There are so many different situations and circumstances that can drive people from their homes. This is often the case for our homeless youth who make up a very vulnerable and unique subset of the homeless population. They can live in multiple places and then nowhere at all. It is the case when a child gets forced from their homes due to drugs or violence. Maybe an unstable family life leads them to live with another family member or friend. They are the runaways or couch surfers in our community. Perhaps they live in the streets or squatting in an uninhabitable area. At a very young age these youth are confronted with very serious circumstances. Most of the time this is worsened by some sort of traumatic event. The very idea of being homeless is a trauma in and of itself. Exposure of this at such a young age leaves an imprint of survival in many of our youth. Then begins the domino effect of increased risk for delinquency, drug/ alcohol use, early parenthood, and let’s not forget disease and death. These aren’t scare tactics. These are facts.
Everyday kids of all ages are forced from their homes for many reasons. Some end up in foster care or some other child services system. Some go with other relatives, friends, or perhaps a trusted stranger. Some runaway. Once a child gets taken from their home it can be a struggle for survival. At least that may be what a child in this situation thinks. Can you imagine being taken away from the only thing you have ever known just to get thrusted somewhere you don’t want to be with people you have never met in a place you have never been. From a trauma informed perspective, this is exposing the child to a lot of unnatural stimuli which is causing elevated stress and an overactive fight or flight system. Thus, we have unknowingly created a trauma in this childs life. It is important to note that it may have been absolutely necessary for this child to leave their home. This doesn’t take away from the childs experience. We must take in to account that when our youth end up in these various circumstances we must have an understanding of where they have been in order to move forward.
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In a society that values image and reputation, the homeless take a backseat. Throughout the city there has been a constant trend with how local business and law enforcement interact the homeless community. Through the enforcement of pan-handling and loitering laws, we see the homeless get pushed away from the public’s eye. Our hidden homeless find themselves throughout our community. Whether it be in the streets, the bus station, or among us; the homeless are faced with constant hardship. Often being forced from their sleeping area regularly. Due to their lifestyle, stigmatization, and image, the homeless often become a target for discrimination. So much so that they face discrimination in their daily lives. The factors that come with living this lifestyle often leads to further discrimination in housing, employment, and using public areas. Former executive director of the Homeless Alliance of Western New York, Bill O’Connell said it best when he stated, “The largest civil rights violation homeless people face is housing discrimination". With discrimination often comes harassment. This issue is amplified with the lack of affordable housing and gentrification that our community faces in Buffalo.
In another view, we see a portion of the homeless commit criminal behaviors such as public urination, camping, having an open container, or sleeping in a public right of way. All of which are illegal under local law. The reality of being homeless means being more at risk for criminal behavior. These behaviors are what shun these individuals in our community. The few, contribute to a stigma on the many. What our community needs is education as much as it needs solutions. Community based programs which focus on serving the homeless are going to always be around. The public needs to be properly informed of the homeless population at large so stigma can be dismissed. We must remember that these people have all lost something more than their housing stability. Let’s start looking at them more like members of our community as opposed to vagrants and criminals. I wish to give a big shout out to Sarge, Del, and the Gang for what I consider one of the biggest outreach events of the year here in Buffalo. On February 4, 2017, Sub Zero gave the gift of warmth to over 250 homeless people. Subzero Mission is a Non- Profit organization based out of Northeastern Ohio. Their goal is to live under the promise that nobody should freeze to death in America. Once a year, a group of volunteers make it their mission to come to Buffalo to help the homeless stay warm during the winter months by providing tents, sleeping bags, jackets, boots and other warming items. They bring with them “Gemma”, which is a modified school bus that they use to conduct outreach. After a rocky start and some vehicle issues, the Sub Zero team persevered through one of the most frigid cold days of the winter to make a difference in the Homeless Community here in Buffalo. I also give a big shout out to Pat and Karen from the VA for assisting and guiding Sub Zero throughout the city. To Sub Zero, the Buffalo Homeless Community thanks you for your hard work and perseverance. We welcome you anytime with open arms!
In January of 2016, Governor Andrew Cuomo enacted an executive order which gave local law enforcement across the state the power to take homeless people off the streets and place them in shelters when temperatures go below freezing. In a short amount of time, this order has gotten both significant praise and relevant concern. This law can be beneficial to an individual that is a danger to themselves or others. This holds true in cases where there is potential drug use or mental illness. It allows people with no place to go, access to temporary shelter and warming centers during a very bitter time of the year.
