Service Orientation
[serialposts]
In this multi-part blog series we are examining the essential elements of successful housing programs that focus on ending homelessness. We pick up here in Part 2 looking at the Service Orientation that is necessary.
PART TWO: Service Orientation
The secret to a successful housing program? Meet people where they are at in their life journey. Don’t set up barriers or unattainable expectations. Accept the decisions that people have made in their life and how they became homeless at face value, help them achieve housing, and then provide the supports necessary to help them achieve long-term residential stability.
In case you missed the subtlety – house people, then support them. If you put together an elaborate service plan or case plan prior to helping someone get housing you are doing it “bass ackwards”.
House people then support them. The evidence is clear that people achieve better long-term housing outcomes and achieve a more positive quality of life when this is the sequence of evidence. While it remains popular for there to be life skills training, budgeting classes, skills upgrading, addiction treatment, etc prior to helping people achieve housing, the evidence would suggest that this is unwarranted and actually results in poorer housing outcomes long term.
We shouldn’t have different standards of behavior for people who access human services compared to others in society generally. For example, sobriety is not a precondition for successful long-term housing. Statistically, most people who are alcoholics or who use other substances are housed, not homeless. Any housing program that requires people demonstrate sobriety for any length of time prior to gaining access to housing is lengthening a person’s homeless experience for a reason not supported by fact. Furthermore, any program that drops support services because someone has started using again is, in my opinion, doing a better job of creating homelessness than ending it.
We need to wrap our heads around what harm reduction is and why it is important for the population that we are working with. We are trying to focus on ways of reducing harm to the individual and community/society at large. We are looking at things like substance use and sex work from a community health and public health perspective. Harm Reduction is not an approach that demands the client achieve sobriety over time. While it can be effectively blended with approaches that decrease involvement in harmful activities, first and foremost a harm reduction approach tries to decreases risks associated with use. For example, using with friends instead of alone or with strangers; use of condoms; use of clean needles and safer crack use kits; drinking palatable alcohol instead of non-palatable alcohol. Some clients may have a goal of abstinence, but this is not a requirement. A harm reduction approach is pragmatic. Not only does it increase the health and stability of the client, it also has public health benefits, decreases policing costs, and also decreases emergency room, ambulance and hospital costs.
As someone who lives with a mental illness (depression) I know I can have strong opinions about how many organizations view and support persons with compromised mental wellness. In the context of creating and maintaining successful housing programs I would urge you to understand, embrace, support and practice recovery-oriented practices with individuals that have experienced compromised mental wellness. I would suggest that everyone learn about the practices and work of the likes of Mary Ellen Copeland and Patricia Deegan. I want people to know how to support individuals who have experienced mental illness in having a hopeful orientation towards the future, with an increased understanding of symptoms and triggers, with thoughtful crisis planning and awareness of resources and approaches that can be used. I want people to know how much survivors of psychiatric services have come to emphatically embrace these practices and experience better housing and quality of life outcomes as a result. I want people who have experience mental illness to feel empowered to have a voice in their care and supports.
For housing programs to be successful, punitive approaches when people relapse – whether that is in their substance use, medication management, housing stability, etc. – should be replaced with approaches that try to focus on what lessons can be learned and how to achieve stability and housing success in the future. People will relapse and it is natural. Sure, we would love to prevent it as much as possible and support people as necessary to try and mitigate it from occurring. But relapse will happen.
Related to this is a relapse into homelessness. Not everyone supported by a program is going to remain housed despite all of the efforts a housing team puts into it. But let’s not rip away their supports or refer to them as a failure or make them go to the bottom of the waiting list if they lose their housing. NO! Let’s re-house them, learn what we can do better and focus on how greater sustainability can be achieved the next go around.
We also need to move away from program models that are coercive if we want to have a successful housing program. Clients should never be tricked or forced to do anything that they don’t want to do. I urge people to be fully transparent on what the housing program and supports are that we are offering and let people choose if that is right for them.
A critical component for a successful housing program is client choice. This starts with empowering the people we work with to choose where they want to live. Some people may want permanent supportive housing while others may want scattered site housing with supports. Some people may want an efficiency or bachelor unit while others will want a one-bedroom. Some people may want housing close to the downtown while others want to be as far away from downtown as possible. Housing programs need to stop thinking that they place people into housing and start thinking that they provide meaningful housing choices for people. We don’t know what is best for people. What we should know is which options we can present that are affordable, actionable (reason to believe the landlord will rent to us) and appropriate (e.g., there are no legal restrictions on where they can live; it isn’t a four storey walk up and the person uses a mobility assistance device). Then we need to respect the housing choice that the client makes and support them in that housing.
We also need program participants to choose the type, duration, frequency and intensity of the service supports that they receive. If we do this in the right way we can remain truly client-centered and support people through the stages of change. This doesn’t mean we are client-directed. It also doesn’t mean that we are system-centered. It means that we are going to take the necessary steps to ensure that our service delivery and organization remain centered on opportunity for growth and positive change.
We need to know under what circumstances it is prudent to create intentional conversations, practice respectful persistence and engage assertively with the people we work with. We are agents of change; navigators of resources. We don’t heal people. We don’t fix people. We aren’t directly responsible for the decisions that people make in their lives. But we should do the best we can to provide access to information and opportunities that will allow people to engage in activities that will provide the greatest likelihood of quality of life improvements.
