if you invited an individual who had been living on the street

想想下面這個狀況：

for many years,

如果你們邀請一個多年來

had mental health issues

住在街頭、

and was an alcoholic

有心理健康問題，

to move directly from the street

且酗過酒的人，

into housing?

直接從街頭搬入住宅中，

We had heard this was being done in New York City,

會發生什麼事？

and it was called the Housing First model.

我們聽說紐約市已經這麼做過，

We wondered if it would work in Utah.

它被稱為「住屋優先」模型。

So to make that determination, we decided to create a pilot,

我們很好奇這在猶他州是否可行。

and Keta was one of the 17 chronically homeless individuals

為了要確認這件事， 我們決定做一個試驗，

we included in this pilot.

琦塔是我們選來進行 這個試驗的十七位長期

She had been on the street for 20-plus years,

無家可歸者之一。

had mental health issues

她已流落街頭二十多年，

and was a severe alcoholic.

有心理健康問題，

The first night in her apartment,

且是重度酒鬼。

she put her belongings on the bed

她住進公寓的第一晚，

and slept on the floor.

她把家當都放在床上，

The next three nights, she slept out by the dumpster

自己則睡在地上。

near the apartment building.

接下來的三個晚上，她睡在外面，

With the aid of her case manager,

公寓附近的垃圾箱旁邊。

she moved back into her apartment

在她的個案經理協助之下，

but continued to sleep on the floor for several nights.

她搬回了她的公寓，

It took over two weeks for her to develop enough trust and confidence

但還是在地上睡了好幾個晚上。

that this apartment was hers

她花了超過兩週的時間， 才發展出足夠的信任和信心，

and would not be taken away from her

相信這個公寓是她的，

before she would start sleeping in the bed.

且不會被奪去，

Homelessness is a continuing challenge for many cities

她才開始睡在床上。

throughout our country.

對我們全國的許多城市而言，

Our homeless population falls into three major categories:

街友一直是個挑戰。

those that are temporarily homeless,

我們的街友人口主要可以分為三種：

about 75 percent;

暫時無家可歸的人，

those that are episodically homeless,

大約佔 75%；

about 10 percent;

不定期無家可歸的人，

and those that are chronically homeless,

大約佔 10%；

about 15 percent.

以及長期無家可歸的人，

Chronic homelessness is defined as an unaccompanied adult

大約佔 15%。

who has been continuously homeless for a year or more

長期無家可歸的定義， 是無人陪伴的成年人

or more than four times homeless in three years

持續無家可歸一年以上，

that totals 365 days.

或是在三年間有超過四次無家可歸，

This small 15 percent of the homeless population

且總天數超過 365 天。

can consume 50 to 60 percent of the homeless resources

這少數的 15% 街友人口，

available in a community.

可以消耗掉社區街友資源的50%~60%。

In addition, they can cost the community

此外，他們每年每人需要社區

20,000 to 45,000 dollars a year per person

花費兩萬到四萬五千美元的

in emergency services costs,

緊急服務成本，

such as EMT runs,

比如急診醫療隊出勤、

emergency room visits, as many of you will be aware,

進急診室，就像在座很多人知道的，

addictions, interactions with the police,

毒癮、和警察的互動、

jail time.

坐牢服刑。

Simply put, this small population costs a lot.

簡言之，這一小群人花不少錢。

Based on this reality, the US government began an initiative in 2003

根據這個現實狀況，美國政府 在 2003 年開始了一項方案，

inviting states and cities and counties

邀請州、城市、郡一起加入，

to develop a plan to end chronic homelessness

發展一個十年計畫 來終結長期街友的問題。

in a 10-year period.

猶他州接受了這項邀請，

The state of Utah accepted this invitation,

並找我來領導這項工作。

and I was asked to lead this effort.

在 2005 年， 我們核准了一個十年計畫，

In 2005, we approved a 10-year plan,

十年後，2015 年，

and 10 years later, in 2015,

我們公布的結果是， 全州長期無家可歸的人口

we reported a reduction in our chronic homeless population

減少了 91%。

of 91 percent statewide.

（掌聲）

(Applause)

那是很驚人的。

That's amazing.

當我們開始這個流程時，

When I began this process, and we began this process,

我發現到我對於無家可歸 以及影響它的因子，

I realized that I had a limited understanding of homelessness

了解都十分有限，

and the factors that impacted it,

我需要針對我的看法、 我的想法，做很大的改變，

and that I needed a fairly major change in my belief, in my thinking,

因為我是在嚴格的個人主義理論

because I had been raised with the theory of rugged individualism

和「自立自強」的觀念之下長大的。

and "pull yourself up by the bootstraps."

