HOW TO CONTACT US Scott Petersen, LCSW, CADC Clinical Administrator HOPE Center Heartland Health Outreach 773-751-4194 spetersen@heartlandalliance.org Susan Pickett-Schenk, PhD HOPE Center Evaluation Director Associate Professor of Psychology in Psychiatry UIC Center on Mental Health Services Research & Policy PICKETT@psych.uic.edu HOPE CENTER (TI14263) HOPE Center (Helping Our People Engage) serves adults who are homeless and use drugs. The program targets people whose commitment to continued use or whose unwillingness to meet conventional treatment expectations makes for a poor fit with most providers. Potential HOPE Center participants first encounter our staff through outreach on the streets and in other locations where homeless users gather. Engaging substance users in this fashion enables HOPE Center staff members to develop the rapport and trust upon which a therapeutic partnership is built. By developing productive partnerships with homeless drug users, HOPE Center works to bridge the gap between users and systems of care. Once engaged, individuals are invited to participate in the program’s drop-in center, which offers a number of enticing amenities – among them, hygiene supplies, showers, laundry facilities, and meals. The center’s “come as you are” approach recognizes drug users for their strengths and abilities and makes no assumptions about what is best for them. Participants inventory and prioritize their needs, which may or may not include changes in their drug use. This process lays the foundation for a partnership that both respects the individual and starts a dialogue about strategies for reducing harm and building readiness for change. As individual needs are identified, participants can be linked to specialized primary care, mental health, and substance use treatment within the HOPE Center. HOPE Center has been highly successful in retaining participants by offering a variety of services. While on-site drug or alcohol use is not tolerated, individuals who are under the influence of substances consumed elsewhere are welcomed as long as they comply with basic behavioral expectations and program safety is ensured. Importantly, intoxication itself never serves as a barrier to the wide array of resources offered within HOPE Center. For instance, all consumers are able to see the program’s psychiatrist, engage in medical treatment with a nurse, participate in psycho-educational groups, and utilize the many other resources the drop-in center has to offer regardless of their readiness for abstinence. (A psychiatrist is available twenty hours per week and a nurse, co-located at the HOPE Center in collaboration with HHO’s primary care services, is available 20 hours per month.) Utilizing a harm reduction approach, the staff counsels participants on strategies they can adopt to keep themselves safer as they engage in street life. Further, resources like condoms and other tools that are essential for reducing disease transmission are readily available. MHRI Midwest Harm Reduction Institute1 CORE PRINCIPLES OF HARM REDUCTION 1 • Harm reduction promotes the human rights of all individuals, including drug users and others who engage in high-risk behaviors: people who use substances and engage in high-risk behaviors have the right to be treated with dignity and respect. • While often focused on drug use, the philosophy of harm reduction can be applied to other populations and high-risk situations. • Harm reduction aims to reduce the harm of substance use and other high-risk behaviors. • We recognize that licit and illicit drugs are part of our culture and that some members of our society will always choose to use them. • Harm reduction offers a spectrum of strategies that includes abstinence as a goal for some who use drugs and engage in high-risk behaviors, while embracing and celebrating steps that reduce harm along the way and improve the quality of life for others. • Through harm reduction, we aim to reduce the stigma associated with drug users and other marginalized groups. • The harm reduction approach neither minimizes nor exaggerates the dangers of substance use and other high-risk behaviors. • Harm reduction includes educating people about the benefit of reducing or eliminating substance use and other high-risk behaviors. • Harm reduction acknowledges that drug use can be adaptive, helping some people survive and cope with traumatic life events. • The philosophy of harm reduction recognizes the resilience of people who use substances and engage in other high-risk behaviors. • People who use substances and engage in high-risk behaviors have the right to self-determination and collaboration in therapeutic relationships. • People who use substances and engage in high-risk behaviors have the right to safe and affordable housing, to health care, to vocational services, to benefits and entitlements, and to other supportive services. • Harm reduction embraces a wide range of treatment, recovery, and change options and seeks to expand access to such options. • As a partner in the change process, the helper’s stance is nonjudgmental; the decision-making power rests with the individual who is seeking help. • The effectiveness of the therapeutic relationship depends on the ability of the helper to be genuine and to establish and maintain a level of engagement with the active substance user. • Success must be continually and collaboratively defined and redefined: success is a process, rather than an event. A collaboration lead by Heartland Health Outreach, in consultation with the National Harm Reduction