Cross-Cultural Dialogues on Homelessness

From Pretreatment Strategies to Psychologically Informed Environments

Jay S. Levy, Robin Johnson, Jay S. Levy, Robin Johnson

• Editorial: Loving Healing Press
• Año: 2018
• ISBN:
  9781615993680
• Categoría: Ciencias sociales
• Categoría: Trabajo social

Cross-Cultural Dialogues on Homelessness Reveal New Insights This groundbreaking book presents compelling narratives and innovative approaches for addressing the psychological traumas that can underlie homelessness and is the first to explore in-depth what the US and UK can learn from one another.
Authors focus on understanding and applying the precepts of Pretreatment and "Psychologically Informed Environments, " as well as effective ways to promote productive dialogue on all levels -- with clients, clinicians, advocates, policymakers, researchers, and others. Detailed case studies review and integrate "hands on" practice with Appreciative Inquiry, Open Dialogue, and Common Language Construction methods. "In Cross-Cultural Dialogues on Homelessness, Jay Levy and co-authors provide the conceptual tools, the hitherto 'missing language', needed by practitioners and policymakers working with excluded individuals. This book has been informed by the authors' practice and should come with a warning: it will revolutionise how you work -- irreversibly and, undoubtedly, for the better"
-- Cliona Ni Cheallaigh, MB, MRCP, PhD, Senior Lecturer in Medical Gerontology, Trinity College (Dublin) "Jay distills many decades of his own street experience, and by cross comparing his brilliant schema of Pretreatment with the British model of Psychologically Informed Environments (PIE), he reveals the underlying common processes of effective street engagement. As a long-time practitioner of street medicine, I recommend this book to anyone who seeks that sacred place on the streets where healing begins."
-- Jim Withers, MD, Founder and Medical Director and Operation Safety Net and the Street Medicine Institute (Pittsburgh) " Cross Cultural Dialogues on Homelessness is a timely and important collection of the latest thinking on how we should respond to the traumatic life experiences of so many homeless people. Levy and colleagues suggest a commitment to reflective dialogue will improve both the quality of frontline services and the way policy makers, managers and commissioners think about responding to the needs of people pushed to the margins of our societies."
-- Alex Bax, Chief Executive, (London) Pathway - transforming health services for homeless people "This book is different because it is based on theory and practises, dialogue and the sharing of ideas - from both sides of the Atlantic. The human interest stories add great value to the book, which should be required reading for anyone interested in creating a better world for his/her fellow human beings. It should be read and debated by all with a vision for a better future for those who need services and those attempting to provide them."
-- Alice Leahy, Director of Services Alice Leahy Trust (Dublin, Ireland)

1

Homelessness on Both Sides of the Atlantic Jay S. Levy

Injustice anywhere is a threat to justice everywhere. We are caught in an inescapable network of mutuality, tied in a single garment of destiny.

–Martin Luther King, Jr. (1963)

Introduction

I can still hear echoes from a distant place. It was a time when people did not believe in the possibility of directly housing long-term homeless individuals without first requiring treatment. There was a din of naysayers and doubters who thought it could not or must not be done. Yet here we are in the midst of a movement. Over the past several years, we have unveiled the promise of finding homes for the most vulnerable among us who live on our streets and at the edges of our communities. Through the hard work of outreach, Housing First and the transatlantic truth of trauma-informed care, we have begun to make that promise a reality.

This project is another important step on our journey… an invitation to share our thoughts and challenges across borders and beyond the limits of cultural boundaries.

International Perspectives

Back in October of 2013, I had the privilege of presenting at the 9^th annual International Street Medicine Symposium. It was inspiring to meet doctors, nurses, social workers, and other human service professionals from around the globe. Without exception, they were dedicated to providing quality healthcare to people without homes who experienced significant medical, mental health, and addiction issues. Upon my arrival at the conference, I was weighed down by the systemic barriers to care that most of us encounter on a daily basis. Locally, this translated to separate silos of mental health, addiction, and medical services with varying eligibility requirements that limited access to needed treatment and resources.

