of them, no, you know, it's not.

It's most often at the time, it's not their first,

like, radio kind of thing.

And so yeah, I'll talk about, you know, hey,

I know these few methadone clinics around,

but I can also write you suboxone.

I can write you along acting injectable, sublocated.

And we can get going on this.

I can bring it to you.

I don't think people understand just how amazing this is.

I mean, really, it's just, it's really incredible.

It's incredible.

It really is.

I mean, a lot of times we come out as a band,

we introduce ourselves as starting with one roof

because we have been out here for a few years,

before I know who one roof is.

And then we sort of build on that.

But I mean, within the first couple of weeks,

I think Craig came out with a joint shot to give to someone.

And I was just like, slap or gassed it

because these are the kind of barriers that we run up to

with our clients that we can like slowly chip away out,

but the more that happens, the more that the person

is giving up, right?

So the fact that we can just do that,

when people have such inherent, I mean, I was a teacher

and I know people have a lot of feelings

about education systems and a lot of mistrust,

especially if they had like particular experiences.

And it's the same with medical care, right?

People fear doctors or they think that they, you know,

that physicians tell them what to do,

that they don't get to ask any questions

and they might have had a traumatic experience with a doctor

and just a lifetime of experience.

Exactly.

And the fact that you're there that you might be able to help

with a joint shot or some, you know,

whatever it is, like whatever it is,

I mean, that's pretty incredible.

Why are you doing this?

Like what?

I mean, I wanted to get through the logistics,

but like, here's what I really am curious about.

Why are you doing this?

You could probably go anywhere and make a trillion dollars

and you wouldn't be like on the street

in probably some pretty gnarly conditions

if we're being honest.

What are you doing?

Yeah, yeah.

I mean, I, yeah, my journey, like, yeah,

includes, you know, undergrad and then...

Did you always know you wanted to be a doctor?

I grew up, yeah.

There was from kind of a young age, I kind of knew.

And then, and then it really solidified

like through my different experiences of like working

in Alaska and then like living in Bolivia

and different things like that that I did.

So cool.

And so...

You're like a hipster at Adam's.

So yeah, and then, but I think my first exposure,

my first like true exposure probably was in medical school

when I did like a month fellowship up in Pittsburgh

where I got to meet, you know, like,

I got to meet Jim Weathers and...

These are like pioneers of street.

Yeah.

Medicine street outreach, yeah.

And I was introduced to addictions of medicine

and street medicine at that point

and kind of different ways to do medicine

and to provide medicine to people.

And I, and just kind of always, I don't believe,

I believe everyone should be able to receive healthcare.

And I believe everyone should be able to receive love.

And I wish, I believe everyone should be able

to be treated equally and be uplifted.

And so what that looks like,

doesn't look like a normal, you know, private clinic.

So yeah, I like the, like working in the hospital

and that is also where people can receive care,

but that's sick care, not healthcare.

And so I desire to, and so yeah,

and so being able to serve any and everybody

that walks into the clinic or that I talk to on the street,

and being able to promote their health.

Because-

Like wellness, like full bodied wellness.

Because if you can get there-

That's all physical.

Yep, if you can get there physically, you know,

if I can help you reach another step in your physical health

and another step in your mental health,

then we can start working on your spiritual health.

And we can, and then, you know, and then the whole,

I'm gonna mess it up, but like the pillars

of eight dimensions of wellness, something like that.

You know, like-

We know what you're saying.

Having like, you know, like health shelter food,

you know, like your basic needs kind of thing.

And that's the beauty of interdisciplinary street medicine

is, you know, we're working on sheltering, right?

We're working on, you know, Kelly and Food for Adderning

is providing the food, the sustenance,

and then there's the physical health aspect of that.

And that's when you can start, you know.

Achieving your goals.

And I think everyone should be able to work towards achieving

their goals or like doing the things they want to do.

Yeah, it's like that Maslow's hierarchy, right?

Like, there it is.

You can't even like think about what it means

to feel satisfied or fulfilled or like thriving

if you're not surviving.

Yeah, if you're hurting, like if you don't know

where your next meal is coming from

or you don't know where you're sleeping.

And that's like, this is like really one of the most

tragic things about our friends is is that,

they just don't even, they just don't even know

where they can put their bodies.

I don't know if you're giving me some time.

And so that's where the beauty of this comes from.

And so that's like where the absolute beauty,

absolute truly evidence-based version of this coalition

comes from is because we are including medicine.

We're including housing first, right?