Coalition. For more information please take a brochure or call Scott Petersen at 773-751-4194. Evaluation: Overview Goal: To determine how the HOPE Center helps homeless persons who have substance use disorders and/or mental illness Includes program participant outcome evaluation and process evaluation • Participant Outcomes: In-person interviews conducted at enrollment (Time 1), 6 months past-enrollment (Time 2), 12 months past-enrollment (Time 3), 18 months past-enrollment (Time 4), and 24 months past-enrollment (Time 5) • Interview assesses: • Government Performance and Results Act (GPRA) • HIV/AIDS, infectious disease, and substance use risk and knowledge • Criminalization/victimization history, housing/homelessness history, quality of life • Client ranking of self-determined goals • Treatment history and service use information collected from client records • Service referrals to outside agencies collected from HOPE Center staff • Process evaluation: Over-the-phone interviews conducted every 6 months with outside agencies where HOPE Center clients were referred • Interview assesses impact of HOPE Center on the community Results presented include Time 1 to Time 3 data for 126 HOPE Center clients. Demographic Information (N=126 HOPE Center Clients) 6-Month Interview Follow-Up Rate: 12-Month Interview Follow-Up Rate: Gender Male N=74 (59%) Female N=52 (41%) 102/114 (89%) 84/94 (89%) Average Age of First Episode of Homelessness: 34 Years Average Total Number of Times Homeless: 4 Episodes Race African American N=79 (63%) Caucasian N=23 (18%) Hispanic/Latino N= 5 ( 4%) Native American N= 2 ( 2%) Most Common Reason for Homelessness: Alcohol and Drug Problems N=80 (64%) Income Sources (Time 1) (averages reported) Average Age: 43 Average Education: 11th Average # of Psychiatric Hospitalizations: 2 Earned Income Public Assistance Disability (SSDI) 552 Illegal Monies Other $ 355 $ 159 $ $1,114 $ 200 Drug and Alcohol Use Outcomes Use in Past 30 Days Time 1 # of Days (N) Time 2 # of Days (N) Time 3 # of Days (N) Any Alcohol* Alcohol to Intoxication (≥5 Drinks) * Alcohol to Intoxication (<5 Drinks) 17 (101) 15 (71) 10 (61) 15 (63) 10 (46) 8 (37) 6 (33) 4 (23) 4 (11) Any Illegal Drugs* 15 (95) 12 (60) 12 (50) (85) (55) (48) Polysubstance Use* (only N’s reported) *Denotes significant decrease between Time 1 and Time 2. • Extent to which clients had stress due to substance use significantly decreased from Time 1 to Time 2. • Extent to which clients reduced or gave up important activities due to substance use significantly decreased from Time 1 to Time 3. • Extent to which clients experienced emotional problems due to substance use significantly decreased from Time 1 to Time 3. Mental Health Outcomes Mental Health Symptoms (Not Due to Substance Use), Past 30 Days Time 1 # of Days (N) Time 2 # of Days (N) Time 3 # of Days (N) Serious Depression* 17 (103) 13 (77) 13 (54) Serious Anxiety or Tension 16 (101) 13 (72) 13 (53) Hallucinations* Trouble Understanding, Concentrating, Remembering* Trouble Controlling Violent Behavior* 12 (30) 8 (17) 6 (12) 16 (83) 13 (54) 14 (38) 14 (53) 9 (28) 9 (21) 1 (1) 2 (3) Suicide Attempts 9 (8) *Denotes significant decrease between Time 1 and Time 3. • Extent to which clients have been bothered due to these psychological or emotional problems significantly decreased from Time 1 to Time 2 and from Time 1 to Time 3. Other Outcomes Changes in Housing/Homelessness • Number of nights that clients spent in a shelter significantly decreased from Time 1 to Time 3 • Number of nights that clients spent in someone else’s apartment significantly increased from Time 1 to Time 2 • Percentage of clients who spent any nights outdoors significantly decreased across all three time points (Time 1 to Time 2 to Time 3) HOPE Center Service Receipt • Participants who attended the HOPE Center more frequently were less likely to experience anxiety or tension 30 days prior to their 6-month interview. • Participants who attended Substance Use Management Group were less likely to drink to intoxication (≥5 drinks) in the last 30 days prior to their 6-month and 12-month interviews. • Participants who attended Health Education Group were less likely to use crack/cocaine in the last 30 days prior to their 6-month interview. • Participants who attended Community Meeting were less likely to experience anxiety or tension 30 days prior to their 6-month interview. What I Want from the HOPE Center2 Time 1 • I’m homeless and want help finding a place to live* • I want to find out what benefits I may be eligible for* • I want to have more structure and focus in my life Time 2 • I want to find out what benefits I may be eligible for • I want more structure and focus in my life** • I want to learn some skills to keep me from returning to alcohol/other drugs** Time 3 • I want more structure and focus in my life • I would like to improve my health by learning more about nutrition • I want to find out what benefits I may be eligible for *Denotes significant decrease from Time 1 to Time 2. **Denotes significant decrease from Time 1 to Time 3. • Analyses of clients’ ratings of self-determined goals suggest that over time, HOPE Center services may be meeting clients’ needs in regard to housing, financial benefits, reduced substance use, and may help them have more structure and focus in their lives. 2 Adapted from “What I Want From Treatment” available in U.S. Department of Health and Human Services (2004). Enhancing Motivation For Change in Substance Abuse Treatment: TIP 35. U.S. Department of Health and Human Services: Rockville, Md.