Tag Archives: homelessness

Pop-top cans: Ensuring services truly support those experiencing homelessness

By Seneka Arrington and Chad Yates October 19, 2020

Community food pantries rely upon the generosity and goodwill of community members. Food pantries are invaluable to those individuals and families who are either homeless or facing food scarcity.

As an education specialist for a large nonprofit, I (Seneka Arrington) oversaw the daily operations of our local food pantry. In the back, from ceiling to floor, nonperishable food items — organized by soups, vegetables, meats, snacks and beverages — lined the walls. On a shelf sat prepared food bags, created by hand and ready to be distributed to those in need.

One afternoon, a man walked through our front doors and requested a bag, stating, “I haven’t eaten in days.”

With delight, I grabbed a food bag and handed it to our guest. Famished, he decided to open the bag in front of me just to “have a few bites.” But to his dismay, he was unable to access any of the food because every can in the bag required a utensil to open.

Discouraged, he mumbled, “It’s so hard to get here. Now it’s hard to get the food out. This always happens.”

I quickly apologized for the inconvenience and asked if I could make the situation right. I took his bag and returned to the fully stocked pantry, scanning for a meal to provide to my guest. On the middle rack, three items in pop-top cans caught my eye. I grabbed all three and created a dinner bag that my patron could enjoy. Upon receiving this new food bag, the man smiled and hugged my shoulders.

This experience highlighted for me contradictions in the ways our society tries to support, care for and aid those who are homeless. Although goodwill is typically present in these initiatives, a lack of intentionality often plagues efforts to reduce suffering in this community. I came to recognize how education could increase the effectiveness of the support offered by society. From that point on, my mantra became that all food bags “need to make sense and include only pop-top cans.”

Homelessness is an ever-present concern in communities. The problem is anything but invisible. More than half a million people in the United States experience homelessness on any given night. The National Coalition for the Homeless highlights three types of homelessness: chronic, transitional and episodic.

Chronic homelessness is used to describe the people who are most vulnerable due to experiencing homelessness for at least a year while also struggling with a substance use disorder, physical disability or serious mental illness.

Individuals experiencing transitional homelessness rely on the shelter system for a short period. These individuals are likely to be younger and to have become homeless because of a calamitous event.

Episodic homelessness includes people who experience mental health, medical or substance abuse issues. These individuals are chronically unemployed, resulting in a frequent shuffle in and out of homelessness.

Homelessness and helping those in need has been a passion of mine since I was in the third grade. In working with this population, I have witnessed a frequent lack of intentionality by those who donate or serve and a subsequent lack of self-worth on the part of those who receive these donations or services. What are we saying to a person when we hand them food that they cannot access? As helpers, what is our attitude around giving to those in need? Do our services reflect our support?

It is important to first look at our biases toward those who are homeless and the difficulties that surround asking for help.

Stereotypes about homelessness

Throughout my career, I have heard words such as annoying, needy and lazy applied to those who are experiencing homelessness, often as justification for someone’s lack of desire to serve this population. Such words are often used when describing panhandlers. “If that person can ask for money, they can get a job” is one prevalent line of thinking that negatively influences people’s willingness to help those they deem to be undeserving. There is also the idea that given all of the community and government efforts to assist those who are homeless, individuals who are still asking for help are not taking advantage of these resources.

Homelessness is repeatedly associated with choice. Those burdened by homelessness are often viewed as being individuals whose predicament resulted from their own poor choices and who have full autonomy to get themselves out. Many of these individuals desire stability, but the added stresses of humiliation, worries of where to sleep at night and food insecurity are their reality.

Their losses of employment, housing and family are commonly viewed as resulting from poor decision-making and mismanagement. These negative impressions are so ingrained in our society that even well-meaning citizens have difficulty giving to those in need. Understanding the complexity of homelessness, addressing our personal biases and updating these beliefs are the first steps on the path toward advocating for this population.

Understanding homelessness through the lens of a counselor

Community mental health agencies are supportive of accepting individuals who are experiencing homelessness. These agencies typically accept Medicaid/Medicare or offer sliding feel scales to help these individuals obtain services.

Other organizations in which counselors may work with individuals who are homeless include nonprofit agencies, Department of Veterans Affairs facilities, and child and family services agencies. In addition, school counselors may assist students whose families are transitory or homeless.

As counselors, we are tasked with being influencers of hope and developers of self-worth. We create spaces for growth and facilitate transformations. Even as we help individuals work through the hardships associated with homelessness, coupled with the psychological processes, we must recognize basic needs. Often, it is a lack of basic necessities that serves as a significant barrier or hindrance to an individual’s progress. Counselors are therefore encouraged to affirm the existence of said barriers, as well as the barriers of discrimination, poverty, injustice and hardship.