We need to think of our work as professional work. Damien Cox, a writer for the Toronto Star, said of my beloved Maple Leafs (and I am paraphrasing) “Stupid and nice is no way to run a hockey team.” I know and appreciate that people get involved in delivering services to homeless people for a wide range of reasons. But they need to know the limits of what they can do versus what experts need to do. I think of, for example, the Sisters of St. Joseph and their involvement in health care and development and administration of hospitals. The Sisters knew the difference between their role and the role of trained medical professionals. They didn’t try to do things that they were neither qualified nor trained to do. They knew that doing so would hurt or even kill more people than it helped.
Given the populations that we are serving, it is necessary to orient program delivery such that it happens in the community. Supports cannot meaningfully be delivered by text message or email or phone call. We need to go meet them in their housing. We need to see the condition of their housing. We need to see their adjustment and skill implementation first hand. We need to respect and support people’s natural settings. We can’t do this in an office. We need to go to the people.
As support functions go, I find it is best when organizations embrace their role as teacher, model and resource specialist. I strongly suggest staff make themselves available to accompany people to appointments. We need to be willing to do a load of dishes or load of laundry with people to teach them the skills. We should demonstrate the likes of budgeting by taking people grocery shopping. We need to be prepared to roll up our sleeves and clean toilets and showers and the like until people have the skills to do it themselves. We need to know whom else within the community we may recommend that the client connect to and for what purpose.
Deficit-based approaches to working with people are not as successful as strength-based approaches. I appreciate that sometimes finding the strengths beneath a rough exterior and years of hard living can present some challenges. Truth is, a lot of the people that we work with may not have traditional strengths. We need to be creative in how we work with and look at the life experience of people. The will to survive after years of living under a bridge may be seen as a strength. Considerable stubbornness may actually be viewed as a strength. Managing one’s basic needs while dealing with active psychosis may be seen as a strength. And I could go on.
Our job when we work with people to support them in housing is to orient our approach such that we enhance dignity and empowerment by making the people we serve the center of all planning activities and goal setting. I suggest transparency and a small wins approach, with the patience to accept that people will change their minds. I want the people we serve to think about the obstacles that may come up and how they will tackle those challenges before they ever happen.
For many years some of the people with the most complex needs have been subject to compliance based programs. This means that they have to do things like demonstrate sobriety for a fixed length of time, take medications, agree to see a psychiatrist, agree to take anger management courses, etc. in exchange for having a roof over their head. Anytime compliance faltered, the individual was subject to a “three strikes and you’re out” or “contracting” process or else asked to leave immediately. Too often this meant a return to homelessness. Evidence suggests that compliance-based service delivery does not achieve impressive housing outcomes, especially in the longer-term.
We need to help the clients we serve understand what our role is and the length of time we are available in their life for. I want clients to achieve greater independence over time. This helps inform the approach used to case planning and supports. It also makes me critically aware at all times that establishing a dependent relationship is not going to be helpful or sustainable longer term. I suggest as many connections as possible to mainstream services with a strong focus on community integration.
There are only six types of homeless people: Someone’s mother. Someone’s father. Someone’s sister. Someone’s brother. Someone’s daughter. Someone’s son. I really love when I see compassionate service providers who never lose sight of the humanity of our work. It is these organizations that exemplify the non-judgmental attitude that I think we need…the same sort of acceptance without criticism that I would love to receive should I ever find myself homeless.
[SERIALPOSTS]
Iain provides extensive workshop training and keynote addresses on changing ideological approaches to truly focus on ending homelessness in a way that accepts people where they are at. Comfortable with his many own imperfections, Iain has found that the focus on the right service orientation not only improves housing outcomes, it also shakes up some of the underpinnings of homeless service delivery systems by encouraging critical analysis of why some programs operate the way that they do.
Ensuring People Who Are Homeless Get the Right Housing Intervention and Supports to End Their Homelessness
[serialposts]
In this multi-part blog series we are examining the essential elements of successful housing programs that focus on ending homelessness. We pick up here in Part 2 looking at the Service Orientation that is necessary.
PART ONE: Ensuring People Who Are Homeless Get the Right Housing Intervention and Supports to End Their Homelessness
“The homeless”. Ugh. What a bland, homogenizing and completely inaccurate phrase. There are homeless people. There are homeless individuals and families. But “the homeless” is downright demeaning in my opinion. There is considerable diversity within the homeless population. While there may be some striking similarities when it comes to indicators of why/how a person becomes homeless, rarely are two paths into homelessness the same. Understanding the heterogeneity within homeless populations allows us to provide the opportunity of the right supports and right housing to the right person at the right time for the right reason.
To be clear, the focus is on ending homelessness. Housing is the only known cure to homelessness.
Homeless service systems need to have meaningful intake and assessment processes where acuity is determined. They cannot be “first come, first served” if they truly want to end homelessness. Truth is, some individuals will have rather complex needs and a higher acuity warranting one type of intervention, while other individuals will have needs nowhere near as complex and with lesser acuity. In the same way that these two individuals are not the same, the services that are offered and the expectations of those services will also be different.
I am frequently frustrated by intake processes. Too often they have evolved to become, “Come in. Let me take your information. I’m not sure why I am asking the questions that I am asking. Oh, and I am not sure what I am supposed to be doing with the information either. I might make a referral somewhere else. No guarantees though.”