We're including like addictions support and food.

And in this, like housing first initiatives

yes, they're important and they're like the normal,

like they're kind of the current political,

like that's the stance.

And it is important and shelter is important.

But housing first initiatives with medicine

and with continued outreach are significantly

more successful than housing first outreach alone.

Totally.

Housing first does mean housing with reprimands.

But the reason the reason Kat and I paused

and I'll say it so you don't have to say it,

but you know, housing first as a model

has come under attack just like harm reduction.

And these are words that we're not really

supposed to say anymore and we're supposed to move away

from research and from what we know is working.

And that really sucks.

I'm just gonna be really latent and say it really sucks.

And what you're describing is a comprehensive model

that is includes housing

because people have to know where to put their bodies at night

before they can think about, I mean,

how do you even get a job

if you don't have an ID and you don't, exactly, you don't.

Kat, you're intense about housing, okay?

You are, you are like intense.

You are like a bulldog when it comes to this.

You are quiet and when you speak,

you have very strong opinions.

And I mean, that is a compliment, right?

Would you?

Oh, her opinion is great.

So where does your,

and this episode might go a little longer

because I'm just like this, it's just amazing to me.

This project is just amazing.

So why are you in housing?

Because like this field is not for the faint of heart.

Where does your intensity come from?

I was a teacher as well.

Oh no way, I didn't know that.

I taught in Oakland, California.

It was an alternative charter school for youth.

So up to 20 totally see this, okay?

It was amazing.

A lot of my students were dealing with housing insecurity.

Yup, some of them homeless, some of them doubled up,

tripled up.

Some people went into the shelter

so they could stay in school, right?

We had a licensed therapist there.

She dealt with a lot of this.

And it was always really interesting to me

and I wanted to know more,

but I just didn't have the time you've taught, you know what it's like.

Right.

But when I moved here, I started immediately volunteering

in homeless services.

And it just caught me up.

I didn't want to teach anymore.

I can't imagine honestly doing something

where I don't learn from the people I'm working with.

I mean, that's what happened when I was teaching.

That's what happened now.

It feels like a huge privilege to be around people

and hear parts of their stories

and be trusted with that.

To kind of take a moment out of the day

where you're really having a real conversation

you're making eye contact,

which might be the first time somebody's here getting that.

Right. And I think the services we offer

are great and very important.

But what we offer that can't really be quantified

is community and care.

People look away from our folks.

And I think I've mostly spent my career working with people

who people look away from, whether it's children

or people disenfranchised in some way.

And that is, those are the people who are interesting.

You know, those are the people who have stories

and have something to offer

and those are the communities I want to be part of.

And I guess that's why I'm doing this.

I would ask both of you about compassion fatigue

or burnout, but I don't really get that from you too.

And you both seem to like, I don't want to say live in community,

but like, I feel like the choices you make

beyond the confines of your normal work day,

like what is a normal work day?

Like it kind of all blends sort of,

do you know what I'm saying?

Like everyone has their own way to deal with compassion fatigue.

Yeah.

That's going to be a definite part of anyone

who does anything like this,

bringing your work home and secondary trauma

and compassion fatigue.

Everyone has their ways to deal with it.

We just have to get to the point

where we give ourselves permission to do that.

And that might sometimes take a while.

Sometimes people know that right off,

or me it took a while, you know, but I'm there now.

Yeah, okay.

I'm off right.

I think like around some of that

I'm like, yeah, burn out and those kind of things.

I think there's a few things in, you know,

the one of the first things I kind of go to is,

I think we're all uniquely created

and have such a unique journey to do the things that we're doing.

Yeah, yeah, yeah.

And so like, honestly, if you put me in a hospital,

I would need you know, I would need your vacation.

If you put me, if you put me in a,

if you put me in a private care clinic, you know,

and in like a rule setting, I would probably crash out, you know,

like I like that's just not where my heart and passion is.

And so when you were working,

where your heart and where your passion is

and like where your training has been,

you like, yeah, it's like reaching that burnout level.

Is a lot, it's a lot further away.

And then, and then yeah, and then I like,

I've actually was talking with one of the case managers

at a firehouse or a house doing some work the other week.

And she was like, yeah, my optimism is just kind of like,

running out and I was like, everybody's does, you know,

and you have some weeks where your optimism is like super high

and your hope and your grace and all that kind of stuff.

And when that happens, or like when that happens,

great, push into it, lean into it, run it, right?

Just full send.

