City program employs homeless people to help promote vaccinations in shelters and on the streets
The D.C. government hired 55 shelter residents this spring and summer to help promote COVID-19 vaccines among people experiencing homelessness and dispel misinformation surrounding the coronavirus. Similar to national trends, D.C. vaccination rates in the homeless community have plateaued. The District is hoping for a second push now to increase that rate.
D.C.’s Department of Human Services hired the first peer educator cohort of 26 to work for six weeks from early February through mid-April. After the program’s initial success, DHS commissioned a second round from June to September, with 29 peers hired. The peers are distributed across five men’s and women’s low-barrier emergency shelters: Adam’s Place, New York Ave, 801 East, Patricia Handy Place for Women, and Harriet Tubman.
Dana Relue, who is a resident at the Harriet Tubman Women’s shelter, is a member of the program’s current cohort. When DHS employees first came to the shelter to interview potential candidates for the program, she was not sure what the peer educator program would entail.
After being hired, Relue explained the peers go through a five-day training with medical professionals to learn about COVID-19, vaccinations, and ways to inform against common misconceptions. “The idea is that sometimes hearing this information comes better from peers, someone who you are living with on a daily basis, rather than a doctor or nurse or who comes in once,” Relue said.
Now, outreach in shelters involves one-on-one peer engagement, with each peer educator assigned a number of shelter residents to speak with. The program also runs group activities, where educators run programs, like COVID-19 bingo, to inform residents about how to stay safe and encourage them to get vaccinated.
While the educators encourage mask-wearing and social distancing, Relue pointed out that vaccinations are especially important for a congregate living environment. “I feel that every person’s life matters,” she said. “You can make everyone wear a mask, but you still don’t get the safety you would get if you were living on your own. If people are vaccinated, that takes some of that worry away.”
According to the Centers for Disease Control, individuals experiencing homelessness are at an increased risk for severe illness from COVID-19 because the population skews older and is more likely to have underlying medical conditions. One in four unhoused D.C. residents have a chronic physical health condition and 37.8% are over the age of 55, according to a recent District survey.
COVID-19 initially spread quickly though D.C.’s congregate shelters. To offer housing for immunocompromised individuals particularly susceptible to the coronavirus, the city took advantage of federal emergency funds. Those funds helped D.C. launch the Pandemic Emergency Program for Medically Vulnerable Individuals (PEP-V) to shelter people experiencing homelessness across four hotels in non-congregate settings. PEP-V offered housing for up to 800 residents at its height. The program was scheduled to end in September despite currently housing over 500 people.
Earlier this month, the federal government extended financial support for programs like PEP-V through Nov. 30. DHS said in an Aug. 10 email to Street Sense Media that it “will operate PEP-V beyond September 30. However, as people who are currently staying in PEP-V exit to housing, the District may consolidate some of the locations … The recent influx of emergency housing vouchers, combined with local resources allocated to end homelessness in D.C., will provide permanent housing solutions for over 70% of current PEP-V residents.”
In its initial vaccination rollout plan last November, city officials classified D.C.’s unhoused residents as one of its highest priority groups once vaccines became available, following health care workers in hospital, outpatient, and group living settings, plus fire and EMS. As a “Phase 1B” demographic, unhoused and transitional housing individuals were targeted alongside nursing home residents, childcare providers, law enforcement, and educators. The report originally estimated 6,500 District residents were unhoused or in transitional housing, though a January point-in-time homelessness survey revised that count downward to approximately 5,100 residents total.
Approximately 39% of in-shelter residents took the shot when vaccinations became available in March and April, according to Relue. The vaccination rate has increased since then but plateaued, with approximately 47% of D.C.’s unsheltered population fully fully vaccinated as of July 27, according to Madeleine Solan, a policy analyst at DHS. The reported vaccination rate comes from DHS vaccination events as well as clinics with Unity Health Care. 55% of District residents as a whole are fully vaccinated as of August 9, according to coronavirus.dc.gov.
