 Hi everyone. Welcome to the last speaker for Virtual Abilities 2018 Mental Health Symposium. My name is Malay Preci and I'm a PhD candidate at the University of Maine. I'm researching the effect of the avatar in social activism. I've been a resident of S.L. for almost a year and I've run the four-bridge project in S.L. since 2008. Virtual Abilities 2018 Mental Health. It's my pleasure to introduce you to Dr. Caroline Weitz. Dr. Weitz is a psychology at the University of Puget Sound, who serves on the advisory committee for the University's African American Studies program. And on the leadership team of the Race and Pedagogy Institute. Her research interests include topics related to central psychology. Most recently, she worked with interviews and intersections of racism and homelessness. Dr. Weitz is a senior fellow of the Tacoma Pears County American Leadership Program. She serves on the board for the Fair Housing Center of Washington and volunteers with the diversion program at Pears County Juvenile Court. In the title of her talk, a stigmatized identity, psychological distress, and physical health among individuals experiencing homelessness. Dr. Weitz will be sharing her research on the multiple stigmatized identities that affect the homeless. And how the complexity of the stigmatized identities perpetuates mental health issues and sustained homelessness. On his preschool year questions until she opens the floor for interaction. Welcome Dr. Weitz and the floor is yours. Hello everybody. Thank you for that introduction Malay and thank you all for inviting me to present today. I was able to watch some of the terrific earlier presentations. So I know many of you are already experts on stigma and also possibly tired from a long day. Like many of the presenters today, I will talk about the connections between stigma and health. What may be different is that I will be focusing on stigma as it relates to people experiencing homelessness. I have an introduction slide up right now that has four images that I have chosen carefully. Two are images of signs that represent stigma. One of those signs says no sitting or lying down on public sidewalks 7am to 9pm. And the other says sleeping prohibited 11pm to 6am. So if you do the math and you are experiencing homelessness you may not find a place to sleep. But people experiencing homelessness have many skills and characteristics other than being homeless. So I have also chosen other slides. One is a beautiful abstract painting by an artist named Chuck Ralston which hangs in my living room. And I bought at a local auction and Mr. Ralston was experiencing homelessness and mental illness. But he creates wonderful art. And the other slide is of a bed. Homelessness can be defined in many ways. For example HUD has defined homelessness as a person, a homeless people, as someone who lacks fixed regular and adequate night time residents. Or whose primary residence is a shelter designed to provide temporary living accommodations. And so I picked a picture of a comfortable friendly looking bed to represent the hope individuals have of finding stable housing. And the hope communities have of ending homelessness. Homelessness is an important issue to understand and address for a number of reasons. In the US we are having a crisis of affordable housing and homelessness. People who are homeless are in a vulnerable physical state because they don't have housing. And are also psychologically vulnerable because of the stress of being homeless. And because people who are homeless often have one or more characteristics that make them the targets of stigma. In this talk I will give you some background information about homelessness in the US. Then I will talk about the challenges of stigma that homeless people experience including stigma linked to homelessness and to race. And I will also share some of my own research on stigma related to health, homelessness, race and mental illness. I'll also describe a collaborative mixed method study by the Center for Social Innovation about the intersection of homelessness and racism. And finally I will talk about actions people can take to address the problems of homelessness, stigma and inequity, racial inequity. So let me move to the next slide. This slide shows some of the recent estimates of homeless numbers in the United States. The US government uses two methods to get an estimate of homelessness realizing that these are very likely underestimates. But they allow us to track change over time and to get at least a minimum number of the scope of the problem. Once a year in January there is an effort to conduct a point in time count in every state to estimate the number of people homeless on a given night or a given point in time. In 2017 there were more than half a million people identified as homeless on a single night. Other way to count homeless people is to track the number of unduplicated individuals who use homeless shelters at any time in a given year. And using that method in 2016 there were about 1.5 million people in the United States who used shelter services at some point in time. Homeless people have diverse characteristics. Part of homelessness is visible such as when you see tent communities under freeways or people spending their days at public libraries because they have nowhere to go. But much of homelessness is also hidden such as families living in cars and college students sleeping on couches. The point in time count found that families made up about a third of people who were homeless which refers to families that have to include at least one child. And both methods of estimating found that more than a fifth of people who were homeless were children. Among those who are homeless there's an overrepresentation of groups including veterans, individuals who recently graduated from foster care, individuals recently incarcerated, people coping with mental illness or substance abuse, and victims of a domestic violence. The next slide shows some of the U.S. national statistics on disability and homelessness which I thought might be of interest to this audience. Mental illness is the most frequently reported disability but I didn't find the statistics broken out by different types of disability although those might be available in particular geographic regions. So what this slide shows is that adults with disabilities were about four times more likely to