Ruben's Story
Part 1
We want to tell you about Ruben’s story for two reasons. First, we think you’ll appreciate getting to know a beautiful soul like Ruben, and second, because Ruben’s story highlights the incredible work our staff and agency partners do every day.
Ruben had lived on the streets along Ponce for as long as most of our Case Managers can remember.
He has records in the Atlanta homeless system that date back to 2010. Team Leader Franco says “he’s a gentle individual and he is easy to get along with. He might have his quirks, but he’s just minding his own business.” Case Manager Matthew shares, “everyone falls in love with Ruben as soon as they meet him.” Aftercare Specialist Tanya reports that Ruben is literally her favorite person and she gets out of bed in the morning because she knows she’ll get to see him that day. Ruben is a kind soul, and people in the community know him well. Business owners look out for him, Mercy Community Church is a big support network, and Case Managers from Intown and many partner organizations have been engaging with Ruben for going on a decade.
Working with clients like Ruben is Intown’s specialty. Our clients are those who all too often have fallen through the cracks of the homeless service system. We work with clients who have been homeless and unsheltered for a long time—more than five years on average, but sometimes ten, twenty, or even thirty years. Clients experiencing chronic homelessness require a different type of outreach and case management and that’s what we do best.
Your gifts today go to support our Homeless Outreach work. Our team of 16 dedicated outreach staff meet clients where they are and take the time to walk alongside them on their journey to ending their experiences of homelessness. Sometimes it takes weeks or months. And sometimes, like with Ruben, our work takes many years. Join us today as we follow Ruben’s journey from engagement to enrollment to navigation and finally to ending his homelessness this past year as he got his own home.
Part 2
The first step in ending homelessness is engaging someone, getting to know them on their own terms. Sometimes, our clients are already engaged with a trusting community, like our partner Mercy Community Church.
Pastor Brittany from Mercy Church knows Ruben well. She reflects about Ruben:
Since the beginning of our community, Ruben has been a vital and consistent member of our church. He used to sleep downtown and would walk all the way across town to come to Mercy every day. Ruben can be quiet, but he is always engaged in his own way.
Being a part of this community so obviously matters to him, and we can count on him as much as he seems to count on the rest of us.
One of my favorite memories of Ruben in our community is the time he quietly asked if he could hold my baby girl soon after she was born, and his delight that I let him. It was such a beautiful image of Ruben's loving heart. Another favorite memory of Ruben in our community is his love of art--he is always excited to participate in our art classes and has lovingly created many beautiful things. He also loves music, and you can often see him humming, smiling, and tapping along to his favorite songs. I love how being at Mercy Church is a part of his routine in a way that allows people to really know him, love him, and watch out for him consistently. This past year when our community was allowed to host people on the outside grounds of a partner church, Ruben found stability (before he was in housing) by sleeping alongside his fellow members in a place where people watched out and cared for him.
Ruben's story is probably one of the best examples I have for why community matters. Ruben has found stability and love in coming to his community every day. What he found here was belonging, love, and support. He laughs at other members' jokes. He knows if he needs a blanket, something warm to wear, or something to eat he can find it there. He talks to us about his likes and dislikes and shares pieces of his life and story with us. It is a place where his case managers know they can find him consistently. Everyone knows his name. Everyone engages with him. This kind of knowing, noticing, and being there for one another matters, and our community is blessed that Ruben has found that with us all these years.
Our community partners are integral to our work! Before we even began to engage with Ruben to end his homelessness, Ruben was known and loved by our partners at Mercy Church. The trust Ruben had in the Mercy Church community was key to our work over the past five years. Knowing that Ruben would be at Mercy Church consistently allowed our Case Managers to create a structure and an opportunity for consistent engagement with Ruben, and with so many other clients like him.
Your gifts today support our Case Managers and allow them to be flexible in their outreach work, spending time with clients and with their communities of support. Relationships with programs like Mercy Church help us support clients with their everyday needs, spiritual needs, and connectional needs as we work to engage, enroll, navigate, and house them.
Part 3
Intown’s Outreach Team Leader Franco met Ruben in 2017. Ruben was one of Franco’s first clients and helped Franco to understand the breadth and depth of barriers to housing stability for folks experiencing homelessness.
