Voices from the Field Blog: Promoting Recovery in Homeless Services

by Darby Penney
August 20, 2014

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Homeless and Housing Resource Network contributing writer Darby Penney interviewed Gloria Dickerson, Recovery Specialist at the Center for Social Innovation, on meaningful involvement of people who are current or former service users in the development, implementation, and evaluation of policies in homeless services.

“Recovery doesn’t have an endpoint,” says Gloria Dickerson, Recovery Specialist at the Center for Social Innovation, “it’s an ongoing journey. There’s never a time when you feel like you’ve finally arrived. You spend your life recovering. The good part is that this forces you to develop skills that allow you to keep moving forward in a spirit of hope. Because for me, no matter what, even though there are setbacks, hope is what recovery is all about.” As someone in recovery from trauma, mental illness, physical health problems, and homelessness, Dickerson has a lifetime of lived experience to support her belief in the healing power of hope.

She has also written about concrete actions that can be taken to integrate recovery-focused principles and practices into the homeless assistance network. There is a need for a recovery orientation when serving individuals experiencing homelessness, Dickerson and her co-authors found, because these individuals often face complex, multi-faceted challenges: “Recovery from homelessness overlaps significantly with the process of recovery from mental illness, substance use, and/or traumatic stress… This overlap suggests a significant opportunity for the homeless assistance network to learn from the research, practices, and policies used to promote and implement recovery-oriented care in the areas of mental health, addiction, and trauma care” (Gillis, Dickerson, & Hanson, 2010).

The first step to adapting recovery principles and practices to homeless services is to understand how this concept has been articulated by different systems and to find the commonalities. In 2012, SAMHSA, released a working definition of recovery that did just this, bringing together a variety of stakeholders from the mental health and addictions fields to craft a shared vision that defines recovery as: “A process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential” (SAMHSA 2012). The working definition is further elaborated through ten guiding principles, the first of which is hope, which is viewed as the “catalyst of the recovery process.”

Dickerson believes that homeless service providers can fan the flames of hope by recognizing that people using services “need to direct and be in charge of our own recovery. Providers need to let clients know what they are doing right, because success breeds success. When you see me succeeding, tell me, encourage me!” Providers also need to recognize the extent to which the people they serve have experienced trauma, both prior to and because of their homelessness, Dickerson believes. “Being trauma-informed is not an add-on,” she says. “Trauma is at the heart of most clients’ experience and its effects need to be recognized; the resilience that people have developed in the face of trauma needs to be honored.”

Another way the homeless service network can promote recovery is to offer low-demand service models like Housing First, which view housing as a basic human right, not as a reward for being compliant with treatment. These models do not tie housing to other services, take a harm-reduction approach, and do not put conditions on retaining housing that go beyond what would be required of any tenant in the general housing market. This model has been found to be effective in promoting recovery. A recent study showed that people experiencing homelessness and co-occurring mental health and substance abuse diagnoses who were served in Housing First programs had significantly lower rates of substance use than people who received traditional “treatment first” services, and were more likely to remain housed (Padgett et al. 2011).

Consumer integration—the meaningful involvement of people who are current or former service users—in the development, implementation, and evaluation of policies and services is another vital part of creating a recovery culture, according to advocates Laura Prescott and Leah Harris (2007). Providers must ensure that consumers are seen as equal and valued partners in the change process and that their input is taken seriously if organizations are to successfully incorporate recovery principles into every aspect of their operations. Through this process, everyone—staff and people receiving services alike—work through the complicated, messy, but ultimately rewarding and ongoing process of figuring out how to make recovery real on a daily basis. “I have a lot of hope for the future of recovery-oriented services,” says Dickerson. “It helps people take joy in their work when they can walk with people on their recovery journey. It’s a process, and sometimes it’s slow, but the relationship of hope and recovery is vital.”

More information on SAMHSA’s working definition of recovery and its ten guiding principles of recovery is available at http://store.samhsa.gov/product/SAMHSA-s-Working-Definition-of-Recovery/PEP12-RECDEF.

References
Gillis, L., Dickerson, G., & Hanson, J. (2010). Recovery and homeless services: New directions for the field. Open Health Services and Policy Journal, 3, 71-79.

Padgett, D.K., Stanhope, V., Henwood, B.F., & Stefancic, A. (2011). Substance use outcomes among homeless clients with serious mental illness: Comparing Housing First with treatment first programs. Community Mental Health Journal, 47(2), 227-232.

Prescott, L., & Harris, L. (2007). Moving Forward, Together: Integrating Consumers as Colleagues in Homeless Service Design, Delivery and Evaluation. Rockville, MD: Center for Mental Health Services, Substance Abuse and Mental Health Services Administration.

SAMHSA's Working Definition of Recovery. (2012). Rockville, MD: Publication #PEP12-RECDEF. Substance Abuse and Mental Health Services Administration.

Interested in being an HRC Guest Blogger? E-mail us at HomelessPrograms@samhsa.hhs.gov.

