From Surviving to Thriving: Humanist Approaches to Street Outreach in Pittsburgh
On the leaf-littered grassy lawn of the park, four Point Park University students sat around a folding table under a canopy tent. Two thermal coffee dispensers, stacks of hot beverage cups, straws, paper, playing cards, small bottles of water, two cardboard boxes of snacks and a tray of (almost gone) brownies populated the table. In the middle of it all sat a teetering Jenga tower. This was the Mobile Thriving Respite.
On a sunny but breezy and cool Friday afternoon, the Mobile Thriving Respite set up in Allegheny Commons park in Pittsburgh’s North Side neighborhood, right across the street from the Light of Life rescue mission. When the sun emerged from behind a passing cloud, the trees’ autumn leaves glowed vibrantly. Around the park, the neighborhood was alive with activity: a steady stream of traffic along East North Avenue, people walking their dogs through the park, kids with backpacks heading home with their parents, a friendly crossing guard conducting them across the street.
According to their website, the Mobile Thriving Respite is “a community action initiative that seeks to work with members of the street community to thrive instead of merely survive.” In theory, they are a group of Point Park students, selected by community psychology professor Dr. Robert McInerney, who run the Respite for a couple of hours every Friday, bringing games, snacks, warm drinks, and good vibes. In practice, they do all of that and more. Inspired in part by the street medicine movement started by Pittsburgh physician Dr. Jim Withers, the Mobile Thriving Respite provides a place for anyone passing by to come together and connect with caring people who will gladly provide a listening ear, a shoulder to cry on, a hug or a smile.
The students who run the Respite set it up every Friday afternoon at one of a handful of specific locations that tend to draw unhoused individuals such as the Second Avenue Commons (a Pittsburgh Mercy low-barrier shelter), the Hot Metal Bridge Faith Community (a Christian congregation that serves free meals twice a week), and Allegheny Commons (the park on the North Side just down the street from the library). There, in the community, they sort of just hang out. But in doing so, they provide an accessible, low-barrier space for both housed and unhoused people alike to come together and socialize with caring, friendly, non-judgmental people.
At a time when the nationwide housing crisis is forcing more and more people onto the streets, and homeless encampments are becoming an ever more controversial issue, the question arises: how do we effectively and humanely help unhoused people living on the streets when homelessness is such an incredibly complex issue with no single, easy solution? Street outreach projects like street medicine and the Mobile Thriving Respite answer with a humanistic, trauma-informed approach.
The beginning of the Mobile Thriving Respite
The Respite project began around 2016 when Point Park University professor Dr. Robert McInerney, fondly known by his students and colleagues as Dr. Bob, was teaching a master’s level community psychology class. Dr. Bob described the content of the class as “not a standard community psychology class,” in that in this class he taught what he called a “radical sense of community.” “It starts with looking at how human beings are, how we come to be, and is what's called a phenomenological account of community—community as a happening, as a phenomenon,” Dr. Bob told me from behind his desk in his spacious and dimly lit office, surrounded by drawings taped to the wall and shelves of books. He speaks how a quirky professor who really loves their job speaks—eagerly and with excitement, but tempered by a sort of professional wisdom.
The community psychology program at Point Park University is different from other universities’ psychology programs. As the PPU website explains, their master of arts in community psychology degree program offers “a theoretical orientation based in existential-humanistic, feminist, critical and liberation social psychologies.” This drastically differs from the types of psychology taught at larger, leading research universities such as the University of Pittsburgh, whose psychology department offers programs in clinical, cognitive, developmental, social, bio-health and teaching psychologies, but no community psychology.
