Question: What is SOAR?
Answer: SSI/SSDI Outreach, Access and Recovery (SOAR) is a national project that increases access to Supplemental Security Income and Social Security Disability Insurance (SSI/SSDI)— the two disability programs administered by the Social Security Administration (SSA) — for people who are homeless and have a mental illness or co-occurring disorder. Currently, only 10-15 percent of people who are homeless are approved on their initial SSI/SSDI applications. SOAR has a training component (Stepping Stones to Recovery) for front-line staff who work with people who may be eligible for these programs and a systems-change component for communities to address this issue. When SOAR critical components are used, those success rates improve to 60-95 percent with a turnaround time of about three months on average (instead of a year or more in most cases). Policy Research Associates, Inc., operates the national SOAR Technical Assistance Center for this SAMHSA-funded program.
As a street outreach worker, the SSI/SSDI application process intimidated me. The application forms looked long, formal, and complicated. I had also never actually seen anyone get approved for disability benefits. It seemed like it was “above my pay grade” and not a good use of my time. An attorney would handle it well, right? After listening to Yvonne Perret (co-author of the Stepping Stones to Recovery curriculum) speak for about two hours, I completely changed my opinion on the value of assisting someone with disability benefits. She taught me what we could do as direct service workers to boost the success rate and expedite applications. The work empowered me. I began having success in an area that most professionals find incredibly frustrating. Using SOAR critical components, my first 23 SSI/SSDI applications were approved in an average of 40 days. I was on fire, far from burning out, and on a mission. I felt more effective in my role as an outreach worker and was able to witness people take the first steps to recovery and possibly future employment once they received the benefits they deserved. Simple, paltry monthly cash payments and health insurance can transform lives. In 2010, 37 states using SOAR critical components reported an average success rate of 73 percent on almost 10,000 initial SSI/SSDI applications in 91 days. SOAR really works!
Question: Housing First or medical/mental health services first?
Answer: Housing First, please! If I were an agency director, I would buy Dr. Sam Tsemberis’ book, Housing First, for all of my board members and begin a conversation about how we would implement the Pathways model of Housing First and transform our agency and community through the implementation of this evidence-based practice. It’s a practical book for a wide audience and it makes the case, yet again, that providing people who are homeless with housing and services despite their background or illness is the cheapest and best way to end homelessness. I only wish this book had been written at least five years ago when many cities began their Ten Year Plans to End Homelessness.
Of course, Housing First interventions do not exist in every community, so you have to do what you can in terms of helping folks meet their basic needs and gain access to medical and mental health services, which is what SOAR is all about. To make the widespread adoption of Housing First a reality, we all need to work together, debunk myths, and challenge the status quo. The status quo says that Housing First is too expensive when in reality we are paying more for traditional shelter, jail and emergency room stays. The status quo wants people to “earn” housing through sobriety when alcoholism and drug addiction are physical illnesses of the brain. Would we offer housing to someone who has cancer or diabetes even if they were not taking all of their prescribed medication correctly? Of course we would. We need to challenge our colleagues who believe addiction is a personal failing and not a disease that needs to be treated with the latest medical interventions like other chronic physical illnesses. These interventions include medications like Vivitrol, talk therapies like Alcoholics Anonymous, and housing with services chosen by the tenant.
Finally, there are myths and misunderstandings about Pathways Housing First that impede its implementation. In the forward to Dr. Tsemberis’ book, Dr. Beth Shinn writes, “Pathways Housing First is neither a ‘housing only’ approach, nor does it offer ‘worker-knows-best’ services coupled with immediate housing. It is a successful, rigorously documented, systematic approach to serving homeless people with addiction and mental health disorders. This manual clarifies the ethos and practices of Pathways Housing First. Hopefully, it will also begin to change the standard training that still makes it hard for many social service professionals to give up coercive control —no matter how artfully it may be disguised — and support the choices of the people with whom they work.” Offering choice and hope to the people we meet may be the biggest challenge.
Question: I’m a brand new outreach worker, working the urban streets. What are the top ten things I should know?
1. Congratulations! You have the best job in the world. Hang on to it for as long as you can. Ninety-nine percent of program administrators don’t have the experience you are about to get.
2. There are mentors out there that can help define your work, enhance your effectiveness, and prevent you from burning out completely. Reach out to them. There are many saints that come to mind, but here are a few: Ken Kraybill, Craig Rennebohm, George Koenig, and my Nashville peeps — Lindsey Krinks, Jeannie Alexander, Ben Griffith, Brian Huskey, Carolyn Cooper, Sam Wise, Steve Samra, Ashley Wright, Jack Blum, Lauren Russell, Tasha French, and Corey Gephart.
