I Could Look People in the Eye

by Donna Wilbur
March 29, 2013

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Donna Wilbur collaborates with Homeless and Housing Resource Network writer Wendy Grace Evans-Dittmer to share her personal recovery experience. In this blog, Donna recounts how, with the support she received along the way, she can now “Look People in the Eye.”

I work at the Center for Psychiatric Rehabilitation at Boston University as a teacher. At first, I volunteered to teach a typing class. As I received positive reviews, I slowly began to fill in for other teachers who were out on leave or taking time off. After three years, I was offered the opportunity to teach a number of courses, including a computer course, Social Security Income courses, and a Navigating Recovery course that is comparable to developing a Wellness Recovery Action Plan (WRAP).

The Navigating Recovery course was comprised of developing an understanding of fitness, as well as learning the importance of connectedness and wellness. While I don't like to disclose on a regular basis, I choose to disclose when it will be beneficial because I believe that disability needs to be valued.

I was trained by Marilyn Copeland in Vermont and have worked at the Center for Psychiatric Rehabilitation for 13 years. Currently, I live and work as the House Manager at a women’s lodging house. All of the women in the house have psychiatric symptoms. They all work in professional careers and choose to live in the house where they receive support for their demanding lives. I have a third job working with a young adult man who has severe disabilities, which include hearing voices, obsessive compulsive disorder, and paranoid delusions.

I had my own darkest days before I entered the Center for Psychiatric Rehabilitation's Training for the Future course and began my recovery. I never thought that I could finish the program, but my father and my best friend supported me through this time. Prior to entering the program I had been on disability for ten years, had posttraumatic stress disorder symptoms, suffered from bipolar disorder, and was receiving trauma therapy. It was through my therapy that I learned of Bessel Van der Kolk's work at The Trauma Center in Boston. I went through several hospitalizations prior to enrolling in Training for the Future, but eventually completed my B.S.W. at Bridgewater State College with assistance from Massachusetts Rehabilitation, who helped me with the cost of books and transportation. Additionally, they paid for half of the cost of enrolling in Training for the Future, while Social Security, through the PASS program, covered the other half. I use much of this training at the Center now.

With the aid of a service dog—a miniature, wire-haired dachshund—I am able to get out of bed in the morning; she helps me not to disassociate. Lee Walmack, a mentor, once said when I thought I could not finish my program, "I hope you dance." When I think of where I am today, and where I have been, I know that I am able to dance. At that time I had no confidence, but by the end I could look people in the eye. I had hope.

Interested in being a HRC Guest Blogger? Email us at generalinquiry@center4si.com.

 

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Category: General | Guest Entry

Where did you sleep last night?

by Rachael Kenney
March 04, 2013

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Homeless and Housing Resource Network writer Rachael R. Kenney recently volunteered for Denver’s annual point-in-time homeless count. In this blog, she recounts her experience and the important lessons she learned when she asked, “Where did you sleep last night?”

Did I really want to do this again? Two years ago I volunteered for Denver’s homeless count. I was stationed in an administrative building and the staff were all in a training that day so my volunteer partner and I only handed out one survey for the entire four-hour shift. I longed for my experience at the Boston count a few years prior, where volunteers take to the street on foot and in vehicles. We didn’t see anyone then, either, but at least it was a change of scenery. But I’ve been meaning to get more involved locally and they say that the best time is the present, so I signed up. I was pleasantly surprised.

We set up at a folding table in the hallway of an administrative building. Instead of us playing the role of eager young salespeople, nearly everyone who passed approached us to ask what we were up to. My partners and I would explain the homeless count and, much to my surprise, the person would usually sit down to talk with us, including: the nervous man who I was certain would say that he had housing—he didn’t; the young woman whose daughter was bouncing in her stroller—I wondered if offering her fruit snacks was a good idea; and the smiling young man whose son wore sweatpants and sweet little sneakers.