Counselors can create spaces for individuals to work through feelings of guilt, shame, helplessness, hopelessness and fear associated with simply surviving from day to day. Counselors can also work with clients who are homeless on overall wellness. We recommend addressing the “Six Dimensions of Wellness” created by Bill Hettler, co-founder of the National Wellness Institute. The six dimensions are:

1) Emotional wellness: Reducing stress and improving sleep

2) Environmental wellness: The creation of happy, clean and safe spaces

3) Social wellness: Relating, interacting and communicating

4) Physical wellness: Regular exercise, proper nutrition and good sleeping habits

5) Intellectual wellness: Problem-solving, processing and creativity

6) Spiritual wellness: Meaning, purpose and guidance

In addition to addressing the emotional and psychological needs of individuals experiencing homelessness, counselors rely on community resources and relationships with community stakeholders to meet the needs of this population. Through interdisciplinary partnerships, counselors can create a broad network of support. These duties — e.g., securing food or shelter — are typically divided among helping professionals rooted in various disciplines other than counseling.

Factors counselors should consider

The stigma around asking for help: Even with a strong support system made up of co-workers, friends, family or helping professionals, it can be difficult to ask for help. People experiencing homelessness are often seen as burdensome, which can reduce the willingness of these individuals to request assistance.

In addition to the stigma of asking for assistance, few organizational and individual resources give without first asking or demanding that individuals meet certain criteria. The number of documents required to prove homelessness and obtain housing, food and security impedes the process at times. Advocacy from the counselor and education regarding how to navigate the complex system of aid can assist clients who are homeless in connecting with the necessary support.

Health: Individuals who are homeless can face severe barriers in accessing basic needs related to health and nutrition. The prerequisites to obtaining medical services, coupled with the financial means to sustain such services, hinder access and consistency. Health complications, poor hygiene, lack of adequate or varied nutrients, possible drug and alcohol abuse, and environmental stress directly affect the health and well-being of individuals experiencing homelessness.

Illnesses that most individuals recover from within a couple of days (e.g., the common cold) can become serious problems for those who are homeless due to living in unsanitary conditions. Chronic conditions are vitally important to consider because they require consistent medical treatment and healthy lifestyle habits to control. When not adequately treated, these physical conditions worsen over time and can contribute to mental health issues and a decrease in quality of life.

To assist these clients, counselors can aid in providing seamless transitions to medical offices. Partnering with local transportation networks, churches, food banks, medical professionals, local free medical clinics and shelter systems can create consistent care and build a supportive community to address homelessness collectively. Support is often evidenced by donations and collaborations.

Mental health and emotional well-being: Mental health conditions can be either the cause or the result of homelessness. A study by the National Institute of Mental Health reported that approximately 6% of Americans are severely mentally ill, compared with 20-25% of individuals experiencing homelessness. The predominant mental health disorders seen in those living in impoverished conditions include major depressive disorder, bipolar disorder and schizophrenia. Mild, yet prevalent, mental health issues show up in the form of generalized anxiety and adult attention-deficit disorder.

Counseling services require weekly sessions for effective treatment. Consistency is key to progression, follow-up and accountability. However, lack of adequate sleep and lack of access to immediate needs can continually disrupt the process of counseling for individuals who are homeless.

A recommended strategy that may be helpful to counselors is incorporating a weekly needs assessment to inquire about the client’s basic needs and whether they are being met. It can also be helpful to connect clients to resources that will allow them to attend counseling more consistently, such as free transportation and stable shelter. It is recommended that counselors put a multifaceted approach in place to address the needs of and provide appropriate mental health care to individuals experiencing homelessness.

Impact on helping professionals

Individuals experiencing homelessness are especially vulnerable due to a lack of access to stable shelter, reliable communication, financial means and medical resources. These barriers also restrict access to preventative health care and treatment that could aid in cultivating a more balanced and healthier lifestyle.

Gaps in professional partnerships often hinder consistent and effective care. Continuity of care should flow from the counselor to the medical professional, to the housing caseworker, to the food pantry volunteer. When this flow is inconsistent, so is the individual’s access to these services. Collaborative efforts, or a lack thereof, weigh heavily on the ability of those who are homeless to have their physiological and psychological needs met.

Most housing and homeless assistance organizations are fragmented and enigmatic systems. The difficulty in navigating such systems often leads to a sense of hopelessness and helplessness among individual in need. People are forced to obtain information on available services and programs through peer-to-peer interactions. Crisis response centers are under-resourced. Helping professionals receive incomplete information related to available resources and to the eligibility criteria for existing programs. Unfortunately, this fosters individual disengagement and distrust for public systems.

Consistently having to address crises and concerns such as trauma, addiction and emotional disorders with clients can be an overwhelming task for counselors. This is characteristic of settings in which clinicians are vulnerable to workplace stress, burnout and compassion fatigue. The latter can result in a lack of intentionality and patience when working with individuals experiencing homelessness.

Due to the physiological demands, working with homelessness requires patience and persistence that are not typical of everyday counseling encounters. As a result, counselors can experience a parallel process of hopelessness and subsequent compassion fatigue and burnout. To combat burnout, organizations can provide space for processing groups in which counselors can provide support to one another. These groups can be extended to partners in the community.

Action steps

Appropriately and competently addressing the needs of the homeless population requires intentional exploration and understanding of the multifaceted tenets of homelessness. The figure below depicts the necessary steps for counselors’ work with homeless communities.

Specific training for counselors and counselor trainees is essential in addressing the privation of the homeless community. Training can be offered through community and private mental health agencies and integrated into counseling programs. Practitioners and stakeholders can play an active role in addressing and supporting the identified needs by providing corporate training in the form of panels, lectures and service learning. Helping professionals and organizations can utilize the literature that expounds on care and attention for homeless communities.