Our case managers engage for as long as it takes a client to be ready to move toward housing.
For clients like Ruben, sometimes this takes years of trust building.
Intown calls this phase of outreach the “Engage” phase. In Intown’s model, Engagement can be as short as one or two meetings, or as long as several years, with an average of 3 to 6 months. Many of our clients have been told “no” so many times over the years that they really don’t believe the “yes” that comes from our team. When we say we’re going to come back next week with a hygiene kit, snack pack, and a bus pass, many clients don’t expect us to follow through. When we do follow through, again and again, people begin to believe that we really will be there to walk through the process with them.
Ruben was a man of very few words when Franco met him, and typically declined any services. Ruben had been telling everyone that his parents are coming to pick him up any day now for a decade, despite no one ever having met or contacted the parents. After a year of engaging with Franco, Ruben started to trust him. Franco explained to him that he should be eligible for disability income and insurance. The idea of having his own money motivated Ruben to enroll in Intown’s outreach program. While he continued to decline services to lead to housing, Ruben was willing to work with Franco to obtain his identifying documents, knowing that that could lead to income. However, Ruben couldn’t remember his date of birth, where he was born, or his parents’ names.
During this time, the team at Intown continued to address Ruben’s everyday needs and to engage with him on a frequent basis. Intown Case Managers continued to ensure that Ruben was fed and had access to medical care through our partners on the Mercy Care Street Medicine team. It took another year and a good deal of sleuthing, but eventually Franco was able to help Ruben obtain his birth certificate and Social Security card.
Your gifts today allow our Case Managers to be consistent. Your gifts help us to pay for staff and for hygiene kits, snack packs, bus passes, and other items. These life essentials help us to develop a trusting relationship with clients as we engage with them for as long as it takes.
Part 4
Barriers to exiting homelessness take many forms: back due bills, mental health issues, physical health problems, or addiction. But the most common barrier to ending homeless for an individual is a lack of documentation. For many housed people, getting a birth certificate, ID, or social security cards is a minor bureaucratic hassle. For someone like Ruben, it can be an extremely complicated and a Herculean task.
Almost all clients experiencing chronic homelessness are missing at least one of these documents. Ruben didn’t have any of them.
When Franco started working with him, Ruben didn’t know his birthdate, parents’ names, or where he was born. These are the standard questions asked to begin the process of ordering a birth certificate. Franco was at a dead end, but we don’t give up easily. Franco was able to have a background check run that gave him enough information to piece together Ruben’s identity. With new information, we filled out the application for a birth certificate. But the applications were denied multiple times and Franco didn’t know why.
Soon after, a new Case Manager joined our staff. Through connections, this new staff member was able to get in touch with a contact at Vital Records, and learned that Ruben’s legal name was different from the name he was using. This error caused months of delay, but we were finally able to get Ruben’s birth certificate. With his birth certificate in hand, his Social Security card application quickly followed.
Your gifts today allow our Case Managers to pay for Birth Certificate applications, State Identification Cards, and labor-intensive research that help us ensure our client are overcome the documentation barrier to housing.
Part 5
In addition to working with our Homeless Outreach team, Ruben has been a guest at Intown’s Food Pantry for years. Since the pandemic began, our food pantry has more than quadrupled our food output.
Ruben had been visiting the Food Pantry regularly and since the beginning of the pandemic, he now comes every week.
The staff and volunteers of our Food Pantry have been another connection point for Ruben. Pre-pandemic, our food pantry operated on Saturday mornings with a hot meal and coffee and time for clients to shop in a grocery store style setting.
Ruben appreciated this community space and came early to get coffee and breakfast. A volunteer typically shopped with him in the pantry, helping him to navigate the space.
As the pandemic began, Ruben was beginning to communicate his needs more readily. He was able to adapt to the new food pantry model and continued to utilize the resource. Ruben enjoys thinking through what fruits, vegetables, and baked goods he might be able to enjoy with our volunteers at the pantry each week.
The Food Pantry has also been able to help ensure that Ruben has access to hygiene supplies, warm coats and blankets, and other items. When household and personal care items are supplied to our neighbors, it helps to decrease food insecurity. Guests use the pantry as a consistent food source, freeing up their budgets to afford other life necessities.
