NEWSHOMELESS HEALTH

Hawaiian teen Erwin Viado Celes had a lot going for him when he killed himself last September at age 19. He had a steady job at a pizza restaurant, college aspirations, a mentor in his kickboxing coach, and caring friends who now are fundraising to cover his burial costs. He'd also survived severe early childhood neglect followed by 14 years in foster care. When he aged out without a stable home in March, he began bouncing between friends' couches.

His death is a reminder of the changes desperately needed for the 30,000 American teens who age out of foster care every year, and Hawaii's state government is now considering reforms.

Forty percent of former foster kids experience homelessness, including couch surfing like Celes, by their mid-20s. Studies have shown that those who age out are also at greater risk of unemployment and criminal conviction, and that a mere six percent obtain college degrees by the time they're 24. Add this to the fact that 5,000 homeless youth die every year from violence, illness or suicide, and you have a dire picture of post-foster care life.

Celes was granted an additional year of foster care, so he aged out at 19 instead of 18 like most foster kids, but his Medicaid coverage ended with his 19th birthday. Without medical coverage, Celes couldn't access mental health services, even after he talked of killing himself following his ex-girlfriend's suicide. And though he wanted to go to college, an uneven transcript and lack of funds kept the dream from becoming reality. (Celes wasn't enrolled in school until he entered foster care, two years behind his peers).

Well, Washington, D.C. will soon join the ranks of cities who like to make the homeless someone else's problem.

Local government, trying to mitigate a $175 million budget shortfall, has determined that about 10 percent of those who apply for shelter and other homeless services in the city are from elsewhere — and officials want them to go back to "elsewhere."

People from neighboring Prince George's County have been known to come to D.C. looking for shelter, in some cases claiming to have been sent by service providers in Silver Spring, Maryland. In response, D.C. Councilman Tommy Wells introduced legislation that would require all people seeking homeless services in the District to produce city identification. He later withdrew it in an effort to avoid creating any unintended consequences.

Washington, D.C. gave the homeless a "right to overnight shelter" in 1984 and rescinded it in 1990, due to the financial burden that it put on the city. (This is reminiscent of Mayor Michael Bloomberg's recent claim that he was saving taxpayers money by sending New York's homeless elsewhere.) Now homeless Washingtonians only have a right to shelter if the temperature is 32 and below or 95 and above.

However, D.C.'s "low-barrier" shelters have traditionally allowed people to enter without showing identification and even allowed them to give a false name. Those who are on the lam, undocumented or avoiding family need not worry about having the police called, so long as they don't commit any new crimes while in the shelter. The same is true for those who enter the shelter drunk or high. The city has, in effect, removed all barriers to entry in an effort to encourage people who might otherwise stay outside and freeze to come in, thus saving their lives. Tell D.C. to provide winter shelter to people in need!

Australians apparently call mosquitoes "mozzies." Too bad a cute name isn't enough to make them any less bothersome.

Darwin, Australia in the Northern Territory is currently seeing the worst mosquito plague since officials started keeping records in 1979. Local homeless people are, of course, bearing the brunt of the bites.

This is just one more of the myriad risks that come with living outdoors. We've written about the prevalence of lice, the dearth of fresh drinking water and the general health risks that come with sleeping in the open air. For homeless people who spend most of their time outdoors or sleep outdoors, the threats just keep coming.

The fear is that these mosquito bites will compound existing health issues for people living in camps. Local non-profits are stepping in with insect repellent and other tools to drive away the bugs, but anyone who has ever itched through the night knows there's no 100 percent effective way to avoid them. Experts expect to see an uptick in the number of cases of Ross River fever, an infectious and nasty condition carried by mosquitoes that, luckily, isn't a threat in America.

It is imperative that homeless shelters and services embrace the best practice of trauma-informed care. The sequelae, or after-effects, of childhood trauma can literally ruin one's life or lead to deadly circumstances. The Substance Abuse and Mental Health Services Administration, or SAMHSA, provides an excellent curriculum and lots of resources and research to help homeless providers get up to speed on this approach, though I can imagine the response of the typical director of an agency (having heard it just a few times): "We save people's lives by providing overnight shelter. That is the most important thing." "We don't have the time and money to train staff." "We have to treat everyone the same way, otherwise we are not being fair."

There are simple answers to each of these responses — the SAMHSA training is free and the entire curriculum and resource guide to providing trauma-informed care is on its website. And yes, it is important to treat everyone the same way. However, the standards of care outlined are a way to treat everyone humanely, not just trauma survivors. The irony is that so many adult homeless people are trauma survivors that treating the eight percent or so who are not is not likely to offend anyone.

Indeed, I would argue that homelessness is so traumatic that even without a history of trauma, by the time a homeless person has observed a few beatings or struggled through a winter on the streets, they are pretty darn traumatized. And I do understand that providing overnight shelter is the central mission of most shelters, but for those who are interested in saving lives, please read this real-life example to understand how understanding trauma can save lives, too.