Sigh.
In Malcolm Gladwell’s book Outliers, he says: “To build a better world, we need to replace the patchwork of lucky breaks and arbitrary advantages that today determine success with a society that provides opportunities to all.”
So true.
When people seek access to homeless and housing services – whether through a central intake or through a more standardized process used across organizations in the same community – we need to have an intake process that will permit us to make informed decisions about what service choices we may present to the individuals. To be clear, we never want to PLACE people into a program. We want to offer it as a choice.
In our extensive research of homeless populations, we have come to realize that there are three dominant categories that provide general descriptors of the intensity of service to be offered based upon information gleaned through intake. Within each of these the autonomy of the individual, their unique needs and individual circumstances are still respected and worked with. What these categories intend to do is help create a service typology so that the right services are offered to the right people at the right time to do the right thing about their homelessness.
The first group is those with lower acuity. Let us keep in mind that most people that ever experience homelessness in their life experience it for a short period of time and are never homeless again. In many communities this can be upwards of 60% of all people who experience homelessness in a given year. Do these people need case management? No. Do they need service offerings that are going to keep them homeless longer – like life skills training within a shelter? No. Truth is, many of these households can be diverted from the shelter in the first place. If they do get in, they tend to use shelters for the purpose they were originally designed – short term and infrequent use. These households may need some instruction on how to apply for benefits. They may need access to a computer. They may need a list of landlords with available rentals. They aren’t going to need much more. Don’t give them anything more. Please. Don’t.
The second group is those with a mid-range acuity. These folks need support with Rapid Re-Housing. Some people erroneously think that Rapid Re-Housing just means getting people who experience homelessness back into housing quickly. Not quite true. Rapid Re-Housing is a specific type of intervention, which our research suggests is between 15-35% of homeless populations. These individuals and families tend to have a few areas in their life with more complex presenting issues, but there are generally two or three areas of higher need in their life. They benefit from having support locating housing and supports once housed maybe for a few months; rarely for more than a year. Most often this will be scattered site housing within the community, most often in the private market, with or without a subsidy or voucher of some kind (depends on the local housing market and local income assistance rates). They benefit from an individualized service planning process and case management supports. They have the ability to reintegrate into mainstream resources more readily than other individuals and families with higher acuity.
The third group is those with higher acuity. These folks benefit from support through Housing First – either Intensive Case Management or Assertive Community Treatment. Housing First is far from housing only. The number of individuals and families requiring a Housing First intervention in a community will be small – between 15-25% of most homeless populations. They will, however, most likely be voracious consumers of services, and the costs of serving this population while homeless tend to be disproportionately higher than other types of individuals and families. They are much more likely to experience chronic homelessness and have more areas in their life where they have complex and/or intensive needs. Given the broader number of issues where it may be reasonably expected that the individual or family have complex issues, it is likely that these people benefit from case management supports over a longer period of time – usually 12 months or more. Research suggests that both permanent supportive housing (like what DESC offers in Seattle) as well as scattered site apartment units with intensive supports (like what Pathways to Housing offers in New York City in the ACT model or what Streets to Homes in the ICM model offers in Toronto) can work for this population. It can take longer to help these individuals and families integrate with other community supports. Given that most will have experienced chronic homelessness just the emotional and psychological adaptation to the reality of housing can take time, patience and intensive support. The service plan for this group definitely needs to be individualized. There is nothing cookie cutter about serving this population.
This latter group – the Housing First folks – have also dealt with considerable stigma within the housing and homeless service sector. They are frequently labeled “service resistant” or “hard to house” or “not housing ready”. The truth is they are none of these things. We cannot blame them for their complexity. Two research studies that I have spearheaded also overwhelmingly support that this population absolutely does want housing, despite this myth that a large group of people choose to be homeless or like the lifestyle. What we need is the right services that are individualized, supportive, non-punitive, non-coercive and oriented towards harm reduction. What we need is access to different types of housing models that people can access rather quickly without arduous bureaucratic processes, with supports that wrap around them in a way that makes sense and is centred on their needs.
There are a couple of other important considerations for the Rapid Re-Housing and Housing First crowd. The first is that they have to make an informed choice about their participation in the program and supports. We cannot force or coerce people to accept a support intervention and expect it to work. The second is that we want people to know in advance that there will be home visits where case management supports will be provided, and we want them to know that they will receive supports to create an individualized service plan that will focus on helping them achieve housing and greater life stability. They need to know that they guide the case management process and get to determine the type, frequency, intensity and duration of services. The third is that we will be supporting them – not forcing them, tricking them or using any other type of punitive measure in the process of delivering supports. It is their supports, not ours, and there is nothing “cookie cutter” about our approach to individualizing services.
Focusing attention on an intake and assessment process that will help service providers and help people seeking service access the right type of service intensity, supports and housing is an important component of having a successful housing program in your community.
Iain De Jong has helped many communities throughout North America retool their homeless service system based upon an understanding of the heterogeneity of homeless populations. Through his work communities see reduced lengths of homelessness and increased accountability in service delivery. Stay tuned for the second installment in the blog series, which looks at the Service Orientation for effective service delivery.
