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Shelter Provider Training: Essentials of Care for People Who Have Been Displaced

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Title: Shelter Provider Training: Essentials of Care for People Who Have Been Displaced


1
Shelter Provider Training Essentials of Care
for People Who Have Been Displaced
2
When the hurricane hits
3
When the levees break
4
When the bridge is out
5
Bringing Health Care into the Shelter
6
Impact of homelessness on health
  • Health conditions requiring regular,
    uninterrupted treatmentsuch as tuberculosis,
    HIV, addiction, and mental illnessare extremely
    difficult to manage without a stable residence.
  • The Institute of Medicine has determined that
    individuals without a regular place to stay are
    far more likely than are those with stable
    housing to suffer from chronic medical conditions
    such as diabetes, cardiovascular disease, and
    asthma.

7
In other words
  • People in shelters are more likely to get sick.
  • People in shelters have a tougher time getting
    well.

8
Medical insurance
  • 71.3 of people experiencing homelessness have no
    medical insurance
  • - 21.5 Medicaid (Title XIX and S-CHIP)
  • - 3 Medicare
  • - 4.1 private insurance/other public
    insurance
  • Uniform Data System, BPHC, 2003

9
For many people
  • The emergency room is the primary care provider.

10
Asthma
  • A homeless child is three to six times more
    likely to have asthma than the average American
    child.
  • Nationwide, 20 percent of homeless children have
    asthma compared to seven percent of all U.S.
    children.
  • Institute for Children and Poverty, 1999

11
Tuberculosis
  • Although TB case rates have been decreasing since
    1992, homeless people are still at an increased
    risk for contracting TB due to the crowdedness of
    shelters and the prevalence of health conditions
    that weaken their immune system.
  • Centers for Disease Control and Prevention.
  • Reported Tuberculosis in the United States,
    1999, p. 2.
  • Six percent of the 15,075 cases of TB in the
    United States in 2002 had been homeless in the
    previous 12 months.
  • Centers for Disease Control and Prevention.
  • Reported Tuberculosis in the United States,
    2003.

12
HIV/AIDS
  • Median prevalence rates of HIV that causes AIDS
    have been found to be at least three times higher
    in surveyed homeless populations (3.4) than in
    the general population (less than 1).
  • Lopez-Zetina J et al. Prevalence of HIV and
    hepatitis B and self-reported injection risk
    behavior during detention among street-recruited
    injection drug users in L.A. County, 1994-1996.
    Addiction, 96(4) 58995, April 2001.

13
Common Concerns
  • Respiratory Illness
  • Intestinal Problems
  • Infestation

14
Organizing Health Services in Shelters
  • Provide a private, dedicated space for services
  • Have a coordinator of health care social
    services
  • Conduct an intake interview with each individual
    or family

15
Organizing Health Services in Shelters
(continued)
  • Keep good records from the beginning
  • Create a communication notebook
  • Find, adapt, or create an up-to-date resource
    notebook

16
WASH HANDS.
  • No, really, get up right now and do it.
  • Just kidding.

17
Communicate. Communicate.Communicate.Communica
te. Communicate.Communicate.Communicate.
Communicate.Communicate.Communicate.
Communicate.Communicate.
18
Preparing to Work in Shelters
  • Review NHCHC manual, Red Cross shelter
    materials, and other resources
  • Review common communicable diseases, common
    chronic health problems

19
Preparing to Work in Shelters (cont.)
  • Prepare handouts for residents to prevent
    communicable diseases
  • Contact resources (clinics, pharmacies, MDs) to
    determine who is available, when and how many
    patients they can see per day.
  • Review CPR, first aid

20
WASH YOUR HANDS.WASH YOUR HANDS.WASH YOUR
HANDS.WASH YOUR HANDS.WASH YOUR HANDS.WASH
YOUR HANDS.WASH YOUR HANDS.WASH YOUR
HANDS.WASH YOUR HANDS.WASH YOUR HANDS.WASH
YOUR HANDS.WASH YOUR HANDS.
21
Communicate.Communicate. Communicate.Communica
te.Communicate. Communicate.Communicate.Commun
icate. Communicate.Communicate.Communicate.
Communicate.
22
Daily Responsibilities in Shelters
  • Make rounds to determine problems, issues
  • Daily meeting of staff and residents
  • Set hours to see patients in the nurses station
  • Update resource list
  • Follow up on pending items form communication
    notebook
  • Have an experienced staff person or volunteer to
    work with new people

