{"id":10100,"date":"2016-12-29T12:19:12","date_gmt":"2016-12-29T20:19:12","guid":{"rendered":"http:\/\/depts.washington.edu\/medex\/?p=10100"},"modified":"2016-12-29T12:19:12","modified_gmt":"2016-12-29T20:19:12","slug":"approaching-homelessness-with-passion","status":"publish","type":"post","link":"https:\/\/familymedicine.uw.edu\/test\/approaching-homelessness-with-passion\/","title":{"rendered":"Approaching Homelessness With Passion"},"content":{"rendered":"

I<\/span>n a historic move<\/span><\/strong>, the University of Washington is hosting a homeless encampment on its Seattle campus, the first such public university to do so. At the same time, MEDEX Northwest is offering an interprofessional course on homelessness, intended to educate health science students on how to effectively engage the homeless around their health care needs.<\/p>\n

The UW 2-credit course, \u201cHomelessness in Seattle\u201d<\/a><\/strong>, begins on January 5th<\/sup>. MEDEX 580 is a 10-week course open to all current UW students in the health sciences. The course came about as a result of the actions of the UW, which has welcomed Tent City 3, a group of approximately 50 homeless individuals, to take up residence on a lot located along south campus through March 2017.<\/p>\n

The course is the first of its kind in the nation organized under a university sponsored physician assistant training program, MEDEX Northwest. In large part it has come about due to the efforts of Lois Thetford, PA-C, a MEDEX faculty member and longtime advocate for the homeless.<\/p>\n[smartslider3 slider=100]\n

We sat down with Lois and her course co-chair, Charlotte Sanders, MSW, a Teaching Associate at the UW School of Social Work, to learn more about MEDEX Course 580, \u201cHomelessness in Seattle\u201d, and how it came about. Both approach the subject of homelessness with passion.<\/p>\n

\u201cHomelessness is actually a much bigger issue than a 10-week course can address,\u201d says Lois Thetford. \u201cI see this as an evolving thing. The next time we do this, it won’t be exactly the same. The information in this course is very basic. Who are the homeless? What are their problems? Are these medical, mental health, or addiction problems? That’s just barely touching the ground level.\u201d<\/p>\n

Interprofessional Education<\/strong><\/span><\/p>\n

D<\/span>esigned as an interprofessional education course<\/strong><\/span>, MEDEX 580 is co-sponsored by several schools within the University of Washington Health Sciences: Medicine, Nursing, Public Health, Pharmacy, Dentistry, Physical Therapy and Social Work.<\/p>\n

\u201cThat\u2019s one of the things we want to model for the students,\u201d says Lois. \u201cWorking in silos is a bad idea, and it’s especially bad when you’re working with the homeless population. No one profession has enough of the answers or resources to address the kinds of needs these patients have. So if you’re going to serve homeless people, you need to be interprofessional in your approach as a provider.\u201d<\/p>\n

\"\"<\/a>
Volunteers lay down pallets that become the base for tents to come.<\/figcaption><\/figure>\n

More often than not, medical providers are unskilled and untrained in how to work with homeless individuals, and that\u2019s what this course will address.<\/p>\n

\u201cOne of our health concerns with this population is trauma and its effects, not only to physical health but emotional and mental health,\u201d says Charlotte Sanders. \u201cNot all providers are conducive of a person\u2019s trauma. It\u2019s important to help students see what trauma-informed care looks like and how, with a few simple changes, they can alter their approach to care and make a world of difference.\u201d<\/p>\n

Lois recounts an instance where she referred a homeless patient to a specialist with shocking results. The patient\u2014a woman with rheumatoid arthritis\u2014was born with one kidney. \u201cA lot of rheumatoid arthritis medicines are hard on the kidneys, so I sent her to a nephrologist.\u201d<\/p>\n

The woman returned, telling Lois, \u201cI\u2019ll never see that doctor again\u201d. Learning that the patient was homeless, the provider had told her, \u201cI don\u2019t approve of your lifestyle, but I\u2019ll try to help you.\u201d<\/p>\n