On the other hand some advocates fear that if this law is not enforced properly it could essentially criminalize homelessness. For a portion of the homeless community, they choose to live a certain way. Freewill and the ability to make a choice is at times all these individuals have. Someone forcing them into a shelter or away from an area where they feel safe can be viewed as traumatizing. A law such as this takes away a person’s freewill in order to avoid the risk that comes with living in extreme cold weather. Such a law can cause shelters to be over populated. With issues such as theft, drug, use, and personal offenses it’s no wonder why people choose to avoid homeless shelters. Homeless people are naturally distrustful being around their peers let alone living alongside them. If this law is going to work, then there must be collaboration from multiple organizations such as law enforcement, homeless service/ outreach workers, and the shelters. The homeless must also be treated with respect, compassion, and courtesy; as well as avoid violations of the individual’s rights. While some question the legality of Cuomo’s executive order, one step that Buffalo is taking comes in the form of the Code Blue initiative. Code Blue gives the homeless community the opportunity to attain shelter and access to services. With successful collaboration and support of homeless service initiatives. There can be a way to make such a law work for the betterment of the community. Code Blue occurs every time temperatures go below freezing. If someone is in need of this service they can call 211 or meet at the NFTA Bus station at 8PM. When working with the chronically homeless many providers focus on addressing treatment first. There can be many reasons for this. Service providers may be constrained by grants which emphasize treatment stability before housing. Providers may not want to risk their limited funds on an individual who’s more likely to fail at housing. Traditional treatment programs focus on abstinence from drugs or use reduction. Abstinence-based or use reduction programs are not always the best approach with the chronically homeless (Collins et al, 2015). It is not uncommon to see individuals go through these programs many times. Being constrained or constantly failing in such programs can lead a chronically homeless individual to be distrustful or lack faith in the providers to address their needs. There must be alternative options to treating addictions in the chronically homeless population.
There has been success in the use of low barrier approaches to treatment on the chronically homeless (2015). A low barrier approach in treating chronically homeless people is done through harm reduction (2015). Harm reduction aims to reduce physical and social damage caused by substance abuse (Inaba & Cohen, 2014). Harm reduction allows a chronically homeless individual the choice to abstain from drug addiction (Tsembris, Gulcur, and Nakae, 2004). This concept is unique when compared to other treatment options which are structured and geared towards complete abstinence. Regardless of their substance use, they can still receive help. Some examples of harm reduction include needle distribution or recovery sites, safe injection sites, Methadone/Suboxone programs for opioid replacement, non-tobacco delivery systems such as nicotine gum, as well as designated driver programs (Inaba & Cohen, 2014). Harm reduction has been applied to psychotherapy and counseling as well (2015). Harm reduction counseling is a patient-centered type of treatment which accepts any step toward towards reducing harm and improving quality of life as progress (2015). There is of course much controversy over harm reduction approaches. Harm reduction can be viewed as enabling addicts to continue their bad habits. Dr. Gabor Mate is a Canadian physician who specializes in the field of addiction and psychology. Dr. Mate preaches a philosophy that encompasses many ideas which coincide with harm reduction, highlighting trauma as the underlying factor in addiction. Mate can be identified as the “voice of harm reduction” throughout Canada, working in clinics throughout Vancouver, British Columbia that utilizes the harm reduction approach. Vancouver made headlines by being one of the first cities to open a supervised injection site called Portland Hotel Society (PHS) Community Services (Small, 2010). PHS provides a space where drug users can bring their illicit drugs, utilize clean equipment, and use their drugs under the supervision of medical staff (2010). Such a place is appealing to drug users because if they bring their drugs and use them at PHS, the drug user cannot be charged with a crime. Understandably, helping someone administer illegal drugs could be viewed as enabling or supporting the drug user’s habit. PHS promotes the idea that even a drug user’s life is precious. An environment that is free of discrimination, sterile, and safe for the drug user, may provide the necessary supports to pursue sobriety (2010). PHS gives the drug user resources and the option to go to begin treatment at any time which emphasizes the drug users right to make a choice. Addiction is a destructive disease that without intervention can be fatal. Harm reduction may not be ideal, but it is humane and minimizes risk which in turn gives a better chance for the individual to get healthy. Harm reduction takes an individual’s trauma into account by helping addicts transcend their destructive habits and heal. Such a treatment philosophy can create a holistic environment for the drug user which emphasizes the right of choice in using substances. Safe injection sites like the one at PHS provides an alternative solution. We need to start looking at addiction through a clear lens. Addiction affects everyone differently. Even those who don’t have one. Please comment and share your view. References