One day, one of the students in his class asked Dr. Bob if he had ever heard of Dr. Jim Withers. Dr. Bob had heard the name before, and this was at least the second time someone had told him he should meet him. Soon enough, Dr. Bob and his Point Park students got to meet the CNN Hero. “We had an event and Jim Withers came,” Dr. Bob told me. “He invented and does street medicine. So, he basically goes under the bridges, to the camps, to folks out in the street… he administers medical attention along with his staff.” According to Dr. Bob, after Withers gave his beautiful presentation at the Point Park University event, “there wasn’t a dry eye in the house.” After the event, Dr. Bob told Withers about the new community psychology MBA program which Dr. Bob had just recently helped start at PPU. He told Withers that he was training his students to be “advocate ethnographers,” and that they’d like to study and advocate for Dr. Withers’ project. “We would like to tag along, if that’s alright, and observe, participate and interview,” Dr. Bob said. “And that’s what we did. It became a research project.”
So, Dr. Bob and his students shadowed Dr. Withers and his staff. They met people in the Pittsburgh street community, sat around fires with them, and interviewed them. “We were trying to understand homelessness as a phenomenon,” Dr. Bob said. Then they looked over their research to find out how they could use their community psychology skills to help the street community. Dr. Bob and his students realized that while there were many good-hearted and well-meaning people in Pittsburgh focusing on helping the street community survive—with things like food, blankets, clothes, hygiene products and medical attention—it seemed there wasn’t time to focus on helping the street community thrive. “So we started to think, ‘what would thriving look like?’”
The Humanist Approach
The Mobile Thriving Respite functions from a humanistic and trauma informed approach, much like some of the other homelessness service programs in Pittsburgh such as Community Human Services (CHS). Alicia Romano, the CEO of CHS, defines trauma informed care as a framework for human service delivery that’s based on the understanding that all humans have trauma and carry their trauma with them wherever they go. This trauma affects the way each of us moves and communicates in the world, and how we form relationships.
“We follow a trauma informed care model, under the notion that the folks that we serve absolutely come with trauma. The fact that the folks that we serve have lived in a situation of homelessness, that in and of itself is trauma,” Alicia said. “You have to be able to understand that people are whole individuals, there is no expectation about what you should do or how we think you should behave. The objective is to get to know people learn them, learn what triggers them, learn what works, learn what doesn't work, and help them identify a path that they feel will work for them.”
CHS differs from the street medicine and Mobile Thriving Respite approaches of direct street outreach, as CHS focuses their mission on the housing first model—they focus on getting unhoused people into a safe home (“a roof over their head and a door that locks,” as Alicia describes it) before trying to address any other goals an unhoused person might have for themselves. However, CHS, street medicine, and the Respite all share the humanist, trauma informed approach.
Some might criticize direct street outreach efforts like street medicine or the MTR for addressing symptoms of homelessness instead of spending that time and effort on addressing the root causes of homelessness through tried-and-true methods like housing first. However, street outreach efforts purposefully focus on the people, the individuals who are unhoused, instead of focusing on homelessness as a problem to be solved. As the current director of the MTR Julia Pugar told me, “We know we're not going to get rid of living on the streets, or what [Dr. Bob] says is like rough sleepers where people are in the parks, and that is their home. We know. We can't do anything about that. What we want to do is build a nice friendly relationship with somebody.”
According to a 2023 state of homelessness report by the National Alliance to End Homelessness, rates of homelessness in the U.S. are on the rise since 2017. In 2016 there were 549,928 homeless people in America. In 2022 there were 582,462.
Additionally, unsheltered homelessness has been rising since 2015, even though the number of shelter beds has increased by 7% since 2009. The unfortunate truth is, there still are simply not enough beds. “In 2022, an examination of national-level data reveals a shortage of a little less than 188,00 year-round shelter beds for individual adults. There are only enough to reach 55 percent of the population.” Homelessness is rising, and despite the efforts of groups like CHS, if shelter beds aren’t made available fast enough, the number of people rough sleeping will continue to rise as well.