Engagement efforts and materialization of the next steps can be demonstrated through interdisciplinary partnerships and collaboration. Immersion, outreach and advocacy can also serve as action steps toward increasing awareness and practical experience.

Action steps for work with homeless communities

Hopes for the future

Highlighting access and engagement is pivotal in effecting change and fostering spaces where homeless populations can receive care. Multiple health and human services agencies, including the Substance Abuse and Mental Health Services Administration (SAMHSA), prioritize connection to programs that help address and prevent homelessness. The core principles of SAMHSA, as noted in its strategic plan, include expanding access to the full continuum for mental and substance use disorders and engaging in outreach to clinicians, grantees, patients and the public.

Health and human services typically include discharge planning in addition to financial support through Housing First programs. The Housing First model was created in New York City by Sam Tsemberis in the 1990s. Tsemberis asserted that housing was the only solution to homelessness. The model highlighted the significance of permanent housing for the chronically homeless with no conditions attached.

Counselors can be at the forefront of advocating for the integration of this model, with modifications that include intentional interaction, purposeful food contributions, advocacy and activism, preparation, partnership and hope. A modified approach could focus on creating opportunities for people experiencing homelessness to adopt a healthy and stable lifestyle through holistic treatment. Specific methods for counselors include:

Training on people-first language
Pursuing partnerships with low-cost grocery stores to provide vouchers to clients
Increasing access to medical and clinical services through remote client monitoring and telehealth mediums
Providing continuity of care by granting computer access in clinical spaces
Offering career counseling
Instituting a commuter benefit program by teaming with an independent transportation network and providing transport vouchers

Neglecting the resources that can contribute to the success of people experiencing homelessness is akin to giving someone a can of food that is inaccessible to them. A pop-top-can-oriented organization or helping professional embodies compassion and wherewithal that fosters change and growth. Counselors can further close the gap by offering substantive interactions with built-in goals for meeting clients’ hierarchy of needs, encouraging comprehensive treatment, and promoting hope by helping homeless individuals discover exceptions.

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Seneka Arrington strives to bridge the gap between research and practice, emphasizing the importance of connection, collaboration, and translating research findings into clinically meaningful information. For the past decade, her practice and research have been in the nonprofit sector, highlighting homelessness, mental health, career counseling and service leadership. She is a licensed professional counselor, as well as a current doctoral student and graduate teaching assistant at Idaho State university. Contact her at arrisene@isu.edu.

Chad Yates is an associate professor of counseling at Idaho State University. His counseling experience includes working with individuals with substance abuse disorders, batterers and survivors of domestic violence, families, and as a generalist treating many diverse client issues. His research interests include evidence-based practice in counseling, client-focused outcome evaluation, and the treatment of individuals with substance abuse and co-occurring disorders. Contact him at yatechad@isu.edu.

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

Voice of Experience: Invisible people, Part 3: The homeless

By Gregory K. Moffatt June 3, 2019

He was the only student in my class who didn’t turn his papers in on time. He was constantly late and regularly fell asleep in class. I felt insulted by his seeming lack of respect for my classroom, for me and for our discipline. If I could have dropped him from the class, I would have. I almost resented the days he showed up.

But he wasn’t truly lazy, and he wasn’t intentionally disrespectful. Instead, he was a struggling member of the third group of invisible people I am highlighting in this series. It had never occurred to me that this student might be homeless, but a conversation with one of my colleagues opened my eyes to his situation. What I learned totally changed the way I saw him. I had been so blind.

The student was the eldest of three siblings who had been living with their mother in a homeless shelter. Mom had married young and had no job skills. When her husband left her, she had no money to pay the rent for their meager apartment. After months of eviction notices, the movers came in and swept everything in the apartment to the curb in less than an hour.

His mother spent the rest of that morning trying to find a place for them to stay. In the meantime, thieves helped themselves to their unsecured possessions on the curb. An afternoon rain had soaked their clothes, bedding and personal belongings. Much of what they owned was ruined. When my student and his siblings came home from school, they found their mother sitting on a broken dresser — dropped by a member of the eviction team — guarding what possessions they had left.

My student slept on a cot in a large room with several other families in the shelter. There was no place to store things other than under their cots, and things put there were often pilfered by other residents. Even an old pair of shoes might be better than those someone was already wearing.

Common bathrooms meant lines, especially in the mornings as my student tried to ready himself, wearing one set of clothes one day and his second set the next. Like others in the shelter, he washed out what he could in the sink, hoping the clothes would dry on the end of his cot by the next day.

This family was homeless because of divorce and a thoughtless ex-husband. Divorce happens to almost half of the U.S. population, so there was nothing unusual in that circumstance alone. My attitude toward my student made it clear I hadn’t even considered that there might be much more to his story.

Many of the people who are homeless in our nation struggle with addiction. Others are seriously mentally ill. To save money many years ago, my home state decided to get out of the mental health business. Mental health patients who were deemed not to be a risk to self or others were sent home or let out on the street, and the facilities closed. Some families couldn’t care for their family members who were mentally ill, and these individuals became nomads.

