One camp at a time, a Seattle group is transforming its approach to homelessness

The breakup is swift.

"Don't be sad," Starr Draper calls over her shoulder to her boyfriend. She's walking out of the homeless camp where they've been living together. "He wanted to have housing together, and I just don't know if we're gonna last," she says.

It's been raining. Draper is tiptoeing her way through the mud. She carries two trash bags, one filled with clothes and the other with food. It's all she owns in her life now, so she takes the bags and leaves the boyfriend. The unhoused travel light.

Draper has been in this camp in Seattle for over a year. In that time, people from the outside world have come around now and then: the cops, the public health officer, the social workers. They've made various offers of assistance. But lately there have been new people from a nonprofit, a team called JustCARE, who've offered her something far better: a way out of this place for good.

Program staff spend weeks getting to know people in homeless encampments like this one. In addition to housing, they find out what the people need. Medical care? Food assistance? Methadone? Then they give residents a choice: Work with them and move into the provided housing or find somewhere else to go. Staying is not an option. The camp is going away.

Most take offers of help.

Draper, 42, is going on this day to a short-term housing unit. The plan is to eventually graduate her to permanent housing.

Other municipalities across the country have tried to create housing solutions for unhoused people, often at taxpayer expense. Many of those programs have failed. JustCARE has evidence that the program works.

Initial results weren't promising. The first evaluations, which were conducted by an outside research group from the University of Washington, showed only 20 percent of participants were still housed six months after being housed through the program.

But a more recent evaluation, completed after the team made some course corrections, told a different story. Seventy percent of participants remained housed six months after they'd been moved from a camp.

If JustCARE creates a successful program, it will come at a time when homelessness is overwhelming larger cities across the West. Unhoused people are colonizing streets and whole neighborhoods, driven there by unrelenting housing costs, exacerbated by an ongoing opioid crisis and lack of mental health care.

The issue fosters a widespread sense of betrayal in cities like Seattle.

Homeless people feel betrayed by municipalities and social service systems they think leave them no choice but to live in the dangerous dark and cold. Businesses and residents feel betrayed when human feces and needles are a regular feature of their sidewalks; they watch as longtime customers turn away rather than try to shoulder their way past tents. Taxpayers feel betrayed when they vote for leaders promising solutions that never materialize.

Sex is currency for many women in homeless camps

If the JustCARE program works for Draper, she's going to be on her own.

"I've always been pressured to have some man in my life," she says. "I've never had a career of my own." She describes leaving school in 10th grade, drifting for a while and eventually finding herself in an abusive marriage, which she fled. Substance use has been a constant.

Draper is slight and quiet, but when she speaks she is direct. She landed here — in an industrial part of the city, a few miles from downtown and under an overpass — after a fallout with a different boyfriend. He promised to return. He ghosted her. She waited for him for months.

Among the people in this program, men outnumber women 3 to 1. Sex is currency out here.

"You get bullied," Draper says. Among other things she's traded for sex: food and for a warm, dry place to sleep. It was hard at first, she says. But she learned the hustle. Then it was easy.

Life in the camp is dangerous. There have been fires. Guns turn up regularly. Someone died a few weeks ago of a suspected drug overdose. Another woman here explains that even if there were a toilet at the camp, she wouldn't use it. She was raped once in a public restroom. She'll never risk it again.

"This is a chance to focus on myself," Draper says. "A new start."

"It's gonna be good," outreach worker Nichole Alexander reassures her as they walk to the car, pulling Draper's trash bags behind them in a wagon. "When you get there, you're gonna like it. I promise."

"I believe you," Draper says with a shaky voice. "I just gotta get through these first few days."

Many feel leaving their homeless encampment is impossible

Seattle is battling one of the more intractable homeless crises in the country. There are at least 40,000 unhoused people in King County. Not all live in camps. Many fall into an invisible population: those moving their cars every night so as not to be found sleeping in them, staying in shelters or crashing in their buddy's basement. County officials say the number of unsheltered people — those living in tents a few feet from the interstate or in broken-down cars without heat — is 20,000 at minimum.

These are the people the JustCARE program helps.

"Never before have I seen so many people living so far from the structures of society," says Lisa Daugaard, the architect of the JustCARE program. Daugaard is also the co-executive director of the Public Defender Association. In these homeless camps, she describes a world that exists in parallel to the rest of society, one that turns on the sale of drugs, sex and stolen goods. It's a world just as foreign to most as another country.

It's a country that is hard to leave. There is a term among those who study this issue: scarring. The longer people are unsheltered, the more difficult it is to acclimate back into society. Many never will.

Daugaard was already running a program serving the unhoused population when COVID-19 hit. A well-known advocate in Seattle for police reform, she received a MacArthur "genius grant" for her work to create alternatives to the criminal justice system. As in many urban centers in the West, the housing crisis escalated alongside the pandemic. Homeless camps sprouted like mushroom patches all over the city.

Daugaard had an epiphany. The only way to help people get off the streets, she realized, would be for her and her team to find housing for their entire camp.

"We're stepping all the way in," she says. "Whatever is going on for this person is my problem."