Collins, S. E., Duncan, M. H., Smart, B. F., Saxon, A. J., Malone, D. K., Jackson, T. R., & Ries, R. K. (2015). Extended-release naltrexone and harm reduction counseling for chronically homeless people with alcohol dependence. Substance abuse, 36(1), 21-33. Inaba, D., & Cohen, W. E. (2014). Uppers, downers, all arounders: Physical and mental effects of psychoactive drugs (8th ed.). Ashland, Or.: CNS Publications. Maté, G. (2010). In the realm of hungry ghosts: Close encounters with addiction. North Atlantic Books. Small, D. (2010). An appeal to humanity: legal victory in favour of North America's only supervised injection facility: Insite. Harm reduction journal, 7(1), 1. Tsemberis, S., Gulcur, L., & Nakae, M. (2004). Housing first, consumer choice, and harm reduction for homeless individuals with a dual diagnosis. American journal of public health, 94(4), 651-656. Housing chronically homeless individuals can be difficult. Their lifestyle leaves them prone to various issues to include substance abuse, criminal activity, chronic health conditions, and trauma. There are many shelters or housing agencies in the city of Buffalo that require sobriety, treatment, or referrals to access their services. Without a stable place to stay during recovery, this increases the likelihood that any treatment will fail (Collins et al, 2015). The inability for programs to understand the needs of chronically homeless people makes treatment difficult. This problem is exacerbated by the shortage of affordable rental housing throughout communities in the United States (Wegmann & Christensen, 2016). A recent study by the National Low Income Housing Coalition (2016), shows only 31 available rental housing units to households earning less than 30% or less of the median income for every 100 households. Not only does this demonstrate a lack of affordable housing, but this also shows the reality of why individuals who experience chronic homelessness stay homeless. Their service-resistant nature makes housing a challenging affair for providers and street outreach workers (Erickson & Page, 1999). Housing providers may not want to waste time and resources on a homeless person who does not want help. The challenge that comes with working with the chronically homeless makes community collaboration and outreach efforts essential to successful housing and treatment.
There are programs that are functional in their ability to work with the chronically homeless population. Since the 1980’s and the passing of the Mckinney-Vento Homeless Assistance Act, the United States Government has been investigating what strategies would work to house chronically homeless people (Burt, 2003). This lead to the development of federally funded Supportive Housing Programs, which are designed to help homeless people transition from homelessness and live as independently as possible (HUD, 2016). Another program is called Shelter Plus Care, which is similar to Supportive Housing Programs but provides additional services to assist homeless people with serious mental illness, chronic physical illness, or substance abuse (2016). Some of the organizations that use these programs follow the Housing First model. The Housing First model was originally developed to meet the housing and treatment needs of the chronically homeless population (Tsembris, Gulcur, & Nakae, 2004). Housing First helped pave the way for service providers to address the specific needs of chronically homeless individuals through the belief that housing is a basic right (2004). Housing First is an evidence-based model which meets housing needs without any requirement for treatment or sobriety (2004). In a study of a Housing First program by Tsembris, Gulcur, & Nakae (2004), chronically homeless individuals in the program sustained an 80% housing retention rate. An 80% housing rate is extraordinary considering the difficulty in working with such a population. Housing First can be a positive change for chronically homeless individuals who specifically struggle with substance abuse. Even though a person in a housing first program can refuse clinical services altogether, the Housing First model provides a step in the right direction (2004). Housing stability can be attained even without abstinence from substance abuse. In a study by Collins, Malone, and Clifasefi (2013), “chronically homeless individuals with severe alcohol problems who actively used alcohol at the point of entry into Housing First were just as likely to stay in the program as those who did not use alcohol.” The Housing First model has the dignity and safety of the client in mind. By taking the chronically homeless out of a high-risk situation, providers may eliminate the stress and hardship associated with the homeless lifestyle and allow for a new environment conducive to change. A safe environment allows for stability which may result in positive outcomes such as treatment and abstinence from illicit substances. Previous studies on homeless programs that did not use the Housing First model have suggested that active users are at greater risk for resumed homelessness after housing placement (Kertesz et al, 2009). Unsuccessful housing placement may not only result in wasted community resources, but it can also traumatize the chronically homeless which may lead them to feel helpless and distrustful of any service. Due to high success rates, Housing First programs are essential to assisting the chronically homeless. References Burt, M. R. (2002). Chronic homelessness: Emergence of a public policy. Fordham Urb. LJ, 30, 1267. Collins, S. E., Malone, D. K., & Clifasefi, S. L. (2013). Housing retention in single-site Housing First for chronically homeless individuals with severe alcohol problems. American journal of public health, 103(S2), S269-S274. Erickson, S., & Page, J. (1999). To dance with grace: Outreach & engagement to persons on the street. In 1998 National Symposium on Homeless Research. Washington