Voices from the Field Blog: How’s Nashville Campaign Celebrates First Year’s Accomplishments

by Darby Penney
July 23, 2014

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Homeless and Housing Resource Network contributing writer Darby Penney charts the work that has led up to the inauguration of the How’s Nashville campaign to end chronic homelessness by reaching out to diverse stakeholders and building a sense of common purpose across service systems.

How’s Nashville, a broad-based community initiative to end chronic homelessness, successfully housed and supported 545 formerly homeless individuals in its first year of operation, according to Steven Samra, a member of the city’s Metropolitan Homelessness Commission, which started the campaign in June 2013. Almost 200 people were housed during the first 100 days.

How’s Nashville exceeded expectations by bringing together community partners from diverse sectors—including real estate developers, landlords, mental health and substance abuse service providers, anti-poverty organizations, health care agencies, veterans organizations, educators, and various government agencies—to identify the city’s most vulnerable homeless citizens and meet their needs for housing and wraparound supports.

Working in collaboration with the national 100,000 Homes Campaign, How’s Nashville was kicked off with a three-day effort, called Registry Week, in which teams of staff and volunteers surveyed Nashville’s homeless residents using the Vulnerability Index Service Prioritization Decision Assistance Tool (VI-SPDAT). This instrument grew out of research conducted by Dr. Jim O'Connell for Boston's Healthcare for the Homeless organization, which determined specific health conditions that led to the premature death of homeless persons. The survey reached 469 people in Nashville, of whom 222, or 47%, were identified as vulnerable or at risk of premature death on the streets.

Based on the survey results, a by-name list of those in highest need was compiled, and those individuals were given priority for immediate services using a Housing First approach. This was supplemented by providing the newly housed people with Critical Time Intervention (CTI) through a contract with Centerstone, a major local behavioral health care provider. CTI is a time-limited model of case management that provides the most intensive services during the first three months a person is housed, when people’s adjustment to their new living arrangements is most acute; interactions are scaled back as people become accustomed to their new living situations.

Samra notes that How’s Nashville’s first-year success stands in sharp contrast to an earlier local effort in 2009, which was not successful due to lack of community readiness and organizational collaborations. In one case, 27 residents of a large homeless encampment were successfully housed, and all of them lost their housing within the first year. “Where we failed in 2009 was that we did not have strong community readiness, and resources were not well-aligned to provide the wraparound services people needed,” he said. “We hadn’t raised enough awareness in the community, and services were very siloed.”

By contrast, the work leading up to the inauguration of the How’s Nashville campaign focused on developing a strong team of local leaders who had not necessarily worked together in the past, educating them about the tools and resources needed to make a concerted effort to end homelessness, and building a sense of mission and shared values among the community partners. In addition, there was a grassroots fundraising campaign that quickly raised $75,000 to help with expenses that were not covered by various government funds, which brought more positive media attention to How’s Nashville.

Other important contributions to the success of the campaign included development of a Memorandum of Understanding (MOU) with the city’s Metropolitan Development and Housing Agency to set aside a percentage of HUD Section 8 housing vouchers for people on How’s Nashville’s priority list. In addition, a major local developer was recruited as a campaign partner, and he reached out to other developers, who agreed to donate 1% of new rental units to the campaign.

How’s Nashville succeeded in mobilizing community resources to house people at the rate of 45 per month during its first year, almost tripling the rate from the previous year. Some of those housed in the past year were people who were back on the street after the earlier efforts in 2009. What made this possible? Steven Samra believes that the Metropolitan Homelessness Commission’s ability to reach out to diverse stakeholders and build a sense of common purpose was a vital ingredient. “For the first time in Nashville, this campaign really brought people and agencies together across service systems,” he said. “The energy has been catching!”

What needs still exist? As How’s Nashville continues to move forward in its efforts toward ending homelessness, Samra would like to see the development of peer support services provided by formerly homeless people. “We need to put more emphasis on the intersection between homelessness, recovery, and peer support,” he said.

More information on the How’s Nashville campaign is available at: http://howsnashville.org/

References
Herman, D. B., & Mandiberg, J. M. (2010). Critical time intervention: Model description and implications for the significance of timing in social work interventions. Research on Social Work Practice, 20(5), 502-508.

Juneau Economic Development Council. (2009). Vulnerability Index: Prioritizing the street homeless population by mortality risk. Retreived from http://www.jedc.org/forms/Vulnerability%20Index.pdf

Kanis, R., McCannon, J., Craig, C., & Mergl, K. A. (2012). An end to chronic homelessness: An introduction to the 100,000 Homes Campaign. Journal of Health Care for the Poor and Underserved, 23(1), 321-326.

Interested in being an HRC Guest Blogger? E-mail us at HomelessPrograms@samhsa.hhs.gov.

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Voices from the Field Blog: Holding Spaces for Care – Trauma-Informed Approaches

by Darby Penney
June 20, 2014

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Homeless and Housing Resource Network contributing writer Darby Penney reflects on the moving testimony of a formerly homeless mother who received trauma-informed services through a SAMHSA treatment for the homeless grant in Albany, the Addiction and Recovery Center for Hope (ARCH) program.

