If you choose to start your hike through Ohiopyle State Park at the top of the mountain, near Kentuck Knob, you can wind your way down to Cucumber Falls in about two hours. Follow the babble of the stream down from the top of the mountain. In July it is humid, but the trails are shaded by some of the tallest trees in Pennsylvania—mostly oak. The trails wind along and across tributaries, feeding to Cucumber Run, and then to the Youghiogheny River. The tributaries carve shelves into the stone on their way down. If you go in the days after a rainstorm, the water at the top of the mountain is clear and cold, cutting the humidity as easily as it cuts into the mountainside.

Here, it is easy to see the ways the weather and the earth affects us. On the side of the mountain you are small, and it takes you much longer to wind down its face than it takes this little stream. Your toes are chilled by the fresh rainwater when you take your boots off and dip them in. Down the mountain, where Youghiogheny Falls stumbles heavily over the steps and shelves it has pounded out of the rocks, it’s even more apparent. From the shore, the rumble overpowers the sound from the road, the birds, everything.

© Pittsburgh Theological Seminary

When Dave Lettrich started seminary school six years ago, he did so with the intention of committing himself to being where God wanted him to be. In the summer of 2015, that place was Ohiopyle State Park, located about 70 miles southeast of Pittsburgh. Lettrich had an internship with an organization located in the South Side that allowed him to meet people who lived on the streets, and after forming a relationship with these individuals, he began taking them on trips to Ohiopyle to hike and swim in the Meadow Run rock slides. Through a crowdfunding campaign, Lettrich raised enough money to take 20 people white water rafting, a popular activity for Ohiopyle visitors. While most activities in the park are free, rafting is dangerous without experienced guides, and day tours cost upwards of $50 per person. 

“We split it equally between people from the streets and people who were not from the streets,” Lettrich reflects. “We had a wonderful time.” 

After this inaugural trip, Bridge to the Mountains was born. In May 2017, Lettrich incorporated the original crowdfunding campaign and became a 501c3 non-profit in order to serve the people he met on the streets. The relationships he cultivates with people translates to what he calls a “continuous care model of service coordination,” which meets people where they are and helps them strategize a more peaceful way of life if they so choose it.

I first meet Lettrich outside his office. He’s talking on the phone while he has a cigarette break, so I walk in ahead of him and meet Kaylee Shockley from The Open Door, an organization founded in 2006 to provide housing for those with HIV, a history of substance use, history of arrest, or some combination of those things. The two organizations share office space, which seems to have at one point been a small medical office as there is a large counter that dominates the center of the room.

Inside Lettrich’s office are stacks of sleeping bags, tents, tarps, backpacks, sharps containers, and Narcan (an overdose reversal drug for opioids; also called Naloxone in generic form).

“Basic need items our people living outside might need,” he said. 

“Our people” and “we” are how Lettrich naturally refers to the people he meets every day. His face looks windburned, and his Bridge to the Mountains hat is worn through around the brim. His eyes and smile add to the rugged approachability, which is an important attribute for him. Lettrich’s role in today’s version of Bridge to the Mountains is “pastoral care in the streets.” His days are sometimes 12 to 15 hours long, and “every single day brings crisis,” he said.

In 2018, Allegheny county emergency shelters, homelessness prevention, street outreach, and other programs saw 9,901 unique active clients, according to Allegheny County Department of Human Services. Of those people, nearly 5,000 were homeless before coming into contact with an outreach program. Another quarter were living in rented or owned housing, meaning they entered into programs that helped them pay their rent or utilities. In a county with a population of 1.2 million, this seems like quite a small number, but when one considers that the total population of the city of Pittsburgh is only about 302,000, and that a majority of those engaging these services do so within city limits, the scope of the problem widens.

Of those 9,901 people who engaged with all the services the Allegheny County Department of Human Services tracks, about 4,100 were in contact with an emergency shelter, street outreach, or day shelter, which offer things like food, clothing, medical services and other immediate necessities to people experiencing homelessness. But of the people who see these services, most immediately go missing or are documented as living on the street soon after. The question comes to mind: Why would anyone given the opportunity to enter a rehousing program not do so? 

