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Homeless individuals struggle on a daily basis to survive. They are affected by their inability to preserve their own independence and self-worth during difficult times. On any given night in the United States, approximately 650,000 individuals are without homes. The rate of homelessness continues to climb, with children and families comprising the most rapidly growing subpopulation of those experiencing homelessness. According to the Broward Regional Health Planning Council’s 2014 survey, there are approximately 2,726 homeless individuals and families in Broward County, Florida on any given night. Many homeless individuals from throughout the nation migrate to Broward County due to our locale's image of being a large tourist destination with an ideal climate, in addition to the many social services provided in this county. This large influx of homeless persons presents a special emergency management challenge to local law enforcement agencies, one that many other communities do not experience.

Alarmingly, those experiencing unstable housing are often the most excluded in emergency management activities, leaving them particularly vulnerable to disasters and emergencies. A myriad of factors compound the ability of the homeless to prepare, respond and recover from disasters, including limited economic and material resources; social exclusion and isolation; and disproportionate rates of disability, illness and addiction. A lack of training amongst first responders in working with the homeless population in emergency management leaves open the notion that another disaster is certain to include additional harm amongst a population that generally believes it has nowhere to go for help and no trust that the government can protect them.

A long-standing feud of law enforcement traditionally “locking up” individuals who experience homelessness through various life-sustaining misdemeanors has compounded the necessity in which law enforcement must also serve to protect these individuals during disasters as well. While quality of life standards are always a forefront issue that peaks in pre-disaster, a post-disaster further entrenches the plight of the homeless population due to further worsening mental, physical, and overall health and steadily increases the morbidity of those who alternatively do not receive care from a disaster.

In an effort to better understand the perspectives of the homeless, focus groups and interviews were conducted with this population inquiring about disaster and emergency preparedness. “Surviving the Streets: A Dialogue,” a model program developed by the National Health Care for the Homeless, is an example of interprofessional collaboration involving emergency management, public health and homeless service providers. The “Surviving the Streets” model is unique in that a peer-to-peer paradigm was utilized with at least one of the “facilitators” being an individual who has experienced homelessness.

Objectives Discussion (cont.)• To describe the understanding of disaster and emergency preparedness from the perspective of individuals experiencing homelessness.• To illustrate a model of educating individuals experiencing homelessness on how to prepare, respond, and recover from disasters and emergencies.• To identify issues that impact disaster preparedness in individuals experiencing homelessness.

Select quotes illustrating the thematic issues:

Adaptability, Coping, and Resourcefulness

“I was trained in the military to survive; to me it’s no different whether it’s out here on the streets, in the jungle, whatever, I was trained, and I keep that discipline in me, that survival instinct in me. I’m clean, I bathe, I clothe, I take showers, and work part time.”

Fear/Safety

“You know what really scares me, and I’m 60 years old, what really scares me is when I lay down somewhere that nobody knows where I’m at and I’m there for 2-3 days, and nobody knows, it hurts, it’s scary.”

Internal (Intrinsic) Control

“I mean one day you’re living good, and I was living good, and all a sudden it’s like the world fell under my feet. But I’m not going to give up. I’ll continue, I’m still human, even though I’m in a position, we’re all here for one purpose.”

External (Extrinsic) Control

“He was always afraid that someone was just going to lock him up, you know, like they used to do. I tried taking him down to the social security and they weren’t going to help him because he was homeless and didn’t have an address.”

Importance of Relationship/Trust

“I have officers I’ve known for a while and they know me, we’re just like friends now; they talk to me, I give them information and they try to get me a job.”

“You know you run into some officers, they come by you know, and they let you know just don’t be rude in this area or that area. But they got concern; I can really say that a lot of them do have a lot of concern.”

“Cause a lot of people that work in the industry don’t care. They’re like listen, I’m here to do my job and this it. Ok, but if you don’t have any compassion or you don’t care, you’re not going to get trust from them either. I mean if I know you don’t care, I don’t want to sit there and talk to you cause it’s like you’re not even trying to understand.”

Background Quotes

Emergency Management and Homeless Services Providers:

The Need for Cross-Sector CollaborationKristi Messer, MPH, MSW; Edward Rafailovitc, MA; Devra Cohen, MPH.; Elliot Montgomery Sklar, PhD; Anna Johnson; Brandon Young; T. Lucas Hollar, PhD

MethodsTo gain insight into the key concerns experienced by individuals experiencing homelessness when preparing for or responding to a disaster or an emergency situation, we conducted a series of focus groups that were comprised of individuals seeking services from homeless outreach providers in the Broward County area. Seventeen participants (7 males and 10 females) participated in the focus groups in conjunction with their participation in daily outreach activities.