be experiencing sheltered homelessness. That's the all year count. Then were adults without disabilities. That same database showed that between 2007 and 2016 the proportion of individuals experiencing homelessness with disabilities increased from 40.4% to 47.3%. And finally, although many people assume that people with disabilities are alone, among adults in families with children the disability rate is 2.6 times higher than for adults in families that are homeless. Sorry, the rate of disabilities is 2.6 times higher for adults in families that are homeless than families that are not homeless. And homelessness is among many life circumstances that occur unequally among racial and ethnic groups. Much of my own work and teaching has been about the connection between racism and homelessness. Although there are regional demographic differences in who becomes homeless, people of color, especially African Americans are hugely overrepresented in the homeless population. And this slide shows numbers of the yearly count of homeless people in shelter. People who identify as black or African American make up about 40% of the homeless population, which is almost four times their frequency in the U.S. overall. And this kind of disparity began the first time the count took place in 2007 and it hasn't changed since then. Really persistent. Additionally, many approaches to ending homelessness assume that if we can reduce poverty, this will end racial disparities in homelessness. However, an important finding is that although black people compromise, comprise 13% of the general population in the U.S. and 26% of those living in poverty, they make up a full 40% of the homeless population. And this suggests that something other than poverty alone is going on that explains the overrepresentation of black folks in the homeless population. Statistics also show that Hispanic people make up a substantial part of the homeless population, but their rates of homelessness are actually about the same as their proportion of the general population. The only other racial ethnic group that comes close to being overrepresented the way that black people are is Native American people. And much less is known about the experiences and circumstances related to Native American people experiencing homelessness. This next slide shows some sobering statistics about homelessness in the public school system in my own state of Washington. About 40,000 K-12 students per homeless is about four out of every 100 students. And the numbers of black children were 10 out of every 100. That's one out of 10 black children experienced homelessness in a single year. And about eight or nine children out of every 100 K-12 homeless children were Pacific Islander. About eight or nine children out of every 100 students were homeless among those who identified as Pacific Islander, Hawaiian, Native Hawaiian, American Indian or Alaskan Native. These are big numbers and huge disparities. Homelessness is the result of many causes and is at the intersection of all the systems that are broken in our society and where racism exists. This slide shows images representing all of the systemic factors that contribute to homelessness. These include systems such as housing, banking, lending and employment sectors. It also includes systems that affect economic opportunity and health such as education, mental health services, health care, criminal justice, policing, transportation and the availability of healthy food. Systemic racism in these and other systems all converge to create high rates of homelessness for people of color, particularly black Americans. The slide also conveys that homelessness is really complex and ending homelessness will require a commitment to understanding and addressing its root causes, which includes the role of structural racism. Next, I'm going to give you a little background about stigma. This slide shows a definition of stigma by Irving Goffman, which defines it as a personal characteristic or social identity that causes a person to be devalued by the larger society. So having a stigmatized identity makes people the targets of negative stereotypes and discrimination and it's linked to outcomes like poor interpersonal relationships, poor health and negative economic outcomes. And people who are homeless all share that common stigmatized characteristic of being homeless, which they may or may not be able to conceal within and across settings. People who are homeless may also have a number of other identities that also make them targets of stigma such as having a disability, being a person of color or being poor. And even if people who are homeless don't have these identities, other people may hold stereotypes and assume that they do. So they may assume people who are homeless use drugs or criminals, have a mental illness or are unemployed. None of that may be true. Lots of research has looked at different types of stigma and their negative effects, but less research has looked at the stigma of homelessness in particular. And we know less about the complex effects of having multiple stigmatized identities. So next I'm going to talk to you about some of these negative effects using research from my own field of social psychology. This next slide is very complicated and you don't need to read all of the small font. I'm going to tell you the take home point. There it is. So in part the negative effects of stigma may be very severe for individuals without homes because the stereotypes about homeless people are extreme. And this slide is showing a study by Susan Fisk and her colleagues about how people perceive different social groups. I am not, let's see. So I'll just explain some of the main points that her model is called the stereotype content model. And what she finds is that across cultures stereotypes about social groups are not just some groups are good and some groups are bad. Instead people perceive groups along two dimensions, the dimensions of warmth and competence. So competence has to do with viewing people as intelligent and having skills and capabilities. Warmth has to do with thinking about people as being morally worthy and attractive and humanized. And what Fisk and her colleagues find based on large samples is that some groups are stereotyped positively on both dimensions, some negatively on both dimensions, but some are high on one and low on another. So I'm not going