The first Mobile Thriving Respite event was a screening of the Pixar movie “Coco” at the women’s section of the winter shelter. It was a brutally cold night outside so the shelter was quite full. Dr. Bob sat in the back of the room, watching the shelter guests and staff sitting together drinking hot cocoa, laughing and enjoying the movie. At one point, a couple of guys peeked around the corner and asked if the men’s shelter would get a movie too. “Hell yeah you’re gonna get a movie!” Dr. Bob told them.
Soon they visited the men’s shelter and showed “Coming to America.” The men thoroughly enjoyed their movie too, laughing and shouting out their favorite lines. Dr. Bob was even moved to tears when he saw some people sleeping during the movie. “A couple of people fell asleep during the movie, which is thriving, you know? Think about it, the luxury, the privilege of being able to watch a movie, laugh with people, or just laugh by yourself, or even just fall asleep during a movie,” Dr. Bob said.
Soon enough, Dr. Bob and his students were taking the Respite to different spots and experimenting with different types of events and activities, from movie nights to holiday parties to giving out free haircuts. Dr. Bob and the student volunteers started getting to know the different locations, like the low-barrier shelter Second Avenue Commons.
“The first time we came there was absolutely crazy, because it was really the dead of winter, there was a lot of people there, it was very overwhelming. But we learned how to be there, you know, because you have to be kind of differently in each place,” Dr. Bob said. “We would set up in a sort of corner and chill out a little bit more, let people come to us, and people who wanted to come would just sort of hang around with us.”
Now when the students go there, the shelter guests know them by name and are happy to see them again. “They’re like, ‘Oh we can’t wait to see you!’” Dr. Bob recounted.
The Respite is funded in part by a number of local business donors including Giant Eagle, The Colombian Spot, Commonplace Coffee, and others. They’re also supported by community partnerships with the locations they frequent such as Second Avenue Commons, Hot Metal Bridge Faith Community, the First Presbyterian Church, and the Pittsburgh Parks Conservancy. They are also partnered with Pittsburgh Mercy, the “trauma-informed community health and wellness provider” that helped Dr. Withers start the street medicine movement, and Bridge to the Mountains, a non-profit street outreach group that distributes supplies and helps the street community through resource coordination and harm reduction work. Most recently, the Mobile Thriving Respite received a $25,000 grant from the Staunton Farm Foundation, which Dr. Bob hopes to use for many things including some good outdoor heaters, another canopy tent, some generators, food, some advertising, and a stipend each for Julia and Bridget, the two student directors of the Respite.
Julia
“It’s a beautiful day in the neighborhood!” Someone shouted cheerily from the sidewalk beside Allegheny Commons park. “It’s a beautiful day for a neighbor!” Replied Toni, one of the Respite’s visitors. She sat beside one of the students, Bridget, while they chatted and played Jenga. On the other side of the table sat Julia Pugar, a Point Park student in her fifth and final year of her master’s program in community psychology. Julia had been helping with the Respite for about two years, and it was clear she thoroughly enjoyed it. Dressed practically and comfortably for the cold weather in brown boots, blue jeans and a red Trader Joe’s hoodie, she greeted everyone who came by with a friendly smile and a helpful attitude.
Julia loved taking classes with Dr. Bob during her first year at PPU. When he heard her mention that she was a trained massage therapist (she has an associate degree in massage therapy from the Community College of Allegheny County), he invited her and her massage chair to the Respite. “It was freezing cold outside,” she said. “We had this bonfire setup. And there were maybe two or three people there, I think it was in late November. And after just talking to the students who've been doing it for a while, I made a couple of friends who are now in the clinical Psy.D. program, I was like, ‘Ooh! This is for me!’”
Dr. Bob selects students from his classes who he feels may do well at the Respite events. Julia agrees with this approach, as she explains that as a student at the Respite “you have to walk in with your guard down.”
“Before I did the Respite, I didn’t know what to expect, and it was kind of nerve wracking. But then once you get into the flow of it, it's one of the most enjoyable experiences,” she said. After that, it just came naturally to Julia, and now she directs the project. Her aptitude for the role is clear when one witnesses the amount of care that she puts into the project, and just how much she enjoys it.