Organizing Information as a System Instead of a Collection of Projects in an Effort to End Homelessness
In working with housing and homeless information throughout my career it has always been my mission to get people to think and act like a system instead of a collection of projects. Truth is, funders like to attach the word “Program” to a lot of the work that they do, and this orientation has led many communities to organize their services by funding source rather than by what the outcomes are that the funding is trying to achieve. Across various funding programs there can be comparable, complimentary outcomes that are intended. So let’s take a closer look at how to organize information as a system instead of a collection of projects – which ultimately means organizing our projects like a system too.
It is my ardent belief that housing and homeless programs and services exist to end homelessness. A system-based approach places this belief at the center of the organization of information and wraps program areas around the central belief of ending homelessness. This means that all of the programs that are funded must be seamlessly linked to ending homelessness. Outreach services? Exist to end homelessness. Prevention services? Exist to end homelessness. Rapid Re-housing services? Exist to end homelessness. Emergency shelters? Exist to end homelessness. And I could go on with other program areas.
If we truly belief in ending homelessness – and we know that housing is the only known cure to homelessness – then each of these program areas needs to have a housing orientation as well. This can be a challenging way of thinking for some program areas that traditionally have not always kept this top of mind. Take for example a program area like street outreach. What is the link between street outreach and ending homelessness? What difference are we hoping street outreach makes? Some might think that street outreach exists to keep people alive through the provision of soup, sandwiches, sleeping bags and those sorts of things. Others might suggest that street outreach exists to connect or befriend people and create a trusting rapport. Yes, I believe that keeping people alive is a good thing. And yes, I believe that there has to be a professional connection. However, I do not believe that providing survival supports or building a trusting relationship is a sufficient output nor outcome in a service system design that supports ending homelessness. Street outreach services, therefore, should focus on getting people directly into housing or providing direct warm referrals to organizations that have a housing specialization.
Another good example is emergency shelter. What purpose do we really want emergency shelter to serve as we work to end homelessness? As it stands now – as I have seen countless times in my travels throughout North America – shelters have become a location that tend to gravitate (though not always) from one end of the continuum or the other without finding a balance. On the one end is the type of shelter that only opens at night – most often long after all other services and mainstream benefits offices have closed – and close up around breakfast time in the morning. On the other end are those shelters that have become so service rich that they have become de facto housing. These are the types of shelters that have the likes of employment programs, life skills classes, parenting classes, counseling services, clothing rooms, etc all on site. Access to these programs is most often predicated on being a resident at the shelter. The unintended consequence of this is that it keeps people homeless longer. And, evidence would suggest that helping people get out of the shelter and into the community and then providing supports to them in their housing would be better. So, with an orientation towards ending homelessness, we really need to view shelters as centers of opportunity. The opportunity we should be creating is the opportunity to get out of shelter rapidly, housed in the community and connected with services that are best equipped to meet their needs. Ending homelessness does not have to be anti-shelter. As I often say in my keynotes and training speeches, just because we have gotten better at fire prevention doesn’t mean you want to get rid of all of the fire halls in your city. The same is true of shelters. The key difference is that we want shelters to return to their original purpose – short term, infrequent use where people have their needs met quickly and move on. If we don’t have this orientation, demand for shelters will just increase more and more, and many a community will erroneously move towards an expansion of their shelter system rather than the original intended use of shelters.
Purpose drives metrics. Information organizes systems. In our world the system is intended to end homelessness. We need to have the right information to know if that is happening.
The first question I ask folks when they are working to address this is: what problem exists that this program should work to solve?
The second question I ask is: what difference will this program make?
These two questions are important because they frame the way in which I suggest projects and information become organized.
Let’s go back to outreach as an example. Broadly, outreach exists to solve the problem of homeless individuals not be connected to the services and resources that will end their homelessness. Within the program area called “Outreach” we can have a series of outreach projects. For example, maybe there is a specific project providing outreach to homeless youth. Maybe another tries to work with veterans. Another still might be for individuals with serious and persistent mental illness. Three different projects (and a lot of communities would have more than three) likely with three different sources of funding. But the common element of all three – and the way we need to look at them relative to a system approach – is that they are all types of outreach. The difference we hope they make may be that people are connected with relative to the intended populations served and geographic area, that services are offered and accepted that end their homelessness, and that their quality of life improves as a result of the outreach experience.
Project logic models are common, but my experience suggests that Program logic models are infrequent. Project logic models are almost exclusively related to a single source of funding. Program logic models transcend funding source and, in fact, are a single place where all investment into a program sector can be tracked regardless of what the source of the funds are.
I think it is important that our work be seen as a quality business, not a quantity business. While the metrics for any program sector are definitely going to be quantified, the biggest mistake we see is that many an organization (often as a result of many a funder) focus on outputs instead of outcomes and seek a large volume of people connected with. If we want to have a quality business we must be thinking about standardized assessments across all program areas, revamped intake processes that provide us the information necessary for knowing which individuals will be best served by which programs (and projects within those programs) and ensuring that investment in the time and resources, say, to house and support 100 people with more intensive service needs is likely going to be more costly than having 300 people with moderate needs housed but having two-thirds or more become homeless again.
If we want to drive this sort of change in organizing by program sectors and perhaps even drive change in service approaches in each of these program sectors, what is necessary next is to have a clear strategic objective for the program sector and the right program indicators and right program targets.