But there are also many people who are homeless who have merely fallen on hard times. Some men and women travel from one state to the next in search of job opportunities that might enable them to settle down with their families. They spend their nights in shelters, doorways, alleys or their cars.

Those who want to pull themselves out of the abyss of homelessness are met with barriers at every turn. Businesses don’t want them warming themselves in their shops. Cynical pedestrians cross the street to avoid saying, “I don’t have any money for you.” Esteem is further eroded by words such as, “You’ll just spend it on drugs.”

Services for those who are homeless are often inaccessible. For example, in Atlanta, the labor pool (where men and women go to find work) was many blocks away from where most shelters were located. It was smarter to sleep under a nearby bridge, thus possibly being first in line the next morning. Better that than to sleep in a shelter and not being allowed to leave until 7 a.m., thus risking being at the end of long lines and having less chance of securing a job for the day.

People who are homeless can also be stalled by people like me — a college professor and professional counselor who should have known better. My student had no place to study at the shelter, no place to keep his homework, and no money to buy his books. With limited transportation options, he was perpetually tardy. And he was exhausted all of the time from caring for his family, working when and where he could, and getting insufficient sleep in the crowded shelter.

Our clients who are homeless need transportation, food, clothing and jobs. I know that we aren’t social workers, but those who work with the homeless have to think pragmatically.

I’m glad that I learned about this student’s story — which has a happy ending. He and his family got back on their feet, he graduated from college, and life is better. It frightens me to think how many other people I might not have seen clearly, however, because of my cultural blindness.

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Dear readers: I would value hearing from you if you found this series on cultural awareness (invisible people) helpful. My primary writing goal is always to help us do our jobs better. You help me do that with your comments, questions and ideas.

Previous articles in this series:

Voice of Experience: Invisible people, Part 1: Native Americans

Voice of Experience: Invisible people, Part 2: The incarcerated

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Gregory K. Moffatt is a veteran counselor of more than 30 years. His monthly Voice of Experience column for CT Online seeks to share theory, ethics and practice lessons learned from his diverse career, as well as inspiration for today’s counseling professionals, whether they are just starting out or have been practicing for many years. His experience includes three decades of work with children, trauma and abuse, as well as a variety of other experiences, including work with schools, businesses and law enforcement. Contact him at Greg.Moffatt@point.edu.

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

Homelessness: A counselor’s role in alleviating a complex systemic issue

By Zach Bruns and Cody Andrews July 10, 2017

How would you know if your client is homeless or at risk of becoming homeless? For counselors working in school or community settings, this seems like a simple question to answer. In reality, homelessness is a complex status that may be layered with shame, guilt, addiction, trauma, family strife, legal pitfalls, economic and employment barriers, and inadequate physical and mental health treatment.

As professional counselors, we are challenged with trying to meet the psychological and emotional needs of our clients. How do we properly treat individuals with mental health symptoms whose needs are so intricately interwoven into personal and environmental factors, especially housing instability? The professional research correlating homelessness and mental health counseling is surprisingly minimal (although not nonexistent), whereas the efficacy of current popular psychotherapy techniques (e.g., cognitive behavior therapy, dialectical behavior therapy, motivational interviewing) has been repeatedly demonstrated throughout research literature. Therefore, it is reasonable to ask: Is psychotherapy alone enough to adequately help individuals living in homelessness or without permanent housing? We will attempt to answer that question in this article while emphasizing the importance of instilling hope in the lives of our clients.

As an American Counseling Association member and a licensed professional counselor and substance abuse counselor in Wisconsin, I (Zach Bruns) have the privilege of working as a mental health clinician on a multidisciplinary team that serves individuals who are homeless or at risk of becoming homeless in Milwaukee County. Our nonprofit agency, Outreach Community Health Centers, receives funding from the Substance Abuse and Mental Health Services Administration (SAMHSA) to run a Projects for Assistance in Transition from Homelessness (PATH) program (see bit.ly/2hcldEg). We do not have all the answers and resources to solve the systemic societal issues of homelessness, but I would like to share my insights on practical ways to help individuals who are living in homelessness or at risk of homelessness.

Let’s start with the basic concepts of homelessness. Each community in the United States has different access to resources for people experiencing homelessness. Smaller rural communities may rely heavily on faith-based organizations to assist individuals experiencing homelessness or economic hardship. Larger urban communities such as Milwaukee often have emergency shelters, open year-round or seasonally, that cater to specific populations (e.g., survivors of domestic violence, single women, women with children, families, single men). Depending on a shelter’s funding source — i.e., private or governmental — shelters may enforce their own rules or be required to abide by certain rules and regulations that dictate who can and cannot be admitted into their shelter, how long residents can stay and what services are offered to individuals or families during their shelter stay. The Department of Housing and Urban Development (HUD) also organizes collaborative countywide Continuum of Care programs throughout the United States. These programs seek to provide services to those who are homeless, including helping individuals, unaccompanied youth and families transition into housing (see bit.ly/27ioSpd).

