A couple weeks ago I attended a SAMHSA workgroup meeting for programs offering sober housing and treatment options for women experiencing homelessness. The workgroup began as a technical assistance (TA) request from Lori Criss of Amethyst Programs, a program in Columbus, Ohio. Amethyst offers integrated sober housing and treatment to women experiencing homelessness and substance use issues. Amethyst staff have sometimes felt isolated because this integrated approach is a unique model in their community. Lori knew that there was interest among other programs across the country, and was seeking an opportunity to begin this dialogue on a national level.

In response, SAMHSA’s Homelessness Resource Center helped to convene a workgroup of similar programs, along with SAMHSA’s Women, Children, and Families TA Center. With such a strong national focus on Housing First, sober living models often struggle to find their place. Programs find themselves straddling a divide between housing and addictions treatment. Some identify primarily as housing providers, some as treatment providers, and others as both, adding to the difficulty of seeking funding in various continuums of care. However, sober housing can be a tremendously beneficial model for women with children, trauma histories, and safety concerns.

Based on the clear desire of workgroup members to connect in person and further define key elements of this integrated model, SAMHSA convened a meeting in Baltimore, MD. Sixteen representatives of sober housing and treatment programs for women attended. The group shared their program designs, discussed what works (and what doesn’t), and explored commonalities, challenges, and promising strategies.

Having worked in this field for a year and half, it has become clear that there are no one-size-fits-all models for individuals experiencing homelessness, substance use disorders, or mental health issues. However, I’ve never seen this so clearly illustrated as I did at the workgroup meeting. Not only were providers recognizing a need for alternatives to Housing First for some individuals and families, but they were also highlighting differences among their own gender-specific sober housing models. For some women, being allowed to live with their children and within a community is an important step toward recovery. This demanded more restrictive relapse policies, in recognition of the safety and recovery of children and other families. For others, living independently, becoming economically stable, and thriving in healthy relationships is central to success.

Programs differed on drug testing policies, services for fathers and children, relapse policies, and approaches to treatment. However, it was clear that these programs were each finding success with their participants. I spend a lot of my time trying to understand what works in homeless services. Through the process, I sometimes forget that there are many paths to success. Flexibility to respond to the needs of consumers is essential.

I was inspired by the providers I met in Baltimore. They were committed to finding the best individualized options for women. These providers, many of whom were in recovery themselves, exemplified that fact that one-size-fits-all is not always possible – or necessary – when working with individuals and families.

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Sometimes the most important lessons—the kinds of lessons that have lasting effect on one’s attitude or outlook—occur in the most unlikely of situations. I recently recalled a patient I had the good fortune of working with a number of years ago, while I was still in clinical practice.

I had a busy morning in clinic that day. The schedule did not leave a spare moment for reflection. After a working lunch, I planned to catch up on phone calls and e-mail correspondence. Around 2 p.m., a young woman came to the clinic. She really made me think twice about all the “business” in my life.

Rachel (not her real name) was a 16-year old suffering from a heroin addiction. She wanted help with her third attempt at drug detoxification. What made Rachel so unique to me (keep in mind that I worked for a number of years in very close proximity to a needle exchange program and thus saw many intravenous drug use patients) was the fact that she came to the clinic with her parents. Mr. and Mrs. Smith (again, not their real names) were anything but “typical” patrons at my clinic. They were both in professional careers, lived an upper-middle class lifestyle, and never thought they would find themselves sitting in a community healthcare center. However, they expressed their commitment to Rachel and wanted to help in any way possible.

It is important to mention that injection drug users do not fit a particular profile. Sure, we can stereotype them to the “skid row” image of Hollywood, but there really is no “one size fits all” addict. I saw injection drug users come into the clinic fresh off the streets, and I saw some come straight from their offices. The single caveat that holds them all together is their powerlessness over a drug that has the potential to destroy their lives.

Rachel started using drugs when she was a 13-year old. She never saw herself becoming an addict. It just seemed to happen. Previous attempts at detox and sobriety had all come to naught. Strung out as a 16-year old, her face held the sort of sorrow that one would expect to see on someone many years her senior. Rachel was the victim of a life that she never envisioned nor desired. She was angry and scared. Most of all, she needed help.

