Interview - Stephany Campos
Stephany Campos
Noé Montes
I know that homelessness has been rising in the county for the past six years, except for this very recent count, it seems like it went down by about 200 people, and at the same time the budget to address and reduce homelessness has been growing. Up to $850 million, I think, was the last count. What I want to do in order to better understand this, is to ask you about yourself, the work that you do, and your experiences and thoughts about homelessness in LA County. Can we start with your name and the organization that you work for, and your title or what you do there?
Stephany Campos
Sure. My name is Stephany Campos. I'm the Director of Strategic Planning and Special Projects for Homeless Healthcare Los Angeles. I've been here for nine years, next month, doing this work.
Noé Montes
Nine years with this organization?
Stephany Campos
Correct.
Noé Montes
Were you doing this work in some other capacity or with another organization before that?
Stephany Campos
Not in the homelessness sector. I've always worked in the public or nonprofit sector, but not within homelessness. So in homelessness specifically, yeah, nine years now.
Noé Montes
One of the things that I'm that I'm learning about is that, because of the size of the homeless population in LA County, a really big system of organizations and initiatives has developed over decades in order to address and reduce homelessness. My understanding of that system is as follows. There's government, with the Los Angeles Housing Services Authority (LAHSA) and County Department of Mental Health being some of the bigger, central, organizations or government agencies. Also, agencies that are emergency services, such as police, fire department, and EMT, are a part of government, but in a different capacity. And there are service providers, which include organizations that are contracted to provide services and resources to unhoused people. The missions and other faith-based organizations are part of this as well. Then there's grassroots and community organizations, including volunteer groups that provide food, water and other services and resources to unhoused people. And then, of course, there's unhoused people themselves. Would you say that that's about right or is there any other sector that I'm not thinking about?
Stephany Campos
I think that's pretty accurate and pretty comprehensive. I think within that, the faith-based groups, the churches, I think that would probably fall into the volunteer groups. You talked about the state and federal funding, and it comes through LAHSA, like city funding. Also, at the local level we work with the council districts on different initiatives, but yeah pretty much, I think you covered it overall.
Noé Montes
I know there's a lot of nuances and a lot of overlap and intersection, but as I'm trying to understand it that's what I've learned so far. So how does a Homeless Healthcare Los Angeles fit into that structure? Where are you?
Stephany Campos
We're a nonprofit organization. We've been around for over thirty-five years now. Service Provider, I guess, you mentioned that. I would categorize us there.
Noé Montes
And you are contracted by the county government? Where does your funding come from?
Stephany Campos
Yeah. So, that's a great question. When you're talking about the nuances, that's very much a good way of kind of segueing into this. We have a $22 million budget, and 85%[CD1] of that is through government contracts. The remaining is private people donating or getting contracts through family foundations. They will sometimes give us funding to do work. But that's not within the public sector funding. That's private money, different foundations, or family foundations. And every nonprofit has a different revenue stream or budget breakdown. For us, it's predominantly government funding. That's really the majority.
Noé Montes
So, 85% of your $22 million is from government funding?
Stephany Campos
Correct.
Noé Montes
How many people are employed by the organization? And in what capacities?
Stephany Campos
Currently, we probably have about 175, give or take; we have a vacancies, so once we're at full capacity, we would be a little over 200 staff across all our programs and departments.
Noé Montes
And what are those programs and departments? I know it's a lot but maybe you can tell me some of the main kinds of work that you do?
Stephany Campos
Of course. So let me see, I'll talk about the work we do outside of Skid Row and then I'll talk about the other work we do. Because that's one way of breaking up the different departments. We have a very large behavioral healthcare department. People may be exiting the incarceration system or being court ordered to do treatment. We do a lot of behavioral healthcare with our folks and then they can come to us. Everything we do is harm reduction driven through a trauma-informed lens. So everything is driven by what people that we work with tell us that they're interested in and what they want, and we help guide them through that journey. It's zero judgment, compassion first-led service provision. And that's across Homeless Healthcare. I always want to make sure that that's clear. Because that's super important in the way we do the services. So yeah, behavioral healthcare is a very large program.