She tries to plan everything that they do at the Respite around what the people that they meet out in the communities want. “We want to know what snacks, food, what kind of games do you want to play, what kind of music do you want to listen to, are you feeling art today, would you rather just sit around and talk with each other? We go with the flow, because I think that's what the Respite is all about. We want to meet people exactly where they're at. We don't want to tell them what to do, [or] how to be,” Julia said.
“With the respite, I was able to take the ideas and what we were learning about and actually see that in communities. And I think that's why I fell in love with community psych. Dr. Bob—I remember last semester—talked about this idea of being resolute. And I'd never heard that word before, but it struck this deep chord within me. It's this idea that you return again, and again, even if it fails, and it’s horrible, and the plan that you had crumbled, and you're feeling a little bit down and defeated and like it's never gonna work out. But it's this fact of returning again. And that's what I've really gotten out of the respite, is returning again,” Julia said. “One of the coolest things and experiences to watch is different people from different walks of life coming together, talking, even if it's about like the Pittsburgh Steelers, or weather, or ‘Oh my god, we know the same person!’ It just brings everything… down, and you just feel so grounded when you leave. It's pretty cool.”
At another Respite event I attended, we were on the outdoor patio adjacent to the Hot Metal Bridge Faith Community building on the South Side. The Hot Metal Bridge Faith Community is a Christian church that is “connected to both the Presbyterian Church USA and the United Methodist Church,” according to their website. They provide free meals twice a week at a community meal called “The Table.” Their vision, as per their website, is “to see wholeness – no more lonely, hungry, hopeless, or homeless in Pittsburgh – and for every person to understand their belovedness.” Besides the religious element, it seems a vision that very much aligns with the Mobile Thriving Respite, and thus is a fitting location.
“Alright John, it’s Jenga time baby!” Julia exclaimed as she unloaded the box of Jenga blocks onto the picnic bench. John, one of the Respite’s frequent visitors, sat beside her and they started the game. “When I first met him, he was introduced to me as Italian John. I see John as like my grandpa. Like, he is this sweet, loving man,” Julia told me.
“I've now swapped phone numbers with this 80-year-old man, and we have this loving friendship between each other that I never thought I'd have. It's amazing,” Julia said. “He always says this too, he goes, ‘You guys are my medicine.’”
John has terminal cancer, and he tells Julia how his treatments “kick his absolute butt,” in Julia’s words. Knowing that John gets so excited about a couple of university students coming around and hanging out for two hours “makes it all worth it” for Julia. Now, she and John talk on the phone every Saturday, and exchange “I love yous” before hanging up.
Though the Respite isn’t the exact same sort of street medicine as what Dr. Withers practices, it is founded on the same philosophy and principles, and is heavily inspired by Withers and the street medicine movement. At a time when funding for shelters is being cut and shelters are having to close, the question of how to serve unhoused people outside of shelters arises. Projects like the Street Medicine Institute and the Mobile Thriving Respite set examples by trying to fill in the gaps that shelters leave open.
Street Medicine
According to the University of Southern California’s street medicine program, most healthcare initiatives aimed at serving homeless populations focus on people already in shelters. But this leaves behind the unsheltered rough sleepers who don’t have consistent shelter and frequently live on the streets. According to the National Alliance to End Homelessness, 40% of unhoused people are rough sleepers, “which means their primary nighttime residence is a place not suitable for human habitation (for example, a city sidewalk, vehicle, abandoned building, or park). Significantly, living unsheltered can impact a person’s health and safety.” It is this population that Dr. Jim Withers created the street medicine movement for.