I listened intently to people’s stories of outreach and the difficulties inherent in providing healthcare for excluded homeless populations throughout the world. One of the prevailing problems encountered by me and many others is the ongoing treatment bias. It demands that a person shows a level of readiness to directly partake in medical and/or mental health services, rather than addressing the immediate concerns of people without homes who experience complex trauma, addiction, and an array of physical ailments.

We were unified in our efforts to help, though some of us experienced barriers far worse than I could have ever imagined. I was astonished to hear that the governments of certain countries considered homeless outreach across cultural-tribal boundaries to be subversive. It therefore became a secretive practice with the accompanying risks of detection by authorities. In contrast, this provided a new and more optimistic view of our efforts in both the United States and England.

In many respects, we are fortunate to live in open societies whose governments support Homeless Outreach services to varying degrees. That being said, systemic barriers in both countries remain, including the criminalization of homelessness, the high cost of housing, lack of social supports, widespread poverty, and far too many vulnerable people suffering dire consequences due to their inability to access affordable housing and healthcare.

My first book, Homeless Narratives & Pretreatment Pathways, was completed during the summer of 2010. As this was both cause for celebration and during the pinnacle of Harry Potter mania, my family and I decided to travel to London. Off we went to visit the British Museum and an array of city parks and English gardens. At the Royal Academy of the Sciences, we were humbled by the great history of observation, experimentation and discovery. Throughout the many sights and sounds of London, which of course included Kings Cross Station’s platform 9¾ and numerous city cafes, there were also the sights and sounds of poverty, homelessness and the day-in and day-out struggle for survival.

Suddenly and without intention, I had entered the familiar territory of urban homelessness. Once I took notice, it was hard not to be reminded of my numerous experiences of homeless outreach throughout the streets and shelters of New York City and Boston. This led to some initial curiosity that fueled my search for further information. I spent several days inquiring about the network of homeless services in London by browsing bookstores, online websites of various helping agencies, and occasionally directly approaching someone in need. I soon discovered that people without homes either stayed in hostels (as opposed to large US shelters) or for an array of reasons may have ended up on London’s streets as “rough sleepers.” Little did I know that my initial curiosity would eventually result in this project — Cross-Cultural Dialogues on Homelessness.

My Writing and Practice

I began my professional journey as a Homeless Outreach counselor during the winter of 1987. Since my initial meeting with my first client (who called himself Old Man Ray) at NYC’s Port Authority, I have never turned back. My outreach experiences with Old Man Ray and others made me realize that people are experts on their own worlds (Epston & White, 1992), and that my role is primarily to foster client-centered relationships and shared objectives. The rest of my work flowed from there.

During the past thirty years, I provided outreach counseling, advocacy, clinical supervision, and directed housing programs that served formerly homeless individuals. I loved meeting people literally and figuratively where they were at, and this brought together my interests in grassroots social work and activism. Homeless Outreach afforded me the privilege of being welcomed into people’s lives, as well as witnessing both the richness and debilitating effects of their day-to-day experiences and challenges.

During my time in NYC, I learned the art of engagement and respect for those who struggled to survive, while searching for their own sense of meaning and dignity among the city streets, shelters, and soup kitchens. This window into the realities of homelessness helped me to realize the importance of relationships, while also valuing our need for autonomy, finding purpose, and having a safe place to reside.

Over time, I realized that Homeless Outreach seemed to be more of a personal art among the most dedicated in the field, rather than a cohesive philosophy with guiding principles of care that outreach professionals could follow. My desire to write was fueled by the long and winding road of field experience, feedback from my work peers, as well as those without homes, which directly led to my formulation of the Pretreatment approach. I tried to right a wrong by putting pen to paper. I witnessed too many people being left out in the cold… too many people without homes deemed “not ready” for help, and the human service community saddled with too many rules and too little compassion.