DC. Kertesz, S. G., Crouch, K., Milby, J. B., Cusimano, R. E., & Schumacher, J. E. (2009). Housing first for homeless persons with active addiction: are we overreaching?. Milbank Quarterly, 87(2), 495-534. Tsemberis, S., Gulcur, L., & Nakae, M. (2004). Housing first, consumer choice, and harm reduction for homeless individuals with a dual diagnosis. American journal of public health, 94(4), 651-656. U.S. Department of Housing and Urban Development (2016). U.S. Department of Housing and Urban Development. Wegmann, J., & Christensen, K. (2016). Subsidized rental housing in the United States: What we know and what we need to learn in three themes. In Planning Forum (Vol. 17). A common portrait of homelessness in our community is the “Panhandler.” Panhandlers often are found in an area with high traffic such as at a stop light, or in front of stores, restaurants, or other places of business. We see these individuals in the community when commuting to work or passing through the city. We see the sign, which draws our attention; the figure of an individual fixed in one position; as well as the face that looks like it has seen its fair share of hardships. Panhandlers are at times viewed as vagrants, nuisances, or predators preying on the good will of others (Peters, 2016). At times we do see these individuals take aggressive approaches (2016). One would argue that they are just people who have ended up in an unfortunate circumstance. Either way, one should not turn a blind eye, but seek to help the homeless and make a difference in their lives. Many of us are charitable. An act of good will or charity is a common theme we see especially around the holiday season.
Charitable people are often concerned with what they could potentially be funding. While it is not everyone, substance abuse is prevalent among the homeless community. Like a false advertisement, we may not always trust what we see. The possibility of feeding an alcohol, opiate, or crack habit may be a deterrent for someone to give their money to a panhandler. Giving a monetary donation to the homeless individuals can be viewed as a gamble in a way; not knowing if you made a good decision but hoping it turns out for the better. Others may just give out of the kindness of their heart; praying that what they give may be used towards something to eat or something to better that individual’s situation. A handful of people are of the mind to provide aid in other ways. Many of the charitable decisions we make are based on what we see or know about the people we are helping. If we see they are cold maybe they need warmth, if they say they are hungry maybe they just need a meal, or perhaps they just need some spiritual support through the hard times. There are always alternatives to simply giving money. A donation can be the gift of a pair of gloves or boots in the freezing weather, giving up that extra sandwich you packed for lunch, or simply starting a conversation. Not too many homeless individuals know what services are in the community. Pointing them in the direction of a reputable charity organization or local homeless service provider is also an option. There is also the option to donate directly to charitable organizations who service the homeless. Even as we see homelessness decrease, panhandling will continue to be prevalent in our community. There can be many reasons for this. As of 2014, 30% of the city of Buffalo is living below the poverty line. Panhandling can be viewed as a way to get extra income. For some homeless, it is a habit that can continue even when housing is no longer an issue. In a recent Blog by Brandon Gaille (2014), there were interesting statistics that highlighted panhandlers. One particular statistic that stood out to me was only 82% of panhandlers were homeless (2014). This statistic indicates that 18% of panhandlers aren’t even homeless. In this same sample, 44% admit to using part of their income from panhandling on drugs or alcohol at least once per week (2014). While some panhandlers can make upwards of $80,000 a year, it is understandable why one would continue to panhandle (2014). This is, of course, a rare occurrence for one to make this much. It merely highlights how lucrative panhandling can be. Making the decision to help, can make a difference in a panhandler’s life. Ultimately, we choose to help for our reasons, but we should always be aware that there are many ways to help a panhandler than giving up spare change. It is important to understand this part of the community and to understand how our decisions to be charitable affects a panhandler. References Gaille, B. (2014). 21 Amazing Panhandling Statistics [Web log post]. Retrieved December 06, 2016, from http://brandongaille.com/21-amazing-panhandling-statistics/ Peters, LaMonica (2016) Homeless Population Drops but Panhandling Still an Issue for Buffalo Businesses. TWC News. Retrieved December 06, 2016, from http://www.twcnews.com/nys/buffalo/news/2016/01/6/panhandling--buffalo--allentown--elmwood--homelessness.html Chronic homelessness is a serious issue that exists in many major cities throughout the United States. With the rise in homeless individuals, shelter’s filled to capacity, and the limited amount of services available, the streets of the inner city become the only option these people have. Substance abuse is a disease that seriously afflicts this population and it should not be ignored. More recently, Buffalo, NY has been experiencing what some may consider an epidemic. The rising Heroin related deaths in the area has increased over the last few years. With the price of heroin decreasing and the disturbing practices in the heroin production, this creates a serious issue for vulnerable populations such as the homeless. These two issues are often co-occurring. It is important to understand the relationship between homelessness and substance abuse in order to better develop programs to assist the chronically homeless population.