But then when it runs out and it starts to weigh,

what you do is you lean on your boundaries

and you lean on your training

and you lean on what you know you can provide.

And if you were giving everything you can up to your training,

up to your boundaries, you're giving them all they got.

Yeah.

All right, and that's okay.

Because that's, and then that's when you have a team.

Right.

That's when you have other services.

And that's when you know how to link into other things.

And that's, and it takes a village, right?

We're built for community.

We are built for community.

So I feel like a big part of it is making sure

that we're not infantilizing the people that we work with.

They don't need us to do everything.

But if we're doing everything, we're enabling.

We're doing a disservice.

I think part of it is like trusting people to survive

because they have survived.

Yeah, autonomy, they still have a time after us, right?

We're not gods.

We're just people just like them, you know?

And we're on this journey together.

We're not necessarily leading.

And that's why we intentionally named it care for our journey.

Like it is a journey.

We're not, you know, it's not cure for our journey.

Like we're not, we're not curing anything.

I think that, that mentality very much helps me

because it's not like thinking, oh my god,

this is my little child, if I don't do this or this,

it's going to, they're going to die

because it's not, they're not.

They're full grown people with, you know,

it prevents you from like having like a savior complex.

Right, right.

And I think that's one of the worst things that can happen here.

You can do way more harm than you do.

And what we've done for a long time

as swoop, we're going to swoop in.

We're going to fix it, especially, honestly, sorry,

but us as white people, like, as a, as a culture,

like us being like, oh, we will fix it.

So like, you're exactly right.

And that is our culture.

So it's something that we as white people have to be thinking

about all the time so that we don't fall into that

because it's easy, totally easy.

So that's what's been built for us.

Mm-hmm.

Yeah.

Yeah, it's often, yeah, I often think through that is like,

so like in medical school, recently, you know,

there's been a change, but like, that's called, like,

paternalistic medicine, right?

Oh.

It's like, that's the kind of, you know,

garbage around that is like, I'm the doctor.

This is what's best for you.

I tell you to do it and you do it.

Yeah, people don't know that you can actually ask questions

of your doctor.

Like, when we go out and we do trainings around Narcan

and opioids and things like that,

when I'll say to full grown adults, like,

hey, if you don't like the medicine that's being prescribed to you,

if you're not liking how it's making you feel,

just because you're given an opioid prescription

or a fill in the blank with another person,

you get to ask questions.

And like, the looks on people's faces is like,

really?

Yeah.

Yeah.

I would say, please, please, just your doctor

and all this.

Of course, of course.

Of course, of course.

But no, I also, in the very pro, like,

when starting different medicines and those kind of things,

specifically for like different conditions,

it's like, yeah, let's try it.

Yeah, let's see how you do.

And yeah, I mean, medicine's great now.

There's a ton of options.

And so like, if you don't like the blood pressure medicine

around, there's another version of it, right?

Right.

That kind of thing.

And so, yeah.

And then, and then also just like,

and then also, there's just like the,

go, go, like, yes, you like mentioned,

like, we as white people, like also we as privileged,

but also just kind of we as, and I'm saying we,

because that's where I came from,

is like suburban America.

Yeah.

Go experience a different culture, right?

Totally.

Not everyone wants to live the life that you want to live.

And so, some people, you know, they like to be rough sleepers.

Some people when offered, you know, shelter,

they're gonna like, like, go sit in a band-o kind of thing.

They're gonna be like, nah, I'd rather stay at my tent.

You know, like, I'd rather stay out in the woods kind of thing.

Like, I've had a patient in my clinic, actually,

for a while, who I knew he was on house.

I knew he was living rough.

He told me and like, medically, he was doing fine.

And I asked him about his goals and he was working at Walmart.

He was putting money into savings.

He was working to get a car.

Well, he had engaged in different services.

And he was just, he chose that life.

And I was like, and so I would, you know,

run the safety screenings, all that kind of stuff.

I would always check up on him.

I would, you know, do the extra screenings

because he was living rough and that kind of stuff.

And we had a great relationship

and now he's got his own apartment, you know?

And he was ready when he was ready.

He was ready when he was ready.

And that's gotta be okay for us to accept.

That's a widening of our horizons.

And that's a benefit of the job to me.

Yeah.

I mean, I have a guy I met who he lived in a tent

for three years, saved his money, bought a house.

Doesn't know anything.

Whoa.

It's, there are different ways to live life.

Yeah.

Yeah.

And that has to be okay.

And I think that's, that's important.