to go through all the examples here, but I'll give you some. For example, there's stereotypes that Jews in the US are high on competence, but low on warmth. So one thing to note, I don't know if you can see it, but at the very bottom left corner, homeless people are among the groups that are stereotyped, at least in the US, as low on both warmth and competence. And why is this important? There's another part of the study that's on the other panel that shows that people experience emotions, social emotions in relation to groups based on the particular quadrant or part of the graph that the groups fall in. So for example, the stereotype of Jews being high in competence and low in warmth leads people to feel envy. For groups such as the elderly or the disabled where people have stereotypes of the groups as being high on warmth but low on competence, people sometimes feel pity, and majority group members in society feel admiration for the groups in the high warmth and competence category, which includes middle class people, white people, and educated people. So what happens in that bottom quadrant where the homeless people are low in warmth and low in competence is contempt, which is disturbing. This next slide, also complicated by the FISC and some other and Harris, which I'm going to show you, shows pictures of brains in fMRI machines. And I am not a neuroscientist, but I can explain to you the take home point since I have studied it now carefully through this article. And what Harris and FISC did is they had Princeton College students look at images of the same groups that I just talked about that occupied the four different quadrants, and they looked at what areas of the brain fired when people were looking at different groups. Their article is called Dehumanizing the Lowest of the Low, Neuroimaging Responses to Extreme Outgroups. So they found that when people looked at groups that were either high in warmth or in competence or in both, the parts of the brain that were involved in social perception and social emotions fired. But those parts of the brain, which include the medial prefrontal cortex involved in social perception did not fire at all to images of homeless people, at least for many of their participants. And then even more disturbing, there's parts of the brain that light up for disgust. And these are the parts of the brain that fire when people look at the control images of toilets and vomit. And these are the parts of the brain that fired when people looked at images of homeless individuals. So there's a lot of research on what social psychologists call the perceiver or the person who holds stereotypes and prejudice. And there's also, as you've learned today, a growing body of literature on what it's like to be the person who is perceived or the target of stigma, stereotypes, and discrimination. So I'm going to turn to some of that research now. Again, coming from social psychology, it's a little different perhaps than some other things you might have learned today. This first slide comes from some of my own research done with my colleague Renee Houston that looked at a survey of 209 people experiencing homelessness. And it was a simple study where we just wanted to know are people aware of the negative stereotypes that people hold about them? So it was a simple task. The participants had to read statements that reflected stereotypes about homeless people and just indicate whether they thought those statements were true or false. And then we also asked them to indicate how they thought the typical person who was not homeless would respond to the same question. So the items were things like most of the homeless are drug addicts or alcoholics. Most of the homeless do not want to work or most homeless people don't want to be helped. We found that the majority of our participants thought these statements about homeless people were false. But the vast majority thought that people who were not homeless would say that the statements were true. So all of our participants were homeless and this finding suggests that individuals who are homeless are aware of the negative stereotypes about their group. And even if they don't believe the stereotypes themselves, they're carrying around with them the knowledge and the concern that other people might be viewing them negatively. So the next topic I'm going to talk about is what are the effects of being dehumanized and socially devalued? Again, coming from research on stigma in social psychology, I'm going to tell you about some research using a method called cyberball that illustrates the very negative effects of social exclusion. In these studies, Kip Williams and his colleagues have people playing the role of an avatar, a simple cartoon character, where they play a game of catch with two other cartoon figures who they think are real people, also participants sitting at computers in other rooms. And it's just a simple game of catch, but it's actually rigged. There are no other ill participants. What happens is that for the first 30 seconds, the characters all play ball and the real participant gets the ball about a third of the time, so it's a typical game of catch. But after 30 seconds, the other two characters start throwing the ball back and forth to each other and never throw it to the participant again. So in some of these studies, they do things like look at the facial expressions of the participant sitting alone at the computer being excluded from a virtual game of ball. And they show that within a three minute time period, the facial expressions just show the whole range of confusion, frustration, anger, and finally just sort of dejection and resolve, you know, just disengagement. And they also do studies where people turn the dial to indicate their mood and their mood becomes extremely negative during a very short period of time. And then finally, again, I'm not a neuropsychologist, but one of their studies had people play this game in an fMRI machine and showed that within a three minute period, the parts of the brain that fire for physical pain started firing just because people were excluded from a simple game of cyberball. So you might imagine what might be going on in people's bodies and brains living as homeless individuals where they continually have signals of dehumanization and exclusion. People avoiding them on the sidewalk, turning their eyes away. Before I talk