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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Voices From the Field: Walking In Daylight

by Steven Samra
February 27, 2014

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Homeless and Housing Resource contributing writer Steven Samra opens up about his mental health recovery journey and from his perspective what peers need to help into support others who are experiencing acute symptoms overcome ostracism, shame, and misinformation.

I “aged out” of the mental health system at 17, after having spent much of my adolescence under the influence and control of the amphetamine Dexedrine, which was used to treat Attention Deficit Disorder for “hyperactive” children in the days before Ritalin and Adderall. For the following 23 years, I wandered from job to job, relationship to relationship, and street drug to street drug, trying to calm the anxiety and the uncontrollable need to move, talk, think, and do something—anything. I suffered classic hypomania symptoms of bipolar disorder throughout my adult life, and eventually gravitated towards those drugs to help me slow down the noise and activity in my mind and body. 

Throughout those decades, the idea of experiencing a mental health condition never really occurred to me. After all, I had been “cured” back in the 70’s, and there was no way I was “crazy”; I was just “high energy,” which frankly served me quite well until I would “overamp” and make inappropriate decisions due to my inability to gauge and tailor/control my own behavior and responses effectively.

Worse, even if I would have been self-aware that I was experiencing a mental health condition, I would have never told anyone because being branded with a “mental illness” brought with it almost certain scorn, ridicule, ostracism, and blatant discrimination from those in my immediate circle and the larger community. It wasn’t until I entered counseling and a Methadone maintenance program in early 2000 that I began to understand there was something underlying my compulsion to use, a need to self-medicate symptoms of my mental health challenges away. 

Fast forward 15 years later and today I am in the final stages of a medically supervised withdrawal from Methadone, but more importantly, I am acutely aware that I suffer from some mental health challenges, exacerbated by trauma experienced as a youth and the repeated retraumatization—accompanied by “collateral” trauma—of decisions and behaviors related to a life spent in addiction. 

Today, I wear the scars of my addiction and underlying mental health conditions on my sleeve. I do so because when I was open to and seeking treatment, I didn’t ask the service deliverer I approached whether they were “addiction” or “mental health.”  I asked, “can you help me figure out what is going on inside?” Unfortunately, what I found was that very few were able to work with me on both fronts and that treatment delineation, to a large extent, continues in provider organizations today. Strides have been made, to be sure, but we as providers, as people in recovery, and as people needing the support of both groups, are still seemingly light years from effective and complimentary dual treatment options. Worse, the discrimination, ignorance, and fear of those experiencing a “mental illness” are still rampant in our communities and show little sign of abating anytime soon.

To help combat this, I and many others now talk openly, freely, and regularly about our “co-occurring” disorder and work daily to raise awareness, reduce discrimination, and promote mental health because with mental health comes not just recovery from the condition, but a liberating freedom, self-esteem, and genuine self-worth as well. We stand as a testament, along with millions of others—colleagues, friends, and peers—that recovery from both addiction and mental health challenges is not only possible, but to be expected. 

From my perspective, what my peers need to do to help support those who are both in recovery and experiencing acute symptoms is simple:

  • Provide easy to understand information that helps us identify and understand what’s happening to us as we endure our mental health challenges;
  • Offer real treatment and “return to life” options that are tailored to—and driven by—our complex needs and conditions; and
  • Suggest opportunities to join our larger community without fear of discrimination, verbal and/or physical abuse, and/or marginalization.

We are making progress every day, and the more we share about our lived experience and our journey into recovery, the more we raise awareness, smash stereotypes, and reduce the ignorance associated with mental health issues. Make no mistake; however, we still have a very long road to travel, and it will be up to us to walk in the daylight along this path so that others are unafraid—and in fact, empowered—to join us.

Interested in being a HRC Guest Blogger? Email us at generalinquiry@center4si.com.

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Katy Hanlon In Recovery: Certified Peer Specialist

by Katy Hanlon
February 04, 2013

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Homeless and Housing Resource Network writer Katy Hanlon recently trained to become a Certified Peer Specialist. In this blog, she and fellow writer Wendy Grace Evans-Dittmer collaborate to share her experience.

I have not always had a voice.