我們家在猶他州西部沙漠， 小鎮上有個牧牛場，

That philosophy came from being raised on our family's cattle ranch

這哲學來自在那兒成長的經歷。

in a small town in the western desert of Utah.

在牧場學到的是：首要之務絕對是

On the ranch, you learned that nothing takes priority

照顧牛隻，

over caring for the cattle,

總是有什麼東西需要修理，

something always needs fixing

還有最重要的，

and most importantly,

努力就能解決世界上的問題。

hard work makes the world right.

我是從那樣的視角 在看無家可歸的街友。

It was through that lens that I would see homeless people.

當我還是青少年時， 我們全家會到鹽湖城，

When I was a teenager, our family would go into Salt Lake City,

我會看到無家可歸的人就坐在街上， 那時我們稱他們為「流浪漢」，

and I would see these homeless people -- "hobos" we called them then --

而我會心想：

sitting around on the street,

「你們這些懶廢物， 去找份工作，自立自強。」

and I would think,

高中之後，我離開了牧場，

"You lazy bums, get a job. Pull yourself up by the bootstraps."

從大學畢業，

After high school, I left the ranch,

在福特汽車公司工作了數年，

graduated from college,

接著在耶穌基督後期聖徒教會 找到一份工作，

went to work for Ford Motor Company for several years,

搬回了鹽湖城。

then got a job at the Church of Jesus Christ of Latter Day Saints

在那段工作期間，我有機會去協助

and moved back to Salt Lake City.

該州最大的街友庇護所，

During that employment, I had the opportunity to be loaned out

幫他們開發和改善

to the state's largest homeless shelter

他們的財務和管理能力。

to assist them in developing and improving

在那裡時，我發現了一種新方法，

their financial and management capabilities.

可用來幫助無家可歸的人

While there, I became aware of a new approach

及有毒癮者。

to dealing with homeless individuals

那方法叫做減少傷害模型，

and drug addicts.

內容包括分發乾淨的 針頭以及保險套。

It was called the harm reduction model,

我心想：「那真是個蠢點子。」

and it consisted of passing out clean needles and condoms.

（笑聲）

And I thought, "Now that is one stupid idea."

「那樣做只會鼓勵他們 繼續原本的行為。

(Laughter)

應該叫他們別做。」

"That's just going to encourage them to continue that behavior.

幾年後，我讀了一些資料， 是關於聯邦政府

Just tell them to stop."

早期推動終結

Several years later, I read some of the early 10-year plans

長期街友的十年計畫。

to end chronic homelessness

我讀過這些計畫的內容之後，心想：

promoted by the federal government.

「呸！這很不實際。

As I read through those plans, and I thought,

街友問題是無法終結的。

"Pfft! This is unrealistic.

它牽涉到太多個人選擇 及我們無法控制的因子了。」

You can't end homelessness.

然而，我的觀點變了，

There's too many personal choices and factors beyond our control."

2003 年時我參加了一場大會，

My perspective changed, however,

在那裡，我學到了 十年計畫背後的理由。

when I attended a conference in 2003,

首先，我學到這一小群的街友族群，

where I learned the reason behind the 10-year plan.

雖然只佔 15% 但卻非常昂貴。

First was this small population of the homeless group

對於猶他州這種保守的州而言，

that was 15 percent and were very expensive.

那數字是合理的。

That made sense

第二，我學到了這個「住屋優先」

for a conservative state like Utah.

或低門檻住屋供給。

The second insight was learning about this Housing First,

在紐約市有一個機構

or low-barrier housing.

一直在邀請有心理疾病的街友

There had been an agency in New York City

直接從街頭搬入住屋當中。

that had been inviting mentally ill homeless individuals

他們也被允許繼續使用毒品和喝酒，

to move directly from the street into housing.

就像我們在自己家裡也可以一樣。

And they were also allowed to continue to use drugs and to drink,

此外，現場的個案經理 也會提供服務給他們──

just like we can in our homes.

不強迫要使用──

They were, in addition, offered services -- not required to use them --

來協助他們調整新的居住安排，

by on-site case managers

讓他們的生活更穩定。

to assist them to adjust to their new living arrangements

他們用的是減少傷害模型。

and to stabilize their lives.