23
WASH YOUR HANDS.WASH YOUR HANDS.WASH YOUR
HANDS.WASH YOUR HANDS.WASH YOUR HANDS.WASH
YOUR HANDS.WASH YOUR HANDS.WASH YOUR
HANDS.WASH YOUR HANDS.WASH YOUR HANDS.WASH
YOUR HANDS.WASH YOUR HANDS.
24
Communicate.Communicate.Communicate.
Communicate.Communicate.Communicate.
Communicate.Communicate.Communicate.
Communicate.Communicate.Communicate.
25
Some Reflections for Helpers
  • The shelter is for basic needs to be metfood,
    safety, warm environment, comfort from the
    storm
  • You do not have to be an expert in every aspect
    of care to be a helper
  • Its ok to ask for help from other staff and
    volunteers

26
Some Reflections for Helpers (continued)
  • Share your ideas about how to make things better
  • Get to know the shelter residents
  • The purpose of shelter services is not as much
    to give care as it is to work with people to
    recover and return to normalcy as soon as possible

27
  • REMEMBER
  • We cannot solve all the residents problems.
    Many come with multiple issues that may not be
    related to the most recent disaster.

28
Environmental Healthand Safety
29
Basics of Environmental Health
  • Wash handsstaff and residents
  • Control of infections, isolation, prompt
    treatment as needed
  • Identify unsafe situations either for
    transmission of disease or hazards
  • Involve residents to help in identifying unsafe
    situations

30
Other Environmental Safety Issues
  • Creating a healthy environment is not just about
    infection control.

31
Be aware of
  • Family violence
  • Child abuse and neglect
  • Ways to prevent and de-escalate potentially
    dangerous situations

32
Mental Illness and Substance Use Disorders
33
Adverse childhood experiences reported by
homeless clients
  • History of foster care, group home or other
    institutional setting - 27
  • History of childhood physical or sexual abuse -
    25
  • History of childhood homelessness - 21
  • Ran away from home - 33
  • Forced to leave home - 22
  • Self-Report Data from the Interagency Council on
    the Homeless, 1999.

34
Victimization and violence
  • In a study of homeless and poor housed women, 67
    reported severe physical violence by a childhood
    caretaker
  • 43 reported childhood sexual molestation
  • and 63 reported severe violence by a male
    partner.
  • Browne A and Bassuk SS. Intimate violence in the
    lives of homeless and poor housed women Am J
    Orthopsychiatry 67(2) 261278, 1997.

35
Mental health problems
  • The experience of homelessness has been found to
    impair the psychological functioning of homeless
    people, regardless of age, gender, diagnosis, or
    medical/psychological history.
  • Gonzalez EA et al. Neuropsychological evaluation
    of higher functioning homeless persons A
    comparison of an abbreviated test battery to the
    mini-mental state exam. Journal of Nervous and
    Mental Disease 189(3) 176181, 2001.

36
Severe mental illness
  • It is estimated that 25 percent of homeless
    people have at some time experienced severe
    mental illness such as schizophrenia or a major
    mood disorder.
  • P. Koegel, M.A. Burnam and J. Baumohl. The
    Causes of Homelessness. Phoenix Oryx, 1996, p.
    31.

37
Substance Use Disorders
  • It is estimated that 20-35 of people
    experiencing homelessness suffer from substance
    use disorders.
  • Zerger, S. Substance Abuse Treatment What
    Works for Homeless People?

38
Co-occurring disorders
  • Some studies suggest that as many as half of
    homeless adults with severe mental illness also
    have a co-occurring substance use disorder.
  • D.L. Dennis, I.S. Levine and F.C. Osher. The
    Physical and Mental Health Status of Homeless
    Adults, a paper presented at the Fannie Mae
    Housing Conference, Washington, DC, 1991 p.9. As
    cited in Organizing Health Services for Homeless
    People. McMurray-Avila. M. 2001.

39
Taking Care Coping with Grief and Loss
40
Common Causes of Stress in Helping Professions
  • Too much to do, too little time to do it
  • Lack of job security
  • Relations with co-workers and supervisors
  • Expectations of how things should be
  • The risk of caring

41
Caring for your Self,your Soul, your Sanity
  • Self-care (mind)
  • Healthy lifestyle (body)
  • Spiritual care (spirit)

42
How to stay healthy
  • Watch out for warning signs of stress and burnout
  • Develop strategies for self-care on the job and
    off
  • Take care of each other

43
Stress Test
  • You will be shown a photo with two identical
    images in it. Despite the fact the images are the
    same, people under stress tend to see differences
    between them. Look carefully at the photo. If you
    detect more than a few minor differences, you may
    need to take some time off.

