San Francisco's "HMIS on Steroids" Is A Prime Example of Inter-Agency Collaboration

A couple of weeks ago, I had the distinct pleasure of presenting a workshop on Street Outreach for the National Health Care for the Homeless Council here in Nashville, Tennessee.  One of my co-presenters will be well known to folks around these parts, Carolyn Cooper, who spent a decade with the Mental Health Coop before recently taking on the role of Housing Coordinator for the Nashville Metropolitan Homelessness Commission, now referred to as the Key Alliance.    Carolyn's years of work on the street definitely brought a richness to the presentation thanks in large part to her own personal experiences, so having her alongside me was one of my better decisions!

The 3rd co-presenter happened to be Doctor Deborah Borne, who is the Medical Examiner for the Tom Waddell Health Center in San Francisco, CA., and I have to say that her level of energy and excitement for providing services to under-served and ignored populations is something that not only impressed me, it frankly amazed me.  She and her Outreach Director both flew into town on the red-eye, arriving in Nashville around 9am, and rather than hang at their hotel long enough to at least catch up on the time difference, they piled into my truck and visited Ken and Carols, where Reverend Pat and Mz Toi provided them with some reality checks on the status of folks languishing on our streets and alleyways around our otherwise fine and dandy city.

From there we bopped over to the Mission, then rolled down into the old Tent City.  The gate was open on the north side behind ICM, so we drove on through and went into what used to be the "heart" of the camp.  From there, we did some wandering while i filled her in as best I could on the camp's demise and where things are at presently.

We then tried to connect w some good "hole in the wall" bbq joint but the one I knew of over near Eastland, Carol -Anns (not sure I have the name right), was so busy that they only had fish left by the time we got there.

I dropped Deborah and Jason off at Jacks down on Broadway - yeah, yeah, it'll do in a pinch - with a promise to hook up w them both about an hour prior to our presentation.

The National Health Care for the Homeless Conference was held at the Legislative Plaza and went off without a hitch.  It was interesting to watch Dr. Borne move from her role as sightseer to trainer; I was so impressed w her that I'd go to work for her in a San Fran second if I didn't already have an outstanding job w its own fine folks who nurture my professionalism and help me grow grow grow as a pro!  Loads of fun for sure, but the biggest deal of all, at least to me, was when Jason shared w me the most amazing, collaborative and downright cool software program I think I've ever seen for folks who work with peeps stuck on the streets. 

Jason would probably be mad at me for lumping this incredible program into the same bucket as a standard Homeless Management Information System, but if anything fits that description, this program does and honestly it's about the only thing I really have to make an example with, since I've not seen anything else like it.

The program is  designed to both disseminate and coordinate information among a host of agencies and services.  I only saw "test case" examples, thanks to a rigorous and strict credentialing access system, but even so I was able to watch as the software revealed how many shelter visits the person had over the past year, how many ER visits, how many EMS calls responded to him/her, what meds the person was on, where they were receiving medical, mental health and general services at, nurses and treatment notes and what medications that person was on!  When queried, the program sends a probe  into the databases of local hospitals, shelters and agencies participating in the program and just about any information you might need is right at your fingertips!

Now, I can almost guarantee you that civil libertarians, and I would consider myself one, are going to be highly suspicious of this program and  it's definitely understandable.  There are a lot of ways the data could be used nefariously.  Already there has been at least one instance that I have heard of (trying t find the actual article on it now but am working on a very slow network that is causing me much frustration, not to mention boredom as I wait for pages to load) where police in some city were able to access the HMIS database, and in Asheville, North Carolina, I believe, there is an officer on the force who is trained in HMIS and has access. 

I still have a hard time supporting any "information collection systems" and this one is no exception, but I've got to say that the benefits, when used appropriately, are definitely significant.   One of he other cool things about this system - and one that brings me at least some peace of mind that it's not being used incorrectly - is that there are designated "snoopers" who log in and review the other "log-ins" on the system.  They are responsible for reviewing who is accessing what and whether the person doing the accessing, even if they have the appropriate credential level, has a direct need to view that particular case file.  As I understand it from Jason, the penalties for improper viewing are severe and include being barred from access, so it keeps folks from "browsing" through folks they aren't directly engaged with.  Now that feature is one I happen to really like a lot!

Michael (Bama) & Stacey Farley Wed at Tent City

For those of you who've spent time at Tent City in the months leading up to the Great Flood of 2010, it's likely you at some point had the pleasure of meeting one or both of the Farleys, although at that time, Stacey would not have been legally a Farley yet, although she probably was already thinking of herself as one.

The Farleys are one of four folks that are being filmed for a documentary on Tent City by Oprah Winfrey's network, Stick Figure Productions.