More than 60 local health and human service providers, researchers, government officials, and community members came together in Albany, NY, on June 10, 2014, for a roundtable discussion exploring how findings of the SHIFT study (Service and Housing Interventions for Families in Transition) can be used to change policies and practices to help reduce family homelessness.

The study found that homeless mothers are a highly traumatized and under-served group; 93 percent of participants had a history of trauma, with 81 percent having experienced multiple traumatic events. About half the women met diagnostic criteria for post-traumatic stress disorder (PTSD) at the beginning of the study. The majority met criteria for major depression, and most were survivors of interpersonal violence by family, intimate partners, or other known perpetrators. Their children were also negatively impacted by their mothers’ trauma histories, with 41 percent having physical and/or emotional difficulties at baseline (Hayes et al., 2013).

The SHIFT study, funded by the Wilson Foundation, was conducted in the upstate New York cities of Albany, Syracuse, Rochester, and Buffalo by the National Center on Family Homelessness (NCFH). It identified mothers in emergency shelter, transitional housing, and permanent supportive housing programs and interviewed them three times over a 30-month period. 

The results of this study are consistent with those of an earlier study of factors involved in family homelessness (Bassuk et al., 1997), according to Carmela DeCandia of NCFH. What is new, she said, is the study’s conclusion that unresolved trauma issues—as indicated by severity of symptoms of PTSD—and low self-esteem were the only predictors of continuing residential instability at 30 months into the study.
 
These findings illustrate the critical need for agencies that serve homeless families to learn about trauma and its impact, along with implementing trauma-informed approaches to service provision. This conclusion was emphasized by the moving testimony of a formerly homeless mother who received trauma-informed services through the ARCH program. After multiple episodes of homelessness, which resulted from struggles with her own emotional distress and her daughter’s suicide attempts, Maria, a single mother, entered the ARCH program. Talking with ARCH staff, she realized for the first time that what she experienced as a child was abuse and that she is a survivor of trauma. Maria and her children moved into a supported apartment program, and with ARCH’s trauma-informed supportive services, she has been able to return to the workforce.

While some in the audience were familiar with the idea of trauma-informed approaches (formerly referred to as trauma-informed care), it was apparently a new concept for most of those who participated in the roundtable. A recent review of the literature found that while trauma-informed care offers a coherent framework for providing homelessness services, the concept remains unclear for many providers and the mechanisms for creating trauma-informed organizational and systems change is not well understood in this field (Hopper et al., 2010).

SAMHSA defines trauma-informed approaches as follows: A program, organization, or system that is trauma-informed realizes the widespread impact of trauma and understands potential paths for recovery; recognizes the signs and symptoms of trauma in clients, families, staff, and others involved with the system; it responds by fully integrating knowledge about trauma into policies, procedures, practices, and settings; and it seeks to actively resist re-traumatization.

Homeless service providers—as well as other human services agencies—can request training and technical assistance on trauma-informed approaches to become a trauma-informed organization and to provide trauma-informed peer support, as well as related issues, through SAMHSA’s National Center for Trauma-Informed Care (NCTIC).

For more information on technical assistance from NCTIC, contact Pam Rainer at prainer@ahpnet.com. To access the SHIFT study, please navigate to this link: http://www.air.org/sites/default/files/SHIFT_Service_and_Housing_Interventions_for_Families_in_Transition_
final_report.pdf

References
Bassuk, E. L., Buckner, J. C., Weinreb, L. F., Browne, A., Bassuk, S. S., Dawson, R., & Perloff, J. N. (1997). Homelessness in female-headed families: Childhood and adult risk and protective factors. American Journal of Public Health, 87(2), 241-248.

Hayes, M., Zonneville, M., & Bassuk, E.  (2013). The SHIFT Study: Final Report. Needham MA:  The National Center on Family Homelessness.

Hopper, E. K., Bassuk, E. L., & Olivet, J. (2010). Shelter from the storm: Trauma-informed care in homelessness services settings. The Open Health Services and Policy Journal, 3(2), 80-100.

Interested in being an HRC Guest Blogger? E-mail us at HomelessPrograms@samhsa.hhs.gov.

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Voices from the Field Blog: Peer Support for Veterans Involved in the Justice System

by Darby Penney
May 29, 2014

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Homeless and Housing Resource Network contributing writer Darby Penney highlights the work of MISSION DIRECT VET (Maintaining Independence and Sobriety through Systems Integration, Outreach and Networking-Diversion and Recovery for Traumatized Veterans), which is a treatment program that serves veterans with co-occurring mental health and substance abuse issues.

“Shortly after the opening of the pilot site for our Jail Diversion-Trauma Recovery program, we quickly realized that one of the veterans involved in our program was homeless,” said David Goldstein, a team member of MISSION DIRECT VET in Massachusetts. “So the two of us got in the car and drove over to the local veterans’ shelter. We were introduced to the staff, and after the veteran told his story of how PTSD (post-traumatic stress disorder) contributed to his homelessness and his involvement with the courts, he was welcomed with open arms. The warmth present in the room brought me to tears. This was my first, and certainly not my last, experience with a homeless veteran and a welcoming shelter.”