Of course there were those who knew better. Outreach workers across America and leaders in the field such as Dr. Sam Tsemberis, founder of Pathways to Housing, and Dr. James O’Connell of Boston’s Health Care for the Homeless, as well as Dr. Jim Withers of the Street Medicine Institute, among others, demanded help for the most vulnerable people living on the streets. Momentum for positive change was further supported by renowned author Malcolm Gladwell’s (2006) New Yorker magazine article, “Million Dollar Murray,” which espoused the merits (cost savings) of a Housing First approach for ending chronic homelessness. Many things have changed for the better. Outreach, Housing First, and other Harm Reduction approaches are now not only accepted, but favored by many of us who provide homeless services.

Throughout the years, I published several journal articles and books on the subject of Pretreatment. These works share people’s stories, while also providing the theory behind the practice in an effort to elucidate effective ways of helping people to overcome trauma and homelessness. The end result was my second book, a Pretreatment Guide for homeless outreach counselors, case managers, and social workers, as well as a resource for others who serve people without homes in a variety of settings, which includes supporting transitions to Housing First apartments.

Outreach begins with getting “where the person is at” to form a trusting relationship in an effort to jointly work on goals to alleviate homelessness and improve one’s quality of life. These goals need to resonate well with the client and are communicated via a “Common Language” (Blankertz, et al., 1990.; Levy, 2000; Levy, 2004) that serves as a bridge between the person experiencing homelessness and available resources, supports, and services. The foundation of Homeless Outreach (Levy, 2010) is a client-centered relationship, while common language construction is the main tool for facilitating positive change.

This is at the heart of a Pretreatment Model that also values supporting the process of transition and adaptation to new environments, as well as promoting safety through crisis intervention and harm reduction strategies. An important goal of my writing is to open up the conversation about Pretreatment and other trauma-informed perspectives in an effort to develop more effective strategies for helping people who have experienced multiple or extended episodes of homelessness, trauma, and loss.

Two Approaches to Helping: Pretreatment and Psychologically Informed Environments (PIE)

My most recent book, Pretreatment Guide for Homeless Outreach & Housing First (2013), was reviewed in the UK’s Housing Care & Support journal. Its editor, and founder of PIE, Robin Johnson. contacted me on LinkedIn to initially inquire about a posting I made on effectively targeting Housing First programs to a chronically homeless sub-population, as opposed to generally applying it to all people experiencing homelessness.

It was during these initial conversations with Robin that I first learned about Psychologically Informed Environments (PIE) and its applications to trauma and homelessness. Robin seemed excited about the connections that he saw between PIE and Pretreatment. In fact, our initial discussion about Pretreatment was as a Psychological Model that neatly fit into a PIE approach for helping persons without homes who experienced complex trauma. This piqued my curiosity, and Robin was kind enough to introduce me to an online community that focused on sharing best practices and information about PIE via video, online chats, access to Library reference materials and more at www.Pielink.net.

So, what is PIE?

Robin Johnson (2015) among others identify a Psychologically Informed Environment at its most basic level as “one that takes into account the psychological make-up — the thinking, emotions, personalities and past experience — of its participants, in the way it operates.” Robin further specifies, “But as all human social environments tend to do that to some degree, we tend now to reserve the term for those environments — places, services — that do so consciously, and with some particular purpose or goals in mind. This site is primarily about how we develop psychologically informed services to meet the challenge of homelessness.” His description fits nicely with the objectives of homeless outreach, drop-in centers, and safe haven programs.

In fact, Robin now suggests, having recently been to visit services in the States, as he describes in a chapter later in this book that many of our long-term and permanent supported housing programs could be described as PIEs. There would be considerable benefits to further modifying many existing shelters and residential programs by applying the basic elements of PIE. Writings and research (see Pielink.net library) on the development and impact of Psychologically Informed Environments on homeless services throughout the UK lends valuable insight to our cause.

