David*, who has been experiencing homelessness for over a year and a half, is an elderly man living under a bridge in Seattle. He has diabetes and struggles to sit up. For outreach worker Ysi Ramos, it is clear that he is close to the end of his life.
David is in a delicate state, and Ysi and his fellow outreach worker from REACH in Seattle have spent the last year and a half making repeated visits and spending time getting to know him. They were eventually able to connect him to a nurse and a case manager. David was slow to reveal the details of his life experiences, but it was ultimately the patience and relationship-building efforts of Ysi and his partner that helped him shift away from distrust and towards accepting help, health, and housing.
Every day, Ysi and his partner scan the streets for people who have positioned themselves sometimes beyond reach, and often for good reason. “We are working to build relationships and rapport with people who have a healthy distrust of strangers,” says Ysi.
The history behind REACH’s City Outreach program began with complaints about encampments (outdoor homes where people experiencing homelessness live together) and an unclear protocol for how to move them. Now, though, things run more smoothly; when city officials receive a phone call about an encampment, they call REACH to locate available city-funded beds across the city and to deploy outreach workers to the encampment.
Ysi believes at his core that patience is the essence of outreach—and that patience allows for the possibility of building rapport. What this means for him is returning to the same place, and talking to the same person, perhaps up to 30 times over the course of a year.
“I give things time,” Ysi says. “Being able to share my name with someone is important. Just being there is important. Even the most well-developed relationship may not always result in actual movement towards healing or housing every time—but doing the groundwork places me in a position to get there. And being there at the right time is a beautiful moment.”
Ysi meets people where they are at. When he talks to someone, he is talking to a unique individual every time, and he meets people with very different histories and needs.
“Everyone’s situation is different. It isn’t always about fixing a problem,” says Ysi. “My work is about being present.”
Having patience is not always simple. “Sometimes it can be the most difficult challenge, especially when we actually have resources available, and we are talking to someone who has no interest in taking advantage of these resources,” says Ysi.
One thing that supports Ysi’s work is his training in the evidence-based practice of Motivational Interviewing (MI). Ysi describes experts in MI who can elicit change with incredible grace. Although he feels that he isn’t at that same level yet, he says he does the best he can with what he has learned so far.
This helps to prepare him to work with the people living in encampments, who often give a mixed response to outreach workers, Ysi explains. “We are essentially moving people out of their homes, although we are not connected to the enforcement of the move,” says Ysi. “We explain that we’re there to help people through what is clearly a difficult time.”
The most difficult aspect of the work for Ysi and his partner on the City Outreach team is its time-sensitive nature. Often, the people they work with do not respond well to being rushed, making it harder for everyone to be patient. When people don’t respond as a result of experiencing mental illness, substance use issues, or other reasons, REACH connects them with mental health providers and nurses.
Ysi is also involved in the program’s Assertive Outreach, which involves two outreach workers, a part-time case manager, and a nurse. It is self-directed, and, while it does not have any of the city-funded shelter beds attached to it, it removes time constraints for outreach workers. “This means we can check in with people and see what they really need,” says Ysi, “which allows us to build better relationships over time.”
Ysi explains that the role of outreach workers is not the same as that of intensive case managers. “But building rapport carries weight, and I believe that we can transition people to a new place in their lives—to a place where they may be willing to accept case management or services that they have not been willing to accept in the past,” he says, “because they have slowly learned how to trust again—or to trust for the first time.”
*Not his real name. His real name has been changed to protect his privacy.
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