The MISSION DIRECT VET program began with a single pilot site in Worcester, MA in 2009 that has expanded to two other sites in the state. Its goal is to serve veterans with mental health, substance abuse, and other trauma-related issues who are involved with the criminal justice system in order to divert them from jail into trauma-informed services. Originally funded through a five-year SAMHSA grant, the program continues now with state funding.

MISSION-DIRECT VET is a manualized treatment program for people with co-occurring mental health and substance abuse issues. It is the primary treatment service that is offered, and it is supplemented by 12 months of peer support services and case management. Referrals and linkages to vital community-based services such as veterans’ services, vocational and independent living skills programs, family support, and transitional residence programs are also central to the program.

Veterans are over-represented among people experiencing homelessness (e.g., in 2010, veterans accounted for about 10 percent of the total U.S. adult population and 16 percent of the homeless adult population). The good news is that homelessness among veterans has declined by an estimated 25 percent since 2007, according to the U.S. Department of Housing and Urban Development’s 2013 Annual Homeless Assessment Report. 

The National Alliance to End Homelessness reports that homeless veterans include service members from every era since World War II. While Vietnam-era veterans are at greater risk of homelessness than those from other eras, veterans of recent conflicts are more likely to be more gravely disabled. One recent study found two-thirds of homeless Iraq and Afghanistan veterans were diagnosed with PTSD, a rate far higher than earlier generations of veterans (Tsai et al., 2013).

This is where programs that offer a strong peer support component can be especially helpful. MISSION-DIRECT VET team member David Goldstein is a Vietnam veteran, a trauma survivor, and person in recovery. He provides the veterans who participate in the program with one-on-one peer mentoring, facilitates veterans support groups, and connects veterans to resources in the community. Perhaps most importantly, he listens, sits with people who are in trouble, and offers a non-judgmental perspective of someone who has been through many of the same experiences as the people he serves.

While Goldstein has seen the success stories of many of the veterans who have been through the program, he cautions that there are still areas for improvement. “Veterans who go into homeless shelters are often there, directly or indirectly, because of substance abuse issues with drugs and/or alcohol that are often related to PTSD. Because of the rules of the shelters subsidized by the VA (Veterans Administration), they may be asked to leave due to abusing the very substances that got them there to begin with. To keep these veterans from falling back into homelessness, the protocols for these shelters must change,” he said.

References
Henry, M., Cortes, A., & Morris, S. (2013). The 2013 Annual Homeless Assessment Report (AHAR) to Congress. Washington, DC: The U.S. Department of Housing and Urban Development, Office of Community Planning and Development.

National Alliance to End Homelessness. (n.d.). Veterans. Washington, DC: National Alliance to End Homelessness. [Website article]. Retrieved from http://www.endhomelessness.org/pages/veterans

National Center for Veterans Analysis and Statistics. (2012). Profile of Sheltered Homeless Veterans for Fiscal Years 2009 and 2010.  Washington, DC: The U.S. Department of Veterans Affairs.Retrieved from http://www.va.gov/vetdata/docs/SpecialReports/Homeless_Veterans_2009-2010.pdf

Tsai, J., Pietrzak, R. H., & Rosenheck, R. A. (2013). Homeless veterans who served in Iraq and Afghanistan: Gender differences, combat exposure, and comparisons with previous cohorts of homeless veterans. Administration and Policy in Mental Health and Mental Health Services Research, 40(5), 400-405.

Interested in being an HRC Guest Blogger? E-mail us at HomelessPrograms@samhsa.hhs.gov.

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Voices From the Field Blog: Removing Barriers to Education

by Mary Poor
April 23, 2014

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Homeless and Housing Resource contributing writer Mary Poor highlights the Boston Public Schools (BPS) Homeless Education Resource Network and its commitment to making a difference for the children and families within the community who are experiencing homelessness.
 
Families represent an increasing segment of the homeless population in the United States, with more than 77,000 households and nearly 165,000 children experiencing homelessness in 2012. The heavy toll of homelessness on children’s health and well-being is well documented – they have higher rates of acute and chronic illnesses, experience emotional and behavioral problems that interfere with learning at almost three times the rate of other children, and go hungry twice as often as other children. The challenges confronting children and families experiencing homelessness can seem insurmountable – except for those individuals who have made a long-term commitment to work creatively to address their complex issues, build relationships, and advocate for a more just system.

Mary William is a Boston social worker that made such a commitment. She is the Director of the Homeless Education Resource Network (HERN), a program that she helped start more than 25 years ago in the Boston Public Schools (BPS). HERN - originally called the Homeless Student Initiative – was established in response to the McKinney-Vento Act, the federal law that removes barriers to education and ensures immediate enrollment and educational stability for children and youth experiencing homelessness. When the HERN program began, it provided basic services, such as transportation, school supplies, clothing, and referrals, for approximately 100 students experiencing homelessness in the school district.

