What do you think would happen if you invited an individual who had been living on the street for many years, had mental health issues and was an alcoholic to move directly from the street into housing? We had heard this was being done in New York City, and it was called the Housing First model. We wondered if it would work in Utah.
想想下面這個狀況: 如果你們邀請一個多年來 住在街頭、 有心理健康問題, 且酗過酒的人, 直接從街頭搬入住宅中, 會發生什麼事? 我們聽說紐約市已經這麼做過, 它被稱為「住屋優先」模型。 我們很好奇這在猶他州是否可行。
So to make that determination, we decided to create a pilot, and Keta was one of the 17 chronically homeless individuals we included in this pilot. She had been on the street for 20-plus years, had mental health issues and was a severe alcoholic. The first night in her apartment, she put her belongings on the bed and slept on the floor. The next three nights, she slept out by the dumpster near the apartment building. With the aid of her case manager, she moved back into her apartment but continued to sleep on the floor for several nights. It took over two weeks for her to develop enough trust and confidence that this apartment was hers and would not be taken away from her before she would start sleeping in the bed.
為了要確認這件事, 我們決定做一個試驗, 琦塔是我們選來進行 這個試驗的十七位長期 無家可歸者之一。 她已流落街頭二十多年, 有心理健康問題, 且是重度酒鬼。 她住進公寓的第一晚, 她把家當都放在床上, 自己則睡在地上。 接下來的三個晚上,她睡在外面, 公寓附近的垃圾箱旁邊。 在她的個案經理協助之下, 她搬回了她的公寓, 但還是在地上睡了好幾個晚上。 她花了超過兩週的時間, 才發展出足夠的信任和信心, 相信這個公寓是她的, 且不會被奪去, 她才開始睡在床上。
Homelessness is a continuing challenge for many cities throughout our country. Our homeless population falls into three major categories: those that are temporarily homeless, about 75 percent; those that are episodically homeless, about 10 percent; and those that are chronically homeless, about 15 percent. Chronic homelessness is defined as an unaccompanied adult who has been continuously homeless for a year or more or more than four times homeless in three years that totals 365 days. This small 15 percent of the homeless population can consume 50 to 60 percent of the homeless resources available in a community. In addition, they can cost the community 20,000 to 45,000 dollars a year per person in emergency services costs, such as EMT runs, emergency room visits, as many of you will be aware, addictions, interactions with the police, jail time. Simply put, this small population costs a lot.
對我們全國的許多城市而言, 街友一直是個挑戰。 我們的街友人口主要可以分為三種: 暫時無家可歸的人, 大約佔 75%; 不定期無家可歸的人, 大約佔 10%; 以及長期無家可歸的人, 大約佔 15%。 長期無家可歸的定義, 是無人陪伴的成年人 持續無家可歸一年以上, 或是在三年間有超過四次無家可歸, 且總天數超過 365 天。 這少數的 15% 街友人口, 可以消耗掉社區街友資源的50%~60%。 此外,他們每年每人需要社區 花費兩萬到四萬五千美元的 緊急服務成本, 比如急診醫療隊出勤、 進急診室,就像在座很多人知道的, 毒癮、和警察的互動、 坐牢服刑。 簡言之,這一小群人花不少錢。
Based on this reality, the US government began an initiative in 2003 inviting states and cities and counties to develop a plan to end chronic homelessness in a 10-year period. The state of Utah accepted this invitation, and I was asked to lead this effort. In 2005, we approved a 10-year plan, and 10 years later, in 2015, we reported a reduction in our chronic homeless population of 91 percent statewide.
根據這個現實狀況,美國政府 在 2003 年開始了一項方案, 邀請州、城市、郡一起加入, 發展一個十年計畫 來終結長期街友的問題。 猶他州接受了這項邀請, 並找我來領導這項工作。 在 2005 年, 我們核准了一個十年計畫, 十年後,2015 年, 我們公布的結果是, 全州長期無家可歸的人口 減少了 91%。
(Applause)
(掌聲)
That's amazing. When I began this process, and we began this process, I realized that I had a limited understanding of homelessness and the factors that impacted it, and that I needed a fairly major change in my belief, in my thinking, because I had been raised with the theory of rugged individualism and "pull yourself up by the bootstraps." That philosophy came from being raised on our family's cattle ranch in a small town in the western desert of Utah. On the ranch, you learned that nothing takes priority over caring for the cattle, something always needs fixing and most importantly, hard work makes the world right. It was through that lens that I would see homeless people. When I was a teenager, our family would go into Salt Lake City, and I would see these homeless people -- "hobos" we called them then -- sitting around on the street, and I would think, "You lazy bums, get a job. Pull yourself up by the bootstraps."