I was down handing off some footage of the camp at flood stage to the show's producers before the wedding then shot a bunch of great photos of Mike and Stacey getting married, Jeannie Alexander performing the ceremony, and Doug Sanders, Lindsey and Andrew Krinks, and Wendell Seagroves, who was the Best Man at the wedding.

The link to their photos is here and I wish Michael and Stacey many years of happiness and wedded bliss!

A Hiatus From Writing Doesn't Mean A Hiatus From Helping Others...

Okay, so I apologize to the one point seven peeps who read this drivel with any regularity; I've heard ya and you can stop sending me emails and comments to "please return" to the blogosphere.

I've been involved in a number of things that have taken the vast majority of my time, most of them computer/training related, and by the time I complete a 10 or 12 hour day on the keyboard or buried in research and writing, the last thing I want to do is head over to the blog and jam in another couple of hours rehashing all the stuff I've been up to.

Besides, I've learned from writing at Change.org that the dry, boring policy-making crap I'm involved with doesn't get a lot of hits.  Folks want sensationalism.  They want to read about "Bumfights" and folks who freeze or bake to death while on the street.  They want to hear about the man who is discharged from the hospital in a wheelchair, rolled out to the curb while still clutching his catheter bag and told to catch a bus or be arrested for loitering on hospital property.  They want to see images of the latest demolition of yet another Tent City, or watch some poor sod get busted for "obstructing the sidewalk" or "blocking a public passageway."  Figuring out how to stop this from happening to people is about as interesting to many folks as watching paint dry.

And basically, it's what I've been doing; figuring out how to provide better services to folks, how to treat people like human beings instead of the dregs of society, how to convince them that after years of hearing "sorry, we can't help you" there actually is someone now who can - and wants - to help. 

A few of the more notable things cooking:
A couple of documentaries underway that I have a small role in.  Oprah Winfrey's upcoming Tent City documentary (I'll get some pics of the Stick Figure production company up shortly as they worked to film a Tent City couple's wedding last weekend) is nearing conclusion after a year's worth of filming and following folks around, both before and after the "great flood" of 2010.   There is some footage of the camp underwater I shot about 3 days after the rains started that they've asked to use in the documentary, so I've been working a bit w them to finalize that.  You may also see a number of camp images in the documentary that also belong to me, although I'm not sure that's going to happen yet.

The other documentary is just getting started and if all goes well will be done by Patricia Foulkrod (also check out the Huffington Post's piece on Patricia here)  on a local female Iraq war vet who is dealing with issues of homelessness and mental illness after serving. Patricia contacted me after reading something I'd written here and at Change.org, so it was nice to see that the blog has been responsible for connecting me to people who have the potential to reach thousands, perhaps millions, with the work they are doing.

I've also been deeply involved in getting a brand new Consumer Advisory Board up and running for SAMHSA.  The Services in Supportive Housing Consumer Peer-Specialist Network (SSH CPN) has had its inaugural meeting, with six of the 8 new members on hand to receive a welcome aboard from SAMHSA federal project officers and project developers and coordinators for the Center 4 Social Innovation.  Additionally, I've taken the lead role in the more established, but differently focused Projects to Assist the Transition from Homelessness Consumer Provider Network (PCPN) and to that end have been working with the six active members of that group on several very interesting efforts.  The PCPN's mission aligns itself with the PATH mission and the focus is primarily on outreach and engagement, while the SSH CPN is going to play a large role in providing consumer input into the policies and projects SAMHSA will be establishing in the area of supportive housing.

Both these groups have the primary goal of ensuring the consumer voice is finally heard, and I cannot give thanks enough to the directors and colleagues at SAMHSA who have really been at the forefront of ensuring that we consumers actually have some role in crafting the treatment protocols designed to assist us!  What a novel concept (kin ya hear the heavy sarcasm???).  The folks at SAMHSA recognize it's really an organizational culture change they're working on here, and to that end have gone above and beyond the call of duty in working to bring our voices to the table.

I just finished a training w the National Health Care for the Homeless Council  right here in my backyard, and invited Carolyn Cooper, who recently left the Mental Health Coop to take on the role of Housing Coordinator at the Nashville Homelessness Commission, as a co-presenter.  She didn't let me down and basically stole the show with her wonderful insight into street outreach, based on the ten year stint as one of the Coop's Outreach specialists.  Also presenting with us was Dr. Deborah Borne, who is the Medical Director for San Francisco's Tom Waddell Public Health Clinic, and let me tell you, Deb is an incredible practitioner, not to mention a wonderful new friend.  Together with Carolyn, we had great fun with our presentation and hopefully were able to share some good insights with the conference attendees.  I know our session was one of the most heavily attended, so apparently we were offering something folks wanted.