Emergency shelters that receive funding through HUD are expected to track the types of services they provide to individuals and the dates of shelter stays. HUD also funds permanent housing programs such as the Rapid Re-housing (see bit.ly/1MtqB19) and Housing First (see bit.ly/1HGeOsl) initiatives, which are required to provide documentation of a client’s homeless status before enrolling an individual or family in services. HUD created criteria for classifying homelessness into four categories (see bit.ly/1Ir9R9v): literally homeless, imminent risk of homelessness, homeless under other federal statutes and fleeing domestic violence. Individuals are placed into housing programs based on their category of homelessness, the length of time they have been homeless (e.g., 12 months or more in the past three years) and their documented disability status.

With this general background of homelessness in mind, how can counselors provide hope and encouragement and help our clients who are struggling with housing instability?

Primary health care. Help your clients get connected to a primary care doctor. This is vitally important because many (but not all) individuals who are homeless or at risk of homelessness have not had a recent physical exam or have unaddressed medical issues. You may be able to make an internal referral if you are affiliated with a medical clinic. Otherwise, you may need to help these clients research clinics that accept their insurance (if insured) or clinics that accept uninsured clients or work on a sliding fee scale.

Psychiatry services. Not all clients’ mental health symptoms rise to a level requiring medication management just because they are homeless or at risk of being homeless. However, many individuals can benefit from the therapeutic effects of psychotropic medications as prescribed by a psychiatrist, advanced practice nurse prescriber or other credentialed prescriber. Depending on where you practice as a counselor, psychiatric services may be difficult to access or feature long wait lists. A primary care physician may be an alternative option, depending on your client’s mental health needs. A primary care doctor may be able to prescribe psychotropic medications for common mental health diagnoses such as mild to moderate mood disorders. Consider asking your clients to sign a release of information so that you can communicate with their doctor and coordinate appropriate services for them.

Public benefits. If your clients are living in poverty and struggling to secure consistent employment and stable housing, they may benefit from public benefits. Help your clients enroll in and utilize benefit programs such as Medicaid or state-based health insurance, the Supplemental Nutrition Assistance Program (SNAP) and unemployment insurance. If you are not the right person to assist clients with these tasks, refer them to an agency in your area that helps with public benefits. Also consider researching additional special benefits that may be available in your area. For example, SAMHSA’s SOAR program helps individuals who are homeless and living with a mental illness apply for and increase their chances of successfully obtaining Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI) benefits (see bit.ly/2eM4YPr).

Emergency shelter. If your community has a coordinated entry system for shelter, you may need to help clients make calls for shelter services, especially if this is their first time experiencing homelessness and they are feeling scared, ashamed or hesitant to ask for help. In Milwaukee County, most shelter bed openings are currently coordinated through IMPACT 2-1-1, which can be accessed via phone or online chat. Private shelters follow different rules and often accept individuals who present to a shelter in person. We recommend that you call the shelter in advance to check for current bed openings.

Disability documentation. Unless it’s your initial intake session with your client, you likely have already completed a formal intake process, including using relevant evidence-based screening tools, so you now have a sense of the mental health needs and issues that affect your client’s quality of life. The next step to helping your client is to vouch for your client in writing. Many supportive housing programs require documentation from a medical or mental health professional noting the individual’s current medical or mental health diagnosis. Work with your client to obtain housing application paperwork, and offer to write the client a letter on your agency’s letterhead documenting any disabilities that you are qualified to diagnose.

Food and clothing (and maybe a sleeping bag). As counselors, sometimes we forget about the physiological and safety needs at the bottom of Abraham Maslow’s hierarchy of needs pyramid. Consider obtaining or creating a list of local community resources, including food pantries, free meal sites and clothing banks, to share with your clients. Many secondhand clothing stores, such as Goodwill and St. Vincent de Paul, offer voucher programs for people in need of clothing and furniture. Consider reaching out to local churches, temples, mosques, synagogues or other nonprofits to request donations of material goods that your clients may need, such as personal hygiene supplies, coats or jackets, boots, blankets or even sleeping bags.

Transportation. Transportation can be a major barrier to a client obtaining and keeping employment and attending regular appointments such as counseling sessions, supervised visits with children and apartment showings. In Wisconsin, individuals with Medicaid can qualify for assistance with transportation for medical-related services, usually via public transportation (if available) or contracted transportation services. Some cities also offer discounted public transportation for seniors, individuals with Medicare or persons with qualifying disabilities. In Milwaukee, our PATH team helps qualifying individuals apply for a GO Pass, a discounted bus pass for county residents older than 65 or for younger residents who receive SSI or SSDI, or who have a veterans disability designation and also have Medicaid or SNAP benefits.

Cell phone. A cell phone is a simple everyday device that most of us take for granted. However, if your client is living on the streets, under a bridge, in his or her car or even “couch surfing” with friends or family, a phone can be that client’s lifeline to the outside world. If your client is enrolled in public benefits, he or she likely qualifies for a free government-issued phone. You can help clients apply for a cell phone online through programs such as SafeLink Wireless (see bit.ly/1ISUYOD) or in person at local cell phone retail stores (call first to check availability).