We also have encampment outreach teams. We have two teams of multidisciplinary folks, two teams of five, that go out into the encampments in the Silver Lake, Echo Park, Westlake area that's our encampment zone. These folks, they have a team of folks with different skill sets. It's a case manager, nurse practitioner, substance use counselor, housing navigator. It's basically folks going and triaging the people in encampments or on the streets in that area and seeing what their needs are. If they're looking for housing, if they're looking for food, hygiene, other referrals, they provide the supports there. You're probably familiar with HMIS.
Noé Montes
No, tell me about HMIS.
Stephany Campos
Basically, that's what we use countywide. It might be statewide. It's the Homeless Management Information System; it's basically how we track people and it's this first step if people are looking for housing or looking for more intensive resources. We have them go into the HMIS. They [encampment outreach teams] are doing a lot of that work, which is kind of a lot to ask of people. So we try not to duplicate.
Noé Montes
So it's a database to track people, to track their needs, to try to figure out how to support them. Some of the work that you're doing is inputting that data, helping people get that data into the database.
Stephany Campos
Yeah. Our funders require that, to streamline, and then all other providers pretty much use that same database. So that's a lot of the work that is happening. Trying to help people, of course, and then also if they're looking for housing or looking for something else, that would be the next step. Going through that HMIS process. And then we have a really great training department. People that are new to the homelessness arena, or all the way to the supervisory level. We do trainings that are approved by the county, the curricula, and it's countywide. We operate countywide so anyone looking to enter into doing this work, we train on over a dozen different trainings and different modules. And we have cohorts. So we have this very large training program. It's part of LAHSA. They call it the CTA, the Centralized Training Academy.
Noé Montes
And this is for people who would like to volunteer and people who want to work in different positions?
Stephany Campos
Yes, typically people that are working in the field that do all of these trainings.
Noé Montes
So very specific training to the needs of the homeless population?
Stephany Campos
Correct. Yeah, so we have a great training department and housing. We house people countywide. We have a large housing navigation department where we place people in permanent supportive housing. We have a 97% retention rate. Once we place someone into housing, there's a pretty good chance they're gonna keep housing. We stay with our clients for life. So if that means a weekly visit, emailing back and forth, or phone calls, whatever the needs are. We really want to make sure we help folks get acclimated to their new communities and don't feel isolated in their house because it's a very, very big transition for people. We definitely take the care and do all of that work. So we have people that house folks.
Noé Montes
It seems 97% is really high. And that's not typical, I think, for organizations that are doing the kind of work that you do. Is that correct? I understand that there's a lot of people going back into homelessness.
Stephany Campos
Yeah, I think it's helpful when it's permanent supportive housing, meaning they have a place. Not a temporary transitional home. And, like I said, we stay with our clients for life, in accordance with whatever their needs or situation may be. We definitely want to make sure that we're there for them; we make sure that they are aware of all of the resources in their new communities or try to place them in communities that they want to be placed in or are comfortable and familiar with.
Noé Montes
About how many people do you house per year?
Stephany Campos
I think we average two to three hundred.
Noé Montes
Okay, so the organization is doing pretty effective work.
Stephany Campos
Yeah, that's our housing department.
Noé Montes
That's great. You mentioned HMIS. One thing that I've been learning about is the Coordinated Entry System, which is apparently a new way or a newer approach to this very thing, to tracking people and their needs. What's the relationship between HMIS and that CES system?
Stephany Campos
We actually used to be the CES lead for Service Planning Area (SPA) 4. So basically, if people were looking to start that process, they could come and walk into our offices. We stopped doing that about two or three years ago because we just kept putting people on a waitlist. We decided to not do the CES anymore. But that is part of the process, the Coordinated Entry System, like you were saying, and we used to be the lead for that area, to enter people into that. That's specific to housing. What we were finding is we kept going through these long assessments with people and then they would just not get housed. It used to be a six to nine month waitlist. Now it's over a year, and we just felt like we wanted to focus our attention elsewhere. So we stopped doing CES enrollments.
Noé Montes
You found that it wasn't that effective for housing people?
Stephany Campos
WelI, I mean you have to do that anyway. We just didn't want to be the ones taking the lead because we just kept putting people on a waitlist and for our value and mission…I feel we understand that's what the requirement is, but we stepped away from being the lead doing that.
Noé Montes
Do you know who the lead is now?
Stephany Campos
It might be PATH, I would have to double check, or The People Concern; they're the bigger, also pretty well-known service providers in the area.