Your gifts today help us to operate our food pantry at greatly increased capacity for guests like Ruben. Your support helps us purchase food, household and hygiene supplies, and other items from the Atlanta Community Food Bank and other sources.
Part 6
Long-term relationships are critical to move someone off the streets into supportive housing. As we assess and enroll people in our program, we identify the barriers to permanent housing, like lack of ID and other documentation.
Our Case Manager Matthew met Ruben in 2017 while he worked for the Mercy Care Street Medicine Team, our close partner agency. Alongside Franco, Matthew and the Street Medicine team worked to give Ruben support for over a year but, but he always declined medical and mental health care.
Matthew and Franco and the team kept coming back, knowing that building rapport and consistency make such a difference with a client like Ruben.
Last fall, Matthew joined the Intown team and continued the work that he had begun with Ruben at Mercy Care.
One day this spring, a stimulus check arrived at the Intown office, addressed to Ruben. Matthew told Ruben that he could take him to cash that check, but Ruben needed a state issued ID to do that. With his Birth Certificate in hand, Matthew took Ruben to Drivers Services, got his first ID ever (!), and took him to cash his stimulus check.
IDs are essential not only for cashing checks, but for getting into housing. IDs, Birth Certificates, a social security card and a Disability Verification form are the four required documents to be considered “document ready” for supportive housing. It takes weeks to months to secure these documents. After more than three years on our caseload, Ruben got all of his documents and became “document ready” for housing!
Your gifts today help fund transportation to Drivers Services, pay for ID cards, and allows our team to complete paperwork and assessments in the field with hotspots and mobile workstations. Your support also pays for our amazing Assistant Director of Outreach who completes disability and mental health assessments with clients outside, where they live.
Part 7
Our next team member to assist Ruben was Intown Aftercare Specialist Tanya. Tanya met Ruben her first week at Intown last year. She shares that Ruben didn’t know how to advocate for himself, and was very quiet. He rarely answered more than yes or no, and typically only talked to people that he had known for a very long time. Over many months, Ruben got used to Tanya and warmed up to her. Tanya says that he didn’t allow many people to get to know him, so she was excited when he began interacting with her.
With support from Matthew, Tanya, Mercy Church, and the Mercy Care Street Medicine team, by 2021 Ruben had become more verbal, sharing what his wants and needs were, and beginning to blossom. He began talking more with his friends, responding to “Good Morning”, and saying “I want my own place”.
This was the first time in all the years of our team working with him that anyone had heard Ruben mention interest in housing!!!
Once Ruben received his ID, he had all the documents needed to be eligible for Permanent Supportive Housing – housing for people experiencing chronic homelessness. Clients can stay in Permanent Supportive Housing forever and their rent is a fixed percentage of their income. Units are managed by a dozen nonprofits in the city, with support staff on-site.
We placed Ruben on the City of Atlanta’s housing queue, a prioritized list of every person experiencing homelessness who is waiting on the next available home. On average, our clients wait 5 months on the housing queue before their apartments is available. Clients like Ruben, who have been on a case load for many years, are given a higher need score and can more quickly move to the top of the queue.
Your gifts today help Intown to enroll and navigate clients into our program on their way off the streets. Your support helps us provide continued staff engagement, MARTA passes, our wheelchair van or other transportation to appointments, warm clothing, coats, and shoes, and other items needed while a client waits for housing to become available.
Part 7
Our next team member to assist Ruben was Intown Aftercare Specialist Tanya. Tanya met Ruben her first week at Intown last year. She shares that Ruben didn’t know how to advocate for himself, and was very quiet. He rarely answered more than yes or no, and typically only talked to people that he had known for a very long time. Over many months, Ruben got used to Tanya and warmed up to her. Tanya says that he didn’t allow many people to get to know him, so she was excited when he began interacting with her.
With support from Matthew, Tanya, Mercy Church, and the Mercy Care Street Medicine team, by 2021 Ruben had become more verbal, sharing what his wants and needs were, and beginning to blossom. He began talking more with his friends, responding to “Good Morning”, and saying “I want my own place”.
This was the first time in all the years of our team working with him that anyone had heard Ruben mention interest in housing!!!
