Heroes Of The Homeless Crisis: How Dr. Jeffrey Norris of Father Joe’s Villages Is Helping To Provide Medical, Dental and Behavioral Health Services To The Homeless Community

If you live life without taking risks, your potential positive impact on the world will be that much less. Too often, we avoid trying something for fear it will not work. The joy of my work at Father Joe’s Villages is that my organization lets me take chances and lets me develop innovative approaches to do better for our homeless neighbors.

As a part of my series about “Heroes Of The Homeless Crisis” I had the pleasure of interviewing Dr. Jeffrey Norris

For the last 4 years, Dr. Norris has served as the Medical Director at Father Joe’s Villages, where he runs a Federally Qualified Health Center within the Village; the Health Center focuses exclusively on those experiencing or at-risk of homelessness. He also serves on the Board of Managers for Integrated Health Partners, which is a Clinically Integrated Network of Federally Qualified Health Centers in San Diego and Riverside Counties. He completed medical school at the University of Utah followed by a residency in Family Medicine at the University of New Mexico.

Thank you so much for joining us! Our readers would love to ‘get to know you’ a bit better. Can you tell us a bit about your personal background, and how you grew up?

I grew up in Houston and Salt Lake City and I have always loved being outdoors. Salt Lake was a great place to get outside to hike, run, bike, ski, paddle, or whatever else. My grandfather was a psychiatrist and my mother is an internist in primary care. My maternal grandmother was Japanese and we still have a lot of family we keep in touch with in Japan.

Is there a particular story or incident that inspired you to get involved in your work helping people who are homeless?

I went to medical school to not only address individuals’ health issues, but also work on public health issues that drive poor health outcomes on larger level. Homelessness is a perfect example how social inequities directly and negatively affect health. What I love about my job is that I can go from injecting someone’s knee to having a conversation with county officials about system changes within an hour. Often when we, as someone not experiencing homelessness, see someone struggling on the sidewalk to make it through life, we feel individually disempowered to do anything to service that person. In a position like mine, I feel like I can work meaningfully on systems changes to improve individuals’ lives.

Homelessness has been a problem for a long time in the United States. But it seems that it has gotten a lot worse over the past five years, particularly in the large cities, such as Los Angeles, New York, Seattle, and San Francisco. Can you explain to our readers what brought us to this place? Where did this crisis come from?

One of the greatest reasons why homelessness has become more prevalent is that housing has become less and less affordable over the last 15 years. Adjusting for inflation, median rents have increased across the country and especially in California. On top of that, adjusted for inflation, low income households are making the same or less than they did in the early 2000s. As a result, low income households spend over 60% of their income to pay for a place to live. With their proportion of income spent on housing soaring, these households have less available funds to buy food, clothing, educational resources and other important needs, let alone savings. Though Father Joe’s Villages and our partners have worked on addressing homelessness for years, society at large has largely ignored these underlying causes of homelessness (income inequality and costs of housing).

For the benefit of our readers, can you describe the typical progression of how one starts as a healthy young person with a place to live, a job, an education, a family support system, a social support system, a community support system, to an individual who is sleeping on the ground at night? How does that progression occur?

We can’t put homelessness in a box. Homelessness is diverse — experienced by people of all ages, race, ethnicities, genders, sexuality, etc. — and each person’s situation is different. Often, both personal and systemic issues contribute to each individual’s state of homelessness. As rent becomes more expensive and income stagnates, people who are already working low-income jobs or supporting children or elderly relatives become more vulnerable. Many people are just one life event away from losing their housing. Sudden or chronic illness, job loss, a death in the family, divorce, substance use disorder, and other issues can propel a person or family into homelessness. Then, once a person becomes homeless, it becomes increasingly more difficult to overcome homelessness. They have to spend much of their time focused on surviving — finding a safe place to sleep, food to eat, showers, etc. — making it more difficult to secure employment and housing.

In terms of health, pain, chronic illness and disability can prevent individuals from being able to secure income and housing. In this way, burdened by medical bills and unable to work, poor health can be the primary cause of homelessness. Alternatively, health issues can also be caused by the brutal and often traumatic nature of homelessness or can make pre-existing issues much worse. In this way, homelessness and health snowball together to make overcoming homelessness even more difficult for the people we serve.

All of these issues create a cycle of homelessness.

A question that many people who are not familiar with the intricacies of this problem ask is, “Why don’t homeless people just move to a city that has cheaper housing?” How do you answer this question?

What many people don’t consider is that people experiencing homelessness need support systems as well. Many of them have friends or family in the city in which they’re living and those connections are essential for mental health, finding employment, and to eventually overcome homelessness. Additionally, a person can’t always afford the costs of moving, and securing employment and housing in a new place is not easy, especially if you’re homeless. Often, if a person moves before finding security, they’ll just end up homeless again but in a new place without their previous support system.

If someone passes a homeless person on the street, what is the best way to help them?

