Sometimes Life Just Sits Up and Bites You

When I first started volunteering a year and a half ago "Bob" was a regular at the shelter. An attractive guy who reminded me of someone I used to work with, he had it together, always with a smile and a helping hand. Soon after I started he disappeared.

In January he was back. He didn't really remember me and he was more reserved than before but he opened up as we worked together in the kitchen.

Last night he was there again but this time "together" would be one of the last words I would use to describe him. He was plastered. I'm used to seeing drunk people at the shelter, it's a wet shelter so pretty much everyone there is high on some sort of substance. But seeing Bob that way broke my heart. Substance use is no joke, it's a lifelong struggle.

Boston Homeless Census

Tonight I made the pilgrimage downtown for the Boston Homeless Census. All communities that receiving funding from the Department of Housing and Urban Development (HUD) for the Continuum of Care (CoC) need to conduct an annual "census" of people who are experiencing homelessness. It consists of literally counting every person in the streets (and shelters submit their numbers too) on a given night, usually in January.

My partner and I didn't find a single person in our assigned area, but I still didn't consider the evening a waste of time. My partner had 15 years of experience working with youth in the city of Boston. I learned about how the Department of Youth and Families responds to gang violence, conflict resolution, and treatment of the family (not just the individual). It was a great learning experience; much more valuable than adding tick marks to our sheet.

When goodby is the absence of goodbye

Tonight I found out that "Will," one of my favorite guys at CASPAR (the shelter where I volunteer weekly), hasn't been around lately because he got housing. Of course I'm glad that he got housing but I'm reminded of why it stinks to be a volunteer and not a full time staff.

As a volunteer I never really get to know these guys (and some gals). I'm only there one day a week so even though I develop rapport it's only surface deep. I often can't tell when they are making up stories to pull one over on me. Tonight one told me that he had a partial lobotomy when he was 26, staff confirmed that this wasn't true but I believed it for a good 15 minutes.

When Will told me he was going to get an apartment I figured that some optimistic caseworker was putting silly ideas in his head. Turns out that the optimistic caseworker was right and I never had a chance to say goodbye.

I'm truly going to miss him, he was at the shelter the whole year and four months that I've been going there. Every week he'd tell me my eyes were so blue with such curiosity that I am certain that he doesn't remember the majority of our conversations. He was inappropriate enough to make me blush but not so bad that I was truly uncomfortable. And he had great stories. I'll miss him but I don't know if he ever even knew my name.

Making a Connection

Recently, I went out in the outreach van with staff at the shelter where I volunteer. The night van operates more like a taxi service than an actual outreach service. They drive around and pick up people who are called in, either by themselves or by hospitals, police, and storekeepers. One of our pick-ups on this evening was at a local hospital. A 21-year-old man that had come in earlier that day was being discharged and since he didn't have anywhere to go they asked him if he wanted them to call us.

A common topic in homelessness literature is how difficult it is to engage people and get them to come into services. Not this guy. Speaking fast enough to impress the most talented speed talker, he was quick to tell us that this was his first shelter visit, even though he had been homeless before. This was the first time I had ever been a part of someone's first night, and the first night is often important to get people to come back for more services. I followed the lead of the program staff and kept quiet while the boy rapidly asked a string of questions. To me, the staff seemed distant and preoccupied with driving the van and filling out paperwork but every once in a while they would interject with the questions that I have read about but never really saw in action.

"What do you do? Do you drink..."

They created a nonjudgmental environment by normalizing substance use.

"I'm glad that you went to the hospital to get checked out"

They showed that they were concerned with his safety and that they recognized the importance of his decision to seek help.

"Do you know where you need to go to get benefits?"

They were knowledgeable and knew exactly where to send him to get an ID, section 8, and other benefits.

I have done so much reading about intakes and first time interactions with people but watching these two seasoned outreach workers was a unique experience. There was this flow to the conversation and it worked. I know it worked because before we got to the shelter the young man said "You guys are good people." I'll never know if he was trying to make a good impression or if he was being honest but it will be a while before I forget how seamless that that interaction was.

Kids Can Help

Winslow Students Working to Help Homeless
Morning Sentential, 10/23/2007

Last year Kendra Littlefield's community-based learning students at Winslow High School were one of 10 national winners of a USA Weekend magazine Make a Difference Day award.

This week they are up to another good deed.

"Raising the Roof Over the Homeless" is the theme for the chem-free dance students have been organizing for the last two months, Winslow High senior Melanie Gagnon said.