Long-term case management. We all have worked with difficult clients — individuals with complex mental and physical health needs whose level of care may extend beyond the scope of outpatient counseling treatment. To better support these clients, consider submitting a referral to a long-term case management program in your county. In Milwaukee County, the Milwaukee County Behavioral Health Division contracts with community agencies to offer three different types of case management programs for people whose primary diagnosis is related to mental health (see bit.ly/2q1uGSl). For individuals whose main diagnosis relates to physical health, there are additional agencies and case management programs, such as Family Care programs (see bit.ly/2hKeRg8), that offer services.

In conclusion, psychotherapy is not enough to treat all the mental, social, emotional and environmental aspects surrounding individuals or families who are experiencing homelessness. By stepping outside the traditional boundaries of a counselor’s role, you can greatly benefit and encourage your clients as they progress along their recovery journeys. By using your person-centered counseling skills, you will encourage and build up hope in your clients, especially if they are struggling with issues surrounding homelessness. Remember the beloved Carl Rogers, who urged us all to treat our clients with genuineness, empathy and unconditional positive regard.

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Zach Bruns, a licensed professional counselor and substance abuse counselor, has been practicing community-based clinical counseling since 2013. He serves as the mental health clinician for the multidisciplinary Projects for Assistance in Transition from Homelessness team at Outreach Community Health Centers in Milwaukee. He also works through Dungarvin Inc. and the Milwaukee County Behavioral Health Division’s Community Consultation Team to provide mobile crisis services to individuals diagnosed with intellectual/developmental disabilities and mental illnesses, their providers and loved ones. Contact him at zacharyb@orchc-milw.org.

Cody Andrews has served as the lead service provider for the Street Outreach Team at Outreach Community Health Centers since June 2015. He is starting graduate school this fall to obtain a master’s degree in social work and from there hopes to pursue a doctoral degree in social welfare. His research interests include housing interventions, social support systems of people experiencing homelessness and homeless outreach. Contact him at codya@orchc-milw.org.

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

Putting a human face on homelessness

By Lynne Shallcross January 14, 2010

Sandy Sheller understands that, sometimes, the best counseling session might take place just waiting for the bus.

Sheller, the coordinator of mental health training for the Salvation Army of Greater Philadelphia, vividly remembers a client who was having trouble making it to a drug rehabilitation program. A caseworker informed Sheller that the woman, who was in her late 30s, was being “noncompliant” by refusing to go to the rehab program, which was a requirement for her to stay in the shelter.

Instead of lecturing the woman, demanding an explanation or jumping to conclusions, Sheller asked the client to talk about her situation. The key, Sheller says, was asking in an empathetic, nonjudgmental way. “I wasn’t trying to make her do anything, and she knew that,” says Sheller, who worked as an art and family therapist in an inner-city Salvation Army family shelter for about five years before becoming a coordinator a year ago.

The client explained that the rehabilitation program had changed locations, meaning she now had to take multiple buses to get there. Waiting for the first bus, the client had experienced panic attacks that prevented her from making it to the rehab program. Eventually, Sheller says, she and the client worked on the triggers and history that fed into the woman’s panic attacks, but first they took it slow and brainstormed more immediate solutions.

Sheller asked if going to the program was something the woman wanted to do and thought she could do, and the woman confirmed that it was. Together, they decided it would help if Sheller stood outside the shelter with the client as she waited for the bus. “She said, ’I think I just need somebody to be there, to remind me it’s just waiting for a bus and I’ll be OK,’” Sheller remembers. After about a week of waiting for the bus together, the client felt she was ready to handle the wait on her own. From then on, she came back to Sheller each day and reported how things had gone.

Much of the work Sheller does with clients facing the challenges of homelessness is simply about recognizing them as fellow human beings, she says. Given different situations or circumstances, any of us could find ourselves in the same position. “If I had gone through your life experiences,” Sheller tells her clients, “there’s no telling if I wouldn’t be where you are.”

Waiting at that bus stop was one of many experiences that taught Sheller the importance of simply being there for clients who are confronting homelessness. “To work effectively in the shelter means you have to really be where they are and go where they need to go,” says Sheller, a member of the American Counseling Association and assistant clinical professor in Drexel University’s Hahnemann Creative Arts in Therapy Program. “It requires you to be open and nonjudgmental, to be there for what’s needed. Get rid of the preconceived ideas that counseling is sitting in an office — be there in a very humanizing way.”

Nowhere to turn

Homelessness leaves people feeling they have no one to turn to and nowhere to go, Sheller says. “It’s the sense of feeling very isolated, very helpless, very alone and, at the same time, very stigmatized by society. You feel like a failure. The sense of feeling helpless is one of the hardest things that we, as human beings, endure. No one who’s homeless wants to be homeless.” There are complex situations underlying why each person becomes homeless, says Sheller, adding that she’s never met anyone who wants to be in that situation.

Michael Brubaker, an assistant professor at the University of Cincinnati’s School of Human Services and academic coordinator in the addiction studies program, says the stigma surrounding homelessness stems in part from the Protestant work ethic on which the United States was built. Not only are people thought to be responsible for pulling themselves up by their bootstraps and getting themselves out of homelessness, he says, but there also exists a general bias that these individuals are solely responsible for their becoming homeless in the first place.

