Jay Levy and I both have books published by Loving Healing Press. I have known and admired him since editing his first book in 2010. For him, compassion, respect and decency are automatic, intuitive reactions. Rather than judge behaviours like addiction, he reacts to them as requests for help, and he offers that help.

Our task for November is to interview a fellow author. This is why I have chosen Jay.

Jay, first tell us a little about your work with homeless people

Flashing back in time to the 1980s, homelessness was skyrocketing in the US across our major cities. Back then, I was a young man living in Brooklyn, NY and the reality of homelessness was on my doorstep. Everywhere I went, I would come across people without homes and began to wonder how this could happen in such a prosperous nation. At first, I gave people spare change on my way to attending social work classes at Columbia University. Soon thereafter, I became interested in people’s stories and made some efforts to get to really know my homeless neighbors. From there, it didn’t take long for me to seize the opportunity to get a Social Work degree and a professional job that empowered me to reach out to them. Little did I know back then that directly addressing housing and homelessness concerns would become my career focus for 40 years or so.

My work began as an Outreach worker in various urban settings. It began in NYC for the Manhattan Bowery Corporation, and from there I worked in Boston for over a decade providing both housing and outreach services on the streets and in shelters for vulnerable adults without homes who had experienced significant trauma and loss while having multiple unmet needs. From there, I spent the last 25 years living and working in western Massachusetts, where I had the privilege to work with folks who lived in the woods and had the courage to welcome me and share their personal stories. To this day, it amazes me that those who appeared to have so little were willing to trust me and connected in such a meaningful way. I truly believe that homelessness is a microcosm of the human condition and I am honored to get to know folks who are so real and not at all pretentious. It truly is a gift and I find it important to share the lessons I have learned along the way. It speaks to the power of the human spirit!

Over the past 20 years, my focus has been more on coordinating and consulting with outreach teams, shelters, and Housing First Programs. Similarly, I have felt honored to meet and really get to know so many people who have taken up the calling of reaching out to those in need. Rather than supervision and overseeing programs, I like to think of it as co-vision and joining people on their quests to help others.

Lastly, I have published several books on the subject and I thank you for your editing services that have been a great help in getting these various book projects together and sharing their important message with the public. It seems to me that we are kindred spirits in regard to our compassion and quest to help others, which piques my curiosity about your humble beginnings in the field of human services.

So, you were already a social work student when you became interested in homelessness. What got you to choose that profession?

Well… Homelessness was on my doorstep, so it made sense for me to try and make a positive difference in that area. Once I got to know some of the folks who were out there, I discovered that most had experienced a great deal of compound trauma, and yet beyond simply trying to survive, people had created a sense of meaning and/or purpose. At first this surprised me, as the popular narrative around homelessness was that folks were simply choosing this way of life and that we should just let them be. It didn’t take long for me to see that this narrative was simply wrong. Once I engaged with folks and really got to know them, it became clear that the vast majority would accept assistance, if it was done in a respectful manner that was in line with their values, as opposed to just telling them from a place of power that they could or should do better.

So, I think it became my profession because I love taking on a challenge to help those that others believed were either undeserving or somehow beyond our help. Early on, I discovered that people without homes genuinely welcomed my presence and I began to witness positive change by simply instituting a person-centered approach to outreach. It felt right to me and I derived a deep sense of meaning from going on a journey with folks to achieve greater stability, while promoting access to affordable housing. This was exciting grass roots work where I got to meet folks from all walks of life and at the same time really learned about the vast and diverse system of helpful resources and services. I became an interpreter and bridge builder to provide greater access.

Hmm… to use a cliché, we have a chicken and egg situation, but I won’t pursue that. From your books I know that over the years, “Housing First” has been a major contribution of yours. Did you invent the concept, or learn it from someone and then championed it?

