effective street outreach Why it’s important, How you can do it better Jeff Olivet & Steve Samra
The outreach process Outreach has been described as a process rather than an outcome (Erickson and Page, 1999)
Outreach principles Meet people where they are--geographically, emotionally, physically Meet basic needs Be respectful and treat everyone with dignity Recognize that the relationship is central to outreach and engagement Create a safe, open, friendly space, regardless of the setting
mobile vs. fixed site Mobile Fixed
Effective outreach workers Are Person-Centered Trauma-Informed
Tips for staying safe Always let your supervisor know where you are Go in pairs Don’t approach people who are “giving signs” they don’t want to be approached Don’t interrupt sales of drugs or sex Introduce yourself and inform people what you’re doing and why
Urban Outreach Commando Tactics Food Transportation Restrooms Sleep Cover Protection from Elements
The Evidence for Outreach and Engagement The body of evidence is limited but growing: 19 quantitative studies 3 qualitative studies 41 non-research articles (program descriptions, curricula, training manuals) (Olivet et al., 2010)
What the Evidence Doesn’t Tell Us Limitations: Quantitative includes no randomized controlled trials Research focuses on: Mental health (63%) Substance use (21%) Veterans (11%) Families with children (5%)
What the Evidence Does Tell Us Despite these limitations, outcomes are promising: Outreach improves physical and mental health (Burlich, 1996) Assertive outreach improves engagement in substance abuse treatment (Fisk, 2006) Consumer outreach staff can be a valuable addition to mobile teams (Lyons, 1996) Homeless children with mental illness show behavioral improvements after outreach (Tischler, 2002)
More Evidence Qualitative research adds other dimensions to what is known: Clients identify feeling valued and being treated respectfully as highly important (Daiski, 2005) Outreach can change attitudes among students serving homeless individuals (De La Cruz, 2004) Hiring consumer staff members is both beneficial and challenging (Fisk, 2000)
Other Supporting Evidence Non-research literature addresses other issues: Staff training needs Ethics, boundaries, and safety Self-care for outreach workers Process of building trust with clients Nuts and bolts guidance about how to conduct outreach
Lingering Questions How do we define outreach and engagement? Is outreach effective--for whom and in what settings? Is it possible to conduct large-scale, outcome-based research on outreach and engagement? Is outreach cost-effective? How can consumers be better represented in outreach practice and research?
Outreach Version 1.0 An upsurge of homelessness has occurred in the United States over the past three decades – beginning in the late 1970s to the present. During this time, outreach has been used as a common intervention to connect people with services and care. Three overlapping, yet distinctive, outreach approaches have emerged during this period of time.
Outreach Version 1.0 Since the early 1980s outreach has primarily taken the form of engaging people living on the streets and attempting to bring people into existing services at shelters, drop-in centers, health clinics, and behavioral health agencies.
Outreach Version 2.0 Recognizing that site-based care was a barrier for some people, some outreach workers began taking direct care to where people were located – under bridges, in parks, on street corners. For example, street medicine – taking basic medical care to people – became common in cities like Boston, Pittsburgh, and Houston. Other practitioners – dentists, psychiatrists, mental health and addictions specialists, case managers – also began providing direct care “on the streets.”
“If someone cannot come to your door, you bring the door to them.” Tim Florence, MD, Ann Arbor, MI
Outreach Version 3.0 These days, another trend is on the rise and entirely shifting the focus of outreach efforts. Outreach is being used as an intervention to move people directly into housing without having to progress through the steps of the traditional “housing ready” approach. Based on “housing first” strategies, outreach is focusing on meeting people’s fundamental need for a safe, warm, dry, permanent, affordable place to live, with support services included.
A paradigm shift Homeless services are experiencing a shift from providing shelter to a focus on prevention and permanent housing.
Theodore Roosevelt “This country will not be a good place for any of us to live in unless we make it a good place for all of us to live in.”
The “do’s” of street outreach Be yourself! Listen Motivational Interviewing Respond, don’t react Dress for the street
The “dont’s” of street outreach Don’t Space Invade Don’t Promise What Can’t be Delivered Don’t “Case Manage” Don’t Go Alone Don’t Preach, Pry and Prod Don’t Go at 4 Don’t Ever Give Up
Buhrich, N., & Teesson, M. (1996). Impact of a psychiatric outreach service for homeless persons with schizophrenia. Psychiatric Services47(6), 644-646. Daiski, I. (2005). The health bus: Healthcare for marginalized populations. Policy, Politics, & Nursing Practice,6(1), 30-38. De La Cruz, F., Brehm., C., & Harris, J. (2004). Transformation in family nurse practitioner students' attitudes toward homeless individuals after participation in a homeless outreach clinic. Journal of the American Academy of Nursing Practitioners, 16(12), 547-554. Fisk, M., Rowe, M. Brooks, R., Gildersleeve, D. (2000). Integrating consumer staff members into a homeless outreach project: Critical issues and strategies. Psychiatric Rehabilitation Journal, 23(3), 244-252. REFERENCES
Erickson, S., & Page, J. (1999). To dance with grace: Outreach and engagement to persons on the street. In L.B. Fosburg& D.L. Dennis (Eds.), Practical lessons: The 1998 national symposium on homelessness research. Washington, DC: U.S. Department of Housing and Urban Development and U.S. Department of Health and Human Services. Fisk, D. (2006). Assertive outreach: An effective strategy for engaging homeless persons with substance use disorders into treatment. The American Journal of Drug and Alcohol Abuse, 32(3), 479-486. Lyons, J.S., Cook, J.A., Ruth, A.R., Karver, M., &Slagg, N.B. (1996). Service delivery using consumer staff in a mobile crisis assessment program. Community Mental Health Journal, 32(1), 33-40. Olivet, J., Bassuk, E., Elstad, E., Kenney, R., and Jassil, L. (2010). Outreach and Engagement in Homeless Services. The Open Health Services and Policy Journal. In press. Tischler, V., Vostanis, P., Bellerby, T., &Cummella, S. (2002). Evaluation of a mental health outreach service for homeless families. Archives of Disease in Childhood,86(3), 158-163. REFERENCES (CONT.)