雖然我一開始聽到這個模型時， 對它的期望是很低的，

They were using the harm reduction model.

但它的成功率卻非常驚人：

And despite my initial low expectations about hearing about this model,

有 85% 的人在 12 個月之後 仍然住在住房中。

they were having an astonishing success rate:

我學到的第三點，

85 percent were still housed after 12 months.

是發展信賴關係的重要性。

The third insight

因為這些人在他們一生中大半時候

was the importance of developing a trusting relationship.

都受到傷害，

Because of the abuse these individuals have had

所以他們很難信任別人，

throughout most of their lives,

而乾淨的針頭、保險套、 低門檻住房供應，

they hardly trust anybody,

就是開始發展信賴關係的手段。

and the clean needles and condoms and low-barrier housing

這非常重要。

was a means to begin to develop a relationship of trust.

會議結束後我搭飛機回家，

Vital.

坐在飛機上，看向窗外，

So as I flew home from this conference,

我發現到我對於 街友的了解和觀點

sitting in the plane looking out the window,

正在轉變。

I realized that my understanding and perspective about homelessness

當我盯著窗外時，

was shifting.

產生了一種很強烈的感覺和想法，

And as I stared out that window,

覺得如果在美國有任何一州

this very strong feeling and thought came to me

能夠終結長期街友的狀況，

that if there's any state in the union

那就會是猶他州，

that could end chronic homelessness,

因為在猶他州有一種很根本的感覺、

it was the state of Utah,

慾望、意願， 要同心協力來服務我們的鄰居，

because there's an underlying feeling

包括無家可歸的人。

and desire and willingness to collaborate to serve our neighbors,

對於要如何做到， 我開始有個清楚的遠景。

including those who are homeless.

我們去參加會議的人說：

A new vision was becoming clear to me how this could be done.

「是的，這些模型 在猶他是可行的。」

Now, those of us that attended the conference said,

但當我們回到家，就有很多人說：

"Yeah, these models will work in Utah."

「不，那些都不可行， 在這裡都不會成功。」

But when we got back home, there were many who said,

然而，有一個在做可負擔住房的組織

"Nah, those aren't going to work. They won't succeed here."

願意為我們先建立 100 個單位。

But there was, however, an affordable housing organization

但他們擔心把 100 個 長期無家可歸的人

who was willing to build our first 100 units.

放在同一個地方會不會有問題。

But they had concerns about having 100 chronically homeless people

為了解決他們的擔心， 我們決定做個試驗，

in one location.

在建立前 100 個單位的同時 先來測試該想法是否可行。

To address that concern, we decided to create a pilot

我們用的是散布在 鹽湖城各地的既有單位。

to test that idea while we built the first 100 units.

接著，我們盤算：

We would use existing units scattered throughout Salt Lake City.

我們應該要選擇 高功能無家可歸的街友？

Then we debated:

還是我們能找到的街友中 最具挑戰性的？

Should we select fairly high-functioning homeless persons

這時，我的牧場背景就派上用場了。

or the most challenging ones we could find?

那時，我母親為我們煮飯，

And this is where my background on the ranch came into play.

為我們每週一次的洗澡把水加熱，

Back then, my mother cooked our meals

用的是燒木材和煤的爐子。

and heated the water for our weekly bath

那些年來不斷為了爐子而劈柴，

on a wood-burning and coal-burning stove.

我學會在我還最有力時，

And after chopping wood for that stove all those years,

就先從圓木比較大的那一端劈下去。

I'd learned to chop the big end of the log first,

我們決定使用的方法是 「先劈圓木較大的一端」，

when I had the most energy.

在我們能找到的所有 長期無家可歸街友中，

We decided to use the "big end of the log first" approach

選出了 17 名 最有挑戰性、最困難的，

and selected 17 of the most challenging,

因為我們知道， 我們能從他們身上學到最多。

difficult, chronically homeless people we could find,

22 個月之後，

because we knew we would learn the most from them.

所有 17 人都仍然住在住房中，

Twenty-two months later,

包括琦塔在內，

all 17 were still housed,

今天已經是 11 年後了，

including Keta,

她現在能睡在自己的床上，

who today, 11 years later,

而且沒喝醉。

is sleeping in her own bed

在這次試驗結束時， 其中一位年輕的個案經理說：

and is sober.

「我們以前在大學上課時會爭論

At the end of this pilot, one of the young case managers said,

哪一種個案管理理論最有效。

"We used to debate up at our university classes

現在我們的個案管理理論是：

which theory of case management was the most effective.

