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