Lettrich explains it like this: If someone has had a lot of trauma in their life, they most likely aren’t going to feel comfortable being in a shelter. Maybe something bad happened to them in a shelter before. Maybe they can’t stay with the people they care about if they go into a shelter. Or maybe they need to use substances to stave off withdrawal symptoms. The reasons are unique to the individual, therefore any care model that approaches a person with an idea of how they should behave will necessarily fail to help people who experience chronic homelessness. 

On top of social and historical reasons to refuse treatment, 61 percent of those who visited an emergency shelter or received care through street outreach answered “Yes” when asked if they had a substance use disorder. This could mean that they’d go into withdrawal during their time in a shelter or risk using alone. Since men and women are separated in most shelters, people in relationships are often split, and trans and gender non-conforming individuals may be subjected to shelter groups not in line with their identities. These are dangerous situations, so to some staying in the street, under a bridge, or in an abandoned building is a safer choice.

The weather in Pittsburgh in the middle of January can steal your breath and make you marvel at the wonders of nature better than the Youghiogheny can. Some mornings, the sky is clear enough to see the sun rise low behind the city, but most days are grey enough to turn even the most chipper person sour. Laura Drogowski seems an exception to this, as I meet her just as the weak sun sets on a January afternoon. As the critical care initiatives manager for Mayor Peduto’s office, Drogowski helps coordinate human services for vulnerable city residents. Because the city is just one of 140 municipalities in Allegheny County, the county’s robust Department of Human Services is tasked with serving roughly a quarter of the total county population just within city limits. 

Drogowski said she works “on a general human services platform. In the city, that’s substance use, homelessness, advocacy for people with disabilities, food security, wellness,” and veterans who need assistance. That means everything from resolving 311 calls from concerned community members about someone who has been sleeping outside to making sure curbs are accessible for those using mobility aids, to devising programs like PORT, or the Post Overdose Response Team.

The Post Overdose Response Team works to reduce fatal overdoses by connecting those who have overdosed before with a community medic, who “works with a trauma-informed care model… from a harm-reduction perspective,” Drogowski said. That medic works to identify and resolve issues that person may be facing, like unstable housing, traumatic situations, and their overall health. Drogowski relates the concept back to work done by The Open Door, asking, “How are you going to take care of your underlying chronic condition? How are you going to address your potentially unsafe substance use when you don’t know where you’re going to sleep tonight?”

According to Drogowski, PORT is one program of many that’s making a difference. There were 266 overdose deaths in 2018, down from 737 overdoses in 2017 at the peak of the opioid epidemic. 

Since May 2018, the Narcan that Lettrich has distributed in the streets reversed 84 overdoses. Of those, only one person interacted with authorities through 911, so information about how they overdosed, where, and when were not recorded. In the first half of 2018, police departments in Allegheny County only reported 29 overdose reversals, meaning Lettrich’s direct connections and relationships with people in the streets are changing both the experience for those who might overdose and the data governments and nonprofits have to prevent overdoses going forward. 

The work by Prevention Point Pittsburgh has also resulted in prompt overdose reversals and safer needle use through its needle exchange, and ultimately, a dramatic reduction in deaths. Prevention Point also offers trainings, free Naloxone kits, and information about what pharmacies have a standing order for Naloxone.

Bridge to the Mountains, PORT, and Prevention Point Pittsburgh follow a harm reduction model, which Drogowski and others describe as “meeting people where they are but not leaving them where they are.”

“It’s helping people to do whatever it is they’re doing in the way that’s safest. And it’s recognizing that a person’s choices are their own choices,” Drogowski said.

In 2006, social worker Dana Davis and her colleagues were noticing that their clients living with HIV had trouble adhering to their treatment. One focus group, a case of wine, and a lot of courage later, they bought an apartment building and started The Open Door. 