Rod has worked his way out of homelessness twice in the time that I have known him. Most recently, he got a job on the night shift at a 7-11, and saved money until he was able to afford a run-down trailer. He slowly fixed it up, and has a picture of himself standing proudly in front of the repainted trailer. Last spring he was running to catch a bus, and slipped on the ice. Nine months later his leg is still swollen from a blood clot, and the doctors are suggesting amputation. Rod is hesitant to agree to the amputation, although he is exhausted, taking drugs to prevent clotting and fighting infection. He is allergic to opiate pain medications and does not drink alcohol, so he is using meditation to deal with his pain. He chooses to sleep in a tree rather than accept a medical respite program in a different city.

How does this relates to the after-effects of trauma? Trust.

Last winter, with a record 55 inches of snow, was a harsh one for Washington, D.C. The city's homeless outreach quite understandably was unable to reach and assist many of the street homeless in their time of crisis, as roads became impassible and all above-ground metro service was halted. The city was literally shut down.

D.C. Central Kitchen, which provides food to all city shelters, was unable to deliver some of the meals, causing those without money to go hungry or go to the park in hopes of being fed by church groups and other do-gooders. Those with money had to fight their way through knee-deep snow to buy a meal at McDonald's. Many people could do little more than sit around for days on end, as they waited for their streets to be plowed and life to return to normal. With last winter having been a "perfect storm" of troubles for D.C.'s homeless, this hypothermia season is shaping up to become more of the same.

While the severity of last winter may have been unpredictable, local government was given fair warning, despite some people's statements to the contrary. In July 2009 dozens testified in front of a city councilman about the shortage of shelter and the fact that many shelters were at or near capacity in mid-summer, creating grave concern about how the city would deal with the spike in shelter usage that always occurs in winter. During that hearing a video was shown in which various homeless people described their need for shelter. The last interviewee had died in June — just three days after being videotaped.

During a post-winter hearing, D.C. Councilman Tommy Wells, who oversees the Department of Human Services, seemed appalled by reports of over 200 families being crowded into a shelter that was made to accommodate only 135 and of male employees having sex with female residents. During that same hearing, he addressed news reports of a shelter employee arrested for dealing drugs at the shelter. Councilman Wells maintained that there was sufficient shelter for single men and women, but said that we needed more shelter for families. The city admits that it still lacks sufficient shelter for families, which leaves one to wonder why Wells and his colleagues still haven't fixed a problem which they became aware of 15 months ago.

"Getting back on your feet" usually means finding a new job, maybe a place to live and whatever else it takes to become independent and self-sufficient once again. But for Anne Mahlum, it means more than changes in circumstances.

If Mahlum's name sounds familiar, maybe it's because you saw her on the national news a couple years ago, recruiting homeless men to join a running club in Philadelphia. Mahlum, a serious runner, says she passed by a homeless shelter every morning on her daily run and began to develop a rapport with the men outside on the corner. One morning she had an idea: "Back On My Feet" running clubs for homeless individuals.

When her initial Philadelphia group ran its first race, the media took notice. So did coaches around America.

Dan Blankenship, a track coach in Richmond, Virginia, and some volunteers coached 20 homeless men and women to their first 10K in March 2010. Blankenship, like many others, credits Mahlum with the inspiration.

Just two years after Mahlum got started, there are Back On My Feet chapters operating in four more cities: Washington, D.C., Baltimore, Boston and Chicago. There are plans to expand to Dallas-Fort Worth, Atlanta and Minneapolis in 2011.

On the BOMF site Mahlum explains why running and the homeless make such a great combination: "Running is such a beautiful metaphor for life. Life is about choosing different roads and our program teaches the importance of choosing roads filled with opportunity, hope and happiness."

More than just a club and a website, Back On My Feet is a non-profit organization that truly runs in the face of traditional solutions for dealing with the homeless. BOMF  "promotes the self-sufficiency of homeless populations by engaging them in running as a means to build confidence, strength and self-esteem." What I like about the BOMF program is that Mahlum goes against the victim-model in which an organization sees homeless individuals as people to be rescued, fed and housed with no effort on their part other than showing up and filling out the paperwork.

She and BOMF require something out of the participants as well. Not everyone is eligible. Shelter staff and BOMF leaders must determine whether the participant and the program are a fit since they invest $1,800 in each runner. Participants must sign an agreement and commit to the program. It's tough. And it works. Running is more than just exercise — it's discipline, life skills, goal-setting, teamwork and self-respect. What comes out of the commitment and completion of the program are the skills and the connections that the participants will use to "get back on their feet."

Homelessness could often just as easily be described as refrigeratorless, bedless, air conditioningless or showerless. It's true. When one is homeless, the prospect of a shower can be terrifying, not in a Psycho way, but because it seems so far out of reach. Shelters have showers (bring your flip flops!), but these days, fewer and fewer folks are getting in the front door.

