Meeting the Client “Where They Are” – A Note to Our Colleagues
Some years ago my mother gave me a bundle of letters. The return address, in London, was for a certain James Woods, Esq. We had come to know Mr. Woods in the early 1970s, when he referred to himself as “Whitey” (for his shock of white crew cut hair) and was one of the 5-6 people who were homeless who came to our door and shared our family’s breakfast every day. Whitey would also spend long hours in the church next door where my father was the priest, playing the grand piano like a virtuoso without music or audience. Whitey had been homeless in London for over 50 years, since 1917 when, as an Infantryman in World War One, he was buried in a bunker somewhere in France when it was hit by German artillery fire. He endured the isolation of that bunker for days until the bunker was ripped open by another shell, after which he never could bring himself to sleep under a roof again. Before WWI Whitey had been James Woods the concert pianist, but chronic trauma and intrusive fear gripped him and he joined the ranks of London’s homeless population, many of whom were also veterans with “Shell Shock,” which later became known as “Battle Fatigue,” then “War Neurosis,” and then Post Traumatic Stress Disorder (PTSD). We came to know Whitey over years, a haunted but terribly gentle man who helped me work through sections of piano pieces when I was having difficulty. And as the years passed, living on the streets took its toll on Whitey. While we had helped get him health access and some psychiatry for his PTSD, he eventually consented to my family helping him get in to housing but was too frightened to stay in his veterans’ subsidized apartment. So we convinced the authorities to let him keep the place and suggested to Whitey that he use it only when the weather was rough. The first time he used his home was probably a year after he got it and, after sporadic use over about 7 years, he finally moved in to his home and stayed for good. It was from this address that he corresponded with my mother. And over the years he stepped back in to our lives in other ways, like when my brother dropped out of medical school at the onset of Schizophrenia and Whitey would watch out for him on the street and was sometimes one of the few ‘safe’ people breaking through my brother’s paranoid hallucinations.
Years later, in my first job doing assertive case management with a population of persons who were suffered with co-occurring mental health and substance use disorders I worked with a client called Mark. Mark had been an Olympiad, but depression and the self-medication of that depression with alcohol had consumed him. When I started working with Mark he was almost perpetually drunk (often resorting to drinking Aqua Net and other hair sprays), homeless, and badly jaundiced. In many ways he had given up on his life but the side effects of his chronic conditions where terrible and his suffering was immense. The treatment plan with Mark was to stabilize his current conditions, try to prevent further complications, and to try to instill hope. I was helped with this by a nurse on my team who would come out with me to the railroad trestle where Mark lived, and who would care for him in a non-judgmental way. In the end we simply helped Mark to die with less discomfort and a lot more dignity.
When I started working at WellSpace Health, I was struck by the mission and commitment of my colleagues. We were all aware that we are surrounded by people like Mark and Whitey, and some of our colleagues have transformed their lives from similar circumstances. We have grown so many remarkable programs across the organization and we all dreamed of helping advance our homeless services further ‘upstream’ to meet our clients where they were. But building the right program was an elusive goal due to funding constraints and the limitations on how we can bill for the treatment we provide. In the end, and despite the enormous resources of our incredible organization and staff, we were limited by our inability to provide billable services out in the streets and focused on trying to work with the community navigators and others to get folks in to us for care but the dream of meeting our clients where they are – and maybe never even seeing some of them in our service sites – remained. So while we envisioned what we came to refer to as our Street Nurse program, we could not afford to provide it. This changed last year, with the help of funding from Sutter Health, we had the incredible opportunity what we saw as the right program and have been running the program for much of 2016, with great success. Recently, Sutter Health was invited to apply for an award for funding innovation and chose to focus on our Street Nurse program. The following link is to the video they created for that award, featuring your colleague and WellSpace Health Street Outreach Nurse Amanda Buccina.
I am grateful to all of you for the shared mission. We are surrounded by people like Mark and Whitey, and one of the values that binds us across all of the services we provide is that we acknowledge them and their narratives and try to meet them where they are.
The “Mid-Month Message” is intended as a place to share pieces of our organizational culture and/or history. As our tagline says, WellSpace Health has been providing care in our community since 1953. Over the decades we have developed quite an organizational culture. We have had many accomplishments, created histories, have profoundly affected so many, and have been profoundly affected by so many. Sometimes it’s hard to keep up with it all. And often, one part of the organization may not know about something affecting another part of the organization.