The specialist assumed that the patient\u2019s homelessness reflected on her character, like she was a drug addict or a prostitute. \u201cAnd that is a common misconception that providers can have,\u201d adds Lois. \u201cI wrote to the specialist, and said \u2018this patient is homeless because of family dissolution, and the home was sold. That is the reason that she is homeless\u2019. But, you know, he saw a poor, uneducated person and therefore, a person of low character. When really, I just needed him to advise me about how to treat her rheumatoid arthritis without killing her one kidney. Whatever his assumptions were, they were completely inappropriate.\u201d<\/p>\n

These are the attitudes among health care professionals that Lois Thetford and Charlotte Sanders hope to change with MEDEX Course 580.<\/p>\n

Then, Lois offers up a shocking fact.<\/p>\n

\u201cHomeless people die an average of 30 years younger than the average American. It isn’t like they have different kinds of health problems. But their health problems go untreated, they progress, and then they have a lot of them. There is no way you can get the kind of care you need if you don’t have a stable place to live.\u201d<\/p>\n

Origins of the Course<\/strong><\/span><\/p>\n

T<\/span>he driving force behind the course<\/span><\/strong> has been the anticipated arrival of Tent City 3 on the University of Washington campus.<\/p>\n

There are a number of Tent Cities in Seattle, and they fluctuate by the seasons. By and large, Tent Cities are a West Coast phenomena, organized around the principle of safety in numbers. People sleeping out on their own\u2014under viaducts or in doorways\u2014are often victimized, beaten and robbed. Tent cities are democratically organized, self-managed communities that offer security and operate within codes of conduct. Tent City 3 has one of the more rigorous standards for conduct, requiring sobriety, nonviolence, cooperation and community participation.<\/p>\n

[smartslider3 slider=101]<\/div>\n

Seattle law requires all tent cities to relocate every 90 days to church or public lands. St. George Episcopal Church in Lake City, WA was site of the Tent City 3 encampment until Saturday, December 17. On that date the entire camp at the North Seattle church was broken down and moved to the UW campus. Approximately 75 volunteers, mostly students and faculty from the UW Health Sciences, were there to meet the TC3 residents.<\/p>\n

Initially, a group of socially progressive students from across the UW health sciences came together as the Tent City Collective<\/a><\/strong> to request that the University host the homeless encampment on campus. The process took around a year and a half, and in June of 2016 UW President Anna Mari Cauce announced that the UW would house Tent City 3 on Lot W35 for three months starting in late December.<\/p>\n

\"\"<\/a>
Ramon is a resident of Tent City 3 for five years.<\/figcaption><\/figure>\n

\u201cIt\u2019s been a lengthy process for these students, but the group really worked within the system,\u201d says Lois. Once they got word it was going to happen, the students approached Lois about developing a course to coincide with the arrival of Tent City 3 on campus \u201cso we can know all the ways to be appropriate and helpful\u201d.<\/p>\n

Lois recruited Charlotte Sanders into the effort because of her background in working with young people experiencing homelessness. Together, they developed a syllabus for the 10 week course that draws upon the most experienced health professionals working on homelessness in Seattle. The lectures will also include speakers from Tent City 3, talking about their organization and community. See the full course syllabus here<\/a><\/strong>.<\/p>\n

\u201cHomelessness in Seattle\u201d is open to 35 for-credit UW students, and an additional 15 individuals may audit the class in person at the UW classroom location. MEDEX Northwest will also livestream all MEDEX 580 lectures for anyone to audit at the MEDEX YouTube Channel<\/a><\/strong>. Lectures will broadcast live from 6:00 pm to 7:50 pm starting January 5th<\/sup> and for the nine subsequent Thursdays. The lectures will also be archived at the MEDEX YouTube Channel. See a list of scheduled speakers here<\/a><\/strong>.<\/p>\n