to you more about my own research on the effects of stigma, I want to back up a little bit and talk a little bit more about racism as a foundation for some of my research. So this slide is just an overview of different ways people now think about and study racism. So we think of racism typically as just being between two individuals or, you know, the stereotypes and bigoted behavior of people. But importantly, racism is part of a systems of society, though we use the term systemic racism to talk about those historic, chronic, embedded systems of advantage and disadvantage based on race. And within that, and within particular institutions, we talk about institutionalized racism and I'll give you some examples in a minute of examples of that that have to do with redlining. But also there's all kinds of research documenting bias in employment and hiring and way people use educational requirements in hiring procedures. In the criminal justice system, racial profiling, police brutality. Within the racism literature, it's also important to know that a lot of interpersonal racism is unconscious. And we use terms like implicit racism or modern racism to talk about the subtle ways our culture has embedded racism inside of people such that they don't even realize they are making stereotyped associations or acting on those those that knowledge and those triggers. So I want to give you an example of systemic housing from the systemic racism in the housing area. Restrictive covenants are legally enforceable clauses in a deed or a lease that are intended to enhance property values. And until 1948, they were legal as ways to discriminate based on race. So this is an example of a covenant from my city of Tacoma that reads, No part or parcel of land or improvement there on shall be rented or released to or used or occupied in whole or part by any person of African or Asian descent or by any person not of the white or Caucasian race other than domestic servants domiciled with an owner or tenant and living in their home. So home ownership was not an option available to a large part of the population of the U.S. Legal discrimination also occurred from the 1930s until 1968 through the practice of redlining. Redlining is a widely used practice by banks and real estate companies to refuse to grant or ensure mortgages in particular neighborhoods that are deemed financial risk. And the Federal Housing Authority guaranteed loans made by banks to promote home ownership except that they set up some rules that basically said, Don't back loans for black people or in neighborhoods where black people live. So this picture comes from a website called Mapping Inequality that shows historical research on maps and loan and bank documents that guided realtors and banks prior to 1968. And this again is my home city of Tacoma where there are red areas labeled as hazardous. And it's not a coincidence that these are the communities of color that are still the most diverse communities into Tacoma. And so an example of what the redlining policies look like, my university is an area that's white right in the middle and it's surrounded mostly by blue parcels. However, there's a red parcel with a note that reads, Be highly respected Negro families own homes and live in the middle of the block and their presence seriously detracts from the desirability of their immediate neighborhood. So redlining directly contributed to the massive racial differences we see in wealth and housing stability today by undermining home ownership and devaluing properties where black people live and inflating the value of properties in white neighborhoods. Redlining was legal until the Federal Fair Housing Act of 1968, but housing discrimination in forms that aren't legal still continue. And next I'm going to show you an example of what I was talking about when I mentioned implicit or unconscious bias. This slide shows a study of something called the shooter bias where people can look at unconscious bias in whether people playing an interactive video game will actually shoot someone who might be holding a weapon. So the instructions are that to protect public safety, if you see somebody with a weapon, you should hit a button that says shoot. But if you see somebody holding an object that is not a weapon, like a Coke can or a cell phone, you should hit a button that says don't shoot. And people are forced to go very, very quickly. The slides move very quickly and they lose points if they don't press one of the two buttons. So in the pictures you see what happens is male young men who are either black or white will show up sometimes with a gun or a knife and sometimes with a Coke can or a cell phone. And people have to play the game as fast as they can. And the game goes fast. And there's two kinds of findings. One is that although people, when the game is going fast but not too fast, you actually find that people can be fairly accurate and therefore they don't show a difference in whether they are shooting black men or white men more often or inaccurately. But if you look at the data more closely, what's happening is when they see a black person with a gun, they hit the shoot button more quickly than when they see a white person with a gun. So they're equally accurate but they're faster to shoot a black person with a weapon than a white person. And when the person doesn't have the weapon, they're faster to hit the don't shoot button for a white person than a black person without a weapon. And then if you make them play the game even faster by putting it at a faster speed, the pattern of errors goes up, the errors go up. And when people do by accident shoot a person who's not holding a weapon, it's more likely to happen for a black person than a white person holding a Coke can or a cell phone. So these are really disturbing findings and a lot of research has used this method to try to train people on implicit bias and see if they can change people's performance on a task like this. And some interesting findings are coming out of that about some ways to reduce bias, but it's a complicated process. So this automatic or unconscious bias may be one of the factors that is influencing modern-day housing discrimination, whether conscious or unconscious discrimination still exists in the housing market today. And this slide shows the results of random testing done in the last few years that shows when people