44
(No Transcript)
45
Helping Others Cope with Grief and Loss
46
  • CHANGELOSSGRIEF

47
  • GRIEF The process of experiencing the
    psychological, sociological, physical and
    spiritual reactions to the PERCEPTION of loss.

48
Grief as Work
  • Not commonly perceived that way
  • Requires energy
  • Expectations make it worse
  • Must mourn all aspects of losses
  • Can be complicated

49
Needs of Sufferers
  • Compassion
  • Comfort
  • Sympathy
  • Freedom to be angry
  • Listening
  • Friends and Family

50
Communication and Connection
51
Motivational Interviewing
  • A client-centered, directive method for
    enhancing intrinsic motivation to change by
    exploring and resolving ambivalence
  • Miller Rollnick, 2002

52
Also Known As
  • Helping people talk themselves into changing

53

A Paradigm Shift
  • Eliciting
  • vs.
  • Imparting

54
OARS Basic Tools of Motivational Interviewing
  • Open Questions
  • Affirmations
  • Reflective Listening
  • Summaries

Motivational Interviewing is not a series of
techniques for doing therapy but instead is a way
of being with patients. William Miller,
Ph.D.
55
OARS Open-ended Questions
  • Can you tell me more about that?
  • What have you noticed about your ____?
  • What concerns you most?
  • When would you be most likely to share needles
    with others?
  • How would you like things to be different?
  • What will you lose if you give up drinking?
  • What have you tried before?
  • What do you want to do next?

56
OARS Affirmations
  • Statements of recognition of client strengths
  • Build confidence in ability to change
  • Must be congruent and genuine

57
OARS Reflective Listening
  • Reflective listening is the key to this work.
    The best motivational advice we can give you is
    to listen carefully to your clients. They will
    tell you what has worked and what hasn't. What
    moved them forward and shifted them backward.
    Whenever you are in doubt about what to do,
    listen.
  • Miller Rollnick, 2002

58
What people really need is a good listening
to. Mary Lou Casey
59
Levels of Reflection
  • Simple repeating, rephrasing staying close to
    the content
  • Amplified paraphrasing, double-sided
    reflection testing the meaning/whats going on
    below the surface
  • Feelings emphasizing the emotional aspect of
    communication deepest form

60
Reflective Listening Practice
  1. Groups of three
  2. Client makes a statement (clear, neutral,
    confused, psychotic, blaming, affirming, etc.)
  3. Other two individuals taking turns practicing the
    three levels of reflection simple, amplified,
    feeling level
  4. Coach each other as needed
  5. Switch roles

61
OARS SummarizingLet me see if I understand
thus far
  • Special form of reflective listening
  • Ensures clear communication
  • Use at transitions in conversation
  • Be concise
  • Reflect ambivalence
  • Accentuate change talk

62
Ambivalence I want to, but I dont want to
  • Natural phase in process of change
  • Problems persist when people get stuck in
    ambivalence
  • Normal aspect of human nature, not pathological
  • Ambivalence is key issue to resolve for change
    to occur

63
Ambivalence
  • People often get stuck, not because they fail to
    appreciate the down side of their situation, but
    because they feel at least two ways about it.
  • Miller Rollnick, 2002

64
Understanding Ambivalence
Costs of Status Quo Benefits of Change
Costs of Change Benefits of Status Quo
Cost-Benefit Balance
Source Miller and Rollnick (1991)
65
Exploring Ambivalence Benefits and Costs
Status Quo
Changing
Benefits of
1. 4.
2. 3.
Costs of
66
Example
Drinking as before
Abstaining
Helps me relax Enjoy drinking with friends Eases boredom Feel better physically Have more Less conflict with family, work
Hard on my health Spending too much Might lose my job Id miss getting high What to do about friends How to deal with stress
Benefits
Costs
67
Sustaining Community Dialogue and Response
68
Next Steps for Ongoing Training
  • Commit to a culture of learning within your
    organization
  • Plan at least one community-wide training in the
    next year
  • Agree upon structures for sharing information
    between organizations

69
Next Steps for Community Dialogue
  • Work to establish or enhance the use of community
    shelter standards
  • Support the work of coalitions and other advocacy
    groups
  • Hold regular networking meetings and events

70
Next Steps for Using the Shelter Health Guide
  • Use the material to provide your own trainings
    for others in the community
  • Use the Guide as part of orientation for staff
    and volunteers
  • Use the information in the Tool Kits to educate
    shelter residents and staff

71
Thank you for being here today.
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