The strategic objective sets out what exactly it is we want the program sector to strategically accomplish. It needs to be SMART: Specific; Measurable; Attainable; Realistic; Timed. Missing any of those ingredients and the strategic objective won’t hold the program sector together and it will also invite ambiguity in mission across the various projects.
Allow me to again use street outreach as an example to demonstrate a SMART strategic objective for the entire program sector:
Decrease street homelessness by 50% or more by the next Point in Time Count, providing direct assistance to street homeless individuals and families by helping them locate and maintain housing, assisting them in moving off the street by reuniting with family/friends, and through the use of emergency shelters.
In this type of example, the Performance Indicators for the Outreach Program Sector (which, as a reminder, is likely comprised of a range of different outreach projects) may include the likes of:
# of unique individuals served
# of single person households, two person households without children and adult head(s) of household with children served, unaccompanied children served
# of successful housing outputs (unique individuals & by type of household)
# of successful reunifications with family/friends that result in moving off the street (unique individuals & by type of household)
# of successful emergency shelter referrals
# and % of households that experience recidivism and return to the street
And we can drive change and provide clarity for the Outreach Program Sector example by providing some very specific Performance Targets such as:
each outreach team to work with no more than 25 unique households per month
4 successful housing outputs per outreach team per month, 3 of which must have higher acuity
6 successful shelter outputs per outreach team per month, 4 of which must have higher acuity
1 successful family/friend reunification per outreach team per month
As you can see, the emphasis is having the right Strategic Objective, Indicators and Targets for the Program Sector. This provides clarifying unity of purpose across all projects within the sector. Does it prevent some projects of having some unique elements? No. Does it take away individual organizational autonomy? No.
For funders and policy makers, this type of approach can allow them to better understand and leverage resources across different areas. It can also streamline meetings, communications and interactions with communities when, for example, all funders that invest in outreach come together at the same time with their service provider community.
For service providers, this type of approach provides many benefits as well. For one, they can increase their community accountability and accountability with the people that they serve. They can better describe their project activities within broader program objectives. And it should provide the opportunity to decrease duplication in services within any program area.
For the community as a whole, this orientation allows everyone to track whether the mission of ending homelessness is making progress. Ending homelessness doesn’t happen as a result of any single funding source. It happens across funding sources. The approach to organizing information and the system as a whole has to reflect that.
The Importance of Mentoring
Yogi Berra once famously said of Bill Dickey, “Bill is learning me his experience.”
I have the great privilege of being a mentor to about a half dozen people throughout the US and Canada. Of all the many things I do, this is one of the most rewarding.
Mentors have had a phenomenal impact on my life. They have helped shape my career track, instilled confidence, taught me different communication and problem-solving styles, given me a safe outlet to share, learn and grow. I will forever be grateful to people like Gerry Lalonde, Barbara Rahder, Noreen Dunphy and John Whitesell. (Prior to John and I becoming business partners, he mentored me for the better part of 10 years.)
We need more mentors – and not just because it helps those who receive the mentoring. Many studies show that it improves retention (see Ragins, Gibb, Lewis). Other studies demonstrate that it increases diversity and gender equity in work environments (see Henford, Tennent). The evidence is also clear that it helps create both leaders and managers.
Consider some of these facts:
A meta-study by Blanchard et al found over 90% of organizations that encourage mentorship have more positive outcomes
A 2006 study by Gartner showed people who received mentoring were 5 times more likely to improve their salary.
The same Gartner study also showed that Mentors were 6 times more likely to advance in their careers and Mentees were 5 times more likely to advance in their careers compared to people not involved in being a mentor or receiving mentoring.
A survey of 60 Fortune 500 companies showed that those who did not receiving mentoring were twice as likely to quit as those that receiving mentoring.
A separate study of Fortune 500 CEOs showed that 75% of the CEOs listed mentoring as one of the three top critical factors for their career success.
A 1999 study called Emerging Workforce demonstrated that organizations with mentoring programs had much better performance.
From a gender perspective, another study showed that 91% of female executives had a mentor at some point in their life, with four out of five indicating the mentorship was instrumental in their success.
Amongst young people, a study called “Mentoring: A Promising Strategy for Development” showed that people who were mentored were better communicators and had more positive societal attitudes.
A Ford Foundation study showed that people who are mentored are much more likely to be involved in voluntary community service.
I separate mentorship from coaching because I don’t see it as necessarily directly related to projects or tasks that I am working on, nor do I think it has to be deficiency-based, and I definitely don’t think the mentor is laying out a game plan. Coaching can be important, but it is a different type of relationship than mentoring in my opinion.
And I separate mentoring from counseling or therapy, because I don’t think it has the same qualities as a therapeutic relationship (though a mentoring session can be revealing).
I also separate it from supervision. While some of the supervisors I have had in my life have had a positive influence, I wouldn’t consider any of them mentors because there was always a power-dynamic that could potentially be at play. Mentorship has been effective for me when it is a safe place to explore ideas and feelings without wondering if it would negatively impact another person’s perception of my job performance.
So what is mentorship to me?
First off, I see it as a developmental partnership. “Developmental” as in growth process. “Partnership” as in joint interest and commitment. When mentorship has been successful in my life there has been a willingness to grow on my part and there has been another person who has made the commitment to engage with me for that growth. The mentee and the mentor both get something out of it.