Over the years, HERN has grown to meet the needs of over 3,000 BPS students who are currently experiencing homelessness in the school district. These students attend 142 Boston Public Schools. On a recent spring day, I had the opportunity to talk with Ms. William about some of the challenges facing HERN and the children and families that it serves. Ms. William immediately said that providing transportation to approximately 500 students who reside outside of the school district is one of HERN’s most pressing concerns. She explained that sometimes families who are experiencing homelessness could find temporary housing only outside of Boston. Some children live as far away as Chicopee or Greenfield, Massachusetts, which results in the children commuting up to four or five hours each school day. Since these families do not choose to move to another school district or city, the McKinney-Vento Act ensures that students who are experiencing homelessness can opt to remain in their original school. Since changing schools can negatively affect how a student performs academically and how they form relationships with other students, every effort is made to provide children with educational stability.

Although families have the option of registering their children in the school in their temporary communities, Ms. William said that 99 percent of the families choose not to enroll them. Ms. William explained, “They have lost everything. The only thing stable is their schools. Nothing is familiar in their temporary communities. They don’t know the teachers. The whole culture is a shock for them. Sometimes it’s hard for them to establish new relationships. Sometimes there’s a language barrier, too.” She also noted that some communities do not have the resources to support the families. The bottom line is that every time a child has to change schools, his or her education is disrupted. According to some estimates, three to six months of education are lost with every move. At the same time, commuting long distance to attend school is far from optimal for students.

Ms. William also talked about the challenges that children who are experiencing homelessness face in the classroom. In addition to the distance that some of the children travel to and from school, many of the children that HERN serves are tired and have difficulty focusing on their work. Oftentimes, homework is not completed and attendance can be inconsistent. And sometimes the children aren’t privileged to share the fact that they are experiencing homelessness with their friends or teachers because their parents do not want others to know about their situation. This inadvertently puts an emotional toll on the children. As Ms. William reminded me, “Homelessness is the end result of a long struggle.” And the long-term consequences of homelessness can be daunting. Students who experience homelessness are 50 percent less likely to graduate, four times more likely to drop out of school, and three times more likely to need special programs. These are tough odds to be up against.

Despite these challenges, Ms. William and her staff at HERN are committed to making a difference in helping BPS children and families who are experiencing homelessness to succeed. In addition to providing transportation and other basic services, HERN has established an evening program aimed at closing the achievement gap. Some BPS teachers are trained to work specifically with children and families temporarily living in shelters. Each of these teachers is assigned to one shelter, which s/he visits on a regular basis throughout the school year, providing two hours of mentoring per visit on topics such as math and literacy, relationship building, parental rights, and managing and coping with stress. The teacher also serves as a liaison between BPS and the shelter, which allows BPS to address issues in a timely way and provide support for the families who live there.

HERN also tries to nurture and develop children’s interests and talents through its small but growing mentoring program, Mpcat. BPS students from grades 5 through 12 who are living in transitional housing are paired with volunteer mentors who provide them with enrichment and cultural activities, such as trips to museums, shows and performances, sports games, and other outings. Ms. William noted that mentoring programs make a difference, both in the feedback that she receives from the students and families who participate in the Mpcat program and in studies that have shown that children who have a mentor have improved relationships with their parents and peers, perform better academically, and are 46 percent less likely to develop substance use disorders.

HERN also has a well-established summer program, which is held throughout the month of July. Ms. William says that the program is “loaded with enrichment activities and art projects.” Participants go to the zoo, bowling, movies, playgrounds, and local museums, including a sleepover at the Boston Museum of Science. They also create poetry, practice writing, act in short plays, and participate in art activities. Ms. William said the summer program allows “kids to be kids,” while helping them to become better readers and writers, strengthening their leadership skills, developing their talents and creativity, and helping them form positive friendships.

In keeping with BPS’s integrated and holistic approach to education, HERN works closely with the BPS Office of Family and Community Engagement, Boston area family shelters and housing service providers, the faith-based community, Interagency Council City of Boston, Boston area hospitals, Citizen Banks, and City Missions Society. HERN also relies on volunteers to provide support for its mentoring program and special events. To volunteer or learn more about HERN’s commitment to action and advocacy for the educational needs of children and families, please visit the HERN website.

Sources:
The National Alliance to End Homelessness: State of Homelessness in America 2013: http://www.endhomelessness.org/library/entry/the-state-of-homelessness-2013

The Homeless Education Research Network: http://www.bostonhern.org.

Interested in being a HRC Guest Blogger? E-mail us at homelessprograms@samhsa.hhs.gov

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Voices From the Field Blog: Alcohol Management: Reducing seizures, falls, and brain injury among alcohol dependent people

by Livia Davis
March 25, 2014

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Homeless and Housing Resource contributing writer Livia Davis details the work of Downtown Emergency Service Center (DESC) in Seattle, Washington in implementing Alcohol Management as a harm reduction strategy and the need for research to determine if Alcohol Management results in better health outcomes, improved safety, and less victimization.