She and her team took advantage of the once in a lifetime deluge of federal pandemic aid and marshaled resources from the city, state and county. They worked camp by camp. In the last few years, they've removed 19 camps like Draper's and housed hundreds of people.

This strategy has changed her staff's orientation to homelessness, Daugaard says. Other social programs, she says, are predicated on providing pieces of the solution and hoping it results in systemic change.

"You start to hold yourself accountable for the outcome in a very different way," says Daugaard of her team's new approach to their unhoused clients. "I'm in it with you, and you live with us now. And if we don't have a good answer, we have to find one. Because the ramifications of not finding one are unacceptable."

The public is sometimes ahead of the politicians on finding solutions to homelessness

So far, JustCARE has been paid for through a series of one-time funding streams and commitments, including pandemic relief. Daugaard and her team are now making the case to city, county and state officials to take on the financial burden.

Truly reducing the number of unhoused, unsheltered people in Seattle would require JustCARE to scale up significantly. Daugaard concedes her program is not positioned to grow exponentially. She imagines a kind of open-source model, where other practitioners would draw fundamental lessons from this program.

"What JustCARE has really done is centered on the interest of all the people who are affected," says Seattle City Council member Andrew Lewis. He describes two highly visible, problematic camps in downtown Seattle that JustCARE removed. This success earned them allies, including from the business community.

Lewis has been a champion of the program, defending it against attacks from the former mayor. He envisions a Seattle in which this kind of work is widespread. "We're going to have to have a dedicated funding stream for this the same way we do with any other essential public service," Lewis says. "We can create a new system that really fundamentally changes how we resolve urban disorder in America. And I think it'll start here in Seattle."

That cost could be in the millions; the price tag per person annually for this program is in the tens of thousands. Advocates like Lewis are quick to point out that these costs have to be considered in light of many unseen costs of homelessness including emergency room visits, jail, lost tax revenue and the emotional toll on the entire population. Those who study the economics of homelessness say pinning down an exact amount is difficult, but multiple studies suggest the average person who is homeless costs society between $30,000 and $100,000 per year.

"Poll after poll shows that people are concerned about public safety," says Lewis. "When you drill down, it is pretty evident that when they say public safety, a big part of what they mean is the massive proliferation of visible encampments."

Establishing funding that preemptively designates money to combat housing insecurity is the challenge. He's yet to forecast how that would happen. "I think the public is willing to pay what it takes," Lewis says. "The public is ahead of the politicians."

The prospect of a home can be frightening for those who've been homeless for years

Starr Draper's new, temporary home is a 20-minute car ride from the homeless camp where she's been living for more than a year. But it's a ride out of one dimension and into another. When she arrives, staff warmly welcome her. The building that is clean, airy and bright.

Ten minutes, later she's sitting down to do her intake paperwork. "Drug of choice?" asks outreach worker Kendra Tate. Her pen hovers above the paper she's helping Draper fill out. Draper pauses. "I just don't want to get in trouble," she says.

Tate puts the pen down and looks Draper in the eye. "I want you to understand that this program is designed to help you re-enter society, no matter what. We're not judging. We're not trying to change you. We offer clean needles here. Whatever you need, you ask."

"Wow," says Draper. "That really takes a big weight off."

Johnny Bousquet works with JustCARE to oversee outreach in facilities like these. He says these first few days of transition are a critical period. People feel uprooted and disconnected – homeless camps can be treacherous, but they provide community. Then there's the issue of addiction.

"You have to find a new supplier if your substance is a priority," he explains. "Which, for a lot of people here, it is."

Ninety-nine percent of the people served in the JustCARE program report struggling with substance abuse disorder or mental health disorders or both.

For people using fentanyl, he says, that means coming up with $20 every two to four hours. Funding an addiction is a full-time job. Or, as Bousquet puts it, "That's a f***ing big deal." Bousquet has been in rehabilitation himself 15 times.

There are rules. No smoking in the rooms. Masks are mandatory. The most significant restriction: Residents are not allowed to have guests in their rooms. This constraint can put them at greater risk for overdose, but Bousquet says it's a calculated tradeoff for this vulnerable population. "Anything that's out there in the streets can come in here." Instead of getting high in their rooms, they encourage guests who choose to use substances to do so in an open tent that sits across the parking lot.

"Never use alone," reads a sign pinned to a bulletin board in the lobby. It includes a phone number and this admonition: "If you're going to use alone, call us. We will never shame."

After completing her intake paperwork, Draper makes her way to her new room. She's not feeling good, battling nausea. The room is clean and spacious, but it's quieter and emptier than she's used to. She's more alone than she's been in years.

She has big hopes for this transition. She talks about getting a job and reconnecting with her adult children. For now, she's sitting on the bed, taking in her new view of Seattle from her third-floor window.

Before she unpacks or does laundry or gets to know anyone else in her new home, she's planning to take a shower. She's most excited about the indoor plumbing.

"No more flashlights," she says with a sly smile. "No more rats."

This story is part of a reporting fellowship sponsored by the Association of Health Care Journalists and supported by The Commonwealth Fund.

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