Secondly, I don’t see mentors as having all of the answers to everything. Sure there can be technical knowledge shared in some mentoring relationships. However, the great value of mentorship I see is in imparting different ways of thinking, knowing, processing, reacting, researching, analyzing, synthesizing, feeling… And this comes from their experience and ability to empathize.
Thirdly, as previously mentioned, I see mentorship relationships as a safe place. In mentorship you get the insights and thoughts of another trusted person while exploring ideas, feelings, perspectives, problems and situations. Mentorship only works if it is confidential.
Lastly, mentorship is how I think people learn leadership…or at least is how I learned leadership. I think management can be taught in many different settings, but leadership for me has always been learned and explored in a mentorship setting. This doesn’t mean that everyone who has mentorship is going to be a leader, but they can learn leadership which increases their knowledge of how influence occurs.
When I think about impactful mentors in my life there are several characteristics that they share that I try to also embody in my role as a mentor:
honesty
carving out specific times for mentoring sessions
sharing insights
never solving problems for the other person
providing encouragement
offering reading or other resources to look at
warm appreciation that mistakes are part of life
teaching things like managing ambiguity, unwritten rules of conduct, organizational culture
cultivating self-confidence and self-esteem
respectfully challenging perceptions or pre-conceived notions
not interfering with the direction provided by a supervisor
actively listening
While there can be informal or formal mentorship, I favour formal mentorship. I think in formal mentorship arrangements it shows that an organization values mentorship (happens during work time) rather than it being something people have to do in addition to their other work. I think it gives supervisors a sense of comfort that they know there is a mentorship relationship going on (even though they don’t know the content) rather than feeling that someone else is giving their staff direction. I also think a formal mentorship allows for better accountability and tracking of the impact of the mentorship over time.
Different people need different types of mentors. I always valued people outside the organization than within it. Larger organizations may have the value of internal mentors. Smaller organizations can have difficulty finding time to commit to mentorship while also creating the right atmosphere.
Mentorship can take different forms as well. As was the case with John, he mentored me on an ongoing basis for a long period of time. This was a huge investment on his part (for which I will eternally be grateful). Obviously we covered a lot of material over that decade. But it doesn’t always have to be this way.
One of the emerging forms of mentorship that is really taking hold is short-term, goal-oriented mentoring. In this type of mentoring the task is to match up a mentor and mentee for a shorter period of time (usually 1-3 months) to work on specific goals in the mentoring relationship. Whereas a longer term mentorship can be much more organic and free-flowing, in this short-term and goal-oriented approach there is an in-depth understanding on the part of the mentee of what exactly they are looking to explore and then they find the right fit.
E-mentorship – surprise, surprise in the day of quick communication – is also becoming quite popular. This allows the communication flow to occur at a time that is convenient when the mentor and/or mentee have already busy schedules. It can also allow for more thinking and thoughtful response to the material being discussed in the mentoring relationship. E-mentorship can also increase the pool of potential mentors when face to face meetings are not critical. Maintaining confidentiality in the communication chain becomes important though.
So, does your organization value mentorship? Do you encourage your senior staff to become mentors? Do you create an environment where your junior staff are encouraged and supported in finding and having a mentor?
Think about it.
Then do it.
If you want to know more about how your organization can become involved in encouraging mentorship, drop us a line at info@orgcode.com
Wellness & A Healthy Social Network
One of the themes that we weave through a lot of our work in Human Services is the importance of creating or recreating a healthy social network for individuals and families that have experienced considerable marginalization, poverty, homelessness and the like.
We also speak about the importance of focusing on wellness instead of illness. If we consider illness to wellness as a continuum as opposed to a either-or construct, then we even further appreciate that achieving wellness is a journey…a process…something that can occur incrementally. We need to move beyond labels and pathology to focus on the individual’s potential and the remarkable ability of the human being to heal – physically, socially, emotionally. Our ability to heal is absolutely remarkable. It is even more impactful if we do not confuse “healing” with “cure” – as they are dangerously considered synonymous by some.
So what is the link between a healthy social network and wellness? Lots. And as you read below, I hope you will become even more convinced that one of the fundamental jobs of support workers is to reduce social isolation by improving access to healthy social networks.
I remember hearing a story – don’t know if it is true – about a doctor who specialized in addressing heart disease and a swami. As a guest of the doctor’s, the swami was asked what the difference was between “illness” and “wellness”. The swami circled the “I” in “illness” and the “we” in wellness.
And it turns out that the swami’s premise is supported by scientific research as well. How a person is situated within a healthy community affects the overall health of the individual considerably. People who exercise in groups (think running groups or gym buddies) are more likely to keep exercising and get healthier together. People who stop using alcohol and other substances are more likely to achieve sobriety for longer with a healthy support network of non-users. In a study of women with breast cancer, those with 10 or more close friends lived longer than those with less than 10 friends. Support groups for psychiatric survivors, cancer survivors and so on thrive because people value the reciprocal feeling of the shared experience in the social network. And the opposite impacts are also true. Fowler’s work proved that having a friend that became obese made you 57% more likely to become obese.
The World Health Organization has also been clear on the importance of healthy social environments and supports, noting that “…social isolation [has] powerful effects on health… the lack of supportive friendships are damaging in whatever area of life they arise. The lower people are in the social hierarchy of industrialized countries, the more common these problems become.” And what problems are we talking about? The WHO indicates higher incidence of heart disease, disability, addiction and other illnesses. Oh, and a much shorter life expectancy.