那是很驚人的。 當我們開始這個流程時, 我發現到我對於無家可歸 以及影響它的因子, 了解都十分有限, 我需要針對我的看法、 我的想法,做很大的改變, 因為我是在嚴格的個人主義理論 和「自立自強」的觀念之下長大的。 我們家在猶他州西部沙漠, 小鎮上有個牧牛場, 這哲學來自在那兒成長的經歷。 在牧場學到的是:首要之務絕對是 照顧牛隻, 總是有什麼東西需要修理, 還有最重要的, 努力就能解決世界上的問題。 我是從那樣的視角 在看無家可歸的街友。 當我還是青少年時, 我們全家會到鹽湖城, 我會看到無家可歸的人就坐在街上, 那時我們稱他們為「流浪漢」, 而我會心想: 「你們這些懶廢物, 去找份工作,自立自強。」
After high school, I left the ranch, graduated from college, went to work for Ford Motor Company for several years, then got a job at the Church of Jesus Christ of Latter Day Saints and moved back to Salt Lake City. During that employment, I had the opportunity to be loaned out to the state's largest homeless shelter to assist them in developing and improving their financial and management capabilities.
高中之後,我離開了牧場, 從大學畢業, 在福特汽車公司工作了數年, 接著在耶穌基督後期聖徒教會 找到一份工作, 搬回了鹽湖城。 在那段工作期間,我有機會去協助 該州最大的街友庇護所, 幫他們開發和改善 他們的財務和管理能力。
While there, I became aware of a new approach to dealing with homeless individuals and drug addicts. It was called the harm reduction model, and it consisted of passing out clean needles and condoms. And I thought, "Now that is one stupid idea." (Laughter) "That's just going to encourage them to continue that behavior. Just tell them to stop." Several years later, I read some of the early 10-year plans to end chronic homelessness promoted by the federal government. As I read through those plans, and I thought, "Pfft! This is unrealistic. You can't end homelessness. There's too many personal choices and factors beyond our control."
在那裡時,我發現了一種新方法, 可用來幫助無家可歸的人 及有毒癮者。 那方法叫做減少傷害模型, 內容包括分發乾淨的 針頭以及保險套。 我心想:「那真是個蠢點子。」 (笑聲) 「那樣做只會鼓勵他們 繼續原本的行為。 應該叫他們別做。」 幾年後,我讀了一些資料, 是關於聯邦政府 早期推動終結 長期街友的十年計畫。 我讀過這些計畫的內容之後,心想: 「呸!這很不實際。 街友問題是無法終結的。 它牽涉到太多個人選擇 及我們無法控制的因子了。」
My perspective changed, however, when I attended a conference in 2003, where I learned the reason behind the 10-year plan. First was this small population of the homeless group that was 15 percent and were very expensive. That made sense for a conservative state like Utah.
然而,我的觀點變了, 2003 年時我參加了一場大會, 在那裡,我學到了 十年計畫背後的理由。 首先,我學到這一小群的街友族群, 雖然只佔 15% 但卻非常昂貴。 對於猶他州這種保守的州而言, 那數字是合理的。
The second insight was learning about this Housing First, or low-barrier housing. There had been an agency in New York City that had been inviting mentally ill homeless individuals to move directly from the street into housing. And they were also allowed to continue to use drugs and to drink, just like we can in our homes. They were, in addition, offered services -- not required to use them -- by on-site case managers to assist them to adjust to their new living arrangements and to stabilize their lives. They were using the harm reduction model. And despite my initial low expectations about hearing about this model, they were having an astonishing success rate: 85 percent were still housed after 12 months.
第二,我學到了這個「住屋優先」 或低門檻住屋供給。 在紐約市有一個機構 一直在邀請有心理疾病的街友 直接從街頭搬入住屋當中。 他們也被允許繼續使用毒品和喝酒, 就像我們在自己家裡也可以一樣。 此外,現場的個案經理 也會提供服務給他們── 不強迫要使用── 來協助他們調整新的居住安排, 讓他們的生活更穩定。 他們用的是減少傷害模型。 雖然我一開始聽到這個模型時, 對它的期望是很低的, 但它的成功率卻非常驚人: 有 85% 的人在 12 個月之後 仍然住在住房中。
The third insight was the importance of developing a trusting relationship. Because of the abuse these individuals have had throughout most of their lives, they hardly trust anybody, and the clean needles and condoms and low-barrier housing was a means to begin to develop a relationship of trust. Vital.