Each group was co-facilitated by a law enforcement officer of the Broward County Sheriff’s Office, a faculty member of the Nova Southeastern University College of Osteopathic Medicine (NSU-COM), and at least one individual who formerly experienced homelessness. The focus groups utilized a semi-structured protocol which introduced stem questions and allowed for novel conversations, while maintaining a degree of uniformity across the topics covered. A member of the NSU-COM research team explained the purpose of the study, risks and benefits, efforts to maintain confidentiality and anonymity, and the ability to withdraw from the study without any penalty. Participants who agreed to participate in the focus-group sessions signed a consent form and received a $5 grocery store gift card along with other daily necessities (e.g. socks, soap, razors, first aid, hand sanitizer). Each of the focus group sessions lasted approximately one hour.

Throughout the focus groups, the issue of control emerged as a major theme. Participants expressed behaviors relating to adaptability, coping, and resourcefulness which seemed to mitigate the conflict between the need and desire for intrinsic control and the realities of extrinsic control. Fear and safety-related concerns were embedded throughout the dialogue, and directly related to discussions indicating a perceived lack of control regarding one’s well-being. The importance of trust and relationships was pervasive and seemed to create an enhanced sense of control by homeless individuals.

Results

Collaboration, not only between law enforcement and the homeless, but also between social service providers, public health, and emergency management is critical if we are to change the relationship from an adversarial (or misunderstood) relationship to a relationship of partners working toward the mitigation and safety in some of our most vulnerable populations. Understanding the balance of internal and external controls among individuals who are unstably housed or homeless is critical in building a positive and proactive relationship with their community.

This partnership between the social services for the homeless, law enforcement, and academic institutions demonstrates how collaborating with external resources can help to establish the necessary trust to assist individuals experiencing homelessness before, during, and following a disaster. This cooperation enables Broward County to use “trusted” community resources with individuals experiencing homelessness in order to better provide resources during an emergency and to establish a level of mutual beneficial assistance during times of crisis.

Results from the Surviving the Streets focus groups reveal that emergency management serves an important role in pre-disaster planning to ensure that preparedness education becomes an essential ingredient in interactions with vulnerable population groups. One of the most effective measures is for law enforcement officers, who serve as first responders and therefore typically have the most contact with the homeless population, to build relationships based on trust with individuals who are homeless and to reinforce/encourage adaptive life decisions that are within their control through a positive discourse in safety and preparedness

An innovative and interprofessional approach connecting emergency management planners, homeless advocates, social service agencies, law enforcement, and individuals experiencing homelessness is critical if we are to collectively work toward the common goal of creating a dramatic change in how we all work together to better understand how to prepare, respond, mitigate and recover from disaster. Recognizing the balance of control and the importance of trust and relationships is crucial. By assisting individuals in the homeless community to regain and recapture their lives, law enforcement professionals can reallocate public safety resources to other critical areas, realize a reduction of public complaints for quality of life issues related to homelessness post-disaster, and equip their officers with the knowledge of the social issues related to homelessness, including the importance of maintaining and developing internal control, building relationships, and establishing trust.

The Surviving the Streets Model is an illustration of how emergency management and public health officials, alongside persons who are homeless, can address issues of preparedness and response. The need for cross-sector interprofessional collaboration and relationship-building is key to meet the needs of some of our most vulnerable citizens.

DiscussionThrough public policy, law enforcement, and homeless shelter management, our society imposes rules to maintain a sense of order and control. There is an inherent struggle within individuals experiencing homelessness to exercise a level of autonomy which is often discordant with the experience of being homeless in which meeting basic physiological needs is challenged. It is, therefore, all the more important for these individuals to feel empowered wherever possible in exercising autonomous control.

Law enforcement and social service actors can make better inroads with individuals experiencing homelessness through relationship building as a means of gaining trust and can motivate positive change by respecting the need to balance the perception of internal (intrinsic) vs. external (extrinsic) control. It is critical to ensure that individuals experiencing homelessness feel that their safety/situation is respected and that they glean a sense of empowerment in the process of preparedness and safety and are educated in this process.

The relationship between Broward County law enforcement and individuals experiencing homelessness is symbiotic through advocacy in the community during a disaster. Often, individuals experiencing homelessness are less equipped to understand services offered during times of emergency, have access to less media to be informed, and perceive a lower sense of trust that emergency management can protect them; this is particularly the case if a relationship has not been established.

AcknowledgementA special thank you to the National Health Care for the Homeless Council, Broward Sheriff’s Office, Broward County Taskforce fore Ending Homelessness, Broward County Homeless Assistance Centers, and most importantly, our homeless consumers for adding such richness to our dialogues.

“A lot of people…turn their backs to homeless people, and they forget we’re all human beings.”