In 2007 I was part of a research study that looked at the Quality of Life changes amongst people served through Housing First. In the eight QoL indicators looked at there were overall improvements. But the one indicator with the smallest improvements pre- and post-housing? Social interaction. Ever since then I have paid considerably more attention to meaningful daily activities and the need to decrease social isolation while creating social networks. And I am quite emphatic that we need to look at individual interest rather than class. I am sick and tired of social events being planned exclusively for poor people. It ghetto-izes their experience and de-values their ability to integrate into social events shared by others in society – and that is just plain inexcusable.
So what can we do to help promote wellness in social interaction amongst those that we work with? Creating opportunities for people to get out of their housing and into events in the community is important. Leveraging the likes of “Welcome Policies” or similar instruments that allow economically disadvantaged people to access community programs is helpful. Accompanying people to events is great.
And there are lots of phenomenal places to connect to in any community. I love libraries because of the range of programming offered at them. Community centres are great when they have a calendar of social and recreational activities to tap into. Faith groups can also be quite nifty to look into because there are often a number of social events that occur in addition to worship. Support groups, especially for survivors, can also be a terrific way to expand a social network. For clients that are considering AA but don’t know if they are ready to go to a meeting, I like to introduce them to online AA meetings and communities to demystify the experience.
One of the tools that I have used a lot in the past and do a workshop piece on is how to schedule a week of meaningful daily activities with the client. I want them to have activities that take up different parts of the day and most days of the week – and I want these activities to be in addition to other appointments or case plan activities. I purposely set out as many suggestions as possible where there will be a higher degree of interaction with other people rather than solitary activities. Their desire to try new things is want I am trying to nourish and support. And the key to the tool is that I ask people to reflect on the best thing that happened that day and the thing that could have gone better so that we can learn in the support relationship what other ideas we may want to put on the table in the future.
If we focus on the “we” in “wellness” our clients will do better and social networks will be meaningfully (re)created, providing the support necessary for a much more enriching and healthy life.
If you want to learn more about the importance of healthy social networks in supporting people or the connection between social networks and health, contact Iain De Jong atidejong@orgcode.com
Appropriately Using Assertive Engagement
So you have a client that has engaged in case management supports with your organization, but they never seem to be around or seem completely unengaged when you do meet. They have high acuity. They likely have several complex issues and have experienced long-term homelessness. Is the fact that they are rarely around or seem completely unengaged sufficient to “cut them loose”? Should your organization move on to another person who is more eager to actively participate in what you have to offer?
No.
In this blog I talk about how to use assertive engagement appropriately to first engage with people who have accepted case management services and then become unengaged, as well as how to effectively engage with people who are homeless and do not seem interested in having a conversation about housing and case management.
In a perfect world – heck, even in a lot of “normal” therapeutic environments – people seeking service come to a safe support environment. Appointments are booked. People are focused on the support and not distracted. People are sober and have taken medications. People have absolutely embraced that they want support and are going to work their butts off to get better. This is not the reality I work in.
When working with a population with long-term street engagement, this is not the norm. Sometimes the best environment you get is an encampment in the woods or a dry spot under a bridge. In my career I’ve had to engage with people from a boat to the undercarriage of a rail bridge; climb trees; tunnel into the earth; stand out in blizzards on street corners; go into make-shift huts; place my face down a sewer grate; and visit homes in vast arrays of conditions.
Assertive Engagement is best understood as the process whereby a worker uses their interpersonal skills and creativity effectively to make the environments and circumstances that their service users are encountered in more conducive to change than they might otherwise be, for at least the duration of the engagement. We accept in assertive engagement that we are not operating in a “perfect world”. We accept that as service providers it is us that has to change and modify our approach to meet the needs of people we are hoping to engage with rather than vice versa. As service providers, the onus is on us to provide service – in whatever environment that may be.
Also important in understanding this process is that we are trying to create an environment where the individual may be more willing to accept change. Building trust and rapport is too often heralded as the only thing that can be expected in these types of exchanges. Hogwash. Neither trust nor rapport building in my opinion are outcomes. They too are processes. The actual outcomes are the changes that are experienced. To me that most often means accepting an invitation for housing, engagement in client-centred and strength-based case planning, and creating a meaningful case management support relationship. Assertive engagement presupposes:
That there are people who want to, or need to, effect some change in their lives because they recognize, or it is recognized, that aspects of their present lifestyle are damaging in some capacity.
That lives can be changed for the better and that professional support workers can be a part of the process towards change.
That change requires processing, decisions need to be made, and this processing is best achieved in certain circumstances and environments (i.e. environments that are safe, free from stress, supportive, with few other demands and needs to be met – roughly, those environments that we would term therapeutic).
That most vulnerable people do not live in environments and circumstances that are conducive to change. And most workers will encounter their clients in environments that are by and large un-therapeutic.
Assertive engagement is both persistent and active. The persistence is friendly. And it can require a tough skin – always being pleasant and professional even when possibly confronted with colourful language. The active approach to assertive engagement means that it is incumbent upon us to be out and in the field, trying new things and new approaches, unwilling to accept that we have tried everything until we come upon an approach that works. To that end, assertive engagement is a process that frequently takes time, is known to require incremental stages to achieving an end goal and is most likely going to need to adapt and confront a number of coping strategies presented by the individual.
