Homeless shouldn’t mean hard-to-reach

Mary-Doug Wright, a health research specialist recently drew my attention to an article reporting that the San Francisco Main Library hired a social worker to work with the homeless, with amazing results. The psychiatric social worker, hired through a partnership with the San Francisco Department of Public Health,  has directed more than 150 homeless people into social services and trained some as library employees –  “health and safety associates” who monitor the facilities and distribute information to the patrons who need help.

It was an interesting coincidence that around the same time, I participated in a service fair organized by the Under One Umbrella Society to provide information and services to homeless/street-involved people in East Vancouver. The participating exhibitors included government agencies,  service delivery non-profits and advocacy groups. The fair offered:

  • physical provisions such as food, warm clothing and toiletries
  • health information and services: street nurses were giving flu shots
  • personal services such as: massages, foot care, pet care, hair cuts and bike repair
  • information on shelters, housing, social assistance, employment services and community voicemail services for people in crisis and transition
  • workshops on topics such as safety, employment and services


  • It was valuable to inform the fair attendees about the provincial prescription drug plan and how to ensure that they were registered. We found that most people who are homeless or at risk are on social assistance and depend on social workers to advocate for them. They are often unaware of the full range of benefits available to them and may lack the efficacy to demand information from a fragmented system. It is often the system that fails them.
  • As the San Francisco library’s initiative above demonstrates, the library is an integral part of the community and can play a crucial role not only in providing the more traditional information services but in responding to the homeless’ needs in practical ways. The local library branch was not represented among the exhibitors. One participant asked me where the library booth was because they were present during the last fair, a clear indication they were missed. As libraries are at the core of information provision and referral to community services, they must make every effort to be present at events like these.
  • As would be expected, there is a high demand for probono dental treatment and scant information about such services. This is certainly an information gap that needs to be addressed by social services workers and librarians.
  • In addition to meeting the information needs of the attendees, it was highly valuable for us to connecting with other service providers. Partnering with outreach workers is an important way to disseminate important information to this group.
  • Judging from the popularity of the fair (held in 2007 and 2009), this kind of event is obviously helpful in connecting with this population and responding to their immediate needs. It is however important that these one-off initiatives are supplemented by a systemic strategy to address the complex problem of homelessness. While shelters seem to be a logical approach to addressing homelessness, their underlying model is often flawed. As reported in a Newswise article, Jason Wasserman, author of  At Home on the Street: People, Poverty and a Hidden Culture of Homelessness found that shelters failed to meet the needs of many homeless people because they addressed addiction and mental illness almost exclusively and alienated those who did not have these problems. Wasserman’s research showed that nearly all homeless people want to find work – rather than treatment or even meals.

“Overall, we found the shelters followed a medical model of homelessness, where treatment is required to access services. This puts a band-aid on just a few of the individual symptoms associated with homelessness rather than being attentive to the way society contributes to the problem. In that way, social programs sometimes can make the problem worse.”

As Wasserman argues, the phenomenon of homelessness is indeed a complex one that defies simplistic solutions. Rather than being a homogenous group defined by characteristic symptoms, homeless people demonstrate a wide range of circumstances, abilities and interests; and often a good measure of resourcefulness. For example, contrary to the common stereotype, homeless people in Washington DC are using technology and adding their voices to the blogosphere as captured in this Washington Post article.  Clearly the authors of blogs like “On the Clock with Eric Sheptock” and “Homeless, jobless, hungry N DC ” are active participants in social discourse rather than helpless victims awaiting rescue by social services. They scarcely fit Mark Rabnett’s description of the “hard-to-reach” as “seldom heard” because they represent the collective voice of their community, are engaged in conversations about bettering their lives and can participate in consultations about developing services to meet their needs. The democratizing potential of social media has given a voice to previously marginalized people. An online forum like Streats is a powerful information sharing platform for their community and can be an avenue for connecting with them and researching their needs.  In fact, thanks to social media, these populations are no longer so “hard-to-reach” and we may need to invent other explanations for why they are excluded from social services.

Explore posts in the same categories: Consumer health


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