To limit potentially life-threatening effects of alcohol withdrawal, including seizures, hallucinations, falls resulting in head trauma or broken bones, and victimization due to acute intoxication, Downtown Emergency Service Center (DESC) in Seattle, Washington decided to implement Alcohol Management as a harm reduction strategy for eligible residents in their 1811 Eastlake supportive housing facility that serves “formally homeless men and women with chronic alcohol addiction.” Alcohol Management is offered to residents who are at risk of harm during periods of alcohol withdrawal or other dangerous behavior associated with their alcohol use. Not without controversy in the local community, DESC is committed to improving the quality of life for program participants, increasing their housing stability, and reducing the harm of alcohol withdrawal. Currently, about 16 out of 75 residents at 1811 participate in Alcohol Management indicating it's not an intervention best suited for everybody. At the Housing First Partners Conference in Chicago held on March 13, 2014, DESC explained how Alcohol Management works.

Using Motivational Interviewing, staff members first approach potential program candidates to facilitate the completion of a client’s alcohol intake goals. Questions are asked to develop an agreement for each participant, including: Do you drink more in the morning to stave off withdrawals? How many drinks do you need to avoid feeling sick? How long between drinks do you begin to go into withdrawal? What is your goal? Do you want to cut back? Based on responses, an individual alcohol management plan is developed and signed by the participant and DESC.

The plan details the dosage of alcohol to be administered by staff at certain intervals. For example, the plan may detail 2 beers at 8 a.m., 12 noon, 4 p.m., and 8 p.m. every day. At the agreed-upon times, the Alcohol Management participant then proceeds to the staff desk and is given the agreed-upon amount of beer.

To implement Alcohol Management, a number of processes and infrastructure and training need to be developed or be in place. Clients need to have a steady income source and a payee. Program funds are not used to purchase alcohol, and both the participant and their payee agree to provide needed funds according to the alcohol-purchasing schedule. Purchasing, storing, and dispensing alcohol dosages also require a number of processes and safeguards that 1811 Eastlake has developed over the last seven years, including locked cabinets, training of staff, and dosage tracking charts.

DESC collects anecdotal data on outcomes from the Alcohol Management program and reports the following:

  1. Increases stability: The chaos of binging and withdrawing occurs less often and provides participants with a sense of stability and control they have not experienced in a long time. This increased stability is often associated with the development of new goals, including changing long standing drinking patterns;
  2. Allows for intervention in case of alcohol withdrawal: With dosage tracking documentation sheets (e.g., if a participant misses his/her dosage for 24 hours) staff will go and check to be sure that the person is not experiencing harmful effects due to withdrawal;
  3. Fosters engagement: Regular conversations can be maintained that increase awareness and stimulate articulation of goals, and allows for engagement around alcohol use to be a centerpiece of ongoing treatment planning;
  4. Slows health decline: Alcohol management is not a magic bullet but getting less intoxicated means more engagement with health providers to address chronic and acute health need;
  5. Likelihood of a decrease in alcohol use over time for some participants. While often not the inital goal, a number of residents participating in alcohol management have cut back or even stopped drinking altogether; and 
  6. Risk of loss of independence: Some participants get dependent on staff through structured alcohol dosage, and DESC recognizes that loss of independence is not necessarily a positive outcome, although has seen the same participants rediscover abilities to better integrate with community members or service providers through the stability afforded by participating in alcohol management.

DESC staff discussed the need for research to determine if Alcohol Management results in better health outcomes such as improved safety (e.g., fewer falls and reduction of instances of brain injury) and less victimization.

For additional information, please click on www.DESC.org or contact
Noah Fay at NFay@DESC.org or Hector Herrera at HHerrera@DESC.org.
 
Sources for this article include: www.DESC.org and the Housing First Partnership Conference workshop on March 13, 2014: Alcohol Management: A Practical Harm Reduction Intervention conducted by Noah Fay and Hector Herrera from DESC.

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

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Voices From the Field: Walking In Daylight

by Steven Samra
February 27, 2014

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Homeless and Housing Resource contributing writer Steven Samra opens up about his mental health recovery journey and from his perspective what peers need to help into support others who are experiencing acute symptoms overcome ostracism, shame, and misinformation.

I “aged out” of the mental health system at 17, after having spent much of my adolescence under the influence and control of the amphetamine Dexedrine, which was used to treat Attention Deficit Disorder for “hyperactive” children in the days before Ritalin and Adderall. For the following 23 years, I wandered from job to job, relationship to relationship, and street drug to street drug, trying to calm the anxiety and the uncontrollable need to move, talk, think, and do something—anything. I suffered classic hypomania symptoms of bipolar disorder throughout my adult life, and eventually gravitated towards those drugs to help me slow down the noise and activity in my mind and body. 

Throughout those decades, the idea of experiencing a mental health condition never really occurred to me. After all, I had been “cured” back in the 70’s, and there was no way I was “crazy”; I was just “high energy,” which frankly served me quite well until I would “overamp” and make inappropriate decisions due to my inability to gauge and tailor/control my own behavior and responses effectively.

