Chapter 4: The List

Last year, when Tulicia Lee called 211 so that she and her son could get help with housing or shelter, the operator told her to go and do an assessment so that she could get into the Coordinated Entry System, or CES, as she calls it.

     211 operator: OK, so tomorrow you can go at 1:00 p.m. at the Henry Robinson Multi-Service Center to do an assessment for the CES program.

Tulicia did that. She sat down with a social worker and answered some questions and was entered into the system. But she didn’t end up getting any help with housing.

     Tulicia: I think – I just feel like somebody… they forgot about me. They forgot about me and my son.

When Tulicia entered that system, she was essentially being put on a big long list with a bunch of other homeless people. But what she didn’t realize – and what I didn’t know at the time – was that this list, it wasn’t just a first-come, first-serve queue. It was a list of all the homeless people in Alameda County ranked according to need. The people at the top were considered the most in need of housing, and they were prioritized first for help.

I don’t think it’s hyperbolic to say that people may actually live or die according to where they end up on this list. Homelessness is lethal. A study in Los Angeles in the early 2000s found that the average age of death for a homeless person was 48 years old, and that life expectancy is about 36% shorter overall. Housing equals more years of life, and being at the top of the list is a path to housing. 

I want to know why as a single mom struggling with her mental health and living in a car with her kid, Tulicia wasn’t high enough on the list to get help. Was she close? Or far? And if this is a ranking of needs, how are they determining whose need is the greatest?

To find the answers to these questions, I’m going take you deep into this bureaucracy. Like Russian nesting dolls, there’s layers to this thing. But I promise we are gonna solve the mystery of where Tulicia ended up on this list, and why it fails so many people. 

This is According to Need, Chapter 4.

If I wanted to know where Tulicia had been on the list, I’d need to find someone who had access to it — who could actually pull it up on their computer screen and look at it. But that proved to be difficult. 

     Elsa: Yeah, so I found her first call that I had with her back September 2019. In my notes, yeah, ‘the caller has been sleeping in her car with her son.’

This is Elsa Gonzalez, she works at 211, and she’s actually the operator who told Tulicia she should go and get into the Coordinated Entry System, or in other words, get on the list.

     Katie: And are you, like as an operator, are you able to see where she would have ended up on that list? 

     Elsa: No.

     Rashana: The list. I mean, today I even told someone, ‘Hey, I don’t know how they prioritize the list. I don’t know how they’re pulling people from the list.’ 

     Osha: So they get you on the list. They’re very good at getting people on lists. And then all of a sudden you’re not on the list or you went all the way back down to the bottom of the list. It’s all a huge mystery. 

     Jamie: You know, that list is… Yeah, I mean, that’s an hour-long conversation…

I had so many conversations about the list and the bureaucracy behind it, and I hadn’t found out anything specific about Tulicia yet.

But one thing I learned is that the way homeless services are administered in this country is that the department of housing and urban development, aka HUD, gives big grants every year to nonprofits that have organized themselves into communities. Like for example, all the non-profits in Alameda County are part of one group, and they share one pot of money. 

HUD isn’t usually able to give these local communities all of the funding they apply for, because HUD itself also doesn’t get all the funding it asks for from Congress. And because funding is scarce, a few years ago HUD told local communities all over the US they would have to implement systems – Coordinated Entry Systems – to make sure the limited resources went to the people most in need.

What that meant was that all over the US, communities like Alameda County had to make a list of all the homeless people in their particular area ranked according to need, and then figure out how to get the available resources to those people, prioritizing the people at the top of the list.  

Eventually, I figured out that in Alameda County, the organization that led the effort to implement the Coordinated Entry System was called Everyone Home.

So, maybe someone at Everyone Home had access to the list? Like, someone has to be looking at this thing and making decisions about the people at the top of it, right?

     Katie: Hi. 

     Julie: How are ya? 

     Katie: I’m Katie.

     Julie: Julie.

     Katie: Nice to meet you.

That’s Julie Leadbetter. She’s since left the organization but she used to work for Everyone Home and she helped put the Coordinated Entry System in place. 

     Katie: This part of it is like a crucial piece, which remains kind of mysterious to me.

     Julie: The coordinated entry piece?

     Katie: Yeah. Everyone’s always referring to the list, right? Yeah, it feels a little bit like the Wizard of Oz. I guess my first question is, like, are you the wizard, is this Oz? [LAUGHS]

     Julie: I am not the Wizard, this is not Oz. But I can give you the system manual, which explains the whole thing. 