Noé Montes
You mentioned the difference between Skid Row and other parts of the city.
Stephany Campos
Yeah, I can share the work we're doing in Skid Row because I was trying to cover some of the other programs, but we have been doing a lot of work in Skid Row for a while, and we are also expanding our presence in that area in the in the coming months and years. We started out back in the ‘90s having a syringe exchange program on Fourth Street and we still have that site there, so it's been decades. It's called the Center for Harm Reduction. That's really targeting and supporting people that are using substances, using drugs. Maybe they're looking to stop, maybe they're not looking, we want to provide support to the populations because they're oftentimes refused services elsewhere. Or are stigmatized and judged and not treated well. That's the population we target there. It's a drop-in center so people can come and hang out.
We also provide safe-for-use supplies, you know, syringes, pipes, tourniquets, alcohol, wipes, sterile water, whatever people may need. We distribute naloxone at all our sites. We probably do more naloxone distribution there than anywhere else, and we do fentanyl test strips so people can test their supply. We're working on getting a drug testing machine also, so people can know what they're taking because there's been so many accidental overdoses that happen. It's unfortunate and it's preventable. And even an overdose itself is; people don't have to die from overdosing. We have naloxone, we have these tools, they’re very safe to use. So that's what the Center for Harm Reduction does.
We also do MAT [Medication Assisted Therapy]. If people are looking to maybe wean off their opioid use or reduce their use or stop, whatever that may look like for them, we can connect them to medication for assisted treatment and do the induction phase out of that location. We think that's important also, to offer that and just give people their options and they can decide what's right for them. So that's a very busy site. And then also, about a year and a half ago, we launched this mobile expansion, a mobile overdose response team. They're basically these golf carts that go around Skid Row and respond to overdoses or check in on people to make sure they're okay. Give out supplies, give out naloxone. It's so much faster to just get on a golf cart and respond to something than our clients telling us someone is OD'ing four or five blocks away and staff would have to run over and hope that they get there in time. That's what we would see for years. So now we're really glad that we have this resource, and this is something the county funded and that we got private funding for also. These golf carts are there seven days a week, from the morning up to like 9:00 p.m. in Skid Row, roaming around checking in on the community.
Noé Montes
How many of these interventions are you doing per day?
Stephany Campos
I do know that for the fiscal year that just passed, they had about 900. On a daily breakdown, I'd have to check. But that gives you an overall view of what our team is responding to. There are more ODs, I think, in that zip code than anywhere else in California. And we see those at the site I oversee as well, which I'll talk about in a minute. But because of the population they're targeting and focusing and working with, overdose situations just happen more.
Noé Montes
That is critical crisis intervention. I don't want to say constantly, but just daily, multiple instances of it.
Stephany Campos
Yeah, that's what it is. And we have teams where that's their full-time job. It's to go and do that work. I also want to mention, one of the biggest innovations for us, in addition to having this type of response, is incorporating oxygen. We have oxygen tanks connected to the golf carts and also oxygen tanks inside the Center for Harm Reduction. So if someone isn't in a full-blown respiratory emergency, their breathing may be shallow, but they're breathing, we can intervene with oxygen and completely, potentially, eliminate the use of naloxone, which puts people into withdrawal every time they get it. It's wonderful when we reverse overdoses, but if we have an opportunity to use oxygen instead of naloxone, because their breathing hasn't stopped, they're still breathing, and it just helps them get 100% concentrated oxygen into their system, that's the preference. And that's what is done in other parts of the world that do this kind of work, harm reduction work, like Portugal and Denmark; they never use naloxone, that's not something that's ever used.
Noé Montes
That's interesting. Why don't they use the naloxone? Because of that withdrawal phase? They have a whole system in place that facilitates [oxygen] in an easier way than what we have, which is the naloxone?
Stephany Campos
Yeah. If someone's at the site that I oversee, where we don't have oxygen, it's a hygiene center, we're not equipped that way, it's different programming; if someone overdoses, we give them naloxone if they're not breathing. And then they, fortunately, start breathing again but they feel pretty terrible, to be honest. And probably want to go use again because they're having those feelings of withdrawal. Because that's what the naloxone does. It pushes all of those opioids off your receptors.
Noé Montes
So using oxygen may give them a little bit of time and space to maybe not feel like they need to do it again right away?