Let me first provide a little context. Back in the 1980s, the Housing First Model was not yet formalized. Nevertheless, any outreach counselor worth salt understood the need for rapid access to affordable housing with ongoing support services for the most vulnerable amongst us. So, we would often place folks into housing who were not yet ready or willing to begin treatment and then follow up with housing support services directly from our outreach teams. Once housed, we were able to encourage contemplation of nursing care and other services including psychiatric, self-help groups, and day programs such as NYC’s Fountain House program (MH Clubhouse model) adding to ongoing support and providing treatment alternatives. Though we respected that it was their choice, and not required before getting housed. The only exception was for folks who required immediate hospitalization for acute medical, psychiatric and/or addiction issues. The alternative to our Housing First approach is that people would be left homeless and extremely vulnerable to hospitalization and/or ending up in prison, or even a worst outcome of premature death. All of the formal housing programs that we could refer people to during that time required folks to be in treatment first, and thereby tragically considered the folks who were often most at risk ineligible for their services.

Now to directly answer your question, Dr. Sam Tsemberis is considered the founder of the Pathways to Housing Program in NYC and he popularized Housing First (HF) across the US and internationally via the Pathways Model. Dr. Tsemberis formalized the HF Model by1992 researching it extensively and laying out its key principles. The research by him and others quantified that HF programs perform better than other residential support programs at housing retention, while significantly reducing the frequency and high costs of emergency services and hospitalization for people who are homeless long-term with major mental illness as a primary diagnosis (addiction was often a secondary diagnosis to mental illness). Studies by Dr. James O’Connell and others (2003, 2005) also confirmed that people who were sleeping rough for 6 months or more and fell into various categories such as have had a history of Frostbite, Hypothermia, or Trench Foot, 3 or more ER visits or hospitalizations in the past year, or had a tri-morbid diagnosis of Mental Illness, Addiction, and Medical Concerns, amongst other categories indicated a high risk of premature death. The average age of death was 47 years of age. 40% of folks who fell into these categories died within a 5 year period.

Over the last 25 years or so, I’ve been an advocate for HF through my writings and have provided some innovation to the support services offered by integrating in Pretreatment principles of care. In addition, I’ve rolled out new HF programs that utilized my design of a REACH Model to better support the transitions from outreach services to housing stabilization. This is done by having a team approach to outreach that includes workers that can eventually provide ongoing support services once the person is housed. This means less transitions to new people and programs for those who had experienced extensive trauma and loss, and thereby had some difficulties managing new relationships.

Right, Jay, now we come to it. How did you come to write your first book? Tell us a little about it

The experience of doing homeless outreach throughout the 1980s and 90s brought me in direct contact with many people either being denied entrance to both treatment and residential programs or refusing to give it a try. They therefore remained at serious risk due to continued homelessness, while not addressing serious mental health and/or addiction issues. In response to this dilemma, I began to research and read the latest information on homelessness via human service journals, as well as share and compare what worked in the field with other outreach workers. Most importantly, people without homes often gave me direct feedback as to what services, resources, and interventions were most effective.

Through my writing, I was able to better process and integrate these new insights with clinical approaches from my direct practice experience and with ideas from my educational background of philosophy, psychology, and social work. This created an evolving wisdom that after several years began to bear fruit. Even though my writing was initially fueled by anger and frustration at the state of homelessness and the lack of a humane response, I quickly came to realize the power of the pen.

I first introduced a Pretreatment model and its five guiding principles by publishing several case studies via Social Work journals (1998-2004). This became the basis for my first book (2010) Homeless Narratives & Pretreatment Pathways: From Words to Housing. It shares people’s stories of survival, meaning making and overcoming of homelessness, while providing a Pretreatment approach for helping those who are most in need. Homeless Narratives & Pretreatment Pathways has been recommended by the National Alliance to End Homelessness, the National Coalition for the Homeless, and the Massachusetts Housing and Shelter Alliance, and by internationally renowned author and researcher Dr Jim O’Connell, Director of Boston’s Health Care for the Homeless program, amongst others.

How many books are you author or joint author of? Do they form a logical series? If so, how?