3. Treat the people you meet on the streets as equals. There is no such thing as an “expert” outreach worker. Be humble and thank your clients for their time when they meet with you. You are their nosy and often intrusive student.
4. Develop a self-care routine to prevent burn out. This is easier said than done. Try to carve out 10 minutes of your morning and afternoon to be alone and breathe. Reflect on each day by writing journal entries or field notes.
5. Walk. Most people who are homeless do not drive cars, and even if they did, you can’t talk to other drivers unless you roll down your car window and yell (not a best practice!). Walking long distances helps develop empathy by reminding you how tough it is to spend the entire day on your feet out in the elements. A good walk also allows for longer, more mindful conversations. The more you walk, the more people will notice and trust you. It’s a sign of solidarity.
6. Sunglasses can be a big turn-off. Imagine what it would feel like if your boss always put on dark sunglasses every time he or she talked to you. You would probably get a little nervous! Protection from UV rays is important, but let people see your eyeballs when you are listening or talking. Other turn-offs: Bluetooth phone headsets, government badges, shirts or jackets with words like “outreach” or “homeless” printed on them, and other less fashionable annoyances like showing up late or not at all, dishonesty, overpromising, and tactlessness regarding personal information or a lack of confidentiality.
7. You may need to check your substance use. It is impossible to engage people fully and give your entire self when you are hung over from drinking the night before (believe me, I’ve tried). If you have ever thought that you can’t control your drinking or drug use, address it early on by asking for help from your doctor, Alcoholics Anonymous, or other mentors and important people in your life.
8. Your supervisor may not know how to supervise outreach workers, but you need supervision! Ask for weekly meetings with your supervisor and invite him or her to come out with you during an outreach round. Ask for their availability on the phone or in person when there are situations that come up that you don’t know how to handle. You can also read this book: Managing Social Service Staff for Excellence, (2010) by Nancy Summers, for tips to share with your supervisor.
9. Your voice is vital to the planning and policy process in your community. Become a student of homelessness by educating yourself on evidence-based practices and tell your colleagues and community leaders about your front-line experiences. You will witness where the system fails and succeeds. You will see the reality of your city. Tell people about it.
10. Street outreach is a “fuzzy” endeavor and there are many definitions of it. Spend some time trying to define what it is and what outcomes you want to achieve. Here is one definition: “…contact with any individual who would otherwise be ignored (or underserved)…in non-traditional settings for the purpose of improving their mental health, health, or social functioning or increasing their human service and resource utilization.” — Gary Morse
Question: What are some risks associated with outreach work?
Answer: With so much need out there, it is very easy to become constantly busy and rushed and hurried in your outreach work. Thomas Merton, a Trappist monk, equated this busyness to violence. He once said, “The rush and pressure of modern life are a form, perhaps the most common form, of its innate violence. To allow oneself to be carried away by a multitude of conflicting concerns, to surrender to too many demands, to commit oneself to too many projects, to want to help everyone in everything is to succumb to violence. More than that, it is cooperation in violence. The frenzy of the activist...destroys [her] own inner capacity for peace. It destroys the fruitfulness of [her] own work, because it kills the root of inner wisdom which makes work fruitful." Ken Kraybill first made me aware of this rich and powerful quotation — a statement that tells me that we need to get back to basics. We don’t need more meetings or programs or technologies. We can reduce our meetings by coming up with better agendas, reduce our programs by focusing on evidence-based practices (let the old programs die honorably) and reduce our use of technologies by separating from them at times so they don’t separate us from meaningful encounters with one another. Without doing so, we will risk doing harm, often unseen harm, even when our intentions are good.
People often ask me if outreach workers face safety risks when out there on the streets. I think it’s smart to carry a cell phone, to follow your gut, and to check in with colleagues. I never felt threatened and most folks are pretty pleasant. If you find yourself getting into arguments, fights, and sketchy situations, it likely has more to do with you than the person in front of you. Critique your approach, ask for help, smile, and listen more.
Question: Can you describe one of your success stories? How did you engage this person, how did you help? Otherwise, how would you define success?