Finally, I'm leaving for Washington DC on Dec. 6th for a week to attend the big PATH Grantee Conference.  Big WillyC will be presenting on SOAR at the event, and I've been orchestrating a presentation on Outreach and how not to get it done.  The entire PCPN group will be role playing through three skits and if they are half as good as the practice seesions indicate, I think folks are really going to enjoy themselves.

I will be out of town during our upcoming Project Homeless Connect and I'm bummed about that, but Denis Huey and I, along with about every person involved with the event this year, have been posting flyers and giving out the handout cards, so I imagine with the number of people who attend and who volunteer, they won't even know I'm gone.

I'm hoping it won't be so long between posts again but all work and no play do make Stevie a dull boy indeed!

HAPPY THANKSGIVING, EVERYONE!!!

"aggressively targeting alcohol... is a valid and necessary public health strategy"

If you've spent any time at all with folks who abuse alcohol, and I'm not talking here about social drinkers but rather those folks who are racking up their 5th, 6th, 7th  DUI or are heading to jail for PI (public intoxication) on an almost daily basis, then you know already just how devastating alcohol can be on a person.  That it's legal doesn't make it somehow less dangerous; in fact, it's actually far more dangerous, in my humble opinion, because it's on damned near every street corner and available 24/7 in most cities, towns and backwoods country stores.  

At least when I was struggling through my addictions to heroin and cocaine, it took some effort to find it.  With alcohol, the battle isn't in finding "good shit," but rather in ignoring the continual barrage of sight triggers as one passes through any part of Anytown, USA.  Also, because it's dirt cheap, an individual can get their fix on with practically the spare change in their pockets. 

Additionally, while crackheads and junkies are definitely dangerous (in the sense that they need money to cop and are so desperate to get it that they are capable of behavior that would ordinarily be out of the question for them at any other time) when they're fiending or on the verge of becoming "dopesick," chances are that once they cop their pouch they're going to leave pretty much everyone else alone and go get their buzz on.  I don't ever recall being hassled, threatened or attacked by a belligerent and completely irrational heroin and/or coke user who was actively under the influence at the time, but I've seen numerous assaults and batteries occur as a direct result of some drunken fool losing control of him or herself.  I've also seen far more than I want to of drunks who slaughter entire families on our nation's highways and roads as a direct result of alcohol consumption while driving.

In terms of costs to our society, I suspect that negative financial impact as a direct result of alcohol in some way, shape or fashion has easily trumped the costs of drug abuse in our society, and that's including what we've been spending annually on the "war on drugs" since the mid 80s.  Think about it, alcohol has been around loooonngg before this country was even a thought in someone's noggin and it's been causing problems for people about the first day after the very first batch of home-brew hit the goatskin bladders of those who learned how to make it.  

From costs associated with health, illness and complications resulting from alcohol use to the costs of crime, interdiction and restrictions to control it, we've spent a bodacious bundle on booze and its associated bad behavior.

I don't have a lot of answers here; prohibition was a dismal failure and frankly I believe that an adult has the right to choose what they want to put into their bodies.  However, just because you decide to put something into your system doesn't mitigate the fact that you're still in charge of your system and the behavior that may result as a direct result of the ingestion of some toxic chemical.....   


Alcohol more harmful than heroin, crack cocaine: study

(AFP) – 10 hours ago

LONDON — Alcohol is more harmful than illegal drugs like heroin and crack cocaine, a new study said Monday.

Scientists looked at the dangers to both the individual and to wider society and found that alcohol was the most dangerous substance, according to the study by the Independent Scientific Committee on Drugs (ISCD).

The results fly in the face of long-held opinions about which drugs pose the greatest dangers, with the authors claiming they demonstrate "the present drug classification systems have little relation to the evidence of harm."
"They also accord with the conclusions of previous expert reports that aggressively targeting alcohol... is a valid and necessary public health strategy," said the authors.

Drug experts on the committee devised their own system to judge substances and believe their consensus provides a valuable assessment which could guide policymakers.

The research, published in medical journal The Lancet, looked at the how much a drug harms the human body as well as other factors such as what its use costs the health care and prison systems.

Heroin, crack cocaine and methamphetamine -- or crystal meth -- were found to be the most deadly. But when the wider social effects were factored in, alcohol was the most dangerous, followed by heroin and crack cocaine, said the study.

Substances were given a mark from zero to 100 based on certain criteria, with alcohol scoring 72 overall followed by 55 for heroin and 54 for crack.

One of the study's authors was David Nutt, a former British government drugs adviser during the previous Labour administration.

He was sacked after a disagreement with the government over the decision to upgrade the classification of cannabis.

The ISCD says its remit is to investigate and review scientific evidence relating to drugs, free from political concerns.