\u201cYou can assume that the students participating in this class\u2014even those people who watch the streaming lectures\u2014will learn a lot about how to interact with homeless patients,\u201d says Charlotte Sanders. \u201cThat would be our goal.\u201d<\/p>\n

The Causes of Homelessness<\/strong><\/span><\/p>\n

T<\/span>here are migrating populations<\/span><\/strong> that are always a part of homelessness. But according to Lois, the biggest modern cause of homelessness started in the 80s with deinstitutionalization by the Reagan administration. \u201cAll these people were turned out from institutions without funding for any alternative programs. There was an assumption that somehow community health services would be there to help these people.\u201d<\/p>\n

The definition of homelessness is \u201cwithout safe and stable housing\u201d.<\/p>\n

\u201cThe thing about homelessness is that there isn’t one kind of homelessness,\u201d says Lois. \u201cThere are many, many<\/em> kinds of homelessness.\u201d She begins to catalogue the causes.<\/p>\n

\u201cThere is homelessness because a parent is in jail and there is no one to take care of you. There is homelessness of families that’s due to domestic violence. There is homelessness of young adults because they were in foster care and they don’t have the skills or the ability to support themselves. There\u2019s the older veteran who has never quite overcome their war trauma because of the conditions in which they returned, and our very poor understanding of post-traumatic stress disorder, which is still debated within military establishments.\u201d<\/p>\n

\"\"<\/a>
Charlotte Sanders, MSW, from the UW School of Social Work<\/figcaption><\/figure>\n

Charlotte Sanders names other contributors including poverty, racial discrimination, access to resources and displacement. \u201cIt’s really difficult to develop wealth when you don’t have it already,\u201d she says.<\/p>\n

\u201cEveryone knows someone who\u2019s been homeless,\u201d adds Lois. \u201cHomeless people aren\u2019t them, they\u2019re us.\u201d<\/p>\n

She recounts how, growing up, there was a man who lived on her family property for 15 to 20 years. \u201dHe was a hobo handyman\u2014someone who didn’t have a place to live, so he just bunked in our barn. He was something of an alcoholic, but he wasn\u2019t dangerous to us.\u201d<\/p>\n

Then there was a niece who went to jail, leaving behind an 18-year-old daughter. \u201cShe stayed maybe a month or two with different relatives,\u201d Lois says. \u201cBut basically she became homeless because her mother was imprisoned.\u201d<\/p>\n

\u201cYou know, homelessness is about poverty, it\u2019s about racism, it\u2019s about the school-to-prison pipeline, mass incarceration and the recidivism,\u201d adds Lois. \u201cAnd it\u2019s about our rapacious economic system, how banks targeted low-income people for bad mortgages and took their life savings. Even if those savings weren\u2019t very big, it was all they had.\u201d<\/p>\n

[smartslider3 slider=102]<\/div>\n

On this last point, Lois attended a national conference on homelessness in Washington, DC, and learned about the impact of the mortgage crisis between 2008 and 2012. An emergency housing director from Philadelphia reported a new category of homeless people, rendered so because of the subprime lending practices. \u201cThey were not our usual homeless population,\u201d says Lois. \u201cThese were the well-educated homeless who were victims of mortgage fraud. They were consuming services that the true homeless population who would normally be using.\u201d<\/p>\n

Both Lois and Charlotte see something similar going on in Seattle right now due to the extreme absence of affordable housing. Six years ago nothing could get built in Seattle. Today developers are on a wait list for construction cranes. Within the city limits, speculators besiege single-family homeowners, offering high dollar amounts to build expensive vertical single-unit apartment buildings. Affordable housing options have quickly become a thing of the past.<\/p>\n

\u201cHomelessness can happen to anyone,\u201d says Lois.<\/p>\n

Brian\u2019s Story<\/strong><\/span><\/p>\n

A<\/span>t Tent City 3, we spoke with Brian<\/span><\/strong>, a recently arrived resident to the encampment. His story underscores just how easily someone can fall into homelessness\u2014and exemplifies the newer population that is ending up on the streets.<\/p>\n