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Category: General | Guest Entry

Voices from the Field Blog: Reflections on Homeless Persons’ Memorial

by Lisa Sepahi
November 18, 2013

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Homeless and Housing Resource Network contributing writer Lisa Sephai details the significance of Homeless Persons Memorial Day that have been held annually since 1990 on the longest night of the year. These national events are aimed at raising awareness of the tragedy of homelessness and to remember individuals who have died on the streets.

Nancy* was 54 years old when she died of cancer. I first met Nancy at an overnight homeless shelter. She was bubbly and happy-go-lucky, her bright personality stood out despite her dire circumstances. Nancy spent the previous four years living on the streets after losing her job as an accountant. Shortly after I met Nancy, she was offered permanent housing through a Housing First program. 

This housing opportunity could not have come soon enough; shortly after becoming housed, Nancy learned that she had terminal cancer. Fortunately, Nancy was housed when she died, but the years on the streets had a significant impact on her health and her ability to seek the treatment that she needed to diagnose and treat her illness. Nancy's story is not unique; however, Nancy was fortunate to die in the comfort of her own home with her friends around her. Many people experiencing homelessness are not as fortunate and die on the streets.

It is for this reason that each year The National Coalition for the Homeless, the National Consumer Advisory Board, and the National Health Care for the Homeless Council encourage communities to host public events on December 21 to remember those individuals in our communities who have died homeless in the past year.  Homeless Persons Memorial Day events have been held every year around the first day of winter and the longest night of year since 1990. 

Homeless Persons Memorial Day raises awareness of the tragedy of homelessness and serves to stand as a public memorial in recognition of friends and neighbors who have died on the streets. The National Health Care for the Homeless Council provides toolkits that include an organizing manual, posters, and fact sheet to help groups organize events every year.

According to The National Health Care for the Homeless Council:

  • Homelessness dramatically elevates one's risk of illness, injury, and death.
  • The average age of death of a person experiencing homelessness is about fifty years, the age at which Americans commonly died in 1900.
  • People experiencing homelessness suffer the same illnesses experienced by people with homes, but at rates three to six times higher.
  • Persons experiencing homelessness die on the streets from exposure to the cold.
  • Poor access to quality health care reduces the possibility of recovery from illnesses and injuries.
  • Persons experiencing homelessness die on the streets from unprovoked violence, also known as hate crimes.

Homeless Persons Memorial Day is an opportunity to bring attention to an every day tragedy. It stands as a testament to the vital importance that housing plays to the health, well-being, and safety of all people.

For more information on events in your area or if you are interesting in hosting your own event, visit: http://www.nhchc.org/resources/consumer/homeless-persons-memorial-day/ and http://www.nhchc.org/wp-content/uploads/2011/09/2013-national-homeless-persons-memorial-day-
organizing-manual.pdf


*Name has been changed

Source: National Health Care for the Homeless Council (2006) "The Hard, Cold Facts About the Deaths of Homeless People" http://www.nhchc.org/wp-content/uploads/2011/09/HardColdFacts.pdf


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Category: General | Guest Entry

A One Year Chip

by Wendy Grace Evans
June 21, 2010

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Recently I listened to Joe*, a man in recovery talk about an experience that occurred shortly after his first year of sobriety. While his life had improved significantly as a result of intensive work with other alcoholics and the willingness to follow a spiritual program of action, he was still struggling, as many people do throughout the ongoing recovery process. Life does not cease to happen in the midst of finding recovery. It happens over and over again and people learn to live with the emotions and feelings that unfold without having to take a drink, or use any other substance.

He described walking in an urban area. Two men jumped him, took his wallet and the little cash he had. Both men were living on the street and in a desperate place. As they pulled the money from his wallet, his one year chip fell rolling to the ground, along with the money. In a moment, one of the men picked up the chip, ignored the money and turned it over in his hand, staring at it with recognition and reflection. The other man took off with the money. Joe describes this incident with a contemplative awe.

Chips are given out in recovery meetings to mark time periods of abstinence, starting at 30 days, 60 days, 90 days, 6 months, 9 months, one year, 18 months, and then annually for every year of sobriety. The chips starting at one year are solid, and rest with weight in your hand.

After staring at the one year chip for some time, the man who had originally set out to take Joe’s money, sat down on the curb. Joe describes the man as wearing soiled clothing, in need of a shower, very thin, and missing many teeth. He had been on the streets for years. As he turned the chip over and over in his hand, he told Joe that once he had been sober for four years. Joe sat down on the curb next to him and they talked for three hours. The man shared how beautiful his life had been. His family had returned to him. He had owned a business and a home. A sober life had been full of gifts.

Eventually the conversation ended and the two men went their separate ways. Joe explained that he never saw the man again, but believed their meeting was not a chance event as he continues to share the experience today with people who are often in need of stories that generate hope, compassion, and possibility.

*Joe’s name has been changed to protect his anonymity.

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Category: HRC Insight