Stephany Campos
Yeah, exactly. It's a harm reduction approach. It's used worldwide. I think we're the first people doing it in the states. I'm fairly certain.
Noé Montes
Why do you think it has taken so long to catch on?
Stephany Campos
I think it's just our general judgment and stigma around drug use. We've always, from my experience, I think generally speaking, it's always been a very punitive approach. And even if you saw what happened with the Supreme Court case, their criminalizing homelessness. They basically said if you want to arrest people for being homeless, we can now. And that's very much in tune with historically how we as a country have responded to these issues.
Noé Montes
Which is unfortunate. It's really dehumanizing to people who are unhoused. Are you at the ReFresh Spot?
Stephany Campos
I'm the director; I oversee the ReFresh Spot. I'm based out of the admin offices. I'm a few miles away from Skid Row, but I'm very close to the area. And the ReFresh Spot is essentially a hygiene center in Skid Row. It's been operating since 2017, funded out of the Mayor's office since day one and to this day still. It's open twenty-four hours a day, seven days a week, with no barriers for entry. Anyone in the community can walk right up and have access to showers, restrooms, laundry, phone charging, Wi-Fi connectivity, drinking water, pet food; we have a pet pantry that's available 24/7. And we have a calendar of events. So aside from these basic hygiene needs, on any day we could have a group called Project ID. They're helping people get their ID cards in partnership with the DMV. Or we could have Department of Mental Health on site or Department of Health Services with their mobile clinics. Salvation Army is there three times a week. We have about a dozen different groups that come out throughout the month and help people with things like resumes. We have a pet grooming event we're planning for this month. We had a dental clinic last month. The need is so great.
Before we talked, I was talking to a new partner. “How can we bring more resources to try to integrate them?” Because it's hard when you're like "Oh, you want this, go four blocks that way." That's a barrier for people. Every month, we also have this court outreach event in partnership with the City Attorney's office and the Public Defender's office. People can come in and maybe get their tickets cleared or get expungements done on site. That was a new program that we launched. We've been doing this for a while, but the difference is we have a judge, virtually, but a judge will appear at the site and people can get their cases heard there. No other place is doing that; cases are being heard at the ReFresh Spot once a month. Court is being held there. And when we have these events, we also have other people tabling, other groups.
Noé Montes
You’re doing a very wide variety of programming and services and resources. A lot of it seems innovative; for example, the court is one of the things that is not being done elsewhere. Are you finding that your partners are open to doing things differently? The court, city attorney, or other organizations that are trying to accommodate the needs of the unhoused population?
Stephany Campos
I think so. I think all of our partners have approached us about partnering. I haven't had time to go out there and try to get people to come and do stuff. We've been fortunate, and I think part of it is because people see the ReFresh Spot. It's a 17,000-square-foot facility, it's always open, and we get 20,000 visits a month. It's a very high volume. So people are like, “There's a lot of people there.” And obviously they're going to say that's a perfect area to go and engage. Right? But it depends, because we have a vetting process. Anything has to make sense for the site. Everything has to be free for the community, and it has to be a need.
Noé Montes
But because of the high volume, it creates a lot of opportunity for different interventions, different programs. So, the Harm Reduction Center and the ReFresh Spot. Are those your main sites and interventions in Skid Row?
Stephany Campos
Yes, those are the two fixed locations. We have brick and mortar sites, we have the golf carts roaming around, and then we have there another site that's going to be opening later this year. That's going to be an expansion of the work at the Center for Harm Reduction because that site is always at capacity. They want to do a bigger drop-in center and also set it up to, hopefully, one day be an overdose prevention site, a safe consumption site; it's different words for the same thing. These operate in twenty countries around the world. We don't have any in California; they have some in New York, but we want to be able to operate them if and when we're legally able to because they're not sanctioned yet. But we've worked with partners for a long time in other places, like Copenhagen, which operates the world's largest safe consumption site. So technically we're there, we've trained staff, we're ready to operate, we're going to open a site to be ready to do that work once we're allowed to. And in the time being, continue doing the other work and serve as a drop-in center. I've also been in talks with the Hollywood area to open a ReFresh Spot there. Those have been conversations that have happened for over a year. So maybe in the future, there's going to be more hygiene services; obviously, the need is so great. And even though the [annual homeless] count may say it decreased, the inflow is still continuing and investment needs to happen.