There were two people who stood out and tugged at my heart. The first was an elderly woman who was hearing impaired and didn’t have hearing aids. I’m hearing impaired and the thought of going without aids is scary, even just “thank you, please come again” can spiral into a stressful experience. Rather than read her the survey like we were trained to do, we handed it to her to fill out on her own. She told us about her day as she carefully checked off the boxes. When she reached the end she couldn’t remember what city she was in the night before and began to cry. I wanted so badly to walk around the table and hug her, but I didn’t think that was appropriate and I just sat there.

The second person was a man in his mid-30s. His sly smile and lanky gait reminded me of a goofy friend on a sitcom. He told us that he was supposed to check into detox that morning but he wasn’t clean so he needed to wait. It amazes me that, even though I’ve worked so hard to break down my stereotypes, it still knocks me off guard when someone is high and communicates so well; these beliefs are such a deep part of our psyches. He made an inappropriate joke; we all laughed. He was trying to get clean to be with his family; we all cried inside. He seemed genuine about wanting to change. We rooted for him as he strolled out into the cold and hoped that we were right.

Almost everyone I spoke to that day fit somewhere on the spectrum of homelessness. I reflected on the fact that I was only two miles from home in an affluent town that doesn’t seem to know poverty, yet here I was, surrounded by it. These were people who I wouldn’t give a second thought to if they were in line behind me in the grocery store or strolling past as I walked the dog. The afternoon was a stark reminder of the importance of open mindedness, of providing a spectrum of services, and of how important it is to ask the question, “Where did you sleep last night?”

Interested in being a HRC Guest Blogger? Email us at generalinquiry@center4si.com.

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Katy Hanlon In Recovery: Certified Peer Specialist

by Katy Hanlon
February 04, 2013

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Homeless and Housing Resource Network writer Katy Hanlon recently trained to become a Certified Peer Specialist. In this blog, she and fellow writer Wendy Grace Evans-Dittmer collaborate to share her experience.

I have not always had a voice.

At the first of nine eight-hour classes to become a Certified Peer Specialist I met a Marine veteran. He introduced himself to me and expressed his thoughts on mental health recovery. He had applied to the program three times before being accepted, but never gave up. That impressed me—his conviction. We developed a friendship that was part of a larger community. I drove him home from class every week. I was connecting with someone I would not normally have the opportunity to meet. This tied back to our classes, where one of the things I learned was the value of difference. Peer Specialists, united in recovery, are all coming from unique places; this is an asset to the profession.

The Certified Peer Specialist (CPS) course I am taking is provided by The Transformation Center of Boston and funded by the Massachusetts Department of Mental Health. It is the only certifying program in the state. I initially took this peer-run course because I wanted to gain knowledge and experience to contribute to my work on SAMHSA’s Bringing Recovery Supports to Scale Technical Assistance Center Strategy (BRSS TACS) initiative. I soon realized my strong desire to also give back to the peer community that has given me so much.

Recovery is difficult to define because its path is determined by the individual. With input from the community, SAMHSA offers a working definition that encompasses the four basic tenets: health, home, purpose, and community. Supporting the importance of community is the term peer itself. It is not possible to be a peer or a peer specialist in isolation. There must always be mutuality.

Not all states have certification programs for peer specialists and there is no national listing of programs. Georgia started their program in 2001 with the Georgia Certified Peer Specialist Project and they are key program contributors as other states look at certification. While there continues to be discussion about whether the certification process removes the “peerness” in peers, there are efforts underway to develop a set of national standards. The International Association of Peer Supporters, formerly The National Association of Peer Specialists, is bringing its voice to the table and BRSS TACS will offer a recovery framework. These efforts will be key as states continue to broaden Medicaid funding for CPS services.

Prior to learning about the Peer Recovery Movement, its historical context, and the opportunity to become a CPS, I experienced all of the traditional paths of treatment. My acceptance to the Boston University Center for Psychiatric Rehabilitation’s Training for the Future program changed my perspective as it introduced me to the concept of recovery, peers, and hope for the future. Yes, hope. I gained so much from my peers that I wanted to give back by sharing my own recovery story, which will always be a work in progress.