The definition of homelessness has many meanings and may apply to a multitude of circumstances. There is the instance of homelessness in which an individual may live with a family member, friend, or simply using a stranger’s occupancy to sleep. This can be known as couch surfing. There is sheltered homeless in which the individuals reside in a homeless shelter or under temporary shelter placement in a social services system. There is also to be literally homeless is to live in the streets or about the community. While substance abuse is prevalent among the homeless population, the focus is on the most vulnerable population which is the chronically homeless population. Chronic Homeless is defined under the Department of Housing and Urban Development (HUD) as someone who has experienced homelessness for a year or longer, or who has experienced at least four episodes of homelessness in the last three years and has a disability (2014). Every episode of homelessness is as traumatic as the individual in such circumstances interprets it to be. Chronically homeless individuals are those whose home has been made in the streets or in nomadic fashion. These individual’s I believe must be the focus and target of help due to their vulnerable circumstances Statistics show that homelessness is an increasing issue from year to year. According to the National Institute on Drug Abuse, 2013, there are 690,000 that are homeless, living in some type of transitional housing program or in the streets throughout the United States. 34.7% of the homeless had substance abuse issues as well as mental illness which was 26.2% (samhsa.gov, 2010). 17% of the homeless died due to overdose. This is in everyone’s community and is an alarming situation. Substance abuse is a significant contributing factor to homelessness. The presence of addiction can often disrupt relationships with families, friends, and can even effect jobs. Addiction also contributes to loss of housing. In a study done by the United States Conference of Mayors (2008), Substance abuse was found as the single largest cause of homelessness for single adults. Two thirds of homeless people report that drugs and alcohol were a major reason for their becoming homeless (Didenko & Pankratz (2007). It is often stigmatized, that homeless people are broke and that is why they ask for money. Several chronically homeless individuals are often disabled and collect some sort of disability income such as social security, military service connected disability, or workers comp. While often co-occurring, substance abuse and homeless are both truly sensitive issues that can lead to the onset of. Whether if one leads to the other is truly a case by case analysis. In a study by Johnson and Chamberlain (2008) which used a very large data set (n=4,291), two thirds developed substance abuse after they had become homeless. This study’s findings found that young people were more at risk of developing substance abuse problems after becoming homeless than older people (2008). Adolescents and young adults that drink or use drugs seem to give themselves permission to engage in a more risk-taking lifestyle (Santelli et al, 2001). This study also shows how substance abuse can lead to chronic homelessness by highlighting that most people with substance abuse issue will remain homeless for 12 months or longer (2008). So it is in fact relevant that substance abuse is related to homelessness and may even be a direct factor. The very nature of the relationship between substance abuse and homelessness is not quite understood. By evaluating this relationship through social selection and social adaption models, there may be a way to understand. In a study by Timothy Johnson et al (1997), the author’s state that models of both selection and adaptation processes are necessary to account for the association between homelessness and substance abuse, indicating that a multi-directional model is more appropriate. Through these processes, it was found that prior homeless experiences were more predictive of first symptoms of both alcohol and drug abuse (1997). Substance abuse plays a critical role in the onset of homelessness, but whether it is a direct or indirect factor is still a question that needs to be answered. More clearly, does substance abuse put the individual more at risk for homelessness? A case study that evaluated this states that through analysis of several nested models of homelessness links substance abuse only indirectly to loss of domicile, primarily through its impact on social and institutional affiliations (2002). The results of this study indicate that substance abuse did not impact homelessness indirectly by diminishing the accumulation of human capital (2002). Substance abuse does indeed play a critical role in Homelessness and in some cases may even cause it. It is important to consider that there are also a multitude of other factors that may play a part as well. A Dual Diagnosis consist of a substance abuse diagnosis as well as a mental health diagnosis. According to Drake, Osher, and Wallach (1991), those individuals with dual diagnosis account for 10-20% of homeless individual’s across the United States. Mental health is a prominent issue in homeless individuals as well. Many programs and systems that were created to enhance community health may have their benefits. They have