St Brenden School Students Prepare Packages for the Homeless
The Providence Journal 10/23/2007

Middle school students from the St. Brendan School, a pre-kindergarten to grade eight private school in Riverside, could say that after preparing 150 sandwiches and other snacks for the state’s homeless Friday afternoon. The bag lunch was paired with personal hygiene items and socks — which were collected by the school’s lower grade students — to make it an all-school project.

Principal Joseph Renzulli said the school got the idea from a St. Brendan parishioner, Anne Pari, of East Providence. She delivers food to the homeless every Friday and Renzulli agreed the school would take over her duties one Friday.

They titled the project “Bread Lines.”

Highschool Helps Homeless
Lakeshore Advance, 10/24/2007

South Huron District High School student, Taryn Anstett handed Trevor Johnson of the Youth Action Centre (YAC) in London $365 for the centre during a presentation on homeless youth at the high school last week.
The students were told to act as lobby groups for a law project and made their primary focus of the campaign, awareness of homelessness. They went above and beyond and started by collecting pocket change from students and teachers over two days, raising the money for homeless youth. “The response was incredible,” says Anstett.

Nine Year Old to Walk to Tally For Homeless
Tampa Bay's 10, 10/22/2007

In the past three years, Zach Bonner has collected supplies for Hurricane Charley victims, raised money for the “Teaching Tools Hillsborough Schools” program, organized a holiday party for kids displaced by Katrina and given away more than 750 backpacks for needy kids.

For his efforts, President Bush last year presented Zach with a volunteer service award. But the 9-year old is not slowing down, he’s just moving on to his next big project.

There is another article that I have saved and want to write about but the sudden flurry of youth and schools working to help people experiencing homelessness deserves some attention. Service learning is a valuable tool for all kinds of social issues and is a fantastic way to bring classroom subjects to real life. I wish that I had an opportunity to participate in projects like these when I was in school but alas, in the 90s it was all about HIV and DARE, subjects that would be a little more risque to develop service learning projects around.

Edit: A couple more...
Virginia Run Students walk for Homelessness
Students Collect Pennies for the Homeless

Nighttime Rounds with Health Care for the Homeless: The Outreach Van

After we met with several patients the Pine Street Inn outreach van arrived. Jim wrapped things up inside and grabbed our coats. It's currently a mild fall in Massachusetts and although it wasn't very cold the skies threatened to storm so I yanked my two sizes two big pullover on, just in case.

I've been out in an outreach van before but the van I'm used to is nothing like this. Inside there were several boxes, one full of blankets and one full of socks. When you opened the back doors there was a cooler filled with sandwiches, fruit, dry soup, hot chocolate, and two water dispensers, one hot and one cold. The van I'm used to plays more of a shuttle service role, is lucky to have socks to distribute, and giving out food is against program policy (because of health concerns, not because it's a cheap program).

We drove down Commonwealth Avenue, on the mall. I have walked the mall dozens of times, during the day and in the early evening hours, but I had never seen someone who presented as a homeless person there. That night I saw how many people really do call the Commonwealth Mall home. There was a variety of people, from an older men who needed to have an injured jaw taken care of to a young guy in a suit.

Outreach runs continue to be engaging, dare I use the word "fun", experiences for me. Everyone was appreciative of what we had to offer, even though it was only a light meal and some human contact. The staff that I talk with are interesting and passionate about their work and those who aren't are often burnt out and need a vacation that this field doesn't allow them to afford. The only thing that worries me is that the shock of seeing how people on the streets are forced to live is starting to wear off.

Nightime Rounds with Health Care for the Homeless: The Night Center

This past Wednesday I had the opportunity to go out for rounds with Jim O'Connell, the founder and president of Boston Health Care for the Homeless. While Dr O'Connell is one of the most humble and down to earth people you could ever meet he's a big wig in the health care for the homeless world and an opportunity to shadow him for the evening was a big deal.

The evening began at The Boston Night Center, one of the many Pine Street Inn programs. The Night Center was a new concept for me, it's an overnight drop in center. The center serves meals, has a tv, and space hang out. An overnight drop in center is the lowest of low threshold services; residents are able to go in and out as they please, they're allowed to be inebriated, and they do not need to accept any services. Because it is not a shelter there are no beds but clients can sleep on the floor and, two nights a week, receive medical services.

Jim brought a backpack full of medical gadgets with him, which included a thermometer, a bracelet-type gadget that takes blood pressure, something that goes on your finger that does something too technical for me, and the classic stethoscope and prescription pad. We saw four different patients, wrote one prescription, scheduled two follow-up visits at the clinic, and gave one person a phone number to call for test results. This was in the span of about an hour in a bustling room full of people.