As part of the nine classes, we had a three-day retreat. Each day focused on specific modules of the curriculum developed by The Transformation Center. All of the modules supported the foundation of a CPS: Peer Support, “In” but not “Of” the system, and Change Agent. This retreat not only brought our class of 26 together, but by example gave me a sense of empowerment and purpose.

I have a voice now.

To find out if there is a Certified Peer Specialist training near you, reach out to local community-based Recovery Learning Communities, State Department of Mental Health, organizations such as The Transformation Center and New York Association of Psychiatric Rehabilitation Services (NYAPRS), or projects such as the Georgia Certified Peer Specialist Project.

Interested in being a HRC Guest Blogger? Email us at generalinquiry@center4si.com.

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Room 307

by Wendy Grace Evans
January 07, 2013

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Homeless and Housing Resource Network writer Wendy Grace Evans-Dittmer recently had the opportunity to testify on a hate crimes bill in the state of New Mexico. If passed, this bill will elevate crimes against people who are homeless to the status of hate crimes. In this blog, she recounts her experience.

Eloise goes to the Plaza Hotel in New York City. Wendy goes to the legislature in Santa Fe, New Mexico. Several weeks ago, Senator Elect Bill O’Neill asked me to testify for a hate crimes bill to protect people experiencing homelessness. I testified on another homelessness matter for the Senator Elect in the past and was immediately happy to participate. Emails back and forth, as well as my experience covering Maryland’s passing of a homeless hate crimes bill, helped develop our plan for the testimony. I spoke with Michael Stoops of the National Coalition for the Homeless for additional information, including how to field questions we might receive from the sub-committee.

While all physical assault is a crime, a “hate crime” is prosecuted more seriously. A hate crime is a crime that is motivated by prejudice towards a minority. Congress’ definition of a hate crime includes: "criminal offense against a person or property motivated in whole or in part by an offender's bias against a race, religion, disability, ethnic origin or sexual orientation." If passed, the bill that Senator O’Neill and I testified for would add New Mexico to the list of states that include homelessness in their hate crime legislation.

I entered the Capitol building in search of Room 307. It was difficult not to meander through the majestic halls, but instead I raced to the third floor. Senator Elect O’Neill had begun his testimony and beckoned me to take a place beside him. My role was to explain that people who misunderstand “the homeless” misunderstand that they are simply human beings without a home. Homelessness is a state of being. Someone you might see on the street is someone else’s brother, sister, mother, father, or child. I stated gruesome statistics about the beatings, burnings, and even decapitations of 880 individuals experiencing homelessness in 46 states over the course of ten years.

Senator Elect O’Neill shared the story of a man experiencing homelessness that he knew personally. This man was the victim of what would be a “hate crime” if this bill is passed. Father Rusty Smith, a giant of a man and the Director of St. Martin’s, a “hospitality center” located in Albuquerque, New Mexico, testified as well. He knew of a young man who lived with his parents, had a job, a car, and lived with mental illness. His parents died suddenly and he lost everything, only to wind up under a bridge. Young boys attacked him, relentlessly stabbing him 20 times. While the man who was living under the bridge survived, his story embodies the kind of hatred-fueled attack that skip the daily lives of the average citizen.

The subcommittee voted to take the bill to a vote for an endorsement the following day. Wendy returned to the Capitol and witnessed the political process: a machine at work. In this case, the machine returned an almost unanimous endorsement, save one abstention. The bill will now go to the legislature. We will testify again, and potentially a third time, if fortune shines through the windows of the legislative hallways.


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Taking a Different PATH

by Amy SooHoo
December 05, 2012

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Amy SooHoo recently began working with SAMHSA’s Homeless and Housing Resource Network (HHRN), coming to this position after two years of providing outreach services in Boston, Massachusetts with the Projects for Assistance in Transition from Homelessness (PATH) program. Here, she reflects on how her past experiences in outreach influence her work today.

