Tag: unsheltered homelessness

The County’s Annual Homeless Estimate Won’t Include A Physical Count This Year. Here’s How It Will Work.

Slide from a recent presentation on how the homelessness authority will use interviews and statistical analysis to estimate and characterize King County’s homeless population.

By Erica C. Barnett

Later this week, the King County Regional Homelessness Authority is expected to announce the results of the process iabot’s using this year in lieu of the traditional point in time count of the region’s unsheltered homeless population—historically, an in-person count in January whose results have always been considered an undercount, combined with interviews at homeless service providers and shelters to gather “qualitative” data about people’s day-to-day experience of homelessness.

Over the years, the count has incorporated various methods to estimate the unsheltered population (such as assumptions about the number of people occupying tents and cars) and has used statistical methods to extrapolate demographic and other information from interviews with 1,000 or more individuals.

The US Department of Housing and Urban Development requires agencies like KCRHA to conduct a “point in time count” of their unsheltered populations every two years. The KCRHA initially planned to opt out of the mandatory count this year, but announced in mid-December that HUD had given them an exemption from its usual requirements, allowing the authority to replace an in-person count with a statistical extrapolation from interviews with unsheltered King County residents conducted over several weeks. As a result, the final “point in time count” number won’t come from a point in time, nor will it represent an actual count.

The process the KCRHA selected, called Respondent Driven Sampling, had two stages. First, volunteers and outreach workers went out to places where people are living unsheltered, such as encampments, to interview people and recruit them to distribute coupons to people in their networks. People who completed an interview received a prepaid $25 debit card and their own set of coupons, each redeemable for a $25 debit card for each recruit who participated in an interview. Those recruits, in turn, would get more coupons to distribute. Through successive waves of recruitment, the system is designed to reach people with no obvious connection to the initial group of recruits.

A spokeswoman for the authority said new approach enabled KCRHA to “capture people’s stories the way they want them to be told. This is not a knock on previous methods; but it is a different approach that allows for rich data collection, honors people’s experiences, and builds relationship with community.”

“Because interviewees identified the next set of interviewees, this helped us interview people we might not otherwise have been able to engage with, including people who are less service-connected,” KCRHA spokeswoman Anne Martens said. The approach, developed in the 1990s, has been used to reach people in “hidden” populations, such as male drug users who have sex with men, in sociological studies ever since.

The benefit of respondent driven sampling, according to University of Washington assistant sociology professor Zack Almquist, who recommended RDS to the authority and helped develop its approach, is that it captures groups that don’t show up with traditional sampling methods, such as random-digit dialing. 

The KCRHA’s researchers started with a large group of “seeds,” Almquist said—the original group of recruits who went out and recruited people in their social networks—with the goal of reaching a broad sample of unsheltered people. Then they sat down with them for in-person interviews at nine designated “hubs” around the county, asking them how they first became homeless, where they currently sleep, and other probing questions about their personal and family history and experience being homeless. Two of the hubs were in Seattle—one in Georgetown and the other on Aurora Avenue N—and the other seven were scattered across South and East King County; the furthest east was in North Bend and the furthest south was in Auburn.

The questions are similar to, but far more detailed than, the VI-SPDAT—a staccato, yes/no list of questions that homelessness agencies across the country are phasing out because it leads to racially biased results. Earlier this year, the KCRHA began using COVID vulnerability criteria (a list of conditions the agency can verify without talking to a person directly, such as age, race, and pregnancy status) in lieu of the VI-SPDAT—in part, the agency said, because the VI-SPDAT’s questions were potentially retraumatizing and invasive.

Martens said the combination of RDS and in-depth interviews enabled KCRHA to “capture people’s stories the way they want them to be told. This is not a knock on previous methods; but it is a different approach that allows for rich data collection, honors people’s experiences, and builds relationship with community.”