我學到的第三點, 是發展信賴關係的重要性。 因為這些人在他們一生中大半時候 都受到傷害, 所以他們很難信任別人, 而乾淨的針頭、保險套、 低門檻住房供應, 就是開始發展信賴關係的手段。 這非常重要。
So as I flew home from this conference, sitting in the plane looking out the window, I realized that my understanding and perspective about homelessness was shifting. And as I stared out that window, this very strong feeling and thought came to me that if there's any state in the union that could end chronic homelessness, it was the state of Utah, because there's an underlying feeling and desire and willingness to collaborate to serve our neighbors, including those who are homeless. A new vision was becoming clear to me how this could be done.
會議結束後我搭飛機回家, 坐在飛機上,看向窗外, 我發現到我對於 街友的了解和觀點 正在轉變。 當我盯著窗外時, 產生了一種很強烈的感覺和想法, 覺得如果在美國有任何一州 能夠終結長期街友的狀況, 那就會是猶他州, 因為在猶他州有一種很根本的感覺、 慾望、意願, 要同心協力來服務我們的鄰居, 包括無家可歸的人。 對於要如何做到, 我開始有個清楚的遠景。
Now, those of us that attended the conference said, "Yeah, these models will work in Utah." But when we got back home, there were many who said, "Nah, those aren't going to work. They won't succeed here." But there was, however, an affordable housing organization who was willing to build our first 100 units. But they had concerns about having 100 chronically homeless people in one location. To address that concern, we decided to create a pilot to test that idea while we built the first 100 units. We would use existing units scattered throughout Salt Lake City.
我們去參加會議的人說: 「是的,這些模型 在猶他是可行的。」 但當我們回到家,就有很多人說: 「不,那些都不可行, 在這裡都不會成功。」 然而,有一個在做可負擔住房的組織 願意為我們先建立 100 個單位。 但他們擔心把 100 個 長期無家可歸的人 放在同一個地方會不會有問題。 為了解決他們的擔心, 我們決定做個試驗, 在建立前 100 個單位的同時 先來測試該想法是否可行。 我們用的是散布在 鹽湖城各地的既有單位。
Then we debated: Should we select fairly high-functioning homeless persons or the most challenging ones we could find? And this is where my background on the ranch came into play. Back then, my mother cooked our meals and heated the water for our weekly bath on a wood-burning and coal-burning stove. And after chopping wood for that stove all those years, I'd learned to chop the big end of the log first, when I had the most energy. We decided to use the "big end of the log first" approach and selected 17 of the most challenging, difficult, chronically homeless people we could find, because we knew we would learn the most from them. Twenty-two months later, all 17 were still housed, including Keta, who today, 11 years later, is sleeping in her own bed and is sober.
接著,我們盤算: 我們應該要選擇 高功能無家可歸的街友? 還是我們能找到的街友中 最具挑戰性的? 這時,我的牧場背景就派上用場了。 那時,我母親為我們煮飯, 為我們每週一次的洗澡把水加熱, 用的是燒木材和煤的爐子。 那些年來不斷為了爐子而劈柴, 我學會在我還最有力時, 就先從圓木比較大的那一端劈下去。 我們決定使用的方法是 「先劈圓木較大的一端」, 在我們能找到的所有 長期無家可歸街友中, 選出了 17 名 最有挑戰性、最困難的, 因為我們知道, 我們能從他們身上學到最多。 22 個月之後, 所有 17 人都仍然住在住房中, 包括琦塔在內, 今天已經是 11 年後了, 她現在能睡在自己的床上, 而且沒喝醉。
At the end of this pilot, one of the young case managers said, "We used to debate up at our university classes which theory of case management was the most effective. Now our theory of case management is: anything necessary to keep them housed." We became believers, and built hundreds of units over those next 10 years, leading to the reduction of our statewide chronic homeless population of 91 percent.
在這次試驗結束時, 其中一位年輕的個案經理說: 「我們以前在大學上課時會爭論 哪一種個案管理理論最有效。 現在我們的個案管理理論是: 做所有必要的事 來讓他們繼續住在住房中。」 我們成為了信徒, 在接下來的十年, 建立了數百個單位, 結果是將全州的長期無家可歸人口數 減少了 91%。
Now, who are homeless people? Many people just want them to go away, to disappear, not disrupt our lives. Through this 10-year, 11-year process, I gained many insights of why people become homeless. One of those insights came to me a few years ago when I was visiting with our medical outreach team. These are our frontline workers that go out and visit the street homeless and the prostitutes to check on their medical health. One of the team members mentioned that eight of the prostitutes had given birth to 31 children that had become wards of the state. They also shared that some of the pimps were their husbands, and worse yet, their parents. These prostitutes, in their late teens, 20s, early 30s, were expected to earn enough money a day to support a hundred-dollar-a-day heroin addiction, their living expenses and their pimp. And with unprotected sex, they were paid more, and predictably, this would lead to a pregnancy. Children born under these circumstances many times end up becoming homeless. And it's not helpful to look at those born under those circumstances, or a parent that makes their child a drug addict at age seven, or a generation of babies born through drug addiction, and not feel some despair. For me, I believe every person is of value, no matter who you are. And it's not helpful to look at somebody with this start in life and blame them for where they are.
