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!

Highlighted Blog

I recently ran across Sans Houses on blogger. She's a photographer who photographs homeless individuals and posts the photos with audio clips. The photos are often haunting and the audio clips bring them to life. She's not a frequent poster but when she does post it is worth the wait!

Empathy vs Sympathy-- Do "Box Cities" Really Work?

Overnight 'box city' will help homeless
Post Bulletin 10/06/07

Cardboard Box City -- the annual overnight event that raises money to help organizations serving Rochester's homeless families and individuals -- will be Oct. 19.

Participants will spend the night in cardboard boxes and tents in a temporary city that will be created at Soldier's Field.

Event helps kids empathize with homeless
Strauss News 10/04/07

Box City ’07 is an event for high schoolers that gives them a chance to experience an aspect of homelessness. The children who participate will sleep in a box on the Sussex County fairgrounds for a night to get a sense of what it’s like for people who sleep that way every night.

Interfaith Hospitality Network (IHN), a nonprofit program providing emergency shelter to homeless families, hosts the “experiential event” for high school youth to promote homelessness awareness. Participants are given a light supper, engage in learning activities and replicate the actual experience of being homeless by sleeping outside in a cardboard box.

Is there anyone else out there that thinks that this fundraising strategy makes a mockery of what individuals experiencing homelessness face every day? For starters, a lot of the homeless people I know or see don't have cardboard boxes, they have tents or nothing. They don't get cozy sleeping bags and footie pajamas.

I understand what these groups are tying to do, they are trying to be able to take the kids from "Wow, that sounds like it really stinks" to "I tried that for one night and it totally sucked. I feel your pain brother." But neither of the events above mention that there will be any "real live" homeless people there to answer questions and interact with the kids. To the participants, it is a giant sleepover. If you want to raise awareness take them to a soup kitchen just a couple at a time, not in a big pack, so they blend in with the regulars and feel what that first trip to the soup kitchen must feel like. Or, better yet, have them help work the soup kitchen for a few weeks. If you want people to even begin to comprehend what homeless individuals experience you need them to interact with homeless individuals. You can camp out in boxes all you want but you aren't going to change someone's view of homelessness until they meet that homeless individual who looks just like their grandfather or who has a heart wrenching story to tell.

"Hello, this is the Friendship Shelter for the Homeless, would you like to hire our client?"

Voicemail to be used to assist homeless

Baltimore Sun, 9/25/07

Without telephone numbers to include on job applications, gaining employment can prove difficult. And without a job, finding a permanent home seems impossible.

"If they get a call from an employer, the phone is answered, 'Arundel House of Hope,'" said director of development Mary Alexander. "That opens up a whole bag of worms."

This is one of the many examples of things that those of us who are housed take for granted. When I was applying for work I wouldn't put down the number to my parents' house, for fear that one of my brothers would answer the phone with a belch, or, more realistically, that I would never get the message. A phone connection is key to job applications, medical appointments, keeping in touch with family and friends, and so much more.

At the shelter residents need to rely on staff to answer the phone, write down the message, and later (often after a shift change, maybe days later when the resident returns from detox or couch surfing) relay the message to them. Voice mailboxes not only eliminate the inevitable "outing" of the individual's status as a homeless person, put the person in control of when to receive messages, takes pressure off of the staff, and keeps personal business personal and not the knowledge of the entire shelter staff team and other residents. While many residents of such programs do have cell phones, not everyone has a cell phone and those who do may not always have minutes to use.

One program that I am familiar with uses their voicemail access as a fundraising plan, and asks possible donors to sponsor a voicemail box. This allows donors to know where their money is going and to have a set goal amount to keep on giving so the individuals can have continued voicemail access.

Innovation is Key

Haven Bottle Drive will Feed Many Homeless in Need
Scabee.com 9/6/07

The Haven of Rest is continuing to collect cans and bottles with deposit to provide food for the homeless throughout the summer. Every 15 cans brought in will provide a meal to a homeless person. Whether you're having a family reunion or a small barbeque with your friends, The Haven is asking that you collect your cans and bottles to help us feed the homeless.

"We have been able to provide over 300 meals already with bottle money," said Executive Director Elaine Hunsicker. "This has been a great fundraiser for the Haven, so please continue to bring your bottles and cans in. Every little bit makes a difference, so whether you have a ton, or just a couple of bottles it all ads up to meals for the homeless."

I just want to point out that shelters oven have many innovative fundraising plans to help sustain themselves. One way to help homeless people, if you are willing to go beyond offering your smile, is to get involved with local shelters and help with the organizing and implementation of such events, which can be quite interesting!:

Volunteer Profile: Farytale Town Night Helps Homeless
Sacbee.com, 9/6/07

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.

Does it matter?

Things have been hectic the past few weeks at work, as we pushed to complete all of our products by the end of the contract year. On Thursday, when I stayed until 10:30p doing "APA Checks," formatting, and printing, trying not to get too frustrated at the fact that the authors of the pieces didn't do all of this themselves, I began to wonder "what does it matter?" I come from a direct service background, only two and a half years, but I've done my time in the field (even if it wasn't homelessness, I feel that human services across all areas have a lot in common) and I wondered if the work that we do will affect the people who we aim to serve?

It's one thing to be at trainings, working directly with providers, but to be sitting in my cushy office checking to make sure that the appendix is in correct APA format? That's another story. We've written some interesting pieces and made some great "contributions to the field" as they say, but it is questionable when the pieces will get out and we don't really have a dissemination plan in place, yet.

I added volunteering to my regular routine because I wanted to be close to the people that I was writing about. I had considered going into direct services more permanently, but the reality is that I'm "too nice," and have a hard time being authoritative. While I did have a sense of accomplishment when we finally put all of the pieces from the year in binders, packed the binders in boxes, and sent my co-worker to the post office, there is a different sense of accomplishment that comes about when people who I've seen at the shelter begin to acknowledge me and engage in conversation. I hope that as I begin to embark on a full scale career that volunteering continues to be a big part of my week, it keeps me from forgetting why I'm in this job and doing this work in the first place.