     Katie: Really? 

     Julie: Yeah, I do. I do have a map of Oz.

     Katie: Okay. Can we, like, look at it together? 

     Julie: Yes. [PAGE FLIPS]

When HUD asked communities all over the country to implement this system that ranked people according to need, the question for Julie and her colleagues became: ‘OK, who is the most in need of help?’ 

     Julie: Who shall we prioritize for these very, very scarce resources?

After Sam Tsemberis’s very successful work with Housing First, experts and policymakers started to think that the people who should be prioritized for resources were the kinds of people Sam had been working with. People who were often dealing with a lot of challenges – mental or physical illnesses, disabilities, addiction. 

These were the people that research showed were the most likely to die on the street if no one intervened. And, importantly, they were also the people most likely to use costly services like shelters or detox centers or ERs. 

But there was a fear that these folks weren’t getting services. Because they were hard to work with or had a hard time self-advocating. 

     Julie: So, coordinated entry also came at a time where people said, wait, the people who really need this are not getting it. 

And so, as the folks in Alameda County – like Julie – started to answer that question – who should be prioritized – they would have been thinking about that group, and they also asked homeless people themselves.

     Julie: You know, a lot of the folks said, “I’m struggling. But that person over there, that person needs help before I do.”

In the end, Alameda County came up with a vulnerability assessment. A questionnaire, basically. This was the thing Tulicia had done with the social worker, where she had to answer questions like:

Does anyone in your household suffer from depression or schizophrenia? 

Do you have a disability? 

Do you have any chronic health conditions?

In the past 30 days, have you had to do things that felt unsafe to survive? 

Every homeless person on Alameda County’s list has been given this same assessment. And depending on how they answer each question they get a score, and it’s that score that determines their place on the list.

     Julie: So that’s where you hear about the list. And the list is long right now. 

There are currently around 8,000 households on Alameda County’s list. A household can be an individual or it can be a mother and her kids, for example. And Julie said she thinks of 8,000 households, only about 20% get some kind of resource. 

     Julie: The resources are all kept, sort of, on spreadsheets…

And only a few hundred of those households – the ones at the very top of the list – will get the kind of housing that you heard about in the last chapter. What’s now called permanent supportive housing, where your rent is subsidized for the rest of your life plus you access to other supportive services.

There are other less intense interventions people can get like short term help with rent or one-time help with a deposit.

But Tulicia, as we know, got none of these things. And sadly, Julie was not the person who could tell me exactly why.

     Julie: And so when you’re ordered on the list, that gives you a rank on this list. But then, you’re matching. So this is the matchers, these people out there who are doing this. 

     Katie: Wait who.. who are those people? 

     Julie: They’re all across the county. 

These matchers, they are the people that look at the list and match the people at the top with resources like housing. I needed to talk to one of them.

     Katie: [PHONE RINGS] Hi.

And, long story short, I had to send a bunch more emails, make a bunch more calls… [PHONE RINGS] And then finally I found a matcher – a person with access to the list.

     Katie: How are you doing?

     Lakeshia: Doing well.

     Katie: Working from home?

     Lakeshia: Yes.

This is Lakeshia Livingston. And she is a matcher.

     Lakeshia: I am doing the matching. And it’s very unbiased as far as our work because the computer tells me – it’s based on a scoring system – which families are higher need than other families.

Lakeshia works for an organization called Building Futures, and she spends a lot of time looking at a sub-section of the list that includes households with kids. 

     Lakeshia: When you’re looking at that list all day, every day like I look at it, you kinda… you become really familiar with where people are, what they rank. And it’s just, like, mesmerizing in a sense.

Not only does Lakeshia look at the list, but she could tell me what Tulicia had scored on her vulnerability assessment which is ultimately what determines how high or low she would have been on the list. This was the person I’d been looking for. I was trying to keep it cool, but I was so excited.

     Katie: Yeah. And is that… that’s part of what I was hoping you guys would share with me is so that I can understand, like, why someone like her wouldn’t have moved into shelter or housing. 

     Lakeshia: So I can’t specifically give you her score…

I truly thought my hopes had been dashed in this moment. But then, Lakeshia’s supervisor who was also on the call jumped in and was like, “It’s cool we have permission from Tulicia to share this info.”

     Lakeshia: OK, let me see here. So I’m looking at the actual assessment right now. 