Assertive engagement isn’t for all individuals. Primarily it is designed for work with clients that are in precontemplation or contemplation – in accordance with the Stages of Change. Those individuals that are precontemplative do not see the damage particular behaviours cause, either to themselves or to wider social groups. They are unlikely to see the need for change. On the off chance that they do see the need for change or a glimmer of change, they are unlikely to see the need for change today – and in that case may have only a vague or not completely articulated expectation that change will somehow occur at a later date. Excuses will be rampant for not working towards change, if there is any acknowledgement at all of the need for change.
When working with a population that is likely to have experienced long-term homelessness, this type of reaction can almost be expected in a number of circumstances. First of all, we need to appreciate that the longer they have been homeless, the more they have adapted to being homeless. Being homeless is normal. Being housed is abnormal. Being in a constant state of survival is normal. Being in a planning stage beyond the present can be abnormal. Safety can be construed as merely being alive for today; whereas the change that is presented may remove notions of safety, being asked to consider the unknown.
Individuals who benefit from assertive engagement usually have a fragile psyche with a range of defences, up to and including lashing out at their worker emotionally. Body language can at times appear threatening. Whereas support workers may see missing appointments or unwillingness to engage as a lack of preparedness to make a decision on whether they want to participate in change, the indecision is in fact a decision.
This is where a keen understanding of the Stages of Change and various tactics that can be used to assist clients work through the Stages is critical. Prochaska’s work tells us that consciousness raising is needed for bridges to be built and the gap between where the client is in their state of harm and behaviour and what would likely lead to life improvements.
In the simplest of terms (and there are many more nuances that need to be understood to practice assertive engagement effectively), the approach to assertive engagement generally follows a particular pattern of behaviour. It starts with information being put forward by the worker. This information may be an invitation to attend a program, understand other support services, explain that they want to help them get housing, explaining why sleeping in a particular location outdoors may be problematic, etc. The key is that the information is actionable and based upon fact. It is not “blue skying”.
Following the information being put forward, the individual is likely going to erect defences. This is reasons – rational or irrational – that the individual sees as making them immune to the information presented by the worker. The defences then must be challenged – respectfully, accurately and factually – by the worker. The intent is not to enter into debate, but it can be confrontational, albeit in a very subdued manner. What the worker is attempting to do is have the individual become more vulnerable to the information so that consequences are understood – at least to some extent.
The pattern is repeated over and over again – at different times of day and in different settings and perhaps using different information until such time as there is a breakthrough. The well trained worker will be prepared for one of four typical responses until the breakthrough happens.
The first is that the individual may deny the issue or minimize the situation at hand. In these instances, the individual is not claiming any responsibility in their life, or the language that they are using demonstrates that they are deflecting or minimizing the impact of their behaviour. Consider the individual who uses language like “borrow” when really they “stole”; the individual who “slept it off in the park” rather than being straight-up that they “blacked out” and really had no premeditated intention to sleep in the park.
The second common response that the individual may use is to rationalize the situation or intellectualize the situation. As a starting point, we need to accept that individuals with complex needs and long histories of homelessness use both rationalization and intellectualization as survival and coping strategies. It is how they internalize their existence of being in need for so long and still being alive. In these situations it is common to see some awareness of behaviour. Consider the individual who does not acknowledge that they consume too much alcohol, but says that they need to drink in order to fall asleep. Or consider the individual who will distort facts – including the possibility of omitting several key facts – in order to defend their current situation.
The third common response is projection and displacement. In these instances the individual is more likely to project the current situation onto others rather than accepting person responsibility. They will be inclined to blame others for their behaviour, even when they did actually have control over their actions. Again using an alcohol example, consider the individual who says something to the effect of “Johnny kept giving me the bottle and telling me to have another swig.” In this example, the individual could have told Johnny no. Or they could have accepted the bottle but not actually consumed anything. However, in how they project and displace, the individual makes it sound like these were not options.
The fourth common response is to internalizing the current situation to the point where the individual tries to often convince the worker that they are unworthy of attention or assistance. The individual will say things like, “I am such a bad, bad person. I don’t deserve any help. I am worthless. I should be left alone. I don’t deserve all you try to do for me. You shouldn’t even try.” And this may be followed by a suggestion on their part that the worker assist someone else instead – someone who in the eyes of the individual is more worthy of attention or more likely going to need help. In my experience of outreach, I have been duped by this defence more than ones by long-term hardened rough sleepers who will even go to great lengths to do outreach on their own when you are not around to round up other suitable candidates instead of themselves.
Understanding what assertive engagement is, how it works, when to apply it, how it relates to Stages of Change and the predicted defences and how to break through them can be the difference between managing homelessness and ending homelessness; between effective and engaged case management and workers spinning their wheels trying to chase individuals down; between community integration and a brighter future and repeated patterns of disengagement and homelessness.
OrgCode offers a three hour training course on effective use of assertive engagement, as well as a training course on the use of the Service Prioritization Decision Assistance Tool (SPDAT) to be more effective in the use of assertive engagement. For more information about our work helping people practice assertive engagement, or the use of the SPDAT to help with assertive engagement, please contact Iain De Jong at idejong@orgcode.com