I now know that one does not need to be a great thinker or renowned scientist to make a difference in the world. Rachel did not need a marvel of modern medicine. She did not want someone to lecture her about the “deleterious” effects of injection drug use. She really only wanted to get well.

Acute early detox-related treatment for injection drug use is not standardized. Earlier that day, Rachel and her family tried to see their family doctor. That doctor told them not to come, because she would not treat Rachel. They tried going to a doctor recommended by a friend, but again the services they requested were not available. Finally, in desperation, Mrs. Smith phoned the needle exchange program at our clinic. She heard that we had limited resources. She said she wanted to come in anyway.

What Rachel and her family needed was someone who would listen to their concerns, and show them that they were not alone. What they wanted from me was a listening ear and a concerned advocate.

What I learned from this remarkably strong family was that I make a difference just by being present to the suffering of another person. I learned that the “little things” (a smile, the gentle touch of a caring hand, an open heart) comfort the biggest of worries and sorrows. I learned that taking time to care about another means that I need to be present to suffering. Most of all, I learned that life’s most significant lessons come in the most unlikely of ways.

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Patty Wudell is the Executive Director of Joseph’s House. in Washington, DC. Here, people who are formerly homeless and dying of HIV/AIDS can come to live and receive compassionate care. Patty spoke with HRC writer Wendy Grace Evans to share reflections on her work at Joseph’s House.

Here at Joseph’s House we have had a heartbreaking—more than heartbreaking, a life changing—experience. About a year ago, a 21 year old woman came to us for respite care. We welcomed her. Her name is Melissa (not her real name). She had advanced AIDS, and was expected to die. She had a three year old and a two year old. She was so very sick and so deeply and profoundly full of anguish and depression, and then she became well. She was here at Joseph’s House for five months. Little by little she started to eat and put on weight. Once she started feeling better, she was willing to take HIV/AIDS medications. She got even stronger. Her children came to stay with her, even overnight. She never thrived, but she got well enough to go home.

For her, home was not a homeless shelter. It could have been; there were so many people living in her mother’s apartment. She and her children had a mattress on the living room floor. There were so many people living there with incredible needs, so much anguish. Her brother and sister had been convicted of killing another sister’s boyfriend and were also living there. The young woman stayed in touch with us. We heard she was in the hospital again, but by the time we arrived she had already checked herself out. Then, four weeks ago she was referred to us for hospice care again. So now she is 22 years old and dying.

Last night at our dinner table, we spent time with this courageous young woman, her great grandmother who is 93, her grandmother, her mother, her children, their father, sisters, cousins, and their babies. Joseph’s House was full of people who really love her and are doing the very best they can. The first time she was with us, we didn’t know her family. Now her family has been here sleeping overnight, in her room, and on couches in the living room. We feed everyone all the time. What I find so moving is that when she first came back to us, I just felt rage—rage at AIDS and poverty, rage at these social issues. But I found that my rage just didn’t feel quite right. It distanced me from Melissa.

I didn’t want that, so I found myself sitting with this little girl and holding her kids on my lap and talking to generations of women who have never had any material security, and yet, they have each other. They have resilience, and they do more than the best they can. They really say yes to each other. I don’t have rage anymore; I have love. I have admiration, sadness, humility, and gratitude to have the chance to have some actual time with these women, time at the table. My first impression of Melissa was that she was isolated and she was. But my initial impression that she wasn’t loved was misinformed. Now, it’s both much sadder and much better to know about the love in her family that has been here since she contracted AIDS as a child. There is more love than anything else. We are part of that love, too. It is moving to be a part of the support for our young volunteers who are Melissa’s age. How do you support them? Well…we do.

This past weekend we anticipated that she might die. I was on call. Our nurse practitioner, Priscilla had a wedding across the country and she called to talk to Melissa’s mother and grandmother. What really moved me is that she happened to call at mealtime. Melissa’s mother said to us, “I cannot believe the love that is here. It doesn’t matter what shift or who is working, there is always love here.”

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Ed Blackburn is the Executive Director of Central City Concern in Portland, Oregon, a SAMHSA grantee that provides pathways to self-sufficiency through active intervention in poverty and homelessness. In a conversation with HRC Writer, Wendy Grace Evans, Ed talks about what inspires hope in his daily work.