Brubaker has worked with homelessness for the past 12 years and conducted a study that involved taking counseling students to a shelter to learn from the residents. “We realized that we, as counselors, are not immune to influences from society,” he says. “(The shelter residents) can probably teach us better than we can teach them what their circumstances are about.” Brubaker, a member of ACA, emphasizes that homelessness is more of a situation and less of a population. Approximately 80 percent of those who become homeless in a given year are transitionally, not chronically, homeless, he says.

A large percentage of people in shelters have trauma in their history, Sheller says. Many of the shelter residents she sees grew up in foster care, aged out of the system, had children and are now homeless. They’ve had little or no consistent support for the long haul, she says.

The experience of being homeless can be traumatic in itself. “That experience of losing support — of realizing that family is not there to support, that friends are not there to support, to realize that society is not there to support — can be a very disheartening and even traumatic experience,” Brubaker says. The physical aspect of being on the streets is also traumatic, he says, in part because people experiencing homelessness are vulnerable to attacks by youth and predators, as well as harassment from authorities.

Sonya Lorelle, a doctoral candidate in the Old Dominion University Department of Educational Leadership and Counseling, says systemic barriers can provide significant hurdles for people attempting to overcome homelessness. Lorelle, an ACA member who spent time as a counselor in a shelter system in Norfolk, Va., recalls instances in which parents secured a job on the late shift in hopes of providing their family some financial stability. But, Lorelle says, barriers popped up from every angle — the bus route back home would stop running at a certain hour or child care wouldn’t be available after 6 p.m. “During a holiday when child care and school were closed or when the child became ill or had a doctor’s appointment, the balance would be thrown off,” she says. “More than once, I saw a parent lose a job for having to take a day off to take care of their children, putting them back at square one. Everything had to be perfectly balanced.”

Telling the story

Because of the struggling economy and the shortage of housing, Sheller estimates the current average length of stay for residents in many of the Salvation Army shelters is approximately a year. “It’s a really long time that you can get to work with them and create healing environments for them,” she says. Many shelters must refer clients out to other agencies for mental health care, but Sheller and other counselors who work with homelessness say having in-house mental health services, whenever possible, is helpful.

Although none of the shelter residents were required to see Sheller for counseling, she tried to build relationships with them and improve their experience within the “system.” Many shelter residents had encountered authority figures elsewhere who were supposed to help them but instead made them feel powerless and at fault for their circumstances, which only added to their sense of shame. “We (as counselors) are changing the paradigm,” she says. “We tell them in words and in actions, ’You’re not sick. You’re not bad. It’s what has happened to you. Let’s tell the story, and let’s help you out of it.’ It’s a trauma-informed perspective counselors should adopt when working with the homeless and one I have found extremely useful.”

Society’s biases against the homeless are often internalized by the people who experience homelessness, Brubaker says. “We offer something unique as counselors in our ability to help expand the perspective and encourage change,” he says. That means helping people take the blame and burden off themselves, while simultaneously empowering them to take the lead in changing their circumstances.

The counselors interviewed for this article agree that the first step in helping is simple and straightforward: Simply listen. “Having someone just listen to your story is really important. They haven’t been heard, they haven’t been validated. They would tell me, ’I feel like a number. No one cares about me,’” says Lorelle, reflecting on her work in the shelter system.

The real key is listening with an open mind, Sheller adds. “Homelessness doesn’t fit into a neat, stereotyped box. It’s an experience that anyone could have. Therefore, we shouldn’t have any preconceived ideas about what a homeless person is and what he needs — it has to come from the person.” Someone might arrive at a shelter with the attitude that all people in authority roles are evil, she says. Rather than telling the individual that isn’t true, it’s important to be respectful, listen and try to understand how that perception has been formed by the person’s past experiences, Sheller says. Many of the systems the homeless go through want these individuals to change themselves, she says. “But they just want someone to understand them first.”

Given their immediate needs and their sometimes-negative experiences within systems theoretically set up to “help” them, it may seem a daunting task to convince shelter residents that counselors have much to offer. “Much of our convincing will not be in words, but rather in our deeds,” Brubaker says. “Are we physically available to those in need? Are we willing to step out of our offices and meet with individuals on a park bench or over a meal at a shelter? Are we quick to judge a person who lives without a home? A caring presence can make a huge difference.”

A place to belong

The specific approach counselors use with these individuals isn’t the most important thing, Sheller says. “Whatever (technique) you use, the basic ability to relate to people and to build those relationships are really the most important,” she says. Homelessness can feel isolating and disconnecting, she explains, so forming relationships can build connection and empowerment. “From that, people can rise up. You’re fostering an experience where they feel like they’re OK and it’s going to be OK.”

Building relationships with homeless clients begins with simply getting to know them, Sheller says. Counselors can strengthen the relationship by being open, joining them where they are and focusing on being with them instead of imposing requirements or restrictions, she says. Counselors should strive to reach a level in the relationship where they can readily recognize when the person is struggling. If Sheller noticed that a resident didn’t seem quite right, she might ask that person to take a walk with her to Dunkin’ Donuts. Counseling in shelters doesn’t adhere to hourly appointments in an office, Sheller says. “You have to build relationships and build community, not just be in an office waiting. You’re just there and available and real.”