Worse, even if I would have been self-aware that I was experiencing a mental health condition, I would have never told anyone because being branded with a “mental illness” brought with it almost certain scorn, ridicule, ostracism, and blatant discrimination from those in my immediate circle and the larger community. It wasn’t until I entered counseling and a Methadone maintenance program in early 2000 that I began to understand there was something underlying my compulsion to use, a need to self-medicate symptoms of my mental health challenges away. 

Fast forward 15 years later and today I am in the final stages of a medically supervised withdrawal from Methadone, but more importantly, I am acutely aware that I suffer from some mental health challenges, exacerbated by trauma experienced as a youth and the repeated retraumatization—accompanied by “collateral” trauma—of decisions and behaviors related to a life spent in addiction. 

Today, I wear the scars of my addiction and underlying mental health conditions on my sleeve. I do so because when I was open to and seeking treatment, I didn’t ask the service deliverer I approached whether they were “addiction” or “mental health.”  I asked, “can you help me figure out what is going on inside?” Unfortunately, what I found was that very few were able to work with me on both fronts and that treatment delineation, to a large extent, continues in provider organizations today. Strides have been made, to be sure, but we as providers, as people in recovery, and as people needing the support of both groups, are still seemingly light years from effective and complimentary dual treatment options. Worse, the discrimination, ignorance, and fear of those experiencing a “mental illness” are still rampant in our communities and show little sign of abating anytime soon.

To help combat this, I and many others now talk openly, freely, and regularly about our “co-occurring” disorder and work daily to raise awareness, reduce discrimination, and promote mental health because with mental health comes not just recovery from the condition, but a liberating freedom, self-esteem, and genuine self-worth as well. We stand as a testament, along with millions of others—colleagues, friends, and peers—that recovery from both addiction and mental health challenges is not only possible, but to be expected. 

From my perspective, what my peers need to do to help support those who are both in recovery and experiencing acute symptoms is simple:

  • Provide easy to understand information that helps us identify and understand what’s happening to us as we endure our mental health challenges;
  • Offer real treatment and “return to life” options that are tailored to—and driven by—our complex needs and conditions; and
  • Suggest opportunities to join our larger community without fear of discrimination, verbal and/or physical abuse, and/or marginalization.

We are making progress every day, and the more we share about our lived experience and our journey into recovery, the more we raise awareness, smash stereotypes, and reduce the ignorance associated with mental health issues. Make no mistake; however, we still have a very long road to travel, and it will be up to us to walk in the daylight along this path so that others are unafraid—and in fact, empowered—to join us.

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

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Voices From the Field Blog: Will You Still Be Mine?

by Rachael Kenney
January 27, 2014

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Homeless and Housing Resource Network contributing writer Rachael Kenney illuminates the challenges that couples experiencing homelessness face in forming connections with others as well as redefining intimacy in their daily lives.

Mark: “Well, if you had three wishes, what would they be?”
Paul: “House. Job. Baby.”

Watch a few of Mark Horvath’s videos about couples and it immediately becomes clear: Couples that are homeless have a similar desire for intimacy as couples who aren’t homeless. Not just physical intimacy, but emotional intimacy; a sense of closeness and emotional warmth. But so many of the ways that we build intimacy aren’t accessible while homeless. There is no kitchen in which to cook for one another, no TV to cuddle in front of, and no place to come home to together.

Paul, and his girlfriend Katie met when they were both already living on the street in London. Like many young folks on the street, they were not in school and could not secure employment, so they built intimacy by spending all of their time together, searching for resources, panhandling, and just waiting for tomorrow. One might suggest that these relationships are dangerous, that the young people glamorize homelessness and getting into relationships will just perpetuate the situation. There is some truth to this claim, as couples have more difficulty getting off the street because they often disregard housing options that won’t allow them to stay together. But dating while living on the street can also have a positive impact. For Katie, homelessness and her relationship with Paul contributed to her sobriety.

Others, like Edward and Anita, were married for twenty-two years before they became homeless. It appears that their strong foundation is what carries them through episodes of homelessness. And then there are Maria and Neville:

Maria: “[I’d wish for] a cheap little car so I can get around, and a wheelchair. Actually, a wheelchair is my priority.”
Neville: “And each other.”
Maria: “And each other. We’ve been married for four months, been together for five years. And I’ve never been happier in the sense of a relationship.”

Even with the stressors of being homeless together, these people value their relationships and work hard to maintain them. Their relationships remind them that they are valuable and worthy. They are important in at least one other person’s life.

When night falls, these three couples can be found “sleeping rough,” or on the street. Some of the reasons they do this are the same reasons that single people avoid shelters: theft, violence, and strict rules. But couples also sleep outside because most shelters can’t accommodate couples, even same-sex couples, in the same sleeping quarters. Sleeping rough may be a way to hang on to a sense of normalcy. Regardless of whether or not they are physically intimate during this time together, it gives them the opportunity to build emotional intimacy. And as they close their eyes and drift off into sleep, they can almost believe that they are holding one another in bed in their own home. And that the light from the stars and the streetlights is filtering in through the windows, rather than directly down on them from above.