of color are visiting properties to rent or buy, they're shown fewer properties on average. And that's what this shows. And often they are quoted the same price, but they're given less information about incentives or other conditions that might make their move easier, like early move in or discounts, those kinds of things. So next I'm going to tell you a little bit about my own research on how stigma could affect health and well-being. And again, understanding stigma processes in populations who are homeless is important because these negative effects on health may contribute to a cycle of distress that prolongs homelessness, that can also negatively impact the family members and community members of people who don't have homes. So I look at two kinds of stigma in my study, something called anticipated stigma and experienced stigma. So anticipated stigma refers to concerns about negative treatment in the future, people worrying about being stereotyped or treated badly, even if they've never experienced it themselves personally. But also people's experiences and memories of actual discrimination and mistreatment are part of the stigma experience. So we call that experienced stigma. And some of my studies have shown that each of these is important in their own right, but in the research I'm going to talk to you about these are two kinds of stigma are highly related, and so I just combine them into one because it's hard to tell the difference between their effects. The other thing I do in my research is look at multiple kinds of stigma, in particular looking at stigma related to homelessness and stigma related to race. So I'll talk about that first, and then I will also show you some parts of the data that have to do with stigma related to mental illness. So the methods I use involve conducting one-on-one surveys, kind of interviews with people experiencing homeless who are attending a service fair. And in one year, my research assistants and I collected data from women and in another year from men, but we found very few gender differences. So we combine the findings and we make an intentional effort to recruit equal numbers of white folks and people of color in order to do those comparisons. So the demographic data on race and ethnicity doesn't necessarily mirror our community or even the event where we recruited, but it allows us to do comparisons. And our participants got a $15 grocery gift card as a form of appreciation. They were very diverse in age ranging from 18 to 70 years of age, and they had been homeless between one month and 40 years. And about half of them reported having a diagnosis of mental illness and about half reported having an addiction. So I'm going to show you some of the measures we used, but you're not going to be able to see all of the items or have time to see them all. As measures of perceived stigma, we have items that relate to both anticipated and experienced stigma. So items like, I worry about being treated badly because I am homeless, or I worry about how people will view me. And items like, I have experienced negative treatment in the last month from other people because I am homeless. So we ask these items about homelessness and then we ask the same items about race and people give those items a rating. We also ask about racial stigma in another particular way, which we should have asked about with relation to homelessness, but we just didn't. So we have a measure of something we call racial stigma from service providers. Where people are asked whether they agree that for things like when interacting with a service provider of a different race than myself, I think about stereotypes they may have of me, or I worry that service providers may have stereotypes about me because of my race. So to look particularly if maybe racial stigma related to service providers gets in the way of people using services. And this next slide just shows some of my results and kind of simple just what are the baseline rates of stigma. And there's no differences in homelessness stigma between white folks and people of color. But for both racial stigma and racial stigma from service provider, the people of color gave higher ratings of experiencing and worrying about racial stigma than did the white participants. And my primary interest was looking at outcomes. So I had measures of psychological distress that included things like a depression scale and general mood. I also had measures of poor physical health that included things like chronic and current health systems day sick out of the last 30 days. And then a measure of service avoidance, which was attitude items like or items like I put off making appointments for services. I avoid using services, even if they might be helpful to me. And then there were lots of other items about demographics, length homeless, current mental illness that people that I tried to control for in some of my analyses is to characterize the sample. So this slide is a graphic that shows some of our findings about homelessness stigma. And we found that after controlling for gender, race, length of time homeless and having a chronic mental health diagnosis, people's concerns about homelessness stigma predicted higher service avoidance, worse physical health, and higher psychological distress. And we don't have data on the mechanisms through which homeless stigma led to these outcomes. But there's actually a lot of literature that points to multiple pathways, such as direct levels of physiological stress or influences on self esteem that might cause people to avoid using services. So I was also interested in whether people who experience more than one kind of stigma have even worse outcomes. So looking just at a sample from participants of color, we could look at the joint influence of homelessness stigma concerns and concerns about racism. And again, it was sort of complex, but in all of these areas, at least for some people, the effects of racism made the outcomes even worse. The people who were most concerned about being stigmatized because of race were more likely to avoid services and had worse mental and physical health. It was interesting if people had high rates of homelessness stigma concerns, they had negative outcomes regardless of the level of racism. And if people had high levels of concerns about racial stigma, they had negative outcomes regardless of the level of homelessness. So both