The Philadelphia Department of Behavioral Health and Intellectual disAbility Services (DBHIDS) is the recipient of a Center for Substance Abuse Treatment (CSAT) Treatment for Homeless grant. The program funds programs that provide intensive services to prevent or reduce chronic homelessness.
“I would rather be sleeping in a snowstorm than be in drug treatment. Why would I want to go to treatment? My life is miserable. Why would I want to be able to see things more clearly?”
Marcella Maguire, Ph.D., director of the Philadelphia Department of Behavioral Health and Intellectual disAbility Services (DBHIDS) Homeless Services, recalls working in the early 2000s to outreach to those experiencing homelessness and co-occurring disorders. This particular sentiment, expressed by a man whom she met while doing outreach, depicts one of the many reasons why someone may be reluctant to enter treatment. The thought of surviving without the numbing effects of drugs or alcohol can often be unimaginable.
DBHIDS Office of Addiction Services (OAS), Office of Supportive Housing (OSH), and local homeless outreach and advocacy agencies have partnered to sponsor Journey of Hope, a recovery-oriented residential treatment program for chronically homeless individuals. This program has transformed five traditional residential addiction treatment programs into recovery-focused programs that provide support for long-term recovery and an enhanced quality of personal and family life. The programs have had unprecedented levels of participation from those in recovery, as well as their families.
“We understand the engagement program. We made the programs longer because we knew we were dealing with habilitation, not rehabilitation. With rehabilitation, you have skills and a life you are going back to, but we are working with people who are at risk of going back to street life, and street life creates complex trauma, so there is no life to go back to,” says Marcella. While this may not be true of everyone coming from living on the street, the team knew they had to make the process stronger by offering housing upon graduation. They now have Housing First in the city, and their programs are prepared to offer responses to whatever needs the residents present.
As one participant says, “I need to recover more from homelessness than I need to recover from addiction.” Marcella explains that he was talking about the need to recover from the trauma of homelessness.
The Journey of Hope project integrates addiction treatment, mental health, primary health care, and trauma-informed care. It can be a challenging task to find interdisciplinary teams with the appropriate funding to support all of these services, and who can do so from a person-centered perspective. All members of the team are given the opportunity to shadow seasoned outreach workers in order to see what they do. “We like to do this in terrible weather so people can see what this is really like. It is part of the hiring process. We want to see that people are committed to the work and are willing to do this a different way,” says Marcella. While it is not a traditional ACT team, the team is comprised of a case manager, a nurse, a consulting psychiatrist, a peer specialist, and outreach workers.
Of the five Journey of Hope residences, four serve men and one serves women. The women’s program, WomanSpace Philadelphia, opened in May 2008 and is a ten bed facility, offering long-term residential care with a 9-12 month length of stay.
WomanSpace operates from a person-first model, which offers choices to the residents and gives them the opportunity to play an active role in their recovery. This model contrasts with more traditional residential treatment models in which residents are given a schedule of activities that they are required to attend. “We work with their goals, rather than requiring that the women work with our goals,” says Marcella.
Trauma work is essential for women residing at WomanSpace. Using trauma-informed care principles, the program asks the women to participate in setting rules for the program in order to create a structure that allows them to feel safe. The program also has a strong focus on relational healing and uses a dialectical behavioral therapy model (DBT) for trauma therapy.
Journey of Hope boasts graduation percentages that are consistently higher than general graduation rates for long-term residential substance abuse programs. Marcella reminds us that behind these numbers are the individual stories of those that have benefited from Journey of Hope’s unique model.
She shares the story of one woman who arrived at the program pregnant and struggling with substance abuse. She had a history of childhood trauma and had recently been living on the streets. WomanSpace supported her as she entered recovery from both substance use and a serious mental illness. She was able to connect with her children, while working to accept that she could not have custody of them. She developed a relationship with her children’s adoptive mother and found meaningful ways to support her children in any way that she could, such as buying school supplies for them. Her story is one of many that shows the positive results that can come from living in a supportive, recovery-focused community—a place to begin seeing life, and all it has to offer, a bit more clearly.
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