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

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Category: General | Guest Entry

Limitless Potential

by Valerie Gold
December 20, 2013

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Homeless and Housing Resource Network contributing writer Valerie Gold recounts the experience joining a team of runners from Back On My Feet, an organization that uses running to help people experiencing homelessness change the way they see themselves and to achieve real change. 

So much of the work to address homelessness involves waiting: waiting for people’s names to rise to the top of various lists, waiting for apartments to pass inspection, waiting for replacement documents, approvals, or funds. Waiting, and its accompanying frustrations, contribute to the sense of powerlessness and hopelessness endured by many people experiencing homelessness.

As 2014 begins, Back On My Feet (BOMF) is not waiting, but instead is racing forward with its mission to use running to help people experiencing homelessness to realize their own power and to achieve real change. With the addition of two new chapters in the last twelve months, BOMF now operates running teams based in homeless shelters in eleven cities across the country. Nearly 400 individuals experiencing homelessness are running with these teams each month. Eighty-two percent report that their health is good or excellent, and 94 percent describe themselves as hopeful about their futures. And so far, 46 percent of BOMF runners have obtained employment, housing, or both.

The Monday before Thanksgiving, I joined the team of BOMF runners who live at the New England Shelter for Homeless Veterans for a pre-dawn run. The team assembled at 5:20 a.m. in the lobby of the shelter. The runners were easy to spot, bundled up in BOMF tracksuits and shod in bright new running shoes. As we waited for a few volunteers (referred to as "nonresident team members") to arrive, Eric,* a tall and friendly vet with an easy laugh, described the 5K race in South Boston that he had run the day before through a fierce wind and temperatures well below freezing. This was his first race, he said, and he almost stopped several times, but was urged on by Kathleen, BOMF’s Program Coordinator, who ran with him the entire way to set his pace and make sure that he achieved his goal of completing the event.

Once everyone arrived, we moved outside, formed a circle, did some jumping jacks to warm up, and then put our arms around one another and recited the Serenity Prayer. And then we were off. I settled in to run next to Joe, an elegantly-coiffed runner with a white goatee whose pace accelerated as the stars faded and the moon slowly set, until I nearly collapsed from trying to keep up with him. The physical suffering was worth it, as Joe was a great conversationalist, expounding upon the concepts of self-efficacy and mental toughness as I gasped and groaned and otherwise generally displayed my lack of any toughness – mental or otherwise. When I finally gave up and waved Joe on, I was immediately joined by a group of women from the Common Ground Team. One of them had her arm in a sling, and all of them shivered cheerfully as they introduced themselves and told me how long they had been on the team. I had no idea which of them were people experiencing homelessness and which of them were nonresident team members. This is part of what works about BOMF– by building teams of runners instead of groups of givers and recipients of support, of assistance, of anything but fellowship and mutual encouragement and accountability, BOMF makes it possible for people who have experienced terrible things, including great isolation, to resocialize and reconnect with others, while building or rebuilding key aspects of their identities: as athletes, teammates, morning people, or just plain survivors. At the same time, nonresident runners have the opportunity to connect in a meaningful and immediately rewarding way with people with whom they might otherwise never be engaged.

After my run, I followed the Boston BOMF staff back to the offices that they occupy, courtesy of Comcast. Victor, Kathleen, and Allison, all fearsomely fit, energetic, and passionate about their work, described their goals for doubling the number of BOMF runners in Boston, and for maximizing the positive impact of their program through strategic partnerships with homeless service providers and individualized supports for runners. They shared challenges, ranging from the easily addressed (advising a new team member that he should relieve himself before leaving the shelter as opposed to doing so mid-run in front of his teammates) to the more complex, like the heightened risk of substance abuse relapse, arrest, or other crisis occurring during the weeks between Thanksgiving and New Year’s Day. Running alone won’t eliminate this risk, of course, but it can help, and the accountability and sense of belonging that comes from being on a team provides further protection. As Victor, the Boston Executive Director, shared his plans for "over programming" with movie nights, dinners, and races during this period, his investment in the safety and success of each team member was clear.

BOMF is more than a novel idea or a promising practice. It is a reminder that the people we work with in outreach programs and homeless shelters have limitless potential for healing and growth. Running is a great way to tap into this potential. It changes a person from the inside out, and provides a daily demonstration of the lesson so eloquently articulated within BOMF’s vision statement: If we keep moving forward, we arrive someplace different, we arrive stronger and often as better versions of ourselves.

Of course, running is not the only way to move forward or fulfill potential. As 2014 begins, I challenge myself and my colleagues to stop waiting and take inspiration from BOMF to search for new and better ways to be reminded of the tremendous power that each of us holds within.

*Permission was granted by all of the individuals identified in this piece to share first names.

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Category: General | Guest Entry

Voices from the Field Blog: Reflections on Homeless Persons’ Memorial

by Lisa Sepahi
November 18, 2013

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Homeless and Housing Resource Network contributing writer Lisa Sephai details the significance of Homeless Persons Memorial Day that have been held annually since 1990 on the longest night of the year. These national events are aimed at raising awareness of the tragedy of homelessness and to remember individuals who have died on the streets.