things mattered. And for some people, they sort of sat on top of each other. And then I went back and I did do the analyses actually for a conference presentation on the data that related to mental illness. And the summary here is that if I just look at the data on individuals who reported having a chronic mental illness, that was correlated with all of the negative outcomes. But if you control for homelessness stigma, so above and beyond the negative effects of homelessness stigma, having more concerns about mental illness stigma led to even higher service avoidance. So a couple conclusions based on this research, the stigma of homelessness may negatively impact psychological and physical health. And stigma related to race and or mental illness may serve as an additional and disproportionate source of stress and as a barrier to using services among people who are homeless. The problem of homelessness is enormous, but it's important for individuals and societies not to become hopeless or despondent. So as researchers often try to draw suggestions about what to do from what we are learning. Clearly supporting efforts to reduce stigma and promote positive relationships are important. Goals for service organizations and the general community in doing research and forming policies and and developing programs. It's important to center the voices of individuals who are experiencing homelessness to respect and learn from what they can tell us about their experiences, including and maybe particularly people of color experiencing homelessness. There are a lot of best practices out there for addressing homelessness. And so again, this isn't my research and I listed a bunch here, but tried and studied. And I want to talk to you just very briefly about a collaborative project that I'm involved with by an organization that I think gives us a lot of reason for hope. It's an organization called the Center for Social Innovation is conducting a national study called the spark initiative. And this program has both a research component and an action component. The research component is to learn more about the intersection of racism and homelessness. And the action component is to engage in training and to develop tools and to share information about what works to reduce homelessness and inequity. And it's happening in 10 counties, 10 communities around the country. Data is available so far for six of those communities, including my own into coma and Pierce. So I'm going to give you just a little preview of some of the preliminary findings. So the research from these particular communities mirror the national trends of disproportionately high rates, really epidemic rates of homelessness for black and Native American people. And then the findings, primarily qualitative interviews and focus groups from people of color experiencing homelessness show that there's a lack of safe and affordable housing. There's a lack of economic capital and opportunities for savings. And what's kind of a new finding and particularly important, I think, is something they're calling network impoverishment, which means that in communities of color, it's not only the individual level of poverty that matters, that individuals may lean on their networks, their families, their close friends to help them when they lose a job or become ill. But that those friends and families also don't have financial stability or capital. And so instead of pooling financial resources in a positive way, what happens is people are pooling sometimes their financial vulnerabilities and nobody in the community can afford to pay the higher bill for electricity or for food. And the whole family may then fall into homelessness or be evicted as too many people are living there. And so communities that have been financially devastated because of historic racism may be particularly vulnerable to having people fall into homelessness. And then we know there are other barriers that also differ by race, like having a felony history, having high rates of mental illness or substance abuse, and multi-generational factors like being in the foster care or family violence. Again, I want to end with something more hopeful, which is that research like this can give us ideas about how to address homelessness and racism. So this slide includes some of the recommendations that come out of the SPARC report. One of the findings also was that the organizations that serve homeless people largely have staff that don't mirror their clients, staff that are wider than the clients, particularly in leadership positions. So intervening to create organizations that mirror the demographics of the clients will be useful both for creating jobs and also creating staff people who understand the life experiences of people who are homeless. And changes in hiring are difficult because those hiring practices have been set up to privilege white people with criteria that, for example, require educational backgrounds where we know there's racial disparities and criminal history screens that rule out particular populations. Another best principle of sort of best practices in conducting research is to center again the voices of people who are homeless and who are people of color in trying to understand the problem and develop interventions. Also supporting policies that enforce fair housing, that reduce evictions and limit barriers to housing related to criminal history and eviction history, all those things will be important as well as creating more affordable housing stock. And reforming again all those systems that contribute to homelessness and to inequity like the child welfare system and immigration policies will help. And finally, some individuals who aren't involved maybe in groups or organizations want to contribute and there's lots of ways to begin that process. One is to educate oneself and others about homelessness, stigma, and racial disparities. And the other is to band with organizations who are doing good work and doing organized efforts to change policies and to support existing programs. So I want to end here so we have time for a little discussion. My last slide is a thank you slide to all of my collaborators in my own research and learning efforts, including a very long list of students at the University of Puget Sound who were undergraduate research assistants. And so I will open things up for questions or ideas that you all