Some members of the KCRHA’s governing board have raised concerns about the authority’s methods and called the process rushed and mysterious. Auburn Mayor Nancy Backus, who sits on the KCRHA’s governing board, recently said the KCRHA had given her “no clue what was going on” with the interviews, and Redmond Mayor Angela Birney, also on the board, questioned the authority’s choice of “hub” locations and the decision to limit interviews to business hours.

The method has its critics, who question whether statistical extrapolation, based on interviews with a small subset of the homeless population, can produce an accurate estimate of the number of people experiencing homelessness in an area or characterize the conditions under which they live.

“In the past, the reason we did the point in time count the way we did is that we went to people where they were—we didn’t expect them to have to travel or get transported or find a location,” Birney said during a March board meeting, when the KCRHA was in the middle of doing interviews. “I’m a little curious about bringing people to a hub, what kind of disruption that creates.”

Respondent-driven sampling has its critics, who question whether this kind of statistical extrapolation, based on interviews with a small subset of the homeless population, can produce an accurate estimate of the number of people experiencing homelessness in an area or the characterize the conditions under which they live.

Academic critiques of the approach have focused on the fact that people experiencing homelessness often have loose and transitory social ties, making their social networks unreliable; the likelihood that “coupons” redeemable for money or goods (like the $25 debit cards) end up being used as a form of currency or in violation of the rules set for recruitment; and that “hub” sites aren’t equally accessible for everyone, both because of physical distance and because more marginalized or vulnerable people are less likely to go to an official government interview site.

The list of questions the interviewers asked are extensive, and not everyone answered all of them; some people responded to most of the questions, but wouldn’t answer questions about their social network and were excluded from the data, according to Almquist. The result is that although the authority initially said it would base its count on around 1,000 initial interviews, they ended up with a usable sample of between 550 and 574 people. “People had to answer questions about their social network, because respondent driven sampling relies on us knowing about” the people survey respondents interact with and “weighting the population based on their network properties,” Almquist said—factors like the number of people a person says they know and how well they know them.

At a meeting of the Seattle City Council’s homelessness committee earlier this month, KCRHA CEO Marc Dones said the authority was planning to do a “Phase 2” of the surveys, which would add to the qualitative data portion of the count—the kind of information the county used to gather by going to homeless service providers and talking to people who showed up to access services. Continue reading “The County’s Annual Homeless Estimate Won’t Include A Physical Count This Year. Here’s How It Will Work.”

As COVID Cases at Encampments and Shelters Rise, Many Are Reluctant to Enter County Quarantine Sites

Kent isolation and quarantine facility
Screenshot: King County Youtube

By Erica C. Barnett

An alarming increase in COVID cases among people experiencing homelessness has been exacerbated in recent weeks, homeless service providers say, by rumors that if people enter a county-run isolation and quarantine site, they won’t be allowed to leave.

And even before these rumors began circulating widely, many unhoused people who tested positive for COVID were reluctant to enter isolation and quarantine, for reasons that ranged from active substance use to the fear that if they left an encampment, they would lose everything they had—a not unreasonable assumption, given the recent uptick in encampment sweeps.

“The resistance, in my experience, has been across the board,” Dr. Cyn Kotarski, medical director for the Public Defender Association, said. “I haven’t met anyone so far who doesn’t have some fear and some resistance to go, and that’s mostly just because it’s overwhelming. It can feel pretty scary to think that you don’t know where you’re going or why, especially when you’re taking someone out of their own environment and their own community,” Kotarski said. The PDA is a partner on several efforts to move unsheltered people into hotels during the pandemic, including Co-LEAD and JustCare.

Although early reports suggested that people living outdoors are less susceptible to COVID infection than those living in group quarters like congregate shelters, the more contagious delta variant could lead to more infections in both indoor and outdoor locations. During the week that ended September 10, King County counted 41 people experiencing homelessness who tested positive for COVID—an undercount, since it only accounts for county testing events.

According to King County Public Health spokeswoman Kate Cole, as of last week, there were 22 active COVID cases associated with encampment outbreaks, defined as two or more people who have tested positive at an encampment—an “increase from baseline” of “one to four cases per month associated with encampments.” A review of the county’s weekly reports shows a steady increase in cases that began in early August and hasn’t abated.