Nancy* was 54 years old when she died of cancer. I first met Nancy at an overnight homeless shelter. She was bubbly and happy-go-lucky, her bright personality stood out despite her dire circumstances. Nancy spent the previous four years living on the streets after losing her job as an accountant. Shortly after I met Nancy, she was offered permanent housing through a Housing First program. 

This housing opportunity could not have come soon enough; shortly after becoming housed, Nancy learned that she had terminal cancer. Fortunately, Nancy was housed when she died, but the years on the streets had a significant impact on her health and her ability to seek the treatment that she needed to diagnose and treat her illness. Nancy's story is not unique; however, Nancy was fortunate to die in the comfort of her own home with her friends around her. Many people experiencing homelessness are not as fortunate and die on the streets.

It is for this reason that each year The National Coalition for the Homeless, the National Consumer Advisory Board, and the National Health Care for the Homeless Council encourage communities to host public events on December 21 to remember those individuals in our communities who have died homeless in the past year.  Homeless Persons Memorial Day events have been held every year around the first day of winter and the longest night of year since 1990. 

Homeless Persons Memorial Day raises awareness of the tragedy of homelessness and serves to stand as a public memorial in recognition of friends and neighbors who have died on the streets. The National Health Care for the Homeless Council provides toolkits that include an organizing manual, posters, and fact sheet to help groups organize events every year.

According to The National Health Care for the Homeless Council:

  • Homelessness dramatically elevates one's risk of illness, injury, and death.
  • The average age of death of a person experiencing homelessness is about fifty years, the age at which Americans commonly died in 1900.
  • People experiencing homelessness suffer the same illnesses experienced by people with homes, but at rates three to six times higher.
  • Persons experiencing homelessness die on the streets from exposure to the cold.
  • Poor access to quality health care reduces the possibility of recovery from illnesses and injuries.
  • Persons experiencing homelessness die on the streets from unprovoked violence, also known as hate crimes.

Homeless Persons Memorial Day is an opportunity to bring attention to an every day tragedy. It stands as a testament to the vital importance that housing plays to the health, well-being, and safety of all people.

For more information on events in your area or if you are interesting in hosting your own event, visit: http://www.nhchc.org/resources/consumer/homeless-persons-memorial-day/ and http://www.nhchc.org/wp-content/uploads/2011/09/2013-national-homeless-persons-memorial-day-
organizing-manual.pdf


*Name has been changed

Source: National Health Care for the Homeless Council (2006) "The Hard, Cold Facts About the Deaths of Homeless People" http://www.nhchc.org/wp-content/uploads/2011/09/HardColdFacts.pdf


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Category: General | Guest Entry

Voices from the Field: Responding to Holiday Triggers

by Katie Volk
October 22, 2013

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Year-round, we encourage providers to adopt a trauma-informed lens – to use knowledge of trauma and its impact to make decisions about all aspects of their relationships with clients and how they run their program.

During the holiday season, the need for a trauma-informed approach is critical. Everywhere we turn, we’re reminded that it is supposed to be “the most wonderful time of the year.” While for some that may be true, for others, the holiday season is wrought with triggers – songs, scents, rituals, pressure to conform to particular social and familial expectations, increased presence of alcohol, more interactions with family/friends. For those experiencing homelessness, the holidays may also serve as a reminder of what does not exist – a home in which to celebrate, cook, decorate, and rejoice. Loss, loneliness, and shame are powerful triggers.

So what can we do?

1. Think about how the holiday season impacts you, the service provider. Are you in a frenzy, hopping from turkey donations to a sudden influx of volunteers to clients in crisis? What are your own holiday triggers? Take time to notice your own responses.

2. Ask yourself “what helps and what hurts?” As you work with clients and your team, be aware in every instance, you have an opportunity to interact in a trauma-informed way. Asking “what helps and what hurts” can be a good “gut-check.” Sure, local honor society students may want to sponsor a gift-giving drive for the kids in your program, but ask yourself: Is that what the kids (and their parents) need right now? How could we set it up so that it doesn’t feel shaming? What could we do instead?

3. Plan now. Talk with your team and clients now about what the holidays may bring up for them. By being proactive, you are being trauma-informed. Even if clients have nothing to say, you have opened the door for conversation. And by talking to your team, you can be prepared as a staff to support one another and those you serve.

4. Pay attention to nutrition and exercise. Cookies, pies, and cake – oh my! Taking care of one’s body is good self-care advice no matter the season, but with additional stress and temptation everywhere, be more mindful about eating and exercise habits. Be sure to drink plenty of water. Indulge in sweets, caffeine, and alcohol in moderation. Go for a walk. Talk with clients about these habits too, as part of routine conversations on good self-care.

5. Create meaningful rituals. This is a great opportunity to involve clients. Let them be your guide. Ask yourself how to celebrate, with your team and your program, in ways that relieve stress rather than add to it.

6. Remember the principles of trauma-informed care. Healing happens in relationships. Recovery is possible. Support client control, choice, and autonomy. Learn more here.

From all of us at the Homelessness Resource Center, we wish you a healthy, safe, and joyful holiday season.

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