Somehow Dr O'Connell made the space his own as he listened about the fractured ankle that wouldn't heal because the client couldn't walk with a cast, "How am I supposed to get around? I'm homeless." Clients who are homeless aren't always the easiest people to get along with, often life has gotten the best of them and sometimes that leaves them bitter and snarky. But the snark didn't matter, Jim still listened carefully and examined his patients with the same care one would expect in a hospital room, not in a homeless shelter.

Health Care for the Homeless is not unique to Massachusetts, there is actually a National Health Care for the Homeless Council that stemmed out of a 19 site demonstration project that is now 95 organizations strong. Not all Health Care for the Homeless Services are delivered like what I witnessed tonight, or what I experienced with Jill earlier this fall. The shelter I volunteer in actually also has a health care for the homeless component; there is a clinic on site where health care services are delivered. This isn't quite as exciting as health care on the streets but it still is an important concept; clients are able to meet their health care providers where they already are. Wouldn't it be nice if our doctors held clinics in our workplaces? Homeless services are onto something!

Outreach Van

I've been volunteering at a shelter for roughly a month and a half and tonight was the first time I was allowed out in the outreach van. It was an excellent experience!

It was just me and two burly guys who are passionate about their jobs, both recovering addicts (I emphasize this because they can relate to clients in a way that I can't), who have a LOT to say about outreach, life on the streets, and interactions with shelter staff. I got an exclusive picture of the friction between the outreach team and floor staff, a relationship that is most likely not unique to this program (I'd be interested to hear what the shelter staff say about the outreach staff... maybe this is my dissertation?). Working with the outreach team was a whole different world.

While I do feel more useful inside (inside I help in the kitchen, check people in, and clean up after dinner, whereas outside I just ride around and maybe hold open the door or talk to some people) riding in the van was an experience not to be missed. I got to go to where people live and meet them in their environment, people who won't, or aren't allowed to, come into the shelter. A few weeks ago I did outreach rounds on foot during the day with Health Care for the Homeless, which was also a great experience, but this was especially interesting because I had already met most of these clients inside the shelter, I had a relationship with the staff, and I had an understanding of the program; when I went for daytime outreach I had never met any of the clients, I officially met the outreach worker for the first time minutes before we began her rounds, and I had little understanding of the program.

The one negative is that this shift made me continue to question the value of what I do, sitting in an office 9-5 M-F with three weeks of vacation (which will be spent in Europe), sick time, holidays, and weekends off. I'm thinking that, if I can handle it, I might want to seriously consider taking up a part-time job in a shelter or on an outreach team. I want to stay close to these people, they are what matters, not the white papers or the statistics that I compile. It is the human lives and faces behind those numbers that I care so much about.

Take it to the Streets

On Wednesday morning, I had the opportunity to shadow a Boston Health Care for the Homeless provider as she did her street rounds. Back in June, I attended a session of the National Health Care for the Homeless Council conference where my host had presented some of the nifty gadgets that she used on her rounds. The opportunity to see those gadgets in action was a memorable experience! At 9am I met Jill, and a student who was shadowing her for the week, across the street from a busy downtown Boston t-stop. She briefly told me what to expect and we were off!

Not even two blocks down the street we encountered three of her regular patients and by the end of the day we had seen over a half dozen people. Most were on the street but three had secured housing and we visited them in their apartments, two of the three had studio apartments on Beacon Hill (one of the richest parts of Boston) thanks to a housing first voucher program. I hate to admit that I was surprised by how clean the apartments, and their tenants, were but I was impressed. One's apartment was cleaner than my own!

The people on the streets were a different story. They were in rough shape. One had the opportunity to go to a shelter but was nervous that they wouldn't take him because he smelled bad and I'll admit, he did smell really bad. But who can blame him? I smell bad after a day in the park. I can't imagine not having the option to shower after spending an 85 degree day outside, never-mind weeks on end of those kinds of days.

Health Care For The Homeless is a particularly unique type of program, when these programs conduct outreach they often are actually practicing medicine on the streets. It is mainly basic medicine, but they use the relationship that they build to help the individual access specialized services when they are ready. I was impressed with the way that she asked what they wanted and gave them options. No one was forced to do anything that they didn't want to but we got two people off the streets that afternoon (though one was to the ER).

The experience also heightened my awareness of how severe many individuals' alcohol addictions are. As both men who agreed to be transported to services (BHCH has cab vouchers for this purpose) they discarded their bottles of mouthwash first, one handed his off to a friend, the other dropped to the ground with a hollow thud. Mouthwash is the easiest way for alcoholics to get their fix and is an indicator of exactly how bad the disease is.

It was a great experience, I hope to do something like it again!