What gives a day meaning? This can vary from person to person, day to day, and year to year. For me, I find meaning in simple moments—in the time I share with friends and family, reading a good book, and going for an evening run. But most importantly, I find meaning in my work.

In my prior position as a Projects for Assistance in Transition from Homelessness (PATH) outreach worker, I didn’t have to look far for meaning in my day—the direct service aspect of that position ensured it. My days were spent in conversation with those experiencing homelessness. I worked to plant seeds of hope and change, wanting others to believe that their future could be different. At the end of the day, I could reflect on what had meaning for me that day, how the tiny part of the world with which I had interacted was different because of my actions. I could reflect on taking a young woman to apply for food stamps, and how she’d now be able to buy food because of that. I could think of visiting a client at his new apartment, the smile on his face, and the long road leading to that moment. I could recall a counseling session in which a woman shared a piece of her struggle and painful past, allowing me to bear witness to her story, and think of the ways that her story had changed me.

I’ve recently done a bit of a 180-degree turn. I left my position as a PATH outreach worker and began a new position working primarily with the PATH program at the national level with SAMHSA’s Homeless and Housing Resource Network (HHRN). It’s an entirely new perspective on the PATH program, and my time spent as an outreach worker informs my work in important ways. HHRN works to provide support and training and technical assistance to SAMHSA’s homeless program grantees, and accomplishes this by offering various resources, trainings, webinars, and consultations.

As a PATH outreach worker, I didn’t give much thought to the work that went into the PATH program—I was simply grateful that my position existed, and that I had the tools and resources I needed to do my job. I entered data about my clients, but didn’t really consider what that meant or how it would be used. I went to trainings and read articles, but didn’t think about the work involved with planning an effective training, or in writing an informative and relevant article.

In my new position, I witness the incredible amount of work that goes into ensuring that the PATH program provides effective services. I am grateful to have opportunities to apply what I learned as an outreach worker to the work that occurs on the national level. I find that I am constantly coming back to my time as an outreach worker, trying to determine how a potential change or new policy might affect the services being offered on the ground. I think about what was most challenging to me when I was working in the field, and if there’s anything that can be done to address these challenges.

At the end of the day, the meaning of my work has not changed. I still strive to improve the lives of those experiencing homelessness, and I know that while my current work does not generally have a direct effect on this population, it indirectly affects these individuals in powerful ways. This is what matters most to me, and what gives my days meaning.

Interested in being a HRC Guest Blogger? E-mail us at generalinquiry@center4si.com.

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Category: HRC Insight

Giving Back in the City of Brotherly Love

by Marcella Maguire
November 07, 2012

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Marcella Maguire, Ph.D., of the Department of Behavioral Health (DBH) and partner in the Journey of Hope project in Philadelphia, has worked in recovery outreach programs for many years. Her work with Journey of Hope demonstrates a commitment to a recovery-focused system that provides support for long-term recovery and enhanced quality of personal and family life. This is a significant change from acute serial episodes of brief stabilization, and requires cooperation across many levels of service, family, and community. In her own words, she explains how the city of Philadelphia is ending homelessness, one person at a time.

Some questions are so simple and yet so complex at exactly the same time. “How do we end homelessness in this county?” is exactly that type of question. The simple answer is that housing ends homelessness. It’s that simple. It’s exactly that simple answer that Philadelphia’s Mayor Michael Nutter decided upon when he took office in January 2008 and decided to make ending street homelessness a priority for the City of Brotherly Love.

When we began the program we had no idea how it would work. The initial thought was that 200 people a year could come off the street, receive vouchers, and leave homelessness. But we knew people need supportive services and it is challenging to determine which supportive services are necessary for someone who is still living on the street. Limited resources make service matching important; you never want to give someone more services than they need because someone else needs them, too. On the flipside, you never want to give people too little services because that may set them up for failure. People experiencing chronic homelessness often have many failures in their lives. One more is not necessary.