It, for me, it keeps me from being complacent, you know?

I get a lot from this work.

It's not just giving, it's receiving.

Can you tell me no names, of course,

but can you tell me about a success story?

We've been, you've been doing this work since October.

Can you talk about a client, a friend,

who received sort of medical care, some, you know,

whatever that looks like, and no names,

but kind of tell me like the, I don't know if you want

to share this one, but the one that you said

at the last meeting where it was like,

this is why we do what we do,

like the person who eventually went in for a trip.

Anyway, you, you, you say whatever you want to say,

but talk to me about a success story.

This is how we're gonna end this.

Because we are so damn proud of this.

And it's just so cool.

I think Kat's got the housing success stories.

Well, I think success looks different.

Yes, that's right.

Exactly.

That's what I was hoping.

Yes, there are success stories that end in,

this person is now housed and getting medical care

and on the road to get a job or whatever.

That's one version of success.

There are success stories of this person

is getting fairly regular medical care.

Is a success?

Yes.

Huge success.

You know, there are success stories.

You know, that are like this person has been engaging

with us for a couple of months and has finally decided

to try treatment.

So it really, you have to expand your idea of success.

I love just one thing because everyone starts

in a different place.

Everyone has different goals and those goals change

all the time.

A success story might just be a person has managed to sit down

and focus their mind on their goals.

Or they've gotten an ID or they've gotten a warrant out of the

way.

And all of those, all of the things I'm saying,

I have a person in mind for them all.

But it's all different.

It is success and another person's success are different.

Awesome.

Anything to add?

Yeah, no.

Yeah, I, yeah, I have all those people that you're,

yeah, you were in.

Think like a couple other ones, you know, like.

One guy thought he was a walkener of the cancer on his arm.

Did a biopsy.

It wasn't cancer.

Got to like tell him, no, you're good man.

That's happened a few times now.

Oh my gosh.

Can you imagine the relief?

Oh, and so, so yeah, and they're like that kind of thing.

And then also just like different things like for the,

for the, for the times in people do have to go to the hospital.

Yeah, it is a true medical emergency, which that is a success

in and of itself to actually get people to go, right?

Yeah.

And so, yeah.

And so I think that was kind of like the thing is like, yeah,

sometimes it is a true medical emergency and they are just terribly

resistant because everything they own is right there on the street.

And if they go to the hospital, then what happens to their stuff?

Right.

And so, yeah, I can think of a couple of people that we worked with,

where it's like, I'll go out and I'll be like, okay.

And like, I'd be like, hey, I really think we should do this.

But there's a couple of things I can try.

And so we try it with them just because like, again,

they have agency.

Yeah.

And so I'll try it with them and I'll come back and follow up and be like,

hey, you see, it's not getting better.

Sadly, let's work through a process.

And so in that time, we as a team are contingency planning on how

to help them get into the care they need, but also protect the things

that they are, they are concerned about.

And then help them.

And then continue to engage in the medical system and help them discharge well.

Yep.

So important because, you know, if you call an ambulance,

they have a very specific job and their job has nothing to do with making sure

you keep your stuff totally or your dog or whatever, right?

You know, they fall out and they end up in the hospital.

And that ID that took them forever again, right?

They don't have anymore.

Right.

And, you know, that's understandable if you are working on an ambulance,

your job is to keep that person alive.

Absolutely.

And they have to be able to do just that.

But what we can do because we're collaborative is make sure that, you know,

we can limit all the different kinds of harm that can come to someone.

I just, I really think this is like one of the coolest things to happen

in the city in a really long time.

And I'm so grateful for you to, grateful for all of the other team members

that are making this happen that weren't here today.

You all drew the short straws and you were elected to be here.

But it's just, it's just been really beautiful to see everybody kind of push

their egos aside and do the work.

And so thank you both for being here.

Yes.

It's just, it's just incredible.

Ronnie, I just, I'm like, I just love this project.

If you like what you heard, please consider rating reviewing and subscribing to the

shield.

And also, if you're interested in supporting this initiative, the Care for

Our Journey initiative is housed on the one roof's page.

There's an Amazon wish list.

If you want to help support with like sleeping bags, socks, wound care supplies,

things like that, or if you want to figure out how to support it in your own way

that does not look like coming into community and walking with cat and Craig,

it's not what that looks like.

But if you would like to support in other ways, please go to one roof's website

and look at the Care for Our Journey page and figure out how you can tap in.

Thank you very much.

Thank you.

Thank you.