their issues as well though (1991). It is important to highlight what can be done to help this very vulnerable population. Of course there are many existing programs and entities that are functional in their ability to work with this population. Some of these long standing entities include Social Services, Housing agencies, as well as a broad range of substance abuse and mental health treatments. There are many issues that a Homeless outreach worker can face when trying to assist chronically homeless individuals. Many individuals with substance abuse problems experience multiple barriers trying to access housing while suffering from addiction. There are many shelters that require sobriety to access their services and they are not qualified or ineligible for public housing. Chronic homelessness is increasingly associated with alcohol and illicit substance abuse. This type of individual without a stable place during substance abuse recovery only increases the likelihood that these treatments will fail. Many of these issues consist of poorly understood needs. The needs of this type of individual may not be equivalent to the needs of the average individual in our complex society. For example, a cell phone seems to be a viable part of an individual’s life in a more modern era. The chronically homeless individual may simply value a cup of coffee or a cigarette. An addict may not need certain mainstream medications or treatment. They may just need someone to talk to or an alternative solution. There are many ways and initiatives used to try to assist the chronically homeless population. One way to do this is through outreach. By meeting individuals in their setting, the worker can assist with the various issues and needs. Many homeless people just don’t know what help is out there. Community outreach breaks the barriers which may exist between the homeless and the agencies that service this population. Outreach will allow for case management, counseling, and referral services. Homeless clients have very unique and specific needs. Whether its access to shelters, housing resources, social services, job training, or any other need; outreach will facilitate the linkage. Too often do Homeless individuals fall victim to the bystander effect. Many of us grow blind to our surroundings and become ignorant of the needs of others. So much so that we go about our daily lives and ignore everything else around us. The bystander effect gives an example of how disconnected we are from our society, as well as gives us insight into how cognizant we actually are of the people around us. We as individuals need to break away from these social constraints in order to become a more productive and meaningful member of society so that others don’t fall victim to the ignorance of others. Whether it’s a home, family, or even sense of self and pride; these individuals are a part of the community as well and need to feel empowered to make changes for themselves. The social services system has always been the center of emergency and public assistance for the wide range of social issues that may exist in the community. In my opinion, this system plays a vital role in trying to end chronic homelessness. With advancements in public services and welfare systems, social services will be able to increase its ability to broaden the range of affordable housing resources. Supported housing programs have been very successful in helping homeless individuals obtain housing. These types of programs are in need of more funding sources in order to increase the amount available housing units as well as create better supportive programs to teach valuable living skills. Homeless Outreach Workers require a very unique skill set. They need the ability to connect, establish relationships, and be able to facilitate the needs of their clients. This is where a holistic form of case management becomes necessary. With the new and evolving advancements in pharmacology and treatment solutions there will be better medications and treatment options for those with addiction issues or dual diagnosis. The presence of more overdose preventative measures in the form of Narcan kits in the streets can make a difference in saving lives. Community based inebriate centers can provide safety for someone in a vulnerable state and create an alternative to the streets or a jail cell. Though vast improvements can be made in a multitude of areas, housing a homeless person and treating his substance abuse issues does not entirely fix the human being. This is important to understand because all human beings perform at a level of functionality that is suited to them. Which may be different than social norms and how the average person conducts themselves in civilized culture. Studies show that chronically homeless adults showed significant improvement in housing even though they remained socially isolated and showed limited improvement in other domains of social integration (Tsai, Mares, & Rosenheck, 2012). Some wounds are deeper than what we can visual see or even truly understand. In a unified effort, any individual can be and must be helped if they are living in such circumstances. Homelessness is a serious issue that exists all throughout the United States. With the rise in homeless individuals, shelter’s filled to capacity, and the limited amount of services available, the