At the first of nine eight-hour classes to become a Certified Peer Specialist I met a Marine veteran. He introduced himself to me and expressed his thoughts on mental health recovery. He had applied to the program three times before being accepted, but never gave up. That impressed me—his conviction. We developed a friendship that was part of a larger community. I drove him home from class every week. I was connecting with someone I would not normally have the opportunity to meet. This tied back to our classes, where one of the things I learned was the value of difference. Peer Specialists, united in recovery, are all coming from unique places; this is an asset to the profession.

The Certified Peer Specialist (CPS) course I am taking is provided by The Transformation Center of Boston and funded by the Massachusetts Department of Mental Health. It is the only certifying program in the state. I initially took this peer-run course because I wanted to gain knowledge and experience to contribute to my work on SAMHSA’s Bringing Recovery Supports to Scale Technical Assistance Center Strategy (BRSS TACS) initiative. I soon realized my strong desire to also give back to the peer community that has given me so much.

Recovery is difficult to define because its path is determined by the individual. With input from the community, SAMHSA offers a working definition that encompasses the four basic tenets: health, home, purpose, and community. Supporting the importance of community is the term peer itself. It is not possible to be a peer or a peer specialist in isolation. There must always be mutuality.

Not all states have certification programs for peer specialists and there is no national listing of programs. Georgia started their program in 2001 with the Georgia Certified Peer Specialist Project and they are key program contributors as other states look at certification. While there continues to be discussion about whether the certification process removes the “peerness” in peers, there are efforts underway to develop a set of national standards. The International Association of Peer Supporters, formerly The National Association of Peer Specialists, is bringing its voice to the table and BRSS TACS will offer a recovery framework. These efforts will be key as states continue to broaden Medicaid funding for CPS services.

Prior to learning about the Peer Recovery Movement, its historical context, and the opportunity to become a CPS, I experienced all of the traditional paths of treatment. My acceptance to the Boston University Center for Psychiatric Rehabilitation’s Training for the Future program changed my perspective as it introduced me to the concept of recovery, peers, and hope for the future. Yes, hope. I gained so much from my peers that I wanted to give back by sharing my own recovery story, which will always be a work in progress.

As part of the nine classes, we had a three-day retreat. Each day focused on specific modules of the curriculum developed by The Transformation Center. All of the modules supported the foundation of a CPS: Peer Support, “In” but not “Of” the system, and Change Agent. This retreat not only brought our class of 26 together, but by example gave me a sense of empowerment and purpose.

I have a voice now.

To find out if there is a Certified Peer Specialist training near you, reach out to local community-based Recovery Learning Communities, State Department of Mental Health, organizations such as The Transformation Center and New York Association of Psychiatric Rehabilitation Services (NYAPRS), or projects such as the Georgia Certified Peer Specialist Project.

Interested in being a HRC Guest Blogger? Email us at generalinquiry@center4si.com.

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The Phoenix Rising: Describing Women’s Stories of Long-Term Recovery

by Gretchen Hammond
April 27, 2012

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I could have explored many topic areas for my dissertation on women and recovery, but I knew there was a distinct need for more on how women talked about their own lives. In my own career as a provider at Amethyst Inc., I worked with women in treatment at the beginning stages of sobriety. This is the start of the big change when many women wonder, “Am I always going to be this uncomfortable?” It made me want to give both women and providers a roadmap for recovery.

Initially, many women I interviewed thought they had to have it all together in the first 90 days of being sober. But when they talked about the “beginning” of recovery, I was surprised to learn that they were discussing the first five years, which are surprisingly difficult. Women talked about new feelings that emerged, emotions that had been previously buried. They were peeling back new layers of understanding about who they had been and who they were becoming, which can be both frightening and rewarding. They were making life decisions about careers, getting married, and how to live life sober.

When I talked to women about years 10 through 12, they realized—perhaps for the first time—that they were no longer questioning who they were, and that they were comfortable in their own skin. Every woman I spoke with had experienced some type of major loss around that period of time—something tragic. All of the women shared, almost in unison and from different parts of the country, “I just walked through my recovery.”

One of my favorite interviews was with a woman who had a long career working in the church and then became, as I put it, a “rip-roaring alcoholic.” She married and then entered into recovery. After her husband died, she reached towards her faith, which had always been present. Like many people who enter sobriety and have been through addiction, this woman understood that she—like anyone who is in recovery—is always just one drink away from losing her sobriety. There are no guarantees.