BL had been living in the downtown train station for over five years. She lived on and off in the shelter system for three years before that. She had some mild mental health issues that life on the street made much worse. Over the winter, she used one of the winter overnight cafes, which are Philadelphia’s version of an overnight drop-in center. The cafe system gives people a warm dry place to sleep and engage with needed services in the morning. She made a good connection with staff at the cafe and they believed she would be successful in her own place with a voucher and a little support. She engaged with a case manager and began the housing process. Her unit was inspected twice before it passed and both delays made her ask the question, would she really receive housing? Eventually, before winter ended, she was able to move in and leave the train station. She still visits friends who remain and advocates for them, but she returns home every night.

We utilized Medicaid-funded supportive services of targeted case management, drug and alcohol case management, and peer supports. Openings that were created in homeless programming were held solely for people with a documented history of street homelessness.

Over three and a half years, my team of committed professionals helped move 587 people out of homeless programming and into their own apartments. Participants were required to participate in supportive services for at least one year prior to their lease being up and had to sign a document agreeing to that fact. Perhaps most importantly, everyone received an individualized recovery plan that matched their needs and desires, rather than a one size fits all approach. As such, the project had fewer participants who disengaged from services and we believe this increased our success rate tremendously. We implemented a monthly feedback form to check in and track housing outcomes such as paying rent, adhering to the terms of their lease, etc. If participants were experiencing challenges there was a process of reevaluating supports to assist them in maintaining their housing and recovery.

As of May 2012, 534 of the 587 remain leased, for a 91 percent housing retention rate. Of those leased, 82 percent have been leased up for at least 12 months. Many have been able to re-enter the work force and a number of them are now employed by the administrative system or provider agencies. Nothing makes this work more worthwhile than being able to organize and plan services with colleagues who have moved beyond their life on the street, engaged with their recovery, and are now giving back to the City of Brotherly Love.

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Remembering the Motivators

by Steven Samra
October 03, 2012

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As a deputy project director for SAMHSA’s Bringing Recovery Supports to Scale Technical Assistance Center Strategy, I sometimes find myself feeling removed from the day-to-day work performed by my colleagues providing direct service to those individuals who must cope with, and exist through, the challenges that arise from mental health and/or addiction issues.

This is challenging for me. I am a person with lived experience whose life dramatically changed for the better because of interaction with direct service providers. I’ve also done my share of service delivery and know firsthand that the real experts are those sitting across from me, hoping that I will be able to provide the answers that will assist in guiding them out of homelessness and into a better life. Truth be told, the best answers for that assistance often come from the individuals themselves. As a direct service provider, my job was simply to reflect what people already knew back to them in a way that reinforced and validated their own knowledge. The people I worked with taught me far more than I could teach them.

So, it is with great enthusiasm and excitement that I greet any occasion to reconnect with direct service providers so that I may learn, refresh my understanding, and share in the joys and the challenges of the work they do and I am passionate about.

Recently, I had this opportunity as organizer of a SAMHSA Homeless and Housing Resource Network (HHRN) webinar, “Increasing Consumer Involvement in Planning, Implementing, and Assessing Homeless Programs.” Three direct service providers shared perspectives on operationalizing their work as Peer Specialist, Recovery Coach, and Tenant Advisory Board Consumer Specialist.

Each presenter articulated not just the standard information concerning the roles of these specialties but, more importantly, their motivation for—and their understanding of—the raison d'etre of each position. As peers who entered their professional roles with a desire to serve and “give back” to their communities, the insight and perspective they shared offered a deeper, more personalized sense of the responsibilities the titles carry, as well as the intense level of commitment each of them bring to the role.

Their passion and commitment came through in dramatic fashion as the presenters completed the discussion portion of the webinar and began answering questions posed by the audience. I felt pride—and a twinge of envy—as I listened to their personal stories of engagement; of working side by side with those individuals who continue their struggle for housing, for recovery, for hope; and of application of their own lived experience as catalysts for providing, as William White calls it, “experientially credentialed” guidance.

