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Moving Forward, Together: Keep Change Sustainable, Step 1—Welcoming and Accessible Environments
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Once an organization implements change, it must develop measures to evaluate the integration process, solicit feedback, and adjust policies and practices. This installment of Moving Forward, Together discusses the first of three steps toward sustaining change—establishing a welcoming and accessible environment.
Moving Forward, Together:

Keep Change Sustainable

Step 1—Welcoming and Accessible Environments



Establishing a welcoming and accessible environment is a significant way to work toward achieving cultural competence within the agency. Agencies can make a number of physical and emotional adaptations to encourage people with experiences of homelessness, trauma, substance use, and mental health problems to participate actively. The needs of the group change as it adds people, or as people leave over time. Therefore, creating a welcoming and accessible environment is not a one-time effort, but rather an ongoing and evolutionary process. It may help to develop a practice of regularly scanning the environment with consumer leaders to assist in identifying and removing anything potentially stigmatizing. This section offers a list of options, understanding that many agencies and organizations have constraints due to limited resources.  

A. Create Physical Adaptations
•   Provide food in recognition that people are extremely poor and may need to eat.
•   Consider providing childcare. If the agency wants to attract homeless families with children (most of whom are women), consider providing childcare at the site or budgeting for childcare coverage for a certain number of hours to cover the length of the meeting or project.
•   Meet in spaces that have easily accessible entries and exits. Ask people where they are most comfortable sitting (or wait until they sit down first). In general, it is helpful to save chairs for consumers near doors or places to sit against a wall. Sitting, standing, or walking behind people who have the experience of homelessness and likely to be hypervigilant is a recipe for distraction or dissociation.
•   Meet in spaces that do not trigger old traumas. Meeting in nonservice delivery environments in communities minimizes the chances of traumatic memories and maximizes the chances that consumers will be comfortable enough to return.
•   Use incandescent lights, and/or high-intensity white lights where possible rather than fluorescent lighting. A recent survey of more than 2,100 people experiencing homelessness in Broward County, Florida found that more than 24 percent of them experienced a head injury at some point in their lives (“Focus on Traumatic Brain Injury,” 2007). While the causes are variable, the outcomes can include susceptibility to epilepsy (National Institute of Neurological Disorders and Stroke, 2002), seizures, photosensitivity, difficulty concentrating, etc. Increasing the use of natural light or high-intensity white light, as well as decreasing background noise can help to accommodate consumers with this history (National Association of State Head Injury Administrators, n.d.).
•   Provide travel vouchers for taxis, buses, metros, or reimbursement for gas in rural areas where public transportation may not exist.
•   Provide a place to store belongings securely. This accommodation provides an option for people who are currently homeless or in transitional housing to store their things safely so they can attend meetings without having to carry belongings with them.
•   Arrange to provide shower facilities for people experiencing homelessness. Creating access to safe, clean, and private facilities where people can shower and wash their clothes is one way to provide reasonable accommodations and promote involvement for people who are homeless.
•   Arrange to have hotels donate extra toiletry items and stock bathrooms with personal care products for women.
•   Pay participants for their time, just as employees receive compensation to attend meetings.
•   End meetings early enough in the afternoon so people who are homeless will not lose their places to sleep for the night. Some agency directors arrange with local shelters to hold beds for currently homeless consumers working late or involved in projects and meetings running late (Dailey, 2003).
•   Create a welcome packet that includes important information about the agency and contact information. Make up a welcome pouch and put small and portable items in it that people might want, need, or like. Ask other consumers for ideas. Some suggestions are pens, small pads to write on, candy, gum, subway or taxi tokens, a charged phone card with minutes on it, and gift cards to local coffee shops, restaurants, stores, etc.
B. Promote Emotional Adaptations
•   Acknowledge and repeat back what people say. Active listening skills are useful in validating contributions in a respectful way. People who are or were homeless experienced psychiatric and physical distress, abuse and trauma, and were subject to a whole host of damaging social messages. Consumers heard they “don’t make sense” and experienced treatment that reinforces messages that they “don’t have anything useful to contribute” and are invisible to other people altogether. Acknowledging what people say and repeating it back to them is one potent way to begin counteracting these messages, promoting active participation, and reinforcing consumers’ visibility and value as team members.
•   Take frequent breaks during meetings so people can move around.
•   Plan enough time for people to ask questions and speak at meetings. It may take awhile for any new member to feel comfortable asking questions, clarifying language, and offering opinions. Planning enough time for everyone to speak is not always easy to do but important when encouraging active consumer participation in an environment. It might take longer for consumers to feel comfortable contributing in teams and meetings for a variety of reasons: (a) post-traumatic stress responses to enclosed, crowded, or noisy environments; (b) alcohol or medication withdrawal; (c) side effects of medications such as altered speech patterns, akathisia, increased appetite, decreased coordination, tremors, or dehydration; and (d) fear of people in authority (Prescott, 2001).
•   Meet face-to-face rather than using speakerphones. While speakerphones are common in meetings to close the distance among people not occupying the same place, they can be a distraction for people who already hear voices. Adding more disembodied voices to the environment can make it hard to concentrate. When possible, use smaller rather than larger group meetings and meet in person.
C. Use Person-First Language