Answer: There’s a nice woman in charge of the Section 8 program in my hometown. I mentioned to her once that people often have a difficult time receiving the approval letter from the housing authority telling them that they had 60 days to find housing with their brand new Section 8 housing subsidy. Her office communicated mostly by mail and phone, and folks checked their mailbox in the day shelter maybe once every couple of weeks, so they would receive the letter with only 30-45 days left. That isn’t much time to find a suitable apartment especially when you don’t have transportation or a phone (or a place to live) and with all of the housing authority inspections that need to happen.
She listened to me and then agreed to streamline the process for people who were homeless and receiving a stable income like SSI or SSDI, which we were able to get using SOAR strategies. If we could gather the necessary documents before the appointment (state identification, birth certificate, social security card, proof of income, tuberculosis test, etc) and make it to the appointment (both big “ifs”), her office would issue the Section 8 voucher on the same day as the application. The same day! That was a huge deal and something that I will never forget. Many of the processes that seem set in stone are actually quite malleable and can change. Engage people with respect and tell them what you see out there on the streets. If you work hard and follow through on your commitments, people will try to help you.
Question: Please explain your process of engagement.
Answer: The basics to engagement are meeting people with a smile and something to eat, drink, or smoke. I also try to keep my mouth shut as much as possible in lieu of some non-verbal communication and big words like “uh-huh” and “yep.” I try to implement motivational interviewing as much as possible and what the late psychologist Carl Rogers called “unconditional positive regard” or plain acceptance of an individual despite what he or she does or says. It’s such a freeing and effective principle.
Getting a little more theoretical, I follow an engagement framework and process that Craig Rennebohm calls the Relational Outreach and Engagement Model. There are four stages in this model: approach, companionship, partnership, and mutuality that help people move from isolation to stability. You can find more information about this model and Craig Rennebohm’s work at www.mentalhealthchaplain.org
The four stages mentioned above are grounded in three understandings: the first understanding is that we are always in relationship with one another — “the question is not whether we have a relationship, but how our relationships will take shape,” the second is that “healing is always possible,” and the third is that the nature of our world is personal and intimate. These understandings have guided my work and helped me explain the nature of what outreach work entails to folks inside and outside of the homeless service world.
Here is a very brief summary of the four stages. The approach stage is marked by observation, empathy, and introduction. The companionship phase involves sharing the gift of hospitality like eating meals together at soup kitchens, drinking a cup of coffee together, walking, waiting in line, or watching the mighty river flow along the riverbank. Partnership occurs when you start working together to meet basic needs and to access services and apply for benefits and housing. The mutuality phase begins when your once isolated neighbor has a support network through the partnering that occurred, and your role as an outreach worker naturally changes. You don’t drop off the face of the earth, but your relationship changes and your neighbor has less time for you because other relationships have grown.
Of course, this is just a conceptual framework and the stages do not always flow in a linear fashion. Each stage can take minutes or years, and sometimes you just feel like you are keeping your head above water!
Question: What are some important partnerships the outreach worker must develop?
Answer: It helps to make friends with anyone who does not want people sleeping on the streets or in shelter. This is pretty broad of course, but this simple goal kept me from excluding anyone from the mission to end homelessness. We all have a role to play and we need all of the help we can get. For example, I am lucky enough to have a supportive family. I let them know that many people I would meet on the street had a tough time meeting their basic needs. In no time, my parents were donating to my employer and other agencies in the community. My cousin started a fund to buy anything from shoelaces to glasses — no questions asked, no red tape — by inviting her friends over for dinner and asking them to bring $20-$30 to put into a pot. It was beautiful.
Despite getting shoddy reputations in many communities, police officers and groups like downtown associations can be lifesavers. In many cases, these groups actually do their homework by researching evidence-based practices and know more about solutions to homelessness than many who define themselves as advocates.
Obvious and natural partnerships to make include: housing agencies; landlords; hospitals and clinics (and anyone who wants Medicaid dollars); day shelters; libraries; corrections agencies; shelters; congregations; and emergency services. Non-evident partnerships to build include the lady that works at the trolley kiosk, staff at gas stations, business owners in the areas you frequent, and the very people you are trying to serve.
Question: How has your work with SAMHSA benefitted your outreach work?
Answer: SAMHSA does at great job at promoting evidence-based practices through direct funding and the dissemination of information to the front lines all the way up to directors and policy makers. In many communities, the funding they provide is the only funding available for outreach services to people experiencing homelessness. We are fortunate to have SAMHSA’s leadership in promoting recovery from mental and substance use disorders and meeting the challenges and exciting opportunities that come with health care reform.