Their responses were potent reminders of the importance of peer contributions in behavioral health, and how essential they are to the field and to the constituency we serve. Peers’ additions to the overall treatment protocols established by treatment teams complement clinicians and professionals in a manner that provides insight, balance, and dignity.

The issues of homelessness and the journey of recovery are as complex and unique as the individuals who experience them. The contributions of peers in assisting them and those who endeavor to serve them are important for many reasons. They provide an important perspective for the rest of the team. Furthermore, peers providing direct service stand as a testament to the ability for recovery. They provide hope and inspiration that simply cannot be conveyed by a non-peer. This in no way diminishes the incredible importance of the professionals in the treatment team. Rather, in my opinion, it provides the impetus for the mandatory inclusion of peers in a treatment team construct.

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Category: HRC Insight

Becoming Trauma-informed, Agency-wide

by Jay Crowe
August 30, 2012

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Jay Crowe is the Behavioral Health Program Manager and Clinical Supervisor at Albuquerque’s Health Care for the Homeless, which is the recipient of a Grant for the Benefit of Homeless Individuals (GBHI) from the Center for Substance Abuse Treatment (CSAT). Recently, Jay and three other members of his team were selected to participate in an eight-week virtual learning classroom on Trauma-Informed Care. The course is offered by SAMHSA’s Homeless and Housing Resource Network technical assistance contract, which supports SAMHSA's homeless programs grantees.

Our Executive Director really believes that having a trauma-informed culture is primary, which means that we must have buy-in from senior management. This is why we selected several managers to take the eight-week virtual learning classroom (VLC) on Trauma-informed Care. Most of my web-based educational experiences have consisted of dialing in, or connecting and watching a slideshow, without ever actually coming face to face with another person taking the course. With the SAMHSA VLC, everyone was on webcams and we were able to see not only the instructors, but the other participants as well. I was able to put faces to names. It is so important to see people’s facial expressions when connecting with another person, as it allows you to discern nuances in what they are saying and how they are learning.

One of the most important things I learned is that it is not enough to be only person-centered and client-focused, but that we must also be staff-centered. That really resonated for me. If we have staff who, over time, have been exposed to people who have experienced trauma, then we are likely to have staff who are experiencing vicarious trauma. If we don’t take care of ourselves, and if the staff doesn’t feel safe, then we cannot ultimately help our clients with their complex trauma in a thoughtful manner.

Currently, we are in the midst of an initiative to become a trauma-informed agency, beginning with making our agency a safe and welcoming environment. This is the first of five dimensions of becoming trauma-informed. One of my main goals is to make sure that we are trauma-informed all the way through the system, meaning that we are staff-centered as well as client-centered because we don’t want people to burn out.

And this is not the end; we hope to take this to an even deeper level. Trauma encodes itself within a person’s brain—codes that, when triggered, result in flight, fight, or freeze. It is complicated to transform that type of encoding, which is why we are committed to becoming a trauma-informed agency for everyone that walks through our doors, whether they are staff or clients.

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Building Relationships Among Beets

by Jolie Olivetti
August 01, 2012

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Jolie Olivetti is Farm Manager of ReVision Urban Farm, an innovative community located near Boston, MA. It is dedicated to opening doors to recovery and hope for individuals and families facing homelessness and living with addiction and other chronic illnesses. Since HRC last spoke with them, their farmland has doubled in size. They have a new greenhouse, a new terrace, and a new farm stand on Blue Hill Avenue, an impoverished area of Boston. The organization provides not only recovery services and shelter, but also the opportunity for people to rediscover healthy ways of eating food, growing vegetables, and rebuilding confidence. Jolie reflects on her role and shares insights about vegetables to the meaning of her work.

My favorite vegetable? Well, I usually say that I love beets. They are easy to plant. They are grown directly seeded and are fun to grow, fun to harvest, and fun to eat. You pull them right out of the ground. It’s a longer crop. It takes 50 to 55 days to grow, and the growing season runs from April to October. They are versatile. You can eat them raw or cooked, and I think they are delicious.