Lakeshia starts skimming through Tulicia’s answers on the assessment.

     Lakeshia: She has been homeless, you know, multiple times. She states that. She checked mental health, chronic health conditions…

All of this added up to a score of…

     Lakeshia: So she was at a 120.

120. That was her score on the assessment. The higher your score, the more vulnerable you’re considered to be, and the higher you are on the list.

     Lakeshia: It’s above the average range, but just not quite high enough. Like right now, if I’m looking at the list to place families, I’m not even near 120. 

     Katie: Really?

     Lakeshia: Yes, I’m still at about 150.

There are lots of people, Lakeishia says, who score 150 or 160 or 190, or higher. They just ticked more boxes on the vulnerability assessment than Tulicia, and so they ended up higher on the list than her.

     Lakeshia: Disability is the big one. HIV positive is another one. 

Another factor that gets you more points on the assessment is length of time homeless. Tulicia had only been in the car for a few months. Before that, she was doubled up with friends or family members which, remember, doesn’t even count as homeless according to this system.

There were such limited resources, and so many people considered more vulnerable than Tulicia that she just never made it down to the still vulnerable, but not vulnerable enough 120s. 

     Lakeshia: It’s devastating sometimes because you want to help. And, you know, we have programmatic rules that we have to follow. So it’s, um, it’s just one of those things that is so you just kind of, you know, this is my job and I don’t make the system, but this is the way the system is operating and just, you know... But it does take a toll on you.

So okay, Tulicia had a slightly above average vulnerability score of 120. She hadn’t checked enough boxes to get a higher score. She didn’t check things like: Have you ever been convicted of methamphetamine production? or Arson? or Do you have an excessive dependency on drugs or alcohol?

And in the system we have now, those things actually help you move to the top of the list. Because they’re thought of as indicators that it’s going to be hard for you to get into housing on your own. People with those kinds of issues are more likely to stay homeless if no one intervenes. So that makes some sense right? But a system that, in a way, rewards things like addiction or criminal record – it’s going to be controversial to some people.

     Julie: Everybody has their own opinion about who should be prioritized, who shouldn’t. And then you hear a lot of conversation about who’s deserving, who’s not deserving. 

Again, Julie Leadbetter who helped build this system in Alameda County.

     Julie: It’s manifested a lot in terms of like, ‘that drug user doesn’t deserve it, why are they getting prioritized?’ 

It’s wild when you think how far things are from when Sam Tsemberis started Housing First. The way it looked pre-Housing First was that only people who were clean and mentally sound enough to navigate the system got housing. Now it’s the opposite. Now, the more of these kinds of barriers and vulnerabilities you have, the more likely you are to get help. 

HUD, and as a result, all of the local communities it funds have decided to focus on this group for reasons both moral and financial. This group really is more likely to die on the street if they don’t come inside and also they’re the most likely to cost the government money if they stay outside. But – and stay with me here – prioritizing this group, whatever the reason, it’s had an unintended consequence in some communities. It can actually end up favoring white people.

     Margot: One of my and other people’s concerns have been that because there’s so much structural racism, it is much easier to become homeless if you’re Black.

This is Margot Kushel. She’s a doctor and a researcher on homelessness at the University of California San Francisco.

     Margot: So what we see, if you just look within the homeless population, the Black folks look healthier. Because to be homeless and Black means you could just be poor. And in general, this is a sweeping generalization, but in general, more… a higher proportion of the white folks who are homeless have these disabilities that are related to their homelessness. Not everyone, of course, but more you’re more likely.

I wanna jump in here because I think this is tricky to understand, but important. So, okay, think about it like this. A white person is standing on a diving board and homelessness is what happens if they fall over the edge. But, it’s a long diving board with plenty of space. Every personal difficulty is a push toward the edge. An injury on the job, a little push; the onset of depression, a push; an addiction, another push. By the time this white person gets to the edge and finally falls into homelessness, they may have accumulated a lot of pushes. You can think of these as vulnerabilities.

On the other hand, people of color and especially Black people – because of the racial wealth gap, and other disparities caused by systemic racism – they just often have a shorter diving board to begin with. Which means one little push might send a Black person over the edge. So there are just more relatively healthy Black people who fall into homelessness. And this matters when it comes to the Coordinated Entry System. Because the system gives people a higher score if they have accumulated more vulnerabilities like addiction, mental illness, etc.