Language has immense power, both to foster connection and to create separation. People with experiences of homelessness, trauma, psychiatric disability, and substance use often know stigma and demeaning references that undermine self-esteem, recovery, and connection. It can take considerable time and effort to shift the use of language, but the rewards go a long way toward creating emotionally accessible environments. Using person-first language reinforces the message that people are so much more than their diagnoses or circumstances (Committee on Disability Issues in Psychology, 2008; Maio & Caras, 2001; Prescott, Soares, Konnath, & Bassuk, 2008; Snow, 2005). It implies strength, wholeness instead of brokenness, complexity rather than reduction, and hope rather than despair.
•   Use people-first language: “a person diagnosed with schizophrenia” rather than “a schizophrenic” or a “person with lived experience of homelessness” rather than “a homeless person.”
•   Avoid phrases that generalize about groups such as, “the mentally ill,” or “the chronically homeless.”
•   Use descriptive rather than characterizing terms. For example, rather than saying, “Lisa is noncompliant” or “Lisa is acting out,” people might want to consider saying, “Lisa does not want the treatment options offered,” or “Lisa is expressing her feelings of distress.”
•   Reduce acronyms and agency shorthand. Every field has its own particular shorthand, but acronyms can be symbols of knowledge, power, exclusivity, and cultural belonging. The more acronyms convey information, the harder it is for new people to cross the cultural divide and participate. One fun exercise is to have consumers and nonconsumers share various shorthand terms and acronyms from their particular worldviews. Some are very funny and some are painful, but the exercise usually offers insight into how language reflects culture and opens up new lines of communication.
References

Committee on Disability Issues in Psychology. (2008). Removing bias in language: Guidelines for non-handicapping language in APA journals. Washington, DC: American Psychological Association. Retrieved August 7, 2008 from http://www.apastyle.org/disabilities.html

Dailey, E. (2003). Consumer advisory board manual for Health Care for the Homeless projects. Nashville, TN: National Health Care for the Homeless Council.

Focus on traumatic brain injury: Exploring the link between TBI and homelessness. (2007, Spring). VISTAS: A Newsletter of the Arizona Governor’s Council on Spinal and Head Injuries, 7(1), 3.
Maio, H., & Caras, S. (2001). Words matter. Accessed August 6, 2008 at http://www.peoplewho.org/documents/wordsmatter.htm

National Association of State Head Injury Administrators. (n.d.). Traumatic brain injury facts: Vocational rehabilitation and employment services. Retrieved September 5, 2007 from http://www.google.com/search?hl=en&q=Traumatic+Brain+Injury+Facts%3A+vocational+rehabilitation

National Institute of Neurological Disorders and Stroke. (2002). Traumatic brain injury: Hope through research (NIH Publication No. 02-158). Bethesda, MD: National Institutes of Health.

Prescott, L. (2001). Consumer/survivor/recovering women: Partnerships in collaboration. Delmar, NY: Policy Research Associates.

Prescott, L., Soares, P., Konnath, K., and Bassuk, E. (2008). A long journey home: A guide for creating trauma-informed services for mothers and children experiencing homelessness. Rockville, MD: Center for Mental Health Services, Substance Abuse and Mental Health Services Administration; the Daniels Fund; National Child Traumatic Stress Network; and the W.K. Kellogg Foundation. Available at www.homeless.samhsa.gov

Snow, K. (2005). People first language. Quakertown, PA: Kids Together. Accessed August 6, 2008 at: http://www.kidstogether.org

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