Part of the beauty of farming is being able to show people where food comes from. Many of the individuals and families who come to our farm have long histories of gardening, while others are gardening for the first time. This is a community of revision, so we share cuisines from all over the world. The work of our shelter is to develop meaningful relationships with individuals and families. At the farm, we are just as much a part of that goal. Working side-by-side while farming is a great conversation starter.

My background is in environmental education and, through working here, my views on homelessness have really changed. All I knew before came from the media, my observations, and volunteering. I have learned that homelessness is not a permanent condition, but rather, that people experience homelessness. It is about stable and safe housing, and it is about poverty. Most people who experience homelessness are not in that situation because of just one thing, and it is not the first thing you should know about someone. It is not an identity.

The young people I work with in the garden have had a significant impact on me. Many of the children between ages 5 and 11 take a real shine to the farm. It is like a dream for them—an exciting place, especially if they like to get dirty. They have so many questions about what we are doing. When a young person calls out to us and shouts out, “What are you doing?”, I may feel I don’t have time to answer because my task list is so long. But I have realized that the most important thing I can do is to make time to answer, because the most important thing that I am doing is supporting and interacting with the young people who are with us.

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Helping Clients Develop Health Literacy

by Claire Berman
June 26, 2012

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Claire Berman, M.S., is a Health Communication Specialist and part of SAMHSA’s Homeless and Housing Resource Network team. She specializes in issues of health literacy, behavior change communication, narrative approaches, and cultural competency. She shares her reflections on the connection between health literacy and homelessness and lessons learned from the Institute for Healthcare Advancement’s Health Literacy Conference of May 2012.

I like to think of health literacy in this way:

Imagine sitting in an advanced calculus class (and for the purposes of this blog, imagine that the last time you studied math was over ten years ago). The professor is saying words and describing concepts you’ve never heard of before—integral, optimize, derivative, function, and infinite series. You are a smart person, but you can’t follow any of it. Before you leave, the professor turns to you and asks, “Do you have any questions?”

You are so lost in the discussion that you don’t even know where to begin. It feels too late to start asking questions now, and you’re afraid you’ll look stupid if you do—so you say no and quietly leave the room.

Now imagine that instead of a calculus class, it’s a doctor’s appointment, and you are a person experiencing homelessness. The last time you saw a doctor was ten years ago. You’ve never had much education around health, and the health issues you struggle with are fairly complex. Your level of health literacy is probably fairly low, which means that you are less likely to understand what your doctor tells you and less likely to ask questions. As a result, your health is likely to suffer.

This May, I attended the Institute for Healthcare Advancement’s Health Literacy Conference in Irvine, CA. The conference explored operational solutions to low health literacy, and it came as no surprise to me that much of the work being done in health literacy intersects strongly with the work being done in homelessness services.

The vast majority of us in the U.S. (nearly 90 percent) have “less than proficient” health literacy skills. We also know that people with certain experiences are especially likely to have low health literacy. Less education, less access to mainstream services, and higher levels of poverty often lead to the lowest health literacy.

People experiencing homelessness often have all of these risk factors, with enormous costs to their personal health and to our health care system.

The thing about health literacy that makes it so hard to “fix” is that it goes far beyond one single skill. Instead, it is a complex process that relies on reading, writing, verbal, and numeracy skills, among others. It’s about how we are able to find and understand health information, and what we are able to do with that information once we have it.

Can we understand the language? Do we have the basic math skills to understand and follow instructions on medication? Do we have the ability to formulate questions for our doctors, and the confidence to ask them? Do we have people we trust to help us when we don’t have these skills?

What I heard at the conference was a commitment from the health literacy field to find new and innovative ways to reach our society’s most vulnerable populations with appropriate health information. Homelessness service providers work hard to cultivate relationships with marginalized individuals—people who may not have any connections to health care at all.

Providers have the chance to be an important part of the solution. As a starting point, I’d recommend some great resources and methods for addressing low health literacy among clients, such as:

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Category: Guest Entry | HRC Insight