What gives me hope is when I see a family that has been reunited. This is a very practical kind of hope. The children are happy because they are with their parents who have overcome substance use and trauma. To see that kind of happiness certainly motivates me.

I am also amazed to see a person who has experienced homelessness for a long time move into housing and find a sustainable job, or to see a person who has been disabled come back to health. I have the opportunity to see the communities that people build together as active citizens, attending city meetings, and that is my constant source of hope. Hope is a powerful response, and the experience of transformation is a powerful antidote to some of the political negativity that can surround the struggle to get funding support for safety net services and housing, as the news isn’t always good on that front.

When you can continue to see hope in humans, it helps to sustain our work. Angela is a single mother who had been living on the streets for years. She lost her baby to foster care, but once she was able to get into Central City Concern’s Hooper Detox Center, she was able to be reunited with her child. She joined our program for families in recovery, is now working, and has gone back to school. I had the privilege of hearing her story and meeting her. I will never forget her story. It was inspiring and a clear reminder of why we are doing what we are doing.

There was also a young man I knew who was heavily involved in street drug dealing. He had been in and out of the criminal justice system. After a couple of times, he entered into our Recovery Mentor Program. Three mentors run the program and mentor others. He has done very well and is now involved in our community volunteer corps to help people who are recovering from substance use. We have teams in the community working on projects for eighty dollars a month for a few hours a week to improve senior centers, parks, recycling centers, and to work with Habitat for Humanity and other small non-profits. Eighty-two percent of participants complete the program. They also work with Supported Employment and serve as inspiring examples to others.

The endless creativity that people have to solve serious problems, to heal people in the community, and to lead the way towards successful solutions demonstrates a limitless spirit. It is great to be a part of something so all encompassing. At Central City Concern we have approximately 650 employees. Fifty percent of our employees are in recovery from substance use and homelessness. I have the gift of participating in an organization that has the highest sense of commitment to its mission.

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Every good story needs a hero. I met some real life heroes this week.

Recently, I traveled to two very different programs. In Alaska, the Cook Inlet Tribal Council is collaborating with a community based housing organization, Cook Inlet Housing Authority to develop model housing programs for people with complex medical, mental health and social needs. In essence, they are helping to shape a “safety net” movement in the city of Anchorage. Their work with Alaskan Native populations involves a strong grounding in cultural competency and respect for indigenous beliefs.

The other program I had the privilege of visiting was the Skid Row Housing Trust (SRHT), in Los Angeles. Smack dab in the middle of one of the most sophisticated cities in the world, SRHT works in a 15-block area of extreme poverty and social isolation. The Skid Row community needs little in the way of introduction. Homeless and social service providers have been wrestling with how to provide the most effective means of delivering resources to the “Row” for years. SRHT, a community based housing developer, is working with cutting edge housing and supportive services to reach the most vulnerable people experiencing homelessness in Skid Row.

One afternoon in Anchorage, staff from the Cook Inlet Housing Authority and the Cook Inlet Tribal Council took our team to the city’s Project Homeless Connect event. Events like this take place in a number of cities across the country. They almost always involve an army of volunteers, a large conference facility venue, and a mountain of donated items.

What made this event different for me was the strong sense of community that I witnessed. Community was expressed in the way the volunteers interacted with the clients. Community was in the gentle smiles that abounded. Community was in the encouraging words heard over and over again. I asked one of the providers at the event why everyone seemed so happy. He said, “We are all in this together. We, clients, providers, clinicians, consumers, are all one big team.”

Walking around the streets of Los Angeles can be intimidating. Walking around the streets of the “Row” can be frightening. One afternoon, the Director of the SRHT Services in Supportive Housing program walked me around Skid Row to visit housing units available to clients enrolled in their housing first program. What struck me most in our brief walk was the seeming enormity of the problems and issues in the Row. I wondered to myself how people prevent being overwhelmed by feelings of hopelessness. I asked a staff person working in one of the SRHT facilities if she ever felt like there was just too much to do. Her response inspired me. She said, “The most important thing for me in my work was learning that I can’t fix anyone. In fact, it’s not my job to fix people. What is my job - is to walk alongside them in this journey.”