Those of us who take our daily (or twice daily) showers for granted can still imagine how hard a job interview or a parent-teacher conference would be after three days without a shampooing. When homeless people are in need of bottles of water, getting the 80 to 100 gallons that the average American uses each day is as unlikely as being handed the keys to a brand new mansion.

Thank goodness for Frank and Louise Fargo, a couple in Seattle who recognize how big an impact a 10-minute shower can have on someone's day, her self-esteem, her life. For these faithful, an effort they call "Shower to the People" is their mission. After meeting homeless people through church activities and reading the book Under the Overpass, Frank decided to buy a small trailer with a shower and several hot water tanks. Louise was on board, provided they also offer clean clothes for people when they get out and dry off.

Since 2008, the couple have been parking their shower-mobile at local churches. They currently offer a good scrubbing on Wednesday nights and Saturday mornings. They've been able to facilitate more than 1,000 showers since they began. On some days, 20 people line up, waiting patiently with a laminated ticket. Baskets of toiletries sit beside them, providing some of the comforts of home, however briefly.

Josh is a funny dude. Most of our time together is spent doubled over in laughter. He draws these amazing comic strips in this tattered old sketchpad he carts around in his backpack (that's his work in the photo to the left). He talks often and intelligently about growing up black in a black neighborhood in Baltimore in the '60s and '70s, about liking Janis Joplin and Bob Dylan more than the O'Jays or the Isley Brothers, and about how most black people were just as afraid of white people as white people were afraid of them. He wrote a poem about it for the high school newspaper his senior year. The poem got picked up by a group of poets in New York and printed in a collection featuring young writers from America's inner-cities.

He met his wife at a waffle shop when taking a lunch break from constructing the Baltimore harbor. He stuck by her and tried to coach her free when years later she got involved with hard drugs. Finally, no longer able to put up with his me-or-the-drugs dictum, she told him she didn't love him, and overdosed a few years after that. He stopped drawing comic strips and stopped writing poetry. He worked as a custodian for hospitals in the Baltimore area for 30-some-odd years, lifted weights, played basketball. The weights ruined his back pretty good, and every once in a while he would have to take a month off work, crash at an uncle's or a friend's house to recoup, then get another job somewhere when things got better.

His asthma flared up around 2005 and he was in and out of the hospital for a year. He was prescribed a steroid inhalant he says worked but became unaffordable after three months. He moved in with his mom, who was mentally ill and living alone. He took care of her for four years, though his asthma was so bad at times he could barely make it the length of a bedroom. Locked in the bedroom, he started drawing again. A few years ago a friend recommended an herbal supplement which he still swears by.

I was down in the basement of the public library, where the periodicals and microfiches are stored, when Josh was telling me about the police officer that came by and asked him to leave the shaded spot on a local college campus where he sleeps, a spot he affectionately calls his rock. It is basically a concrete block against a lecture hall that serves as a makeshift bench. He sleeps there behind the trees and shrubs, sitting upright. He had moved out of his mom's place when the violence and frustration became too much, and his younger brother moved in.

This new video comes from Mark's InvisiblePeople.tv 30-city, 11,000-mile, 75-day road trip, going on now.

"Caution: some content may be offensive." Ka'e k'e's interview from St. Paul, Minnesota, is exactly why I have that disclaimer on InvisiblePeople.tv, where I post my videos. She flat out tells us what life is like on the streets for a young woman.

The disclaimer ends with the sentence, "Our hope is you'll get mad enough to do something." I am sure Ka'e k'e's experience will offend you in some way. She has to sleep with strangers just to survive. It's the better option than freezing outside. Ka'e k'e is pregnant, and because she has "survival sex," she does not know who the baby's father is. I sure hope that gets you crazy mad.

Before you label Ka'e k'e an awful mother, know that she is just one of many young girls having babies on the streets. It's a vicious cycle for many. They don't know how to avoid it and many don't have the choices we take for granted. Having sex with strangers and taking drugs to forget the pain is the only way to survive.

I wish you could see what I see in person. I see a hurting young woman who is screaming for help. She is living the life that her family's socio-economic background gave to her. Most of these young adults come from families who were also homeless, or very close to it.

Here's a homeless outreach event that doesn't presume to know what people's needs are:

Next Thursday, Oct. 14, the Tacoma Dome will host the area's 2010 Project Homeless Connect. This year, the program hopes to help 750 people. At this event, homeless people can access a variety of services such as medical, dental and vision. The offerings also include haircuts, pet care, rapid HIV testing, flu shots and a host of other things geared towards helping homeless people have a better life. Even round-trip transportation is provided to get homeless people to the event.

The interesting thing about this project is that it's run by volunteers. In fact, they're the one who serve as greeters at the door. When homeless people walk in, the first thing they're asked to do is name the three most important needs they have. The volunteers then help people navigate their way to the needed services. Each service provider will record the number of clients they see along with the types of services provided. The information collected helps the program find out who is getting served so that future needs can be addressed. Secure on-site childcare is offered to ensure that parents can get to the services they need. If you've been to Homeless Connect events in other areas, let us know in the comments if they were as user-centric.