‘Signs of Humanity’ Return to Life

It has been more than two years after the compelling “Signs of Humanity” project and exhibit showcased the work of public health and medical students, faculty and researchers that brought into stark focus the experiences and emotions felt by Philadelphia’s unhoused.

That project—led by Dr. Rosie Frasso, public health program director in the Jefferson College of Population Health (JCPH) and artist, advocate and Southern Methodist University professor Willie Baronet—centered on purchasing signs from the unhoused and interviewing them about their experiences “panhandling” and living on the streets of Philadelphia.

Multiple aims of the project included bringing Jefferson students out of their comfort zones by engaging them in field research, starting a conversation about poverty, exploring and reducing dehumanization and populating an art exhibit to educate others.

It clearly accomplished all those goals and more.

The first paper from Dr. Frasso and her team of student authors—titled “Even a Smile Helps: Exploring the interactions between people experiencing homelessness and passersby in public space”—has been published in the International Journal of Social Psychiatry.

According to the paper, a team of Jefferson researchers, MPH and MD students (now alumni) along with Baronet purchased about 100 signs and interviewed 41 people over the course of one week in July 2018.

Those interviews covered the “lived experience of people in need here in Philadelphia, including their interactions with passersby, their opinions about how money collected is used by their counterparts, their experiences with housing insecurity and their perception of how the opioid crisis has effected them. The signs they carry point to common hardships such as housing and food insecurity and substance abuse disorders, however, they do not tell the complete story.”

Among the insights learned from these interviews:

• Participants described being ignored and subjected to violence, leading them to crave meaningful interaction with passersby.
• They described experiences of receiving kindness and support while panhandling.
• Many shared personal histories of tragedy and called for greater empathy and compassion from passersby, as well as society as a whole, for people experiencing homelessness.

“Participants’ experiences were consistent with loneliness, as characterized in the literature as distress at lack of social connection and were also notable for the verbal and physical violence endured in public spaces,” the paper concludes. “Social isolation and trauma are detrimental to mental health in this vulnerable group, so interventions to support this population should provide opportunities for consistent, supportive social connections and focus on providing low-barrier, stable housing.

“The findings of this study lend support to providing stable housing as a strategy to improve the health of those who are unhoused. This strategy would remove them from the emotional and physical abuse and social neglect associated with living on the streets.”

The effort doesn’t end with this publication. Dr. Frasso and the team are currently working on a paper delving into what the field experience meant to students and how it impacted their career trajectories.

“Additionally, we have always planned to get back in touch with people who attended the exhibit to ask whether it changed the way they interact with people they pass by on the street,” says Dr. Frasso, noting that the COVID-19 pandemic delayed those plans.

(Data collection is now underway. If you attended the exhibit and would like to be involved, please email Frasso, who is exploring the research question, “Does art stick in a way that lectures about poverty or housing insecurity don’t?”)

Co-authors of the paper—spurred on by limited research on the “quality, nature or value of interactions between people living on the street and those who pass them by”—are Dr. Frasso, Baronet, Sidney Kimmel Medical College student Alyssa Tate and JCPH MPH alums Kaéla Edwards, Steven Buffer, Zachary Fusfeld and Nichole Holmes.

Holmes graduated with a Master’s of Public Health degree in December 2019 and now works with the Philadelphia Department of Public Health as the immunization program’s flu project coordinator. Thinking back to this project, she recalls being instantly interested in participating upon hearing about it from classmates.

“Growing up in North Philadelphia, when I was around eight years old, our church would package meals and take them to the homeless, so this really resonated with me,” says Holmes, noting that it gave her an outlet to connect with people through the course of research. “It was humbling to talk to people trying to get back to where they once were or beyond, in a city with one of the highest rates of poverty in the country. I would ask myself what can I do to help the community?

“When you’re growing up, you hear that you shouldn’t give money to homeless people because you don’t know what they’re going to do with it. This project enabled me to listen to people, and it was humanizing to hear their life stories. In my interviews, I remember asking someone what do you identify as. The answer was not black, white or Hispanic, but human. Can you imagine if we all just identified as human? We could move forward in ways that eliminate the things that hold us back.”

Holmes notes that the project impacted her career trajectory insofar as establishing that she wanted to be in the public space helping people so she could help the community and partner with like-minded people.

Tate, currently on her ICU rotation, agrees that the field experience was “incredibly impactful and emotional,” noting that being on a great team of faculty and students left her grateful for the opportunity.

Before this project, she felt good about what she was doing to support the underserved, and working hard to become a doctor who would provide compassionate care while volunteering with JeffHOPE at Prevention Point.

“After this project, I realized that the work I had been doing was defined largely by what my medical colleagues established would be most helpful for this group, but that I could be doing more to support what people experiencing housing insecurity are actually asking for,” Tate shares. “Most of the people we spoke with wished for a cultural shift to regard them as neighbors who deserve acknowledgement, respect and human connection in all public spaces, and not just homeless shelters or other spaces sanctioned for them.

“We learned that it is very emotionally taxing and painful to be ignored when asking for help as an unhoused person in public, and a simple way to address this would be to normalize smiling at and kindly greeting these folks, even when a person doesn’t have money to offer them.”

Now, Tate is currently applying to psychiatry residencies and hopes to continue working with people who are unhoused and living with addiction as a psychiatrist in the future.

“This project gave me a first taste of what it’s like to give people who are hurting emotionally the space to share whatever they want, which is a lot of what psychiatrists do,” Tate says. “Thinking critically about the findings and writing them up deepened my passion for supporting this population and was really affirming of my career choice.

“When doing work intentioned to help the underserved, space should be made for the input of those who are supposed to be benefiting from the work, and that both qualitative data, like the interviews, and art are extremely useful but sometimes underutilized ways of getting their input.”

As the project continues to develop, Frasso notes that there are plans to do a journal club during National Public Health Week in April, which will include Baronet who has been buying and collecting signs since 1993 as part of the "We Are All Homeless” art project, and two Philadelphians who will share reflections on a time in their life when they were unhoused and asking for help.

She is also working with harm-reduction colleagues on a project designed to explore the healthcare experiences of people who are housing insecure and dealing with substance use disorders.

Holmes could not be happier about that.

“This allowed me to not be selfish, to take the time to talk to someone who is homeless and ask how they’re feeling, what their goals and ambitions are,” says Holmes, whose parents operated a state license personal-care home in South Philadelphia. “I really hope that Jefferson is able to expand this, and I would love to see more projects like that, which enable students to see the real world like we did. It’s such a great project, and I appreciate having been a part of it.”