“The facilities are not secure, and staying is totally optional. When people come in, we say, ‘Your isolation period is this long, your quarantine period is this long. If you do not want to stay the whole time, let’s talk about it.'”—Hedda McClendon, King County

The increase in COVID cases has impacted every part of the county’s service system. The county’s public health department offers testing and transportation for people who test positive, but service providers and county officials say the system is stretched thin, with long waits for transportation and even testing. According to Cole, the current wait for a test by the county’s HEART E Team, one of two teams that performs testing at homeless encampments, can be as long as five to seven days. When someone living in an encampment tests positive, an outreach provider often must wait with them for hours until a county vehicle arrives to take them to isolation and quarantine, increasing the likelihood that they’ll give up and decide not to go. 

Just getting someone on the phone, outreach workers say, can be a challenge. “You call in and they take your number, but if you call back, it’s an automated line and you have to try to reach the person you were talking to,” Dawn Shepard, the south district outreach coordinator for REACH, said. If an outreach worker or unsheltered person misses a call from the county’s COVID hotline, Shepard says, they’ll have to start the whole process over again, “and by that point the person’s just losing interest.” Currently, Shepard added, “It’s taking us about eight hours from coordination to pickup.”

The county, through a partnership with T-Mobile, has handed out about 500 cell phones for outreach providers to distribute to clients, according to Cole, but Stewart says they need more, along with rapid COVID tests so that people don’t have to wait for days to get tested. Currently, rapid tests are hard to come by and expensive when they are available.

Meanwhile, the number of people staying at the Kent isolation and quarantine site, where 60 rooms are currently available, has increased from zero to 50 virtually “overnight,” King County COVID Emergency Services Group director Hedda McClendon said, stretching resources thin. If all the rooms fill up, the county will have to start triaging people based on test results, exposure, and other qualifications, turning people away if their cases aren’t severe.

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Shepard said that in the early days of the pandemic, “we really didn’t see folks that were living outside contracting the disease…  largely because the viral load is much lower when you’re outside. Now, though, I think it’s safe to say that with the delta variant, our clients don’t have the same protection, because we’re seeing it all over the city.”

Shelter providers, including Compass and WHEEL, also confirm that they’ve seen an increase in cases; according to WHEEL organizer Michele Marchand, COVID “is ripping through many, many homeless programs and communities,” including WHEEL’s women’s shelter at First Presbyterian Church on First Hill, which has seen at least 11 positive cases in the past few weeks. “We’ve had to stop doing intakes now because of this outbreak,” Marchand continued, adding that the organization is seeking funds for hotel vouchers “to meet the immediate need during this current crisis.”

Charlene Mitchell, the program manager at the Compass Housing-run women’s shelter Jan and Peter’s Place, said that the shelter requires people who test positive to stay “in their bed area” while they wait to be taken to the site in Kent, a process that’s considerably faster than testing and moving people living unsheltered. (Currently, the county uses Yellow Cabs for this purpose). She can remember one recent case when a woman left the shelter for the Kent site and decided not to stay. “She turned around [after arriving] and stayed outside in the streets and at the bus stop” after family members refused to take her in. “She recovered, but I don’t know who all she infected” while she was contagious, Mitchell said.

Shepard says that she’s encountered an increasing number of unsheltered people who tell her they have COVID-like symptoms but don’t want to be tested or go into isolation and quarantine because they’re afraid they won’t be allowed to leave. “There was this big push, when isolation and quarantine opened, that they were not going to hold people against their will, but now there are stories coming out about that happening to people.” Shepard says she takes these stories “with a grain of salt—when I’ve asked who has had that experience, it’s just like, ‘everyone knows'”—but says they’ve had an impact nonetheless. “The big thing I’m hearing right now is, ‘No, I don’t want to go because they won’t let me leave.'” Continue reading “As COVID Cases at Encampments and Shelters Rise, Many Are Reluctant to Enter County Quarantine Sites”