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Moving Out of Homelessness, Adapting to a New Life
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Provider Content Network member Daniel Farrell shares the story of Henry, who navigates the challenges of moving from homelessness to being housed. Henry’s story highlights the importance of respecting someone’s right to self-determination within outreach, engagement, and case management.
Daniel Farrell is a contributing writer for the HRC website as a member of the HRC Provider Content Network. He is the Director of the Park Avenue Women’s Shelter in New York City, and an Adjunct Professor at the Hunter College School of Social Work. He is a graduate of psychoanalytic training at the New York Institute for Psychoanalytic Self Psychology and a doctoral student of Social Work at New York University.

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Henry is a forty three-year-old single, white, disabled male. He spent five years homeless, frequenting various drop-in centers, shelters, public hospitals and New York City streets. Each month, Henry received a disability check, which would disappear quite rapidly. Rather than buying food or clothing, he spent the money on drugs and prostitutes. Within a few days the money would be gone. For food, clothing, and an occasional stay in a hotel, he relied on the little money he earned by running errands and panhandling.

Henry began seeking services from a Bronx-based settlement house, Citizens Advice Bureau. Their Homeless Outreach Team linked him with case management services. In the first few months of case management, Henry exhibited frequent outbursts of rage. Staff made multiple emergency service calls because his threatening behavior could not be contained.  The case manager and entire team struggled to understand Henry’s need to lash out. These outbursts made it hard to form a therapeutic relationship. Still, the entire team was committed to working closely with him. Their mutual goal was to end Henry’s homelessness. Month after month, the team maintained consistent contact, listened non-judgmentally, and was committed to the shared value of self-determination. Their persistence led to a clearer understanding of Henry’s boundaries. Developing the therapeutic relationship was a crucial step in supporting him.

Henry slowly developed the confidence and trust that allowed him to open up about the patterns he lived. At times, Henry felt extreme excitement about the challenges of day-to-day survival on the New York City streets. He described having to “jump the turnstiles,” to ride the subway and always searching for his next meal. Other times, he felt lonesome, vulnerable, hopeless, afraid, and full of shame and dread. Henry’s negative emotions were manifested in his outbursts. This adaptation to street life enabled Henry to survive in a hostile environment and giving it up would not be easy.

Henry and his case manager began laying the foundation to end his homelessness. They discussed the pain associated with change and the excitement that street life aroused in him. Henry committed to reducing the intensity of his binge behaviors, which involved drugs and prostitutes. Together, they developed a plan that included ways to obtain food on weekends and to ensure that he had cab fare. Henry also agreed to stay at a local shelter instead of on the streets. They discussed other concrete tasks like obtaining vital documents, buying new clothing, and addressing his medical needs.  

Over time, slight yet significant changes in Henry’s behavior became noticeable. His outbursts were less frequent and less intense. He began talking about leaving his life of homelessness. His binge behaviors decreased. Together with his case manager, they obtained important documents - like his birth certificate and social security card - and began the process to find housing. New concerns arose over whether Henry would be able to tolerate the challenges of moving from the streets to a home.

One challenge included dealing with the housing providers. Henry would have to pass an interview process, which was especially challenging for him. Many housing providers rejected his application. His long history of homelessness and hostility in the interviews hindered the process. To his credit, Henry continued through the process after every rejection. Finally, Pathways to Housing, a non-profit housing agency, agreed to accept him. The program uses the Housing First model, which does not require sobriety or an interview. Henry only had to provide the necessary paperwork, look for an apartment with their housing team, and allow the provider to manage his money. Pathways to Housing respected Henry, which was instrumental to his acceptance of the process.  
   
Henry returned to some of his old behaviors while waiting to move into his new housing. He missed appointments, did not plan for weekend needs, and engaged in binge behavior. Henry’s outbursts returned during this period of regression. He was giving up homelessness and transitioning from a familiar team of people to a new program. Henry had worked with his case manager and team for over two years. The regressive behaviors were familiar and expected to them. However, over time Henry exercised more control over his regressive behaviors, and they became less intense.  The foundation provided by the close therapeutic relationship with his team enabled Henry to reduce his negative symptoms and successfully move into housing.

Now one year later, Henry lives in permanent supportive housing. He credits his work with his case manager and the entire homeless outreach team for his successful transition from homelessness to housing stability.

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Provider Content Network
2009
Newton Centre, MA
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