It’s critical that we see people experiencing homelessness as people. Father Joe once said, “These are neighbors not strangers. They are somebody’s son, daughter. They’re just in trouble but there’s a way to help.” People experiencing homelessness often feel invisible. Just a smile, eye contact or a conversation can give hope to a person in need. If you are moved to act, then volunteer or donate to a local homeless services organization. Support nonprofits working towards comprehensive solutions.

What is the best way to respond if a homeless person asks for money for rent or gas?

It’s okay to politely decline. Panhandling is not a long-term solution to an individual’s homelessness. It’s better to support services that are providing shelter, health care, meals, employment training and more that help address larger causes of homelessness.

Can you describe to our readers how your work is making an impact battling this crisis?

Father Joe’s Villages is on the frontlines of this pandemic working to protect the health and safety of our homeless neighbors in San Diego. In addition to continuing to provide critical medical, dental and behavioral health services, the Village Health Center has provided thousands of screenings to proactively identify possible symptoms of COVID-19 and rapidly test and isolate the potentially infected individuals. These efforts help to mitigate the risk of spread. We have also supported in mass testing efforts to help identify those who are asymptomatic. Our team in the Village Health Center has been incredible day-to-day. They show up, day after day, with energy and enthusiasm to do what is needed to save lives! Further, I have seen our community come together to address this crisis in ways I would have never imagined.

How has the COVID-19 pandemic affected the homeless crisis, and the homeless community? Also how has it affected your ability to help people?

Right now, the people that we serve are scared — and rightfully so. People experiencing homelessness are far more vulnerable to complications and death from COVID-19. While most of us will be able to stay safe or recover in our homes, our neighbors experiencing homelessness face an added layer of challenges, including limited access to hygiene supplies and sanitary living conditions. To protect the health and safety of those most vulnerable in the community, all of the staff at Father Joe’s Villages are working far more hours and under more stress than ever before. In the face of physical distancing, we found more shelter space to ensure our neighbors have a safe place to sleep each night. In the face of food and supply shortages, we still continue to feed hundreds of neighbors warm, nutritious to-go meals every day. In the face of a pandemic, we offer proactive screening, testing and on-going medical, dental and mental health services that protect our neighbors’ health and save lives. We have to be more creative about how we provide our services but we must continue on to meet the basic needs of those experiencing homelessness during this uncertain time.

Can you share something about your work that makes you most proud? Is there a particular story or incident that you found most uplifting?

I am most proud of the fact that I never lost sight of my dream when I became a doctor. I went to medical school to serve those often forgotten by society. Many people go to medical school with such aspirations, but then end up elsewhere. I like to say that I think the 22-year-old me would be proud of what I have become!

Without sharing real names, can you share a story with our readers about a particular individual who was impacted or helped by your work?

One of our patients was dealing with debilitating depression, substance use disorder and suicidal thoughts as the result of a traumatic event. Unfortunately, these issues eventually led him to losing his home and living out of his car. After living in his car for a little while, the client developed debilitating back pain — so bad that he needed to use a walker to get around. Eventually he began sleeping on the streets, which only exacerbated his pain. Soon, he was struggling to walk at all. As you can imagine, it is impossible for a neighbor in need to focus on finding work and housing when they’re facing such insurmountable challenges. This man needed multidisciplinary, holistic support to address all of these issues and he needed housing and a safe bed in order prevent the pain from getting worse. Through the Village Health Center, he received mental health care and physical health care. Through San Diego’s coordinated entry system, he was able to find housing. With support from his Village Health Center doctor, he was eventually able to get back surgery, which relieved his pain and allowed him to focus on the future. He is now living on his own and self-sufficient. His story emphasizes how poor health and homelessness feed each other in a dangerous cycle.

Can you share three things that the community and society can do to help you address the root of this crisis? Can you give some examples?

Stand up for affordable housing in your community. If you hear of an affordable housing building being built in your neighborhood, let your friends, neighbors and community leaders know that you support it.

Contribute to a local homeless services provider in your area. Donate cash, household goods, donate a car or vehicle, or organize a donation drive of much-needed items.

Volunteer your time at a nonprofit providing food, health care, or shelter to people in need during this time. Even if you can’t volunteer in person, you can sew masks, assemble hygiene kits or do other creative work.

If you had the power to influence legislation, which three laws would you like to see introduced that might help you in your work?

The first would be to allow Medi-Cal (Medicaid in California) to directly pay for housing and related supports for individuals with complex health and social needs. Medi-Cal explicitly does not allow pay for housing of any kind right now, but we know there is a clear link between housing and health. Many people getting federal “disability” payments only get around $1,000 per month, which is not enough to cover housing costs on top of food, utilities, clothing, etc. in a city like San Diego. “Housing is healthcare”!

Federally Qualified Health Centers (like our clinic) in California are not paid for behavioral health visits that are provided the same day as a physical health visit. This means that health centers across the state provide largely uncompensated care to patients with mental health issues. This is not fair and must be fixed.