Women told me about the importance of support from other women and of spiritual exploration without being told what to believe. All of the women insisted on sharing with me how they became addicted to alcohol or other substances. They needed to make sense of their trajectories. It was often challenging for women to recall periods of time that followed the first five years. Years can blend into each other.

I believe it is critical to give women time to exhale. One of the most important things for service providers to do is teach women to not be so hard on themselves. Self-discovery is an evolving process for women in recovery, and allowing them to foster this is crucial. Some of this has to happen through private sharing. It is also important to remove time limitations. Light bulbs turn on at intervals, and moments of realization happen at different times for different women.

When I asked women how they knew that they were in long-term recovery, they explained the presence of a feeling, a knowledge that an internal change had transpired. As one woman said, “I walk differently, I move differently—and I know my life is different.”

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Paul Appleby: I Played Like Breathing

by Wendy Grace Evans
July 25, 2011

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Paul Appleby, a Licensed Substance Abuse Counselor from Tucson, Arizona shares his thoughts about aspects of his life, self-care, his parents, losing himself and getting started again in recovery with the HRC’s Wendy Grace Evans. In his own words, he reflects on his journey.

I came from a family of nine and was raised in the sixties. I was always exploring life from a different perspective, asking questions and never getting any answers. I watched people around me and did not want to grow up because the world seemed so crazy. My mind worked in a way that didn’t seem to work the same as people my age. I tried to escape it. I felt odd even in my own family. What gave me a sense of reality was sports. My father was a funny, but very serious man and conscientious about his family. He introduced me to baseball. I had never seen him play, but those that did said he was great. He had seen his own father hung to death, but baseball became our relationship and I ate, slept, and drank baseball. At twelve I was throwing 80 mile an hour pitches. I played like breathing. My father worked three jobs.

I was young when my father died of black lung disease, heart disease, and diabetes. He dwindled from this opposing figure to nothing and my mother would literally pick him up. During this time she developed cancer and died shortly after my father. I was taking her back and forth to the hospital, but I still had a mom. She would tell me about my gift, but she would tell me that she was dying and dying to be with my father. I wondered if I was not important enough to live for. When she died, that was the thought that permeated my mind. And there were no answers.

I quit playing baseball and turned to basketball, leaving my hometown of Cleveland, Ohio, for Central Arizona Community College and eventually the University of San Diego on a basketball scholarship. Unfortunately, I fractured both kneecaps and lost my scholarship, as well as an opportunity to play professional ball. These losses, including the death of both of my parents, propelled me into drugs and alcohol. This took the shape of 12 years of addiction, including eight years on crack, two years of homelessness, sleeping on the streets, in parks, and under bridges in two states.

The pain of my parents’ death became something I sought out once I was tied to them as a victim in my own memory. I selected self-destruction, developing defense mechanisms to protect myself from feeling emotion. Eventually I would pride myself as someone who had no emotions until I entered into recovery.

For me, living in recovery is going to the mountains, praying, getting together with friends for relaxation, going to meetings and staying focused. I really have to pay attention and be grateful for being clean and sober. My work life can bleed into my personal life. I focus on trust because no one wants to live in a self imposed shelter, or box of fear. I ask the question “Who is really living in recovery?” I don’t forget what it was like to be homeless, doing drugs, and feeling so badly about who I was, when I know that today I have been given the chance to start a recovery program to help other people. Today I have been in recovery for 17 years. I like to say that I have “flipped the script.” I am a Licensed Substance Abuse Counselor so that I can help others as I have been helped with a “Yes, I can” attitude.

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One Size Does Not Fit All: Lessons Learned in Baltimore, MD

by Laura Winn
July 06, 2011

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A couple weeks ago I attended a SAMHSA workgroup meeting for programs offering sober housing and treatment options for women experiencing homelessness. The workgroup began as a technical assistance (TA) request from Lori Criss of Amethyst Programs, a program in Columbus, Ohio. Amethyst offers integrated sober housing and treatment to women experiencing homelessness and substance use issues. Amethyst staff have sometimes felt isolated because this integrated approach is a unique model in their community. Lori knew that there was interest among other programs across the country, and was seeking an opportunity to begin this dialogue on a national level.