have that maybe things you learned today or questions you have as they relate to the topics of stigma, homelessness, and race. Caroline, I want to thank you. It's really important to look at mental illness and where it intersects with other types of pervasive social issues such as homelessness that we haven't talked about yet today. This was a really powerful way to end our symposium this year, so I wanted to thank you for that. You're welcome. Luke has a question. She's got always good questions here. You said adults with disabilities were about four times more likely to be experiencing sheltered homelessness than were adults without disabilities. Do you think there might be some relevance in Maslow's idea that shelter is a basic need of the person that without the fundamental requirement that is shelter or a home, the person's mental and physical health inevitably suffers, consequently also contributing to the development of self stigma. And she says Maslow's upper levels of needs are disputed, but that may not apply to you. Luke is right on. At a basic level, not having a safe, warm, or appropriate place to sleep, interferes with people's basic functioning and thinking in profound ways. So with homelessness and with mental illness, I think there's an expectation that people have, that people will help themselves, that they will seek out treatment and follow good advice and apply for jobs and apply for housing, even in the face of a lot of the challenges of transportation and getting rejected and all of those things are exhausting. So I think it's a very basic principle that when people are not rested and focused, that all of those things become more challenging. And I think that fits right in with Maslow's hierarchy of needs in probably the most extreme way that we all know how important sleep is for functioning, for people who have mental illness and also for people who don't. Well, I'm going to take the opportunity to ask you a question. I'm going to start by citing a statistic, and this is from the NHCH, nearly 16% of the non institutionalized US population is disabled, yet people with disabilities constitute over 40% of homeless people in America. The reasons that this report gives are there are four of them, lack of affordable housing, lack of health insurance, lower wages for people with disabilities, and very high unemployment for people with disabilities. Would you please comment on the relative importance of those contributing factors? That is a tough question, and just naming those things I think is always really important. I'm going to be honest and say that I'm not sure I know about the relative importance of each of those compared to the others. I can comment a little bit on some things I know from the spark findings about some of those, and also just knowing about the affordable housing crisis happening in my own community in Tacoma. Certainly, the cost of housing relative to the living wage that most people now get is way out of whack. So I'll give an example of something happening in my community, but I think has happened all around the country. There used to be a stock of very low cost housing in the form of mobile homes and mobile home community, and although that may not have been the greatest housing and as the housing got older, some of those units were not safe or even habitable, they were affordable and they did provide stable housing. But they were never upgraded and replaced with affordable housing. When those pieces of property became older, they got bought up and people built expensive suburbs or what was called affordable housing but never really was affordable. Never really was affordable in the way that mobile homes were. And so that's disappeared. It's disappeared. So for every listed unit that might have a rent of $800, they may exist. They find those being listed for rent and so you can look and say, I've seen things listed that way and there might be four of those units listed and 3,000 people who can afford only that much and need housing. So housing affordability is way out of whack. Some places more than others, but that's major. The other things you mentioned clearly are living wages are not living wages and that's a finding of the Spark study that people often say people with disabilities or who are people of color don't want to work or haven't worked. In fact, many people have resumes that show they have worked and they know how to get a job. But the problem is they can't get a job that pays a living wage. And so figuring out how to give people employment, sorry, education opportunities so that they can get jobs that actually pay a living wage is going to be important for people who are homeless be able to pay for market rate housing units even when those units are in the affordable range. That's a little bit of what I know. You mentioned affordability and accessibility. There are posters around town that are housing authority put up to help people to identify housing discrimination. Have you heard of that? Well, I am on the board of the Fair Housing Center of Washington, which is among many organizations around the country. Often they're either located within city or county governments or private organizations that try to educate and enforce fair housing laws. So I encourage anyone who thinks they're experiencing housing discrimination related to disability to contact a fair housing agency, to get support and find out if there's something that can be done to intervene with landlords or organizations that discriminate. Is there another question? Zip is pointing out there's a difference between discrimination and availability. Ah, it's a good point. Because property owners, housing providers need to provide reasonable accommodation, and I'm not sure where the line is between availability and accommodation. I think that's where fair housing agencies could be helpful in encouraging or requiring at least some housing providers to increase the availability of units that are accessible. I just wanted to also acknowledge that the crisis of housing accessibility is so huge that there simply aren't units available, affordable, for people with housing vouchers, whether or not they have a disability. People just sit on wait lists for years because the units are not available, and I agree that this disproportionately disadvantages people with disabilities because they are overrepresented in the homeless