The heroes of this story are the inspiring staff and service providers of both organizations, and the work they are doing everyday to serve the underserved and end homelessness.

Are you interested in sharing your voice on “Voices from the Field”? Email us at generalinquiry@center4si.com

The Homelessness Resource Center training team is in the swing of the training season. Over the next five months, we’ll be criss-crossing the country to offer free two-day training events in four cities. Mark your calendars for the following events:

• Denver, Colorado, May 19-20, 2011
• Providence, Rhode Island, June 28 & June 29-30 2011
• Los Angeles, California, August 1-2 & August 3, 2011
• Roanoke, West Virginia, August 23-24, 2011

Stay posted for information on how to register and details on the training workshops for each event.

Each training will offer HRC’s core curriculum, Promoting Wellness: An Integrated Approach to Homeless Service Delivery. Join us to learn more about innovative strategies for providing homeless services and creating environments that are person-centered, trauma-informed, and recovery-oriented.

HRC’s training team and our federal and local partners will share expertise in Motivational Interviewing, Consumer Integration, Trauma-Informed Care, Self-Care, Housing, Outreach, and much more. Continuing Education Units (CEU) will be available to participants who complete the training.

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

Sister Mary Scullion has been a tireless advocate for men, women and children experiencing homelessness since 1975. She was honored by Time magazine as one of the World’s Most Influential People in 2009 for her work with Project H.O.M.E in Philadelphia. In 2009, HRC profiled her work in “Upholding Human Dignity.” Now, two years later, HRC catches up with Sister Mary to hear about her recent work.

As told to HRC’s Wendy Grace Evans

One thing for sure is that the external environment is shifting quickly. I see this at the local, state, and national levels. This presents both challenges and opportunities. I am most excited about homelessness prevention and how we can work together to accomplish this. Initiatives like Rapid Re-Housing and Housing First, and increased permanent supportive housing, as well as other homelessness prevention strategies, have really sparked interest. I think there is a strong sense of hope that we can end homelessness.

Project H.O.M.E. has established an alumni association. It has been such a positive development in so many ways. Many people come back and our current residents see how former residents have reunited with families, are living with their kids, are working, and are engaged in life.

Just last night I met an alumna whose kids go to the after-care program. Her kids are on the honor roll and she was so happy and proud to have had the stability of Project H.O.M.E and to have transitioned to the stability of her own home. It is gratifying to see that the future can be different than the past.

When some of our alumni are struggling, they have a place to come back to here, rather than returning to homelessness. This is another homelessness prevention strategy that promotes social connectedness. Another exciting development has been the establishment of best practices. SAMHSA has been a strong reference point that has allowed us to deepen our knowledge of Evidence Based Practices and best practices in order to change and empower ourselves and our community to grow and achieve our potential.

We are participating in trainings on Critical Time Intervention (CTI), and the WRAP model. These have been important opportunities. We have also been more conscious of how we approach the hiring process. We are so grateful to be part of a community that is growing. While the number of people who are becoming homeless is unfortunately growing, more people are working to end the problem. We are all on a journey home. If we always do what we have always done, we are always going to get what we’ve always gotten. So we do things differently to make a change. . We have to redouble our advocacy efforts to ensure just and equitable public policies.

Are you interested in sharing your voice on “Voices from the Field”? Email us at generalinquiry@center4si.com

“People join organizations and leave supervisors.”

This was one of the key messages of a recent HRC webcast, “Promoting a Healthy Work Environment in Homeless Services: What Works.” Presenters Ken Kraybill, B.J. Iacino, Ayala Livny, and Tye Deines discussed strategies to help homeless service agencies promote healthy work environments.

Ayala and Tye’s section of the presentation focused on the importance of supervision. They shared research by Marcus Buckingham and Curt Coffman, published in First, Break All the Rules: What the World’s Greatest Managers Do Differently, based on 25 years of research and interviews with over 1 million employees, managers, supervisors and executives.

Buckingham and Coffman learned that the front-line manager is the most important factor for attracting and retaining talented employees. They found that a person will stay with a great manager in a mediocre company, but will leave a mediocre manager in a great company. Even more surprisingly, they learned that pay and benefits are less important than the quality of a manager.