The findings from the focus group were undeniable: people needed stable housing before they could consistently access treatment. In the 12 years since it began, the 14 apartment units have been supplemented by a Representative Payee care model, which helps people by taking their rent directly out of their income, dealing with landlords, and helping people access to food and medical care. Representative Payee ensures clients have full financial control, without some of the risks associated with that freedom. This type of harm reduction allows clients to use their money how they wish, but it prevents them from losing housing. These two approaches are housing first, but they include a strong social element that give clients a sense of community. 

Kaylee Shockley, a social worker who began working with The Open Door while she was still a graduate student at the University of Pittsburgh, said “it’s not just about the apartment itself, it’s about a greater culture and a family.”

“Even when individuals move on, we engage everybody over the history of the 12 years, so they can still very much be a part of our family.” 

They do this by hiring direct care staff for their apartment building who are peers with the residents; these people may have HIV, a history of substance use, history of arrest, or some combination of those things. The Open Door succeeds by not stopping at housing first, which Lettrich calls “a socioeconomic response to what is inherently, most often, not a socioeconomic challenge.”

According to the National Alliance to End Homelessness: “Housing First is a homeless assistance approach that prioritizes providing permanent housing to people experiencing homelessness, thus ending their homelessness and serving as a platform from which they can pursue personal goals and improve their quality of life”. 

For Allegheny county, it’s the only model supported by the Department of Human Services and the Allegheny Link, the first place those seeking housing assistance of any kind can go. 

After an initial self-resolution attempt, which can divert people experiencing housing instability to rent, mortgage, and utility assistance, a vulnerability assessment helps Allegheny Link determine the best program for the individual or family. After being placed on a waiting list, people who are staying in shelters, living in the streets, or in temporary housing programs can enter rapid rehousing.

Like The Open Door, these programs aim to keep people in contact with their social communities as best they can, and case management staff work with those in need of housing to create solutions that work for them. This can mean housing non-spousal partners and friends together as roommates so they don’t lose social support, or moving someone into close proximity to where they used to stay outside, to helping someone reconnect with family members who might be able to help. 

“There is not one county or city resource that I work with that I can think of that in any way poses a challenge for me. They’ve all been so helpful in serving our population,” says Lettrich. 

It was nine degrees on January 31 when I met Carol outside a Starbucks in Oakland. She had on a pair of sweatpants that rode up a bit when she sat on the ground, and her calves were pink and chapped from the cold. She sat directly under an outdoor light; a little pool to protect her from the cold night around her. The purple fuzzy gloves and sweatshirt she wore seemed insufficient to me, but she gripped my hand firmly when I shook hers, not shivering. Her cheeks were pink like her legs. She cheerily accepted my offer of help, but when my friend and I found an open shelter, she told me she didn’t need to go. “My friend is coming to get me,” she said. I asked if I could buy her a coffee, or anything, so she could sit inside and wait. She held up a large paper cup, “No, I’ve got hot chocolate,” she said. “Can we pay for your Uber to a friend’s house?” We volunteered our phones, hoping there was something we might be able to do. 

After sitting in some of Pittsburgh’s coldest weather, Carol accepted a little bit of cash, but nothing else. We walked away and I wondered if we’d done enough. Our winter boots crunched over the salted pavement; breath condensed on our scarves. On the way home, I thought about all the posts and tweets I saw that day: if you see someone outside, call 311. But calling authorities before you engage the person, who shares your community space, who might be choosing the weather over a traumatic shelter experience, did not seem like a solution.

Our instinct is to give only what we perceive as helpful, when really we need to take time to introduce ourselves to our neighbors and ask them what they need. Harm reduction and continuous care don’t start when a person first engages with Allegheny Link ( 1-866-730-2368, alleghenylink@alleghenycounty.us), but rather when their community engages them.

Author: Gabrielle Keane
Photographer: Maranie Staab (for black and white photographs), Will Halim (top banner photo) 

Editor: Alyse Horn-Pyatt
Web Producer: Will Halim