Noé Montes
Somebody mentioned to me that a new idea that's being floated or being talked about is to have a less centralized location for these service centers or resource centers as a new approach, or an additional or different approach, to what has been done for the past many years. This idea of having different nodes throughout the city that provide services, support, and resources to unhoused people. Is that something that you're thinking about? That you see?
Stephany Campos
Yeah, I think anytime people ask, "Is this needed?" or "Is that?" or "Where do we?" or "Where do you think?" I always say, "Always. Yes. And more." The landscape of Skid Row is changing, there's so much development happening, there's so much investment happening. There's going to be a huge community-led [facility]—they're calling it the Campus, [based on] the Skid Row Action Plan—that's supposed to be opening. I think that's great. It needs it because there's over 5,000 unsheltered people within forty square blocks that make up Skid Row. However, we need to have versions of hygiene centers or other services everywhere, because that's where we're seeing unsheltered people. It's really spread out. And the containment isn't going to really happen in one area realistically. I think permanent supportive housing in every council district and other services spread throughout. I hope people get on board because I don't see an alternative.
Noé Montes
Right. That's what would make sense. You mentioned Copenhagen, you mentioned Portugal; it sounds like you might have done some research, or at least are knowledgeable about approaches and kinds of services in other countries. How do we compare to other countries? Obviously, every country is different. But generally, it sounds like you feel that there are some approaches, some types of services that are maybe more effective, or at least more humane, in other places.
Stephany Campos
Yeah, that's interesting. I went to Copenhagen; I spent a couple of weeks there two summers ago. And I was working in their consumption site. It's called H 17. Copenhagen is a socialist country. They have high tax rates. This area was within the community. People accepted it; the judgment wasn't really there. But they're a small country and people use different substances there than people do here. People have different reactions to them. And while they're very much about taking care of one another, I feel like it's more in terms of non-immigrant populations, because people coming in, they're getting refused services, the immigrant populations. So that was interesting. I would say just comparing harm reduction in general to other parts of the world, I love Portugal's model or the Trieste model in Italy, where it's more of the mental health side and people that are unsheltered in this community are really taken care of, taken in. I think that was the idea of deinstitutionalization; that did not happen in the ‘60s and ‘70s in this country. So when I think worldwide, I think “Oh, my gosh, we have such a long way to go.” But then also, if you look in other countries, like in Mexico, we have different partnerships with a group called Casa Prevencion. [There] it's a really dire situation. So it puts things into perspective, where we really are fortunate in so many ways. But like looking at how things could be just feels like it's so much more.
Noé Montes
Right. So I guess it depends on who you're looking at if you're trying to make a comparison.
Stephany Campos
Yeah, I feel like the possibilities are endless, and like seeing what other communities and countries invest in. Like in Denmark, they have a government-run heroin program. So people aren't trying to steal and get money for heroin and are getting supply that they don't know what's in it. It's government grade medical and they get it consistently however the need is. And maybe get tapered off eventually. But they don't have to worry about all these other things that come along with having to find the funds and resources for your dependence issues. But for other people, that never would happen; no one would ever agree to that, depending on who you're talking with, right? It just seems really far-fetched. But if you actually look at the benefits on a personal level, the public health level, and even economically, there's data to back that up.
Noé Montes
So those have proven effective outcomes, but our cultural and social environment is such that it's very hard for some people to accept it.
Stephany Campos
I feel sometimes it doesn't matter, all the data and the benefits we can present, people just cannot wrap their heads around knowing people are going to use and you have to accept that. "These people need to stop!" That's what we hear a lot and "How do you get them into treatment? How do you get them to stop?" And if that's not their goal, that's not going to be our goal.
Noé Montes
I appreciate that perspective. It's something I hadn't been reading about or thinking about. One thing that I'm seeing and learning about is the fact that it seems that you can divide the work into two parts. One of them is management. Management and support of the existing homeless population. And then another part is system and policy work to try to reduce homelessness through various means. It sounds like your organization is pretty squarely in the management and support of the unhoused population. Would you say that's correct?
Stephany Campos
I would, yeah.
Noé Montes
Somebody also mentioned that sometimes the work overlaps or intersects, because some of the service-providing organizations sometimes get involved in policy. Do you do any of that?