做所有必要的事 來讓他們繼續住在住房中。」

Now our theory of case management is:

我們成為了信徒，

anything necessary to keep them housed."

在接下來的十年， 建立了數百個單位，

We became believers,

結果是將全州的長期無家可歸人口數

and built hundreds of units over those next 10 years,

減少了 91%。

leading to the reduction of our statewide chronic homeless population

無家可歸的人是誰？

of 91 percent.

許多人只希望他們能走開、消失，

Now, who are homeless people?

不要擾亂我們的生活。

Many people just want them to go away, to disappear,

在這 10、11 年的過程中， 我深刻理解到

not disrupt our lives.

為什麼人會無家可歸。

Through this 10-year, 11-year process, I gained many insights

其中一點是我在幾年前理解到的，

of why people become homeless.

當時我和我們的外展醫療隊 一同去做拜訪。

One of those insights came to me a few years ago

他們是我們的前線人員，

when I was visiting with our medical outreach team.

走出去實地拜訪街友和性工作者，

These are our frontline workers

檢查他們的健康狀況。

that go out and visit the street homeless and the prostitutes

醫療隊的一名成員提到，

to check on their medical health.

8 位性工作者生了 31 個孩子，

One of the team members mentioned

這些孩子變成這個州要監護的人。

that eight of the prostitutes had given birth to 31 children

她們也分享說， 有些皮條客就是她們的丈夫，

that had become wards of the state.

更糟的是，

They also shared that some of the pimps were their husbands,

是她們的父母。

and worse yet,

這些性工作者

their parents.

接近 20 歲、 20 多歲， 或 30 初頭，

These prostitutes,

一天得要賺足夠的錢來負擔

in their late teens, 20s, early 30s,

一百元的海洛因毒癮、

were expected to earn enough money a day to support

自己的生活花費

a hundred-dollar-a-day heroin addiction,

和給皮條客的錢。

their living expenses

不安全的性行為讓她們可以賺更多，

and their pimp.

但也可預期， 沒有保護措施會導致懷孕。

And with unprotected sex, they were paid more,

在這些情況下出生的孩子， 下場常常就是無家可歸。

and predictably, this would lead to a pregnancy.

如果不感到絕望地去看待 在那些情況下出生的孩子，

Children born under these circumstances many times end up becoming homeless.

或是讓孩子在七歲 就變成毒蟲的父母，

And it's not helpful to look at those born under those circumstances,

或是染毒父母所生下的寶寶，

or a parent that makes their child a drug addict at age seven,

那是沒有幫助的。

or a generation of babies born through drug addiction,

對我而言，我相信 每個人都有其價值，

and not feel some despair.

不論你是誰。

For me, I believe every person is of value,

對於人生起跑點是這個樣子的人， 去責怪他們的處境，

no matter who you are.

是沒有幫助的。

And it's not helpful to look at somebody with this start in life

（掌聲）

and blame them for where they are.

沒有人在成長過程中會說： 「我的人生目標是要無家可歸。」

(Applause)

那就是減少傷害 和住屋優先模型的美好之處。

No one grows up saying, "My goal in life is to become homeless."

它能認清一個人的人生

And that's the beauty of the harm reduction and Housing First model.

是由許多不同的複雜因子所形成。

It recognizes the complexities of the different factors

這些模型看的是那些人的處境，

that can shape a human life.

而不是我們的處境，

These models meet people where they are,

也不是我們認為他們該有的處境。

not where we are

我們做的 17 人試驗 教了我們許多東西。

or where we think they should be.

當人們流落街頭許多年，

The pilot we did with our 17 taught us many lessons.

要搬回到住房中

When people have been living on the street for many years,

會需要學很多事。

moving back into housing

而唐諾，

requires lots of things to learn.

教我們去了解一些這種轉變。

And Donald

他的個案經理問他， 為什麼公寓那麼冷

taught us some of these transition lessons.

還不把暖氣打開？

His case manager asked him why he had not turned up the heat

唐諾說：「要如何打開？」

in his cold apartment.

這才有人教他如何用自動調溫器。

Donald said, "How do you do that?"

個案經理也觀察到，

He was shown how to use a thermostat.

他會在爐上加熱罐頭裡的豆子，

The case manager also observed

就像他多年來用營火加熱一樣。

that he was heating the beans in the can on the stove,

這才有人教他如何用壺和鍋。

like he had done over the campfires for many years.