\u201cI\u2019ve never been homeless before\u2014anywhere, in my entire life,\u201d Brian tells us.<\/p>\n

Tall, clean cut and in his early 40s, Brian and his girlfriend had a home in Seattle for the past three years. Both are employed. Tina works at a sous-chef at a high-end restaurant. Brian has his own moving business, a bit of an irony considering his present situation.<\/p>\n

\u201cWe were in a spot where our neighbor was difficult, and we just couldn\u2019t do it anymore,\u201d he says. \u201cWe gave notice, but then our living situation that we were going to move into fell through. We weren\u2019t adequately prepared.\u201d<\/p>\n

[smartslider3 slider=103]<\/div>\n

Brian and Tina ended up staying with friends. \u201cBut you can only impose for so long,\u201d he says. \u201cWe didn\u2019t have a lot of money. We ended up sleeping in the truck. We found ourselves in the absolute chilling cold last week when the temperatures hit freezing. It was unbearable. We were turning the truck on periodically to stay warm.\u201d<\/p>\n

During this time, they had driven by the Tent City 3 site in Lake City. \u201cWe were entertaining options, and I went in to talk to them,\u201d says Brian. \u201cThey gave us a tour. We moved in.\u201d<\/p>\n

The two of them made the move from Lake City to the UW campus with the rest of the encampment.<\/p>\n

\"\"<\/a>\u201cMy girlfriend and I were in bed last night all bundled up, laughing. We called this an urban living community, which happens to have tent homes. They have a huge set of rules at Tent City 3. I mean, it\u2019s a community. Pitch in, or you don\u2019t stay here. It\u2019s drug and alcohol free. It\u2019s for people caught in difficult situations. I\u2019m grateful for it. I never thought I would say that.\u201d<\/p>\n

Brian reports that the first three days at TC3 presented a rough transition. \u201cWe had no idea,\u201d he says. \u201cNumber one, we\u2019d never been homeless before. Number two, we didn\u2019t know anybody here. We didn\u2019t know what to expect. We had no clue. It was a total crash course.\u201d<\/p>\n

Despite their novice status, Brian and Tina were welcomed. \u201cThere are some really smart people here, really nice people. They\u2019re very accommodating. When we moved here they could tell we didn\u2019t really know what we were doing. They\u2019d come over and help. It\u2019s an urban community that really cares about each other.\u201d<\/p>\n

Brian is impressed by the Tent City 3 operation, with its objectives and expectations.<\/p>\n

\u201cOriginally, we were looking to get out of the gosh-darn cold, thinking about dropping coin on hotels and living paycheck to paycheck until we figured out what the heck we were going to do. After being here, and now that it\u2019s not ice chilling cold, we\u2019ll stick around for a while if it continues to work the way that it is. And we\u2019ll save our money. Once we get a good solid first-last deposit\u2014a few months of extra cushion\u2014then we\u2019ll go back out and attack it. We\u2019re looking forward to that opportunity.\u201d<\/p>\n

Move Master<\/strong><\/span><\/p>\n

J<\/span>ason Tavares is a resident of Tent City 3<\/span><\/strong> and the designated \u201cmove master\u201d during the relocation efforts to the UW campus. It\u2019s a surprisingly organized scene at Lot W35, with wooden pallets being laid down in rows. These are then covered with plywood and plastic tarps, creating the base to raise individual tents. TC3 residents, UW students and faculty freely mix as the puzzle pieces take shape.<\/p>\n

\u201cI\u2019m the one who makes sure all this happens,\u201d he tells us. \u201cWe have enough room to fit one hundred people. Our permit allows us to have 99, but with the dorms we have an overflow capacity, so we can house 120. We won\u2019t turn anyone away. Even if we\u2019re full, we\u2019ll put them in overnight somewhere.\u201d<\/p>\n