In total, I have authored 6 books that I categorized into three pairs. So, my first book primarily focuses on outreach with unaccompanied homeless adults, while the second book of that pair is Pretreatment Guide for Homeless Outreach & Housing First (2013). It expands the focus to outreach and Housing First with unaccompanied adults, couples, and youth.

The second pair is composed of books to assist with staff training for human service professionals on how to integrate Pretreatment into their practice. In 2011, I wrote a brief guide for housing and homelessness staff entitled, Homeless Outreach & Housing First: Lessons Learned. This was followed by an interactive workbook published in 2021 entitled, Pretreatment In Action. This book provides a whole host of exercises and case illustrations followed by questions for the reader to ponder and answer to enhance their learning process. Both books are about integrating person-centered work that is based on a common, goal focused language between practitioner and client.

In many ways, I am most proud of the two books I co-authored with a little help from my colleagues in the US and UK. In 2014, Pretreatment Guide for Homeless Outreach & Housing First (aka: The Yellow Book due to its yellow cover) was given a very positive review in a UK Human Service Journal. This led to the editor of the journal contacting me and over the years we communicated via the internet and by in-person visits to understand and explore our mutual human services systems of care, and in particular the housing and homelessness sectors. During this same period of time, Pretreatment became accepted and practiced in the UK, while continuing to spread throughout the US. This ultimately led to two collaborative book projects with several US and UK authors as follows:

Cross-Cultural Dialogues on Homelessness: From Pretreatment Strategies to Psychologically Informed Environments (2018)

Pretreatment Across Multiple Fields of Practice: Trauma Informed Approach to Homelessness and Beyond (2024)

Cross-Cultural Dialogues on Homelessness shares various stories of people sleeping rough in the US and UK, while providing helpful guidance through state of the art approaches that are utilized in both countries including, but not limited to Pretreatment, Open Dialogue, Appreciative Inquiry, Solution Focus work, Psychologically Informed Environments and Trauma-Informed Care. Pretreatment Across Multiple Fields of Practice tells the success stories of practitioners utilizing Pretreatment in a variety of service environments with a wide range of people in need of assistance. This includes Special Education in our schools, Street Medicine and outreach work, various residential settings, and even as Pretreatment Therapy to help prepare people for more formal counseling to address issues of significant trauma and loss.

You co-authored your latest book with your wife, didn’t you? Finally, tell us about this one

My wife, Louise Levy, is the co-editor for my latest book. Louise has had a successful career in education and she was instrumental in reaching out to a fellow teacher Ginny Bilz to write a chapter on Pretreatment and Special Education. Further, Louise assisted Ginny in both the formulation and editing of her work. Throughout all my years of writing, Louise has always been there to be not just a soundboard for my ideas during our long walks, but also to provide valuable feedback throughout the creative process. For this collaborative project, Pretreatment Across Multiple Fields of Practice, Louise read through the various drafts submitted by all of the authors to provide feedback on whether the ideas we were trying to communicate were complete and clearly written.

What is different about this project is that applications of Pretreatment across multiple systems of care have matured and are now widely utilized. This sets the stage for practitioners and others to tell their stories directly from the field. Some of the notable contributors are Dr. Jim Withers, Director of the Street Medicine Institute, Matt Bennett, renown Motivational Interviewing trainer and author of Connecting Paradigms, as well as Robin Johnson, founder of Psychologically Informed Environments movement in the UK, as well as John Conolly who authored a chapter on the impact of Pre-treatment Therapy throughout London and the UK. I am extraordinarily thankful to all those who have contributed to make this book possible.

Jay, what is the next project?

Loving Healing Press is getting ready to launch a new edition of Pretreatment Guide for Homeless Outreach & Housing First: Helping Couples, Youth, and Unaccompanied Adults (2013). It is my best-selling book. It has sold several thousand and is referred to in the UK, and especially in London, as ‘The Yellow Book.’ In addition, I remain active in the field of Housing and Homelessness services providing consultation, supervision, and presentations for various non-profits and charitable organizations throughout the US and elsewhere. If people have any questions or thoughts to share, I can be reached at my email:
Jslevy34@gmail.com