Street medicine, as defined by the Street Medicine Institute, “includes health and social services developed specifically to address the unique needs and circumstances of the unsheltered homeless delivered directly to them in their own environment.” It began in 1992, when a physician at Pittsburgh Mercy hospital named Dr. Jim Withers began working with formerly unhoused people who guided him through the streets of Pittsburgh to medically treat “rough sleepers” (unhoused people sleeping on the street) right where they were: on the street. It was from this practice that Pittsburgh Mercy’s Operation Safety Net was officially born in 1993. Since then, Operation Safety Net has provided medical and social service outreach to unhoused people in Allegheny County and has become a leading example in the field of street medicine. In 2009, Pittsburgh Mercy helped Dr. Withers start the Street Medicine Institute, a 501(c)(3) organization focused on developing the field of street medicine.
Now, the Street Medicine Institute “has become the global leader in developing the field and practice of Street Medicine and has helped cultivate or improve Street Medicine programs in over 140 cities in 27 countries across 6 continents,” according to their website. They’ve held a Street Medicine symposium every year since 2005, each time in a different city. Cities that have hosted so far include Santa Barbara, California; San Juan, Puerto Rico; Dublin, Ireland; Geneva, Switzerland, Rotterdam, The Netherlands; London, England; and more.
Obviously providing free healthcare for unhoused people isn’t the most money-making business model, so street medicine efforts have been largely supported by philanthropy like individual donations. However, thanks to street medicine’s success and the concerns around growing homelessness, the U.S. government has finally recognized street medicine as a legitimate healthcare practice. The Biden administration has changed the rules so that street medicine providers can get paid by more Medicare and Medicaid programs, according to KFF Health News.
“As of Oct. 1, the Centers for Medicare & Medicaid Services began allowing public and private insurers to pay ‘street medicine’ providers for medical services they deliver any place homeless people might be staying,” KFF reported. With support from insurers, street medicine programs have more opportunities to expand their services as well as the Street Medicine Institute message, “go to the people.”
Dr. Withers and the beginnings of street medicine
As Dr. Withers explained in a TEDxPittsburgh talk about 8 years ago, his journey into street medicine began when he was a young teaching physician working at Pittsburgh Mercy, a local hospital. He got into an argument with a homeless man who insisted on leaving the hospital against medical advice and venturing out into a raging snowstorm outside. “I lost my argument with that man, and I later learned that he had frozen to death,” Withers recounted somberly on the TEDx stage.
As disturbing as his death was, Withers was even more disturbed by the responses from his own medical colleagues as he heard them call the homeless man a “bumsicle.” This insensitive dehumanization of a man they were supposed to have helped made Withers wonder if “the sickest patient was actually the healthcare system itself.” Withers sees his fellow medical professionals sometimes responding to those that they serve in dehumanizing ways, as if their humanity is secondary to the process of their medical care. When medical providers blame and shame patients for their circumstances and conditions, they end up excluding people who don’t fit and only effectively serving the patients who are the easiest and most convenient to serve.
“Your denominator, the people that can actually get insurance, people that can actually get care, the people that can actually keep appointments and have telehealth or whatever else it is, it’s smaller and smaller. And it gets more and more convenient for the people that are billing them and processing them in a smooth, user-friendly way,” Withers explained to me in a recent interview.
A more inclusive model of medical care, on the other hand, sees him and his colleagues trying to “wrap” themselves around each individual’s reality to adapt the care process to the individual, instead of trying to make the individual conform to certain expectations in order to get care. “I always like to use the example of geriatrics—it’s a field that emerged largely because not all of the standard operating procedures and stuff that we use in adult medicine fully serves the elderly.” For example, elderly patients sometimes need more assistance remembering to take their medications. Sometimes it helps to have people checking in on them to make sure they are able to navigate the medical system and help them figure out how to afford the care they need. Their dietary needs are often different, and sometimes depression and loneliness set in that some doctors may misdiagnose as dementia.