Once Ruben received his ID, he had all the documents needed to be eligible for Permanent Supportive Housing – housing for people experiencing chronic homelessness. Clients can stay in Permanent Supportive Housing forever and their rent is a fixed percentage of their income. Units are managed by a dozen nonprofits in the city, with support staff on-site.
We placed Ruben on the City of Atlanta’s housing queue, a prioritized list of every person experiencing homelessness who is waiting on the next available home. On average, our clients wait 5 months on the housing queue before their apartments is available. Clients like Ruben, who have been on a case load for many years, are given a higher need score and can more quickly move to the top of the queue.
Your gifts today help Intown to enroll and navigate clients into our program on their way off the streets. Your support helps us provide continued staff engagement, MARTA passes, our wheelchair van or other transportation to appointments, warm clothing, coats, and shoes, and other items needed while a client waits for housing to become available.
Part 8
The ultimate goal of our outreach work is to end homelessness for every single person we meet. Three months after becoming “document ready”, Ruben’s number came up on the housing queue and he had an apartment waiting for him! When move in day arrived, Ruben was hesitant. He said, maybe next week. Matthew and Tanya recognized that after more than ten years sleeping outside, it was going to take patience and consistency to get Ruben comfortable with sleeping inside again. The first day, Matthew just worked with Ruben to sign the lease and to go see his apartment.
At first, Ruben didn’t want to sleep at his apartment. Since then, Ruben has spent more and more time at his home. He’s eaten meals in the dining room and at the table in his apartment. He has now paid two months’ rent out of his social security check. He knows how to get a money order and pay his rent.
One day last month, Ruben decided he was ready to stay the night, and for the first time in at least a decade, woke up in his own bed, in his own home!
Your gifts today help Intown helps end homelessness as clients move into their own home. Your support helps pay for security or utility deposits, furniture, or home goods like pots and pans, dishes, linens, and cleaning supplies. Intown works with each individual client to ensure they have what they need to be successful in their new home.
Part 9
Once we work with a client to move out of homelessness, we want to make sure they thrive in their new home.
Tanya continues to work with Ruben and is providing regular aftercare checks. They are working on life skills like money management. Matthew comes to see Ruben at least once a week at his apartment. They’ve started listening to music together - Ruben likes to listen to soul music. Ruben still spends his days with his community at Mercy Church and utilizes the Intown Food Pantry almost every week.
Tanya’s position is fairly new to Intown. We recognized that many of our clients moving into housing need ongoing support and skill building. Because our program is so relational in nature and so many of our clients have developed rapport with our Case Managers, we’re excited to be able to offer this aftercare support where it is needed.
Your gifts today help us to ensure that when homelessness is ended for our clients, they don’t fall back onto the streets. Your support helps us provide aftercare when it is needed for our clients that are at the highest risk of ending up homeless again. Tanya is able to check on Ruben every day and to help him learn the skills he needs to maintain his stability because of support from friends like you.
Part 10
Ruben is one of over 500 people our team has moved off the streets into permanent housing over the past five years.
Ruben’s story gives you a glimpse into the work our team does week after week, year after year, to end homelessness.
Ruben’s story captures the trust and commitment of our team as we engage, enroll, navigate, and house our clients we meet on the streets.
Matthew says that Ruben’s story is also proof that people are incredibly resilient. It took four years for Ruben to trust Matthew enough to transport him. He still won’t ride with Tanya, but he is excited to see her every morning. Tanya says that he has grown so much this past year.
When asked what makes Ruben her favorite person, Tanya responds:
“his smile. He’s very respectful. He always responds to good morning. I just think he’s the coolest guy. When he walks, it’s like he’s strolling. He’s very social now: all of his friends can see the differences in him. He’s one of the reasons that I get up in the morning. Knowing that he’s ok. He’s getting better daily. Every day you can see some change in him.”
Your gifts today help give hope to our neighbors like Ruben. It truly takes a village to help a client who has experienced years of homelessness. Franco, Matthew, and Tanya from our team, and so many others from partner agencies, worked together tirelessly over the years to make sure that Ruben was safe, cared for, and part of a community. For a long time, housing didn’t seem like something we’d ever see for Ruben. But years of consistent, ongoing engagement helped to change that. We believe that each and every person deserves to be housed and is capable of moving into housing. Your support helps us to get out there and walk along that path with Ruben and every client we meet.