streets of the inner city become the only option some people have to sleep. Substance abuse is a disease no matter where a person lives and should not be ignored. These two issues negatively affect the individual and are often co-occurring. New research must be geared towards evolving and improving the social services systems. More funding must be allocated to affordable and available housing resources and the agencies. Also new therapeutic techniques and psycho-pharmacological advancements must be made in order to improve upon mental health and substance abuse treatments. It is important to understand the relationship between homelessness and substance abuse in order to better develop programs to assist the chronically homeless population. References Didenko, E. and Pankratz, N. 2007. “Substance Use: Pathways to homelessness? Or a way of adapting to street life?” Visions: BC’s Mental Health and Addictions Journal, 4(1), 9-10. Available from http://www.heretohelp.bc.ca/ Drake, R. E., Osher, F. C., & Wallach, M. A. (1991). Homelessness and dual diagnosis. American psychologist, 46(11), 1149. Evans, W. (2010). What Makes an Effective Outreach Worker? Q&A with Doug Becht. Homeless Resource Center. Retrieved November 5, 2014. Hasenfeld, Y., & Garrow, E. E. (2012). Nonprofit human-service organizations, social rights, and advocacy in a neoliberal welfare state. Social Service Review, 86(2), 295-322. Johnson, G., & Chamberlain, C. (2008). Homelessness and substance abuse: Which comes first?. Australian Social Work, 61(4), 342-356. Johnson, T. P., Freels, S. A., Parsons, J. A., & Vangeest, J. B. (1997). Substance abuse and homelessness: social selection or social adaptation?. Addiction, 92(4), 437-445. National Alliance to End Homelessness (2014). Chronic Homelessness. Retrieved November 12, 2014 from http://www.endhomelessness.org/pages/chronic_homelessness Santelli, John S., Leah Robin, Nancy D. Brener, and Richard Lowry (2001, September). Timing of alcohol and other drug use and sexual risk behaviors among unmarried adolescents and young adults. Family Planning Perspectives33.5. Retrieved November 11, 2014 from http://find.galegroup.com.ezproxy.umuc.edu/itx/start.do?prodId=AONE Tsai, J., Mares, A. S., & Rosenheck, R. A. (2012). Does housing chronically homeless adults lead to social integration?. Psychiatric Services, 63(5), 427-434. Vangeest, J. B., & Johnson, T. P. (2002). Substance abuse and homelessness: direct or indirect effects?. Annals of epidemiology, 12(7), 455-461. United States Conference of Mayors. “Hunger and Homelessness Survey: A Status Report on Hunger and Homelessness in America's Cities.” 2008. Available from http://www.usmayors.org/uscm/home.asp. http://www.drugabuse.gov/about-nida/directors-page/messages-director/2013/01/overdose-deaths- The Dept. of Housing and Urban Development (HUD) has established definitions and policies for the many organizations that serve the homeless population. This means that there are clear guidelines about who homeless providers and agencies can serve. Homeless service organizations must adhere to the law as well as the policies and procedures given by specific grants. This can make life for homeless individuals and families very difficult. Much of the time, they feel like they have to jump through hoops for a shelter placement or to get help with temporary financial assistance. How can we tell a homeless person that they are not homeless? The truth is no one can. How exactly is the term “homeless’ defined?
There are actually multiple definitions for this term and the following will highlight what that is. These definitions as defined by HUD are taken from the National Health Care for the Homeless Council Web Page (NHCHC, 2016)….. “A homeless individual is defined in section 330(h)(5)(A) as “an individual who lacks housing (without regard to whether the individual is a member of a family), including an individual whose primary residence during the night is a supervised public or private facility (e.g., shelters) that provides temporary living accommodations, and an individual who is a resident in transitional housing.” A homeless person is an individual without permanent housing who may live on the streets; stay in a shelter, mission, single room occupancy facilities, abandoned building or vehicle; or in any other unstable or non-permanent situation. [Section 330 of the Public Health Service Act (42 U.S.C., 254b)]” “An individual may be considered to be homeless if that person is “doubled up,” a term that refers to a situation where individuals are unable to maintain their housing situation and are forced to stay with a series of friends and/or extended family members. In addition, previously homeless individuals who are to be released from a prison or a hospital may be considered homeless if they do not have a stable housing situation to which they can return. A recognition of the instability of an individual’s living arrangements is critical to the definition of homelessness. (HRSA/Bureau of Primary Health Care, Program Assistance Letter 99-12, Health Care for the Homeless Principles of Practice)” “Programs funded by the U.S. Department of Housing and Urban Development (HUD) use a different, more limited definition of homelessness [found in the Homeless Emergency Assistance and Rapid Transition to Housing Act of 2009 (P.L. 111-22, Section 1003)].
