Making Care More Accessible: Reimagining Boston’s Homeless and Recovery Services

Olivia Yao (she/her) is a 2020 Summer Fellow with the Mayor’s Office of New Urban Mechanics focusing on expanding low-threshold overnight spaces for people experiencing substance use disorders and homelessness.

This summer as a MONUM fellow, I’m designing supportive structures for people who are experiencing homelessness and substance use disorders. With the rise of the opioid crisis throughout the last 20 years, these two populations have overlapped while Boston’s services have stayed divided as primarily housing-oriented or primarily recovery-oriented. In an effort to create a space that better provides for its guests, I’ve spent my last five weeks researching best practices for a “low-threshold overnight space.”

The easiest way to explain “low-threshold” is to describe what it’s not. The majority of spaces for people experiencing homelessness are “higher-threshold,” meaning they have strict and exclusionary policies that decrease the accessibility of services. Some of these policies include:

• Single gender:
  Single-gender institutions exclude partners, families, and friends of different genders from staying together through the night. Gendered policies often force people to choose between indoor shelter and the comfort of a loved one.
• Inflexible hours:
  In many homeless services, guests are not allowed to step outside during the night after they have checked in. This is in part to prevent guests from leaving to use drugs throughout the night. However, for many people with active substance use disorders it can be difficult to commit to several hours without drug use and these rules prevent them from accessing shelter.
• Forced consistency:
  Some shelter spaces require guests to return every night to be guaranteed services. If a guest misses one night for any circumstance (whether it be wanting to stay outside for one night, being hospitalized, being taken into police custody, etc.) they may not be able to access shelter services for extended periods of time.
• Mandatory security checks:
  Many spaces have security checkpoints, including metal detectors and bag scanners to check for weapons, drugs, drug paraphernalia, and other banned items. It may seem intuitive that these checkpoints are necessary to maintain a safe space but these policies can also exclude guests, contribute to an institutional and carceral system, and be triggering to guests who have experienced trauma.
• Shelter bars:
  Breaking the rules of these spaces can result in being barred from using the service for a specified length of time. Sometimes, people are permanently banned from a homeless service, preventing them from being able to access adequate help to move out of homelessness.

Low-threshold spaces don’t subscribe to the same policies. Their foundation of care is tied to meeting people where they are at. The City of Boston currently operates one daytime low-threshold drop-in space, called the Engagement Center and nicknamed “the tent.” At the Engagement Center, staff are trained to build relationships with all guests regardless of their living situation or drug use. It acts as a touchpoint for people who aren’t able to access traditional shelters to get connected to resources such as addiction services, housing planning, and career advising.

In some cases, specialized spaces with high thresholds are necessary for better care. For example, people experiencing domestic violence or people with trauma inflicted by someone of another gender can turn to single-gender institutions as a safe haven. In addition, some people recovering from substance use disorders can be triggered by the presence of others actively using drugs. These people might find help from sober living homes, wherein strict policies against drug use help people maintain sobriety. Although these places are effective for catering to the needs of a subset of the homeless population, they do not effectively serve people who are experiencing both homelessness and substance use disorders.

We need to reimagine Boston’s current ecosystem of homeless and recovery services, starting with the needs of the people we are trying to serve. We need to make space for low-threshold drop-in centers, overnight shelters, and housing plans. All of our care, generalized or specialized, low or high threshold, must start with a baseline of mutual respect, dignity, and trust — if not, we are neglecting to help the people of our city.

Olivia Yao is an engineer and designer passionate about using principles of empathy to amplify the voices of people in the city of Boston. She works to foster inclusion and understanding, translating ideas into objects through installations and editorial publications. She recently graduated from MIT with a Bachelor’s degree in Mechanical Engineering, where she served as the editor-in-chief of MIT’s arts and fashion publication, Infinite Magazine, and as a founding member of the Asian American Initiative, MIT’s Asian advocacy organization. Olivia loves figure skating and is spending her time during isolation making zines.

About the Fellowship:
The New Urban Mechanics Summer Fellowship is designed for entrepreneurial students and professionals interested in working in public service. During this highly selective eight-week program, summer fellows work as a team and on their own projects, generating and implementing creative and thoughtful new prototypes to benefit the City of Boston.