“There's just a lot of things that, if you spend time and really observe what's going on with the population like the elderly, you see that you need to supplement your overall health response to them in ways that will make their lives better but also reduce illness and expenses to in the long run,” Withers said. It seems to be a pattern then that working with those who are vulnerable and marginalized, like unhoused people or elderly people, and being open to approaching these demographics differently than is traditionally taught (or not taught), can help medical professionals learn how to better care for those people and truly help them.
Withers said he spent time working with domestic violence victims, another vulnerable and marginalized population, during his time before starting street medicine. In the early 80’s, he created a domestic violence consult service at Mercy hospital and they hired a full-time advocate. Once Withers started working with Pittsburgh’s Women’s Center and Shelter, doing trainings and speeches, and learning how to understand and help victims, “it was like a window into another reality.” Domestic violence victims, many of whom are women, often appear at first to be just like anyone else. “But they may be in a chronic, traumatic, stressful, terrible reality and they are struggling to survive…Many are isolated so that they’re not allowed to get services by their abusers…They present with headaches or stomach pain or confusion, or they adapted to using substances that help them numb the pain. So they come in and we would label them as addicts or drug seekers or malingerers, and we run lots of expensive tests to try to make a medical diagnosis,” Withers explained in a pained voice.
“We ended up resenting people who we can’t understand and fix, blaming them and giving them labels like drug seekers and malingerers and all kinds of different negative stereotypes.” Soon Withers realized that victims were everywhere, and they were under-recognized. “The unwillingness to recognize the central reality of victims was a form of insanity on the part of the health system, because we kept trying the same thing and it didn’t work, and blaming the victims and just not wanting it to be real or [wanting it to be] someone else’s job.”
Though focusing on domestic violence helped Withers begin to see the cracks in the healthcare system, Withers didn’t want to specialize in domestic violence. He wanted to “explore the principles of exclusion, or reality.”
“It just blew my mind how we could be so close but so far away from what people were experiencing. And that needed its own classroom, to make that leap into putting yourself really in someone's shoes, or close to them, and without judgment, without re-traumatizing, without taking more power, without shaming and blaming and driving people further away. That was a skill set.” It is a skill set he wants to impart onto his students as well, as a medical educator. He wants to teach them how to look at healthcare from a systems perspective, how to “get a little bit more revolutionary” and reclaim what he calls the humanistic and realistic principles of healthcare.
“The students I have, often say ‘it's so real.’And they say, ‘I got my common sense back this month,’” Withers said. According to Withers, under our for-profit healthcare system, medical professionals are taught a sort of “hidden curriculum,” tools and attitudes that serve the system instead of honoring the individual patient. These tools and attitudes lead medical professionals to see those they serve as patients, as problems to be solved, before they see them as human individuals with complexly different realities.
To Withers it seems as though the trend has continued to grow—patients are having to fit into boxes, and medical professionals are approaching patients with a lack of curiosity toward what their patients’ realities might be and how those realities affect said patients. This leads to “little forgiveness.” “And I think that stems from the fact that we’re locked into structures that don’t give us the flexibility to organically connect with people, to get to know them, to have nuance in how we relate to them.” Withers believes medical professionals must “form relationships that allow us to have a collaborative process for healing.” This is what Withers, Dr. Bob and their students seek to do in their humanist approaches to street outreach.
Dr. Bob and two of his students experienced in street outreach through Operation Safety Net, Kelsey Long and Rachel Stough, recently published an article in the Journal of Humanistic Psychology titled “The Mobile Thriving Respite With and for the Street Community.” In the article, Kelsey and Rachel reflect on their experiences at the Respite, comparing and contrasting their Respite experiences with their other street outreach experiences. In a touching testimony, Rachel recalls the movie night at the men’s shelter, “The general mood was relaxed if not jovial, compared to how loud, hectic, and sometimes hostile it is… playing this movie seemed to make a positive impact on this space.” Meanwhile Kelsey, recalling an MTR art studio event, writes, “As we leave, I get asked whether we will be doing the event again, and I tell them that we may try to do another one in the future. The event seemed to be one that people really liked.”