Over the past couple of years, I’ve been inspired by multiple video conference conversations with homeless service workers in England. This has led to an ongoing dialogue about the similarities, differences, and benefits of varied approaches to helping the homeless, as well as sharing specific strategies of outreach and engagement. Our aim is to facilitate a cross-cultural fertilization of ideas and practices that are rooted in a common language. This sharing of perspectives can help guide outreach counselors, social workers, and homeless service employees with the formidable task of reaching folks without homes who are most at risk and in desperate need of assistance.

In turn, this book explores the phenomenon of homelessness on both sides of the Atlantic. In particular, it focuses on people without homes who have been marginalized due to traumatic experiences and/or disability through the lens of Pretreatment and PIE. This brings a cross-cultural sharing of ideas and approaches to the vexing and complicated issues that homelessness inevitably presents. It is a societal ill that is in need of many voices from different places to spur compassion, discovery, and action.

I invite the reader to join us in an open dialogue that spans both time and space in an effort to create solutions to an age-old problem. Together we can provide both the inspiration and hope necessary to energize a movement, and thereby provide the optimism that successful change demands. I believe that both Pretreatment Strategies and Psychologically Informed Environments are among the seeds from which new ideas and innovative approaches to “hands on” practice can and will grow.

References

Blankertz, L. E., Cnaan, R. A., White, K., Fox, J., & Messinger, K. (1990). Outreach efforts with dually diagnosed homeless persons. Families in Society: The Journal of Contemporary Human Services,71(7): 387-396.

Epston, D. & White, M. (1992) Experience, contradiction, narrative, and imagination: Selected papers of David Epston and Michael White, 1989-1991. Adelaide, Australia: Dulwich Centre Publications

Gladwell, M. (2006) Million Dollar Murray: Why problems like homelessness may be easier to solve than to manage. The New Yorker, February 13 & 20.

Johnson, R. (2015) Published on PIElink website: http://pielink.net/

King, M. L. Jr. (n.d.) BrainyQuote.com. excerpt from April 16, 1963 Martin letter from Birming...

Índice

• Cover Page
• Title Page
• Copyright
• Dedication
• Contents
• Words of Appreciation
• US Foreword - Creating a Common Langage: Joe Finn
• UK Foreword - Transatlantic Dialogue: Different Journeys with Common Goals: Ray Middleton
• Introduction — Cross-Cultural Dialogues on Homelessness: Jay S. Levy
• Chapter 1 - Homelessness on Both Sides of the Atlantic: Jay S. Levy
• Chapter 2 - Principles and Practice in Psychology and Homelessness: Core skills in Pretreatment, Trauma Informed Care & Psychologically Informed Environments: Robin Johnson
• Chapter 3 – Miguel’s Narrative: Challenges of Common Language Construction: Jay S. Levy
• Chapter 4 - Pre-treatment Therapy: A Central London Counselling Services’ Enhanced Response to Complex Needs Homelessness: John Conolly
• Chapter 5 - Working with Meaning and Riding Transitions: Jay S. Levy
• Chapter 6 - Ladder4Life: Developing Dialogical PIE: Ray Middleton
• Chapter 7 – Peer Advocacy: Here, There, and Everywhere: Jay S. Levy
• Chapter 8 - Telling a different story: Appreciative Inquiry’s Contribution to Creating Dialogue and Psychologically Informed Environments: Suzanne Quinney
• Chapter 9 – Ending Homelessness for the Most Vulnerable Among Us: Jay S. Levy
• Chapter 10 – They do things differently there: PIEs, Housing First and the New Social Psychiatry: Robin Johnson
• Chapter 11 – The Dialogue Continues: Robin Johnson & Jay S. Levy
• Chapter 12 – Cross-Cultural Connections: Homelessness, Costs and Interventions: Jay S. Levy
• Chapter 13 – The Calculus of Inclusion: Jay S. Levy
• Appendix i – Pretreatment Approach
• Appendix ii - A US/UK Glossary of Homelessness terms
• About the Authors
• Index