     Margot Kushel: And so what people who have interrogated this have found – and this is true in many places across the country – is that the white folks are more likely to get resources just because they score higher because these scoring systems are all based on individual vulnerability. 

Alameda County, I should say, has actually worked to address this issue by adding different kinds of questions to their assessment and white people are not currently getting resources at a higher rate than people of color. But these issues with the assessment are still a problem in other places across the US. And I feel like what we can see from this, is that it’s hard to find a framework for vulnerability that fits everyone. Like, where does this framework, which focuses so much on things like mental illness and addiction, where does it leave Tulicia’s son Jordan? An 11-year-old kid who doesn’t have those particular issues, but is vulnerable in so many different ways? 

So okay, the assessment process isn’t perfect. But the biggest problem, the biggest problem isn’t that figuring out who the most vulnerable people are is tricky. It’s that in Alameda County, there are 8,000 people on the list and the vast majority of them will get nothing. Not to mention all of the people who never make it onto the list to begin with, because they’re not considered literally homeless. 

And those people who don’t get any help from the system – or who don’t even get to enter the system – they don’t just disappear. Some of them will find their way back into housing. But many of them won’t. And eventually, some folks will end up in more vulnerable, and often more visible forms of homelessness. People who start out on a friend’s couch may end up in a car, but then the car gets towed and they end up in a tent by the side of the road. Along the way, they accumulate trauma. They get injured or assaulted, or have mental health crises brought on by stress. Eventually there are more and more people who can check a lot of those boxes on the vulnerability assessment. And, there’s not even enough resources for all of them. That’s what’s already happening right now in Alameda County. The system is just completely overwhelmed.

     Julie: The pressure on the system to do well and to be good and to be efficient and to be clear, just feels like a burden. I mean, we’re all just experiencing this. We just want to be the best you can be in a time of crisis. And, you know, you’re not quite there yet, you know? And you have to just keep working on it. 

People will keep trying to make this whole thing run more smoothly. They’ll try to make it as fair as possible. But the thing is, no matter how much you work on the system, if you’re trying to feed 8,000 people with 2,000 sandwiches, that math is just never going to work out.

And people like Julie – who work in this system, who helped build it – they know this. They certainly don’t need me, a reporter, to point it out. They feel the system’s deficiencies all the time, and it’s hard on them. It wasn’t until the end of my interview with Julie as I was getting up to leave, that I realized just how hard.

     Katie: Um well, thank you.

     Julie: [CRYING] Goodbye. I don’t know if you see lots of people cry out there these days, but it is tough.

     Katie: Oh, man. 

     Julie: And it’s not tough for me, I sit here, but I just think about all those frontline people who are just, like, feelin’ it these days. I mean, everyone on the streets. All the workers who are doing the assessments, you know, like everybody. It’s just an incredibly brutal time these days. And everyone out there is feeling this pressure to do more. And people are, you know, doing a lot. People are really doing a lot and there’s just a lot more to be done.

It’s not just Julie. So many of the people I talked to who work in this system have the sense that they are being asked to solve this problem without having been given the resources to do it.  Like Rashana, from 211. She told me the main thing she understands now about homelessness that she didn’t understand before the job, is that for most people out there, there is no help. 

     Rashana:  What are they getting? Nothing. Sent back in a circle to call 211 and cuss us out and say you guys aren’t doing, you know, this and that for me. And we take it. We’re the emergency room for the community, we take it. But it’s like, we share our frustrations like… we don’t like telling people we don’t have these resources.

Every person I met working in the different corners of this system wanted there to be more resources. And local communities like Alameda County are always scrambling to find new revenue sources since they don’t get anywhere near enough funding from HUD — ballot initiatives, sales taxes, state funds. 

And if we want to help the people who are homeless right now, we will need this system to have all of the resources it requires to do that. But that won’t actually solve the bigger problem. Because this system just wasn’t designed to do that.

When homelessness started exploding in the 1980s, people didn’t understand what was happening. We blamed it on deinstitutionalization and crack. Homelessness was something that happened to people who weren’t well. And we created a system to respond to the people who seemed the least well, the least capable of solving their own homelessness. The most vulnerable, we called them. 

But increasingly experts agree that homelessness isn’t caused by mental illness or addiction. Those things can serve as a catalyst, but they aren’t the cause. The cause is economic. If people can’t afford housing making minimum wage or can’t afford housing if they’re on social security or disability, you’re just going to have homelessness.