We see that there many ways to define the term “homeless”. These definitions affect many organizations on the state and local level currently serving this population. It affects how programs determine eligibility for individuals and family members. Keep in mind that every program is unique and may have to adhere to strict guidelines. This simply provides the facts of who the government considers to be homeless. Please share and comment. References National Health Care for Homeless Council (2016). What is the official definition of homelessness? Retrieved November 17, 2016, from http://nhchc.org/faq/official-definition-homelessness/ U.S. Department of Housing and Urban Development (2016). U.S. Department of Housing and Urban Development. Retrieved from http://portal.hud.gov/hudportal/HUD While traveling the streets on routine outreach, I wander to some of the back roads of the city to discover a couple of homeless people squatting under an overpass. This is a spot I have been before so I am familiar with the area and these individuals. In these hidden spaces I observe old mattresses, wet blankets, card board boxes, among other things used for bedding. I see discarded bottles, food wrappers, and piles of garbage in several places. Within the garbage I spot syringes. The sight of dozens of needles laying amongst the squatters was certainly alarming. I attempted to speak to one of them asking if anyone needed help, I just got silence and a blank face searching in the distance. This instance showed me the seriousness of heroin use in our society. Human beings put themselves in virtually uninhabitable places and dangerous situations to feed their addiction. One of the major problems that we are facing in Western New York is Heroin. Everywhere in the news we see cases of heroin related stories or deaths. This is certainly not a new problem but the increase of overdoses attributed to Fentanyl laced Heroin is certainly prominent. Opiates in general have led to hundreds of death in Erie County alone. According to the Buffalo News (2016), “Erie County is on track for 570 opiate related deaths in 2016.” Along with this the number of drug dependent babies is on track to double from last year (WIVB, 2016). This is triggering the growing concern for some sort of response to this epidemic. Some organizations have already stepped up to the challenge. Crisis Services has implemented a 24/7 addiction hotline which will provide the community with access to information, resources, and treatment. This will point people in the right direction who are unaware of the many resources in the area. Care coordination has increased over the last few years allowing more managed care for those on public health insurance. Primary care clinics and substance abuse programs are growing in their relationship through communication on specific cases. Law enforcement is also doing their part by cracking down on the dealers and distributors that are selling these powerful drugs on the streets. Some of the barriers include the lack of quick and easy access to rehabilitation facilities. Many rehabs require a referral or doctor’s approval for admission. This delays the treatment process and often deters people from seeking help. There also needs to be more training for healthcare staff and coordinated care organizations to increase understanding of resources and how to properly serve individuals with an addiction. In terms of opiate treatment, there needs to be better access to Methadone or Suboxone clinics. Insurance companies need to expand options and make treatment access less costly and cumbersome. The society at large needs more education on the matter as well. Many people aren’t accepting of the addicts in our community. This creates a negative stigma with this population. More training on the benefits of Narcan is essential to saving someone from a potential overdose. There needs to be some public training and distribution so that more people in the community have these kits. With some collaboration and increased training, the community can be better fit to address these high overdose rates. Please share and comment below on your thoughts. 24/7 Addiction Hotline: 716-831-7007. References The Buffalo News (2016). On track for 570 opiate deaths in 2016, Erie County steps up response. Retrieved from http://buffalonews.com/2016/04/05/on-track-for-570-opiate-deaths-in-2016-erie-county-steps-up-response/ WIVB (2016). Number of drug dependent babies in parts of WNY on track to double this year. Retrieved from http://wivb.com/2016/11/10/special-report-number-of-drug-dependent-babies-in-parts-of-wny-on-track-to-double-this-year/ |
Chris CandelariaCommunity health worker, Blogger, social rights supporter, mental health counselor, veterans service worker, homeless outreach worker, and all around good guy. |