Change Takes Time

When someone sends you important mail, you probably expect to receive it in your mailbox at home.

For Mike, who’s homeless, mail is a little more complicated. To receive his mail, his caseworker Candace explored three shopping centers, two river banks, and a few other spots he hangs out at, looking for his signature turquoise bike. Mike receives his mail at the Multi-Service Center (MSC), a one-stop shop for services and resources for those experiencing homelessness in Long Beach, Calif.. Candace wasn’t able to track him down to give him his mail about benefits, but she ran into a friend of his — a man, also homeless — who promised to deliver it to him.

The last time we were in Long Beach, we spent an afternoon riding along with MSC outreach workers Lucy and Candace as they drove all over the city to do outreach to people experiencing homelessness about services available to them.

One of our first stops was a homeless encampment along the concrete banks of the L.A. River. A man who lived there came out to meet us, wary that we were the police. Lucy and Candace explained that they were outreach workers and told him about how they had helped get a friend of his into housing. Satisfied, he told everyone in the encampment to relax, and that we would be coming through.

As we crept along a steep slope near a bridge, we passed a man fixing his bike and an array of windchimes. We scampered down the river bank, but as we got close to the bridge, the man warned us to hold onto the “lifelines,” pieces of rope that they had strung up to hold on to while navigating the space. It was a steep slope down into the grungy river from where we stood.

We passed a woman who was lying in her bed, and she stopped us to say hello.

Candace introduced herself. She let the woman know that she was with the MSC and was there to help if she was interested in any services. We found out that the woman doesn’t currently have any health insurance, despite being qualified for Medi-Cal. Candace was about to give the woman information on where she could go to get signed up, then another detail emerged: the woman had been diagnosed with multiple sclerosis a few years ago but never received treatment.

Candace sprang into action, calling to make an appointment for the woman at the MSC clinic so she could start getting treatment and get help enrolling in insurance. She was able to make the woman an appointment for the very next morning and arranged for a van to pick her up so that she’d be able to make it.

Our research into people who are super-utilizers of the emergency room has shown that to be successful, interventions often have to be very hands-on, personal, and sustained over time. These cases are often complex and can include significant mental health issues, histories and present realities of severe trauma, social factors such as homelessness, effects of substance use, and overlapping conditions. We saw firsthand the effort that high-touch interventions take: delivering individual pieces of mail and making one-off clinic appointments. It could take six, seven, or dozens of conversations over months or even years to connect people with services, but Lucy and Candace never give up.

Photos by Molly McLeod

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