Stephany Campos
Over the years, we've done a lot of advocacy work. We still do. We partner with DPA, Direct Policy Alliance, on different bills and try to advocate to the board of supervisors for different legislation. Yeah, we've done that work. I wouldn't say we have a dedicated department to do that, but that's a passion of mine, for sure. And other people here in the office. If the opportunities come up, we try to do our part to advocate for what we feel and know is the right thing,
Noé Montes
Right. But it sounds like your work is really focused on helping, supporting, and bringing resources to the existing unhoused population throughout the county. You have these very, very targeted efforts in Skid Row, but then in different places as well. How is that work divided up? Where are those services? You did describe the work earlier; I'm just wondering about the locations.
Stephany Campos
We're close to one another. The sites in Skid Row are walking distance from one another. One's on Town Avenue and the other one is on Fourth Street. And then outside of that, I'm in the administrative offices or headquarters, which is like three miles away, but it's still close to downtown. And we have two more sites down the street from here. Beverly Boulevard, which is a big street in LA. So within a five- to seven-mile radius is where we have all of our main buildings. And then everything else we do is like outreach. We're not technically headquartered; it's more going out into those areas. If we're placing people into housing, we don't have offices there but we go out there. However, we do have partnerships with some folks, some developers, or some people that own the apartments where we would have a case manager working out of that apartment and managing maybe a caseload of fifteen. Countywide, we spread out, but it's more as needed. Maybe one of our housing navigators drives out to Lancaster to visit with the person they placed in housing. So the reach is like that, but it's more happening in the Central DTLA area.
Noé Montes
We've touched a little bit on some of these, but I'm wondering about the barriers to reducing homelessness that are more social and cultural. You talked about that when we were talking about the inability of some people to accept that others are going to use drugs, for example. There are also economic and class differences that seem to be a part of the equation.
Stephany Campos
Well, in LA, the contrast is so visible. The inequality. It's jarring. I think that's the number one cause of homelessness, right? It's because people lose their housing. Because the rent is too high, the cost of living is too high. It's not sustainable.
Noé Montes
The lack of affordable housing seems to be a big reason, too. Is there an approach or an idea that you think should be invested in more that maybe we're not doing?
Stephany Campos
I think a lot of the work we're involved with, and that is happening, I think just doing more of that. More permanent supportive housing, more hygiene access, less criminalization of homelessness or substance use, more compassion, more support, and our approach to mental health or people that use. We don't really have community acceptance. We don't have a mindset here where people understand mental illness and what that can look like. Just because someone might be having some kind of crisis, it doesn't mean they're dangerous, it doesn't mean you should be scared; we just really don't know how to interact with people properly, or we don't invest in the training for that. And having police be first responders, I don't think most of them want to be responding to those situations. It really needs mental healthcare professionals. Or just a different approach by the community where it's more embraced. And I don't know what it's going to take for that shift of the pendulum to happen, or the paradigm to be seen that way. But I feel like things would be so different if we just had such a softer and more compassionate approach. It's really hard. When I was starting out in this field, we had Proposition Triple H and Measure M, and we were advocating for the taxpayers to pass these initiatives and they did. And people are not seeing the results they want, so I feel like we're getting a backlash. Before people would be like "Oh wow! you do this work," and I always would be so excited to talk about the work. And now, if I don't know people, I don't talk about what I do if I don't have to, because people have reactions. So I definitely am concerned that people are kind of fed up. And that's the sense I get.
Noé Montes
They're hardening a little bit.
Stephany Campos
Yeah, which is unfortunate. I hate to see that. You hate to see it go that way. And I hope something can happen.
Noé Montes
Okay. I don't know if there's anything else that you think it's important for people to know about this issue or about your work. We've covered a lot of different aspects of it. But I wonder if there's anything that you always want to say to people. You don't have to; I just want to create an opening for that.
Stephany Campos
What can I say to people that hopefully gets them to just give people more grace? Just because someone's unsheltered doesn't mean they're a bad person, or they're a dangerous person, or they're trying to do anything harmful. Figuring out how to humanize the issue has been one of the constant struggles throughout doing this work. There have been so many campaigns to try to do that. If there was a way to do that, that would be amazing.
---
Transcript has been edited for clarity.