How can a homeless service agency move toward fostering, promoting, and providing quality supervision? Buckingham and Coffman suggest starting with 12 Questions. In a healthy work environment, all employees would answer affirmatively to these questions:

1. Do I know what is expected of me at work?
2. Do I have the materials and equipment I need to do my work right?
3. At work, do I have the opportunity to do what I do best every day?
4. In the last seven days, have I received recognition or praise for doing good work?
5. Does my supervisor, or someone at work, seem to care about me as a person?
6. Is there someone at work who encourages my development?
7. At work, do my opinions seem to count?
8. Does the mission/purpose of my company make me feel my job is important?
9. Are my co-workers committed to doing quality work?
10. Do I have a best friend at work?
11. In the last six months, has someone at work talked to me about my progress?
12. This last year, have I had opportunities at work to learn and grow?

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Feeling stressed? One of the most valuable things you can do is to practice a little self-care, every day. Here are some self-care tips to help you remember to breathe.

1. Take one thing at a time.
2. Avoid over-scheduling.
3. Treat your body well.
   • Eat healthy food.
   • Exercise.
   • Get enough sleep as often as you can.
   • Take time off when you are sick.
4. Remember to ask for help.
5. Cook and enjoy a meal with a friend or loved one.
6. If you have only 5 minutes, you could:
   • Chat with a co-worker
   • Step outside for fresh air
   • Enjoy a snack or make a cup of coffee or tea
7. If you have only 10 minutes, you could:
   • Write in a journal
   • Call a friend
   • Meditate
   • Tidy your work area
   • Assess your self care routine
   • Draw a picture

Most importantly, whether you use some of these tips or create a few of your own, remember that sometimes in only takes a little bit of time to nourish your mind and body – and the benefits can go a long way.

Check out What About You? A Workbook for Those Who Work with Others for more self care tips.

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

We all throw around terms like “stress” and “burnout” as though they should be regular parts of everyday life. We might say, “Oh man, am I stressed out!” Or, “Did you see Tom during today’s staff meeting? He totally snapped! He is really burnt out.”

Sure, we all have stress at work. In fact, some stress is healthy for us. But we need to be careful not to ignore the dangers of stress and burnout. Recently, I had the opportunity to research these issues. What I found honestly surprised me.

Chronic stress and burnout can lead to devastating health and mental health conditions. These can include heart disease, musculoskeletal disorders, depression, anxiety, and emotional exhaustion.

In the homelessness field, service providers face a unique risk factor for burnout known as vicarious trauma or compassion fatigue. This occurs as a result of regular exposure to clients who are dealing with trauma. Among people who are homeless, their life stories often consist of violence, loss, despair, and family separations. As the caregivers, providers absorb these trauma stories. As a result, providers may begin to exhibit signs of post-traumatic stress disorder. Or they may feel powerless, angry, and have a sense that their expectations for helping others have gone away. Vicarious trauma is a serious concern that can impact how providers view themselves, others, and the world around them. It can also severely impact providers’ quality of life.

What is most striking about this information is that issues such as burnout and vicarious trauma are preventable. With proper training and supports, individuals can minimize the dangers associated with these occupational hazards.

One way to do this is to adopt self-care practices. Both individuals and organizations play a role in self-care. In fact, it is essential that self-care is supported by both the individual and the organization.

Individuals can create self-care plans to help create a healthy work-life balance. Activities might include deep breathing or meditation, exercise, proper nutrition, spiritual activities, social activities, or even just making the time to take a lunch break. Organizations can create healthier cultures by talking about the importance of self-care, allowing time for staff to take breaks and seek out peer support, encouraging staff to take vacation time, and providing physical and mental health benefits.

For some HRC community members, this is not news. Perhaps for anyone who works, the dangers of job stress and burnout are not news. However, what may be news to you is just how dangerous stress and burnout can be when left unaddressed. For homeless service providers, the challenges are even greater as we walk alongside people who are struggling with trauma.

Even if you start small, start today. Strike up a conversation about self-care in your office. Take a walk at lunchtime. Breathe.

Please don’t forget to take care of yourself as you take care of others. Visit the HRC’s Self Care Topic Page to learn more about how to practice individual and organizational self care.

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