In response, SAMHSA’s Homelessness Resource Center helped to convene a workgroup of similar programs, along with SAMHSA’s Women, Children, and Families TA Center. With such a strong national focus on Housing First, sober living models often struggle to find their place. Programs find themselves straddling a divide between housing and addictions treatment. Some identify primarily as housing providers, some as treatment providers, and others as both, adding to the difficulty of seeking funding in various continuums of care. However, sober housing can be a tremendously beneficial model for women with children, trauma histories, and safety concerns.

Based on the clear desire of workgroup members to connect in person and further define key elements of this integrated model, SAMHSA convened a meeting in Baltimore, MD. Sixteen representatives of sober housing and treatment programs for women attended. The group shared their program designs, discussed what works (and what doesn’t), and explored commonalities, challenges, and promising strategies.

Having worked in this field for a year and half, it has become clear that there are no one-size-fits-all models for individuals experiencing homelessness, substance use disorders, or mental health issues. However, I’ve never seen this so clearly illustrated as I did at the workgroup meeting. Not only were providers recognizing a need for alternatives to Housing First for some individuals and families, but they were also highlighting differences among their own gender-specific sober housing models. For some women, being allowed to live with their children and within a community is an important step toward recovery. This demanded more restrictive relapse policies, in recognition of the safety and recovery of children and other families. For others, living independently, becoming economically stable, and thriving in healthy relationships is central to success.

Programs differed on drug testing policies, services for fathers and children, relapse policies, and approaches to treatment. However, it was clear that these programs were each finding success with their participants. I spend a lot of my time trying to understand what works in homeless services. Through the process, I sometimes forget that there are many paths to success. Flexibility to respond to the needs of consumers is essential.

I was inspired by the providers I met in Baltimore. They were committed to finding the best individualized options for women. These providers, many of whom were in recovery themselves, exemplified that fact that one-size-fits-all is not always possible – or necessary – when working with individuals and families.

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Category: HRC Insight | HRC Insight

Ed Blackburn: What Gives Me Hope

by Wendy Grace Evans
May 16, 2011

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Ed Blackburn is the Executive Director of Central City Concern in Portland, Oregon, a SAMHSA grantee that provides pathways to self-sufficiency through active intervention in poverty and homelessness. In a conversation with HRC Writer, Wendy Grace Evans, Ed talks about what inspires hope in his daily work.

What gives me hope is when I see a family that has been reunited. This is a very practical kind of hope. The children are happy because they are with their parents who have overcome substance use and trauma. To see that kind of happiness certainly motivates me.

I am also amazed to see a person who has experienced homelessness for a long time move into housing and find a sustainable job, or to see a person who has been disabled come back to health. I have the opportunity to see the communities that people build together as active citizens, attending city meetings, and that is my constant source of hope. Hope is a powerful response, and the experience of transformation is a powerful antidote to some of the political negativity that can surround the struggle to get funding support for safety net services and housing, as the news isn’t always good on that front.

When you can continue to see hope in humans, it helps to sustain our work. Angela is a single mother who had been living on the streets for years. She lost her baby to foster care, but once she was able to get into Central City Concern’s Hooper Detox Center, she was able to be reunited with her child. She joined our program for families in recovery, is now working, and has gone back to school. I had the privilege of hearing her story and meeting her. I will never forget her story. It was inspiring and a clear reminder of why we are doing what we are doing.

There was also a young man I knew who was heavily involved in street drug dealing. He had been in and out of the criminal justice system. After a couple of times, he entered into our Recovery Mentor Program. Three mentors run the program and mentor others. He has done very well and is now involved in our community volunteer corps to help people who are recovering from substance use. We have teams in the community working on projects for eighty dollars a month for a few hours a week to improve senior centers, parks, recycling centers, and to work with Habitat for Humanity and other small non-profits. Eighty-two percent of participants complete the program. They also work with Supported Employment and serve as inspiring examples to others.

The endless creativity that people have to solve serious problems, to heal people in the community, and to lead the way towards successful solutions demonstrates a limitless spirit. It is great to be a part of something so all encompassing. At Central City Concern we have approximately 650 employees. Fifty percent of our employees are in recovery from substance use and homelessness. I have the gift of participating in an organization that has the highest sense of commitment to its mission.

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Category: HRC Insight

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