Which is why it feels clear to me after all of this that the homeless service system cannot solve homelessness. And I guess if the journey into understanding this system has been like opening a set of Russian nesting dolls, this is the one at the center. This system can’t solve homelessness. It can only address it. It can treat the symptoms, but not the disease. And currently, it’s not even treating the symptoms all that well.

     Sam: We are still talking about homelessness like it’s about the people on the street today. It’s unbelievable to me.

You may recognize that voice, it’s Sam Tsemberis. 

     Sam: And everybody’s talking about how do we get these homeless people off the street? It has nothing to do with these homeless people. I mean, these are just the current victims of a system that’s creating homelessness much faster than we are ending it. So it’s like even if you took the 60 or 80 thousand people that are on the street right now and house them, you haven’t ended homelessness. Because next year, you’re going to have 20 and the year after, 40 and 60… 

In some ways, it was Sam’s work with the most vulnerable that led to the system we have now which focuses only on them. But Sam thinks that if we’re really going to solve homelessness, we’re going to have to prevent people from ending up homeless in the first place. By making sure extremely low-income folks have access to housing they can afford. That’s what we had before the 80s. Sam wants that back. Not the way it was then, with poor people sequestered in ghettos, but mixed-income development on a massive scale.

     Sam: Where’s the plan to build 80,000 units of affordable housing? Everyone talks about, oh, we’ll do 200 units a year. Oh, we just got 400 new units. It’s like.. [LAUGHS] So what? Not really so what, but like… so what?!

Sam gets so worked up when he talks about all of this. He’s infuriated that as a society, we don’t invest in truly fixing this problem. We just do these half measures and then wonder why they haven’t worked. Instead of doing what really needs to be done, we’ve built a whole system – a whole industry – around addressing homelessness for a very, very small number of people. 

But Sam still works inside this system, and when I ask him why he hasn’t just given up on it completely, he says it’s because it’s still worth it. It still matters to house even just one person. 

On the last episode of According to Need, one person finally, actually gets something from this system.

     Katie: Well, what else is going on in your world right now, Sam? 

     Sam: Nothing else is going on in my world, Katie. This is my world. I live… eat, live and breathe you know, homelessness. And then I try and go for walks to stop thinking about it for a little bit.

After the break, a preview of our final episode.

[BREAK]

Coming up on According to Need.

     Sarah: Why is it draining through the tent?!

     Katie: Hey!

     Sarah: Hi.

     KC: We don’t want to break the law. But we have to live someplace and have to sleep someplace. Just like, I need to live.

     Sarah: Now you won’t help KC get water? You want me to do it, as I’m digging a ditch to save her tent?

     Katie: I was trying to figure out a situation in which you might use your escape hatch. 

     KC: I don’t know. I really don’t. It just…

     Katie: You just like knowing it’s there.

     KC: Yeah. I like knowing it’s there.

     Mukund: It’s really hard to find a decent place in Berkeley with a voucher. If you do find a place in Berkeley with a voucher, they tend not to be the nicest places.

     KC: You know they’re renting not apartments, they’re not bedrooms. Beds! For twelve hundred a month near the college? Twelve… That’s outrageous! 

     Katie: And did she tell you when you could expect to hear anything?

     KC: She said she’d know where I stood on the list by Tuesday, or Wednesday, so…

Getting to the top of the list is just the beginning. What it looks like to actually get help from the system, that’s next time on According to Need.

This chapter of According to Need was produced by me, Katie Mingle, with associate producer Abby Madan and managing editor Whitney Henry-Lester. Huge thanks to Ann Oliva, Jamie Almanza, Dennis Culhane, Alison DeJung, Regina Cannon, Jessie Shimmin, Osha Neumann and Iain De Jong who all spent time talking to me about the list.

Roman Mars is the executive producer of According to Need. Invaluable editing from Lisa Pollak, Emmett FitzGerald, Delaney Hall, Christopher Johnson, Joe Rosenberg, and Roman Mars. Bryson Barnes was our sound engineer. Fact checking by Amy Gaines. Beautiful music by the beautiful Sean Real. Branding and Design by MUCHMORE.io. Kurt Kohlstedt was our digital director. Additional support from Sofia Klatzker, Vivian Le and Chris Berube.

Special thanks to Marisol Medina-Cadena, Johanna Zorn, and Chelsea Miller.

According to Need is a project of 99% Invisible, which is a founding, proud member of Radiotopia from PRX, a network of independent, listener-supported, artist-owned podcasts.