無家可歸的人是誰? 許多人只希望他們能走開、消失, 不要擾亂我們的生活。 在這 10、11 年的過程中, 我深刻理解到 為什麼人會無家可歸。 其中一點是我在幾年前理解到的, 當時我和我們的外展醫療隊 一同去做拜訪。 他們是我們的前線人員, 走出去實地拜訪街友和性工作者, 檢查他們的健康狀況。 醫療隊的一名成員提到, 8 位性工作者生了 31 個孩子, 這些孩子變成這個州要監護的人。 她們也分享說, 有些皮條客就是她們的丈夫, 更糟的是, 是她們的父母。 這些性工作者 接近 20 歲、 20 多歲, 或 30 初頭, 一天得要賺足夠的錢來負擔 一百元的海洛因毒癮、 自己的生活花費 和給皮條客的錢。 不安全的性行為讓她們可以賺更多, 但也可預期, 沒有保護措施會導致懷孕。 在這些情況下出生的孩子, 下場常常就是無家可歸。 如果不感到絕望地去看待 在那些情況下出生的孩子, 或是讓孩子在七歲 就變成毒蟲的父母, 或是染毒父母所生下的寶寶, 那是沒有幫助的。 對我而言,我相信 每個人都有其價值, 不論你是誰。 對於人生起跑點是這個樣子的人, 去責怪他們的處境, 是沒有幫助的。
(Applause)
(掌聲)
No one grows up saying, "My goal in life is to become homeless." And that's the beauty of the harm reduction and Housing First model. It recognizes the complexities of the different factors that can shape a human life. These models meet people where they are, not where we are or where we think they should be.
沒有人在成長過程中會說: 「我的人生目標是要無家可歸。」 那就是減少傷害 和住屋優先模型的美好之處。 它能認清一個人的人生 是由許多不同的複雜因子所形成。 這些模型看的是那些人的處境, 而不是我們的處境, 也不是我們認為他們該有的處境。
The pilot we did with our 17 taught us many lessons. When people have been living on the street for many years, moving back into housing requires lots of things to learn. And Donald taught us some of these transition lessons. His case manager asked him why he had not turned up the heat in his cold apartment. Donald said, "How do you do that?" He was shown how to use a thermostat. The case manager also observed that he was heating the beans in the can on the stove, like he had done over the campfires for many years. He was shown how to use pots and pans. We also learned that he had a sister that he had not seen in 25 years, who thought he was dead. She was happy to learn otherwise, and they were soon reconnected. Hundreds of people like Keta and Donald are now housed and reconnecting with their families. Also, many of our communities are incurring fewer emergency services costs.
我們做的 17 人試驗 教了我們許多東西。 當人們流落街頭許多年, 要搬回到住房中 會需要學很多事。 而唐諾, 教我們去了解一些這種轉變。 他的個案經理問他, 為什麼公寓那麼冷 還不把暖氣打開? 唐諾說:「要如何打開?」 這才有人教他如何用自動調溫器。 個案經理也觀察到, 他會在爐上加熱罐頭裡的豆子, 就像他多年來用營火加熱一樣。 這才有人教他如何用壺和鍋。 我們也知道他有個姐妹, 25 年沒見到了, 她認為他已經死了。 她很高興發現他沒死, 他們兩人很快就再聯絡上。 有數百個像琦塔及唐諾的人 現在有房子可以住, 並和家人重新取得聯絡。 此外,我們許多社區要負擔的 緊急服務成本也變低了。
I have learned over and over again that when you listen to somebody's story with an open heart, walk in their shoes with them, you can't help but love and care for them and want to serve them. This is why I'm committed to continuing to bring hope and support to our homeless citizens, who I consider to be my brothers and sisters.
我一而再再而三地學到, 當你打開心去傾聽一個人的故事, 換到他們的角度去思考, 你就一定會去愛他們、關心他們, 會想服務他們。 這就是為什麼我承諾 要繼續把希望與支持 帶給無家可歸的市民, 我把他們視為是我的兄弟姐妹。
Thank you.
謝謝。
(Applause)
(掌聲)