After the spring cohort, 70% of the peer educators did an assessment to gauge future employment opportunities with trainers, and 5 out of 26 reported a job interview or new job following their vaccination work. D.C. compensates the peer educators with a stipend and prepaid cell phones. At the end of the program, they keep the phones but must pay for their own plan thereafter. According to Relue, the program has also paired her with employment opportunities and having a phone is extremely helpful for applying to jobs and getting in contact with social workers.
In addition to vaccine encouragement within shelters, the peer educators program includes street outreach, with groups of educators going to tent encampments to offer transportation to vaccination sites.
Kirk “Scooby” Ellis, who previously experienced homelessness, helps lead the DHS outreach team. “We aren’t going to beat you over the head with the vaccine and say you have to get in this van, because that never works. We just give as much information as possible.”
In order to vaccinate residents experiencing homelessness, the DHS partnered with the nonprofit Unity Health Care to host mobile pop-up vaccination clinics in locations such as Miriam’s Kitchen, Marvin Gaye Park, and So Others May Eat. According to a Unity press release in March, its clinical staff had hosted two educational town halls and vaccinated more than 1,200 unhoused residents.
According to Ellis, the outreach team transports people to vaccination sites, waits for them, and takes them back to their tents. “That way they don’t have to worry about bringing stuff with them because they are walking around with their whole lives with them,” he said.
Ellis and Relue explained common questions and misconceptions people have about vaccinations.
Media reports about the Johnson and Johnson vaccine being dangerous, as well as stories about “breakthrough cases” of people who got vaccinated but still got COVID-19, create misconceptions about the vaccines. “There are different news stories about the virus every single day, scary stories about Johnson and Johnson or someone dying,” Relue said. “That has been one big issue, trying to combat misinformation.”
D.C.’s coronavirus website estimates that only 0.18% of vaccinated residents contracted COVID-19 and only 2.38% of those cases resulted in hospitalization. Taking both shots of COVID-19 vaccines makes you less likely to have severe symptoms, require a hospital stay, or die, according to the CDC. The vaccines available in D.C. are free and help protect you against new variants of COVID-19, as stated in research cited by that same disease research center. Deciding to get a vaccine doesn’t just protect yourself, or affect you, as multiple studies collected by the CDC last month show that a vaccinated person is less likely to transmit their “breakthrough case” to others — or, if they do, it will spread to fewer people.
Relue also attributes apathy to delays in the vaccination rate within D.C. shelters. According to her, if people haven’t gotten sick so far, some might think they do not need the vaccine. Others prefer not to discuss their vaccination status with the peer educators.
For the outreach program, Ellis explained that the DHS team is often asked to come back on a different day for transport to sites, but it can be difficult to locate people. “We will go back three or four times. When working with homelessness, a lot of people are having a bad day. It’s like going to someone at their work. They are trying to scrape up money or get settled into a location, so they ask, ‘Can you come back?’” Ellis said.
And when people do agree to be transported to vaccination sites, long delays make it harder. Ellis said some pop-up sites do not open up until noon, or will open up after advertised, meaning that people will need to wait for hours in the heat before getting their vaccination.
Despite challenges to the program, the peer educators are seeing success. The first cohort is estimated to have engaged with 400 people, based on final evaluations when their employment concluded. It held 29 listening sessions across shelters, and 100% of participating shelter manager’s reported that vaccination rates increased following the first cohort.
That success has continued with the second cohort.
“I am feeling optimistic,” Relue said. “We had our first listening session at the shelter and had a lot more people than I expected to come, and a lot of people interested in talking about COVID-19 and vaccination.” While she says that there are still many people distrustful of the vaccines, there has been a positive change.
Both Relue and Ellis said the peer educators participate in the program because they genuinely want to inform their fellow residents or people experiencing homelessness.
“Everybody in the cohort — it’s about caring about people,” Ellis said. “It’s because they really, really, really want to help.”
John Woolley contributed to this report.
The article has been updated with the correct spelling of Dana Relue’s last name.