One part of getting to know clients is understanding why they act in certain ways, Sheller says. She recalls a particular shelter resident who seemed to be having unnecessary trouble getting food stamps and setting up her gas and electric accounts so she could move to available housing. Instead of jumping to conclusions, Sheller sat down with the client and asked what the problem was.

“What I really needed to understand was that it wasn’t her being noncompliant or resistant, but something else was going on that was preventing her from doing that,” Sheller says. The woman revealed she was frightened that if she followed through on those tasks and moved into new housing, a perpetrator from her past would be able to find her at her new address. Avoiding the move and remaining at the shelter felt safer, she told Sheller. Sheller helped the woman find ways to make herself safer, including getting a restraining order, and also helped her work through some of the trauma she had experienced. After that process, the woman was able to fulfill the requirements to move out of the shelter. “Don’t always assume the behaviors that seem to be uncooperative or unmotivated are really that,” Sheller says. “They may be behaviors people have adapted to help them survive.”

Many people who have experienced homelessness have also experienced trauma, which often makes them hypervigilant and hyperalert, Sheller says. Creating a safe environment — an environment that isn’t further disempowering or demoralizing — will encourage these clients to seek out the counselor. “If people can’t feel safe, it’s really going to be hard for them to move forward in their lives,” she says. Safety encompasses feeling safe within yourself and learning how to handle your own emotions, Sheller says.

Loss is also inherent in homelessness, Sheller adds. Many people find themselves in shelters after a loved one becomes ill or dies, someone loses a job or a home burns down. Helping people deal with their losses is critical, Sheller says, and one way of doing that is through building a sense of community because when people break through their isolation, they realize they aren’t alone in their problems. In addition to community meetings and therapeutic groups, Sheller has organized rituals to help shelter residents deal with loss. For example, she led a “balloon memorial” during which individuals wrote down a loss they wanted to let go of and then attached the paper to the string of a balloon. “It could be a tangible loss or a loss such as loss of missed years while I was using, loss of childhood innocence because of abuse, etc.,” Sheller says. “The balloons were simultaneously released as a group on the grounds of the shelter. We held hands and had a few minutes of silence together. It was very powerful.”

The most important component to building trust with homeless clients is following through and doing whatever you say you’re going to do. “If I said I was going to make a call for them, I needed to make that call. Otherwise, the trust was broken,” Lorelle says.

Contrary to what most traditional counseling teaches, Sheller says it can be helpful for counselors to be vulnerable and share their feelings when working with homeless clients. Let these clients know that you’re sad or hurt or angry about what has happened to them, Sheller tells counselors.

Changing the path

Looking back, Brubaker says the most important thing he learned about helping people who have experienced homelessness is to focus on their strengths — what they are doing well and what has enabled them to survive on the streets. “The mere use of the word homeless is a deficit-based identifier,” he says. “The biggest change for me was seeing the strengths of individuals and being mindful of that. I wish I had been trained from the beginning to really look for that. That’s made a huge difference in my approach and how effective I can be.”

Considering the high incidence of trauma among people who experience homelessness, Brubaker says training in trauma would serve counselors well. “This will hopefully wake up many counselors to their need to obtain training in the area of crisis and trauma work,” he says. “Counselors should also know their limitations, consult with others who know this population and advocate for the best services possible. No counselor should feel alone in their pursuits, so networking with competent professionals, indigenous healers and other service providers is essential.”

Counselors agree that working with homelessness is very demanding. It’s challenging emotionally, Lorelle admits, and if a counselor feels hopeless for too long, burnout might be waiting around the corner. “The lesson I learned is that you have to find that hope and find the value in what you’re doing. It may not (come in) huge leaps and bounds, but appreciating the small things along the way and celebrating their successes, that’s an important piece, and that’s what kept me going.”

No counselor can fix everything, Sheller says, and it’s important for counselors to accept that truth while maintaining the proper perspective. “You might not ever see the change; you might just be planting the seed,” she says. “You have to go in there and believe that if you can create an experience that is different, that you’re setting the course. You’re changing the path for that person, and that’s all you ever have control of.”

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Lynne Shallcross is a senior writer for Counseling Today. Contact her at lshallcross@counseling.org.

Letters to the editor: ct@counseling.org.

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Effects on education

Sonya Lorelle, currently earning her doctorate from the Department of Educational Leadership and Counseling at Old Dominion University, worked for two years as a children’s counselor with an agency providing emergency and transitional shelters in Norfolk, Va. School was a common area of struggle for the children, Lorelle says. “It was not uncommon to have children who were at least one grade behind, which often seemed to stem from the history of residential instability and resulted in switching schools often.”

Research has shown that children who experience homelessness are at increased risk for developmental delays, Lorelle says, so she often requested a full psychological assessment to check for learning problems or delays. The assessments sometimes helped secure the children extra assistance at school in areas in which they were falling behind.

In addition to providing counseling services to the children, Lorelle says the case managers helped inform parents of their rights under the McKinney-Vento Homeless Assistance Act, which allows children to remain at their home school for the remainder of the academic year if there is residential instability. Schools are supposed to provide transportation for these children, and Lorelle says case managers and counselors can help parents work with a school liaison to ensure that happens.

— Lynne Shallcross