HIPAA and HITECH, a set of federal healthcare privacy laws passed in 1996 and 2009, have served to worsen the quality of healthcare. The intent of the laws is noble: to protect the privacy of patients. But because of the way the laws are implemented, doctors and other team members are often unable to quickly share critical information about patients. This issue has undoubtedly caused numerous deaths in our country over the past few decades. There is an urgent need change the interpretation of these laws in order to make sure the healthcare system can take quality care of patients.

I know that this is not easy work. What keeps you going?

What keeps me going is my team. I am nothing as a leader without the right people around me. There have been very challenging days during this crisis, but the reality is that we are all supporting one another. A number of my employees have directly told me, as I was struggling to try to take a day off, “go home, I’ve got this covered.” When we take care of each other, we are better able to be present and engaged for everyone else.

Do you have hope that one day this great social challenge can be solved completely?

At Father Joe’s Villages, our mission is to prevent and solve homelessness, one life at a time. I do believe that we can get to the point where homelessness barely exists or is only a transient state. But getting there requires our society to completely re-envision its commitment to the most vulnerable around us. On a policy level, massive changes to housing policy and income equality need to occur, with especial focus on race and class inequities. And on an individual level, we have to recognize that there is a face to homelessness and individual people who are suffering.

What are your “5 things I wish someone told me when I first started” and why. Please share a story or example for each.

“Move quickly, but not too fast.” As humans we are often impatient. When we see something “wrong”, we want it fixed quickly. As I came into my current position in 2016, there were many challenges to work on. It has been easy to try to “take it all on”, and one of my biggest vices is that I want to fix everything. But when you overextend yourself and your team, you become less effective and lose a sense of mission. In our Health Center, we have had to be very careful to pace out the projects we work on. Because of this approach, over 5 years, we have started a Medication Assisted Treatment program, implemented Health Homes, started a Recuperative Care program, increased our case management team, integrated a Behavioral Health team into the clinic, and greatly expanded the number of primary care clinicians.

“Your employees are your customers.” In any “business,” whether non-profit or for-profit, our traditional “customers” are the recipient of our products and services (patient in healthcare). But of course, work is not done without a team. And as such, employees are as much the customer as the patient. It has taken me a couple of years to learn this lesson, but it is a lesson I will not forget! This approach allows us to keep and retain staff, which in turn means we do better for our traditional “customers”.

“Don’t try to be everything to everyone.” It is easy to see ourselves as needing to try to solve every issue out in the community related to “healthcare for the homeless.” Our Health Center does a huge amount of work in the community, far disproportionate to our small size. We have to be great at what we do, and sometimes that means saying “no” when we know we have enough to work on already. Instead, you have to leverage partnerships to lean on others to do the work you cannot on your own. An example of that is at the San Diego Convention Center, which currently serves as a homeless shelter. We were asked to do all the primary care for around 1,000 clients on top of providing mass COVID-19 lab testing and running our traditional clinic. The needs of the 1,000 clients far exceeded what we could accomplish on our own. So, while we said “no, we cannot provide all the primary care,” we then leveraged our relationship with La Maestra (another Health Center) to cover where we were not able to.

You are a person of enormous influence. If you could inspire a movement that would bring the most amount of good to the most amount of people, what would that be? You never know what your idea can trigger. 🙂

I would like to inspire healthcare companies and institutions to start seeing housing as an integral element of healthcare. The social issues faced by those with housing insecurity are as important, if not more important, than their health issues. How can we truly address the serious health issues people who are homeless are facing without first addressing their housing? For example, when a person doesn’t have a safe place to stay or a lock on their door, their medications are very frequently lost or stolen. Alternatively, some critical medications require refrigeration — which is virtually impossible for a person who is homeless. This makes managing acute and chronic health issues very challenging. At the Village Health Center, we work with patients first and foremost to get housing. In this way, obtaining that housing is often a critical step to achieving better health outcomes or even to saving a life.

Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?

“You miss 100% of the shots you don’t take.” — Wayne Gretzky

If you live life without taking risks, your potential positive impact on the world will be that much less. Too often, we avoid trying something for fear it will not work. The joy of my work at Father Joe’s Villages is that my organization lets me take chances and lets me develop innovative approaches to do better for our homeless neighbors.

Is there a person in the world, or in the US whom you would love to have a private breakfast or lunch with, and why? He or she might just see this, especially if we tag them. 🙂

Atul Gawande. Dr. Gawande is an acclaimed surgeon and author who has written numerous books about the challenges of doing “Better” (the title of one of his books) in healthcare. His frank, direct, and reflective style of writing helps healthcare providers really think about what is missing in our current healthcare system. I would love to spend a lunch with him and pick his brain about what he thinks about health care for those experiencing homelessness.

How can our readers follow you online?

On Facebook, @FatherJoesVillages, Instagram and Twitter, @FatherJoes, or LinkedIn, Linkedin.com/in/jeffreyn.

This was very meaningful, thank you so much!

Heroes Of The Homeless Crisis: How Dr Jeffrey Norris of Father Joe’s Villages Is Helping To Provide was originally published in Authority Magazine on Medium, where people are continuing the conversation by highlighting and responding to this story.

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