population. I'm sorry. Zombie had a very interesting thought here. She says she comes across homeless people from time to time, and then she stops and has a conversation with them. Do you think this might help homeless people to know that someone gives a darn, stops and just talks without any sort of assumptions on how they got in their situation? Absolutely. That's a great thing to add to the list because I showed the effects of feeling excluded and being dehumanized. So just smiling, saying hello, talking with someone can be very positive and very powerful. Thank you for that. Can I make a comment regarding that? Orange, go ahead. A few days ago while I was walking at work, I ran across an elderly gentleman wearing pajamas and a sweater with an IV bag hanging up from under his sweater. That is IV as in he's getting medications from an IV bag. And he looked up from what he was doing, which was raking his yard. He saw me. We looked at locked eyes and he got this big smile on his face. And from 20 feet away, he started to walk towards me and put his hand out to shake my hand. So I went over, shook his hand, and we proceeded to have about a half an hour chat. Turns out he has cancer. He's 75 years old. He's been locked in his house for the entire winter. And apparently I was one of the few people he had a chance to meet that he didn't know before. And he was desperate to talk to people. He indicated to me that he had been in the field of clinical psychology, which means he's a people person. And I guess he'd been denied that contact. And so it was wonderful for him to talk to me. And he actually had some interesting information to impart. And the conversation we had was really very good. So I feel very sad that he had been stuck in his house. But I'm glad I had the conversation with him. If for my own education, at least I gave, I brought a smile to his face that day. That's right. And some people don't feel comfortable or safe talking to people who look a homeless, who are sitting on a street corner or who are asking for money. But there are organizations that provide environments where people come to get a meal or get other services. And a lot of them create opportunities for volunteers. And I've been in a lot of those settings and sort of seen people get comfortable by volunteering over time in settings where they can just get, you know, feel like they can smile with someone and strike up a conversation. I think that's a great thing to do to encourage people to expand their networks and their comfort zones by reaching out and connecting in whatever way. And I appreciate your story that illustrates that. Here's some other illustrative stories. Jennifer says she has an impressive resume to some people. She sees it as normal. But she knows she can't work because of social disabilities, which is why she's starting her career in second life. She says she can't deal with people face-to-face now as she used to in the past in the real world. So there's one possibility. Right? So this says in her city, you haven't been able to even apply for Section 8 housing for years. I think that's true in many places. Yes. Jennifer says she thinks people have to know if you can work in the physical world. I think that's one of the things you were talking about. Miley says many shelters across the country are looking for volunteers. Picking up day-old stuff from grocery stores, preparing food, et cetera. Volunteering is a great way to be involved and help others get involved. It also puts a face to their issue. Terrific. Yes. Folks, I know it's late for some people. It's very late for people like Moog from the UK. Okay. Maybe there's one last question or comment, or should we wrap up? So on says last year, there was a challenge nationwide for crocheters to create blanket squares and her guild joined in and made hundreds of those squares and put them together into blankets. Donated those to a housing situation there locally. But a couple has going, but it was a project just to find someone to take the blankets as a donation. So they had things to donate, but they couldn't figure out anybody who would take the blankets. I've heard stories like that also, and I think it is important to try to coordinate with organizations because we have a shelter in Tacoma where people need to bring food. It's actually kind of a tent community. But if people just come and drop food off, there could be too much food one day and no food another. And it can be wasteful and confusing. So the Salvation Army has taken up the job of coordinating food deliveries online. So volunteers can sign up for a particular date. And sometimes it does take a bit of work to figure out where is a particular need for blankets or socks or food and make sure you can target it. So going in expecting it to be challenging, I think, you know, is realistic. But I think all the kinds of help are valuable. I'm thinking it is time to have our audience let Dr. Weiss know how very much we appreciate her sharing her research with us and how important it is for researchers to come in and talk with us in the virtual world. Thank you so much. A couple more comments here. Looking for volunteer options for people with physical disabilities is tough. Most of his encounters with homeless men did not go well. When they ask him for money, he offers to buy them a meal, take them to a shelter, or take them to a 12-step meeting, and they almost always look sad and walk away. That is a tough one. That's a tough one. I think it's worth a quick conversation only because, again, people's lives are complicated. So it's hard to assume as a potential helper that you know where a person is at or what kind of help they need. That's why I was saying if you really want to help, maybe connecting with an organization, because folks sometimes know, have gotten to know individuals and know their particular needs better. I personally don't give money on the streets. I just don't think as a young woman, or not so young, but a small woman, it's a good idea to be opening my purse or my wallet. But there are other settings in which I do feel comfortable contributing personally or financially. So it is tricky. But I appreciate the intention to help and the consistent efforts to do that are so important. And I want to thank all of you for sticking it out at this long conference and being a great audience with great comments and questions.