The opportunity that Prevention Point has given me is incredible. They’re giving me the opportunity to work, they’ve helped me with my psych meds, they’ve helped me with my addiction, to learn how to cope with it. All of the case managers here just tend to look for the better, but it is up to you. They can put out a plate, but if you don’t eat from it you’re not going to get full.
That’s what they give us here: an opportunity. They tell you, ‘Do you want to get on Suboxone? We’ll help you get on Suboxone.’ They help you with so many different things that come with addiction that a lot of people don’t see. There’s more to it than just changing needles. There’s the Step program, there’s the outreach program, they try to get you housing, they try to get you into shelters. At Prevention Point, they try to help you love yourself.
Phil Costello – Clinical Director, Greater New Haven Healthcare for the Homeless, Cornell Scott-Hill Health Center
When I got pregnant, I was still homeless on the streets in Philly. I met a doula who hooked me up with Maternity Care Coalition to help me get situated in a treatment program for mothers and their babies. They help you with housing for the future, we do AA, NA, life skills, budgeting, and of course parenting. When I came here, I literally had four outfits for my baby and a pack of diapers, and no income because I didn’t have my cash assistance at that time. She goes to a lot of specialists because she was premature and they’ve helped me get to her appointments.
The program is 6-12 months and you have therapy that deals with trauma and different classes, like we go shopping on certain days and they teach you how to manage your money. In addiction, I always had cash and I would blow it. Now I have a credit card and I have a bank account—I never had that kind of stuff before. So they help you learn simple things like how to cook a meal and balancing your nutrients. They’ve really helped me so much.
I was very nervous to become a full-time mom. People look at moms who have been in addiction and they’re like, ‘She never should have had kids.’ Well I just look at it as people change every day. You never know what someone has been through or what they’re going through so I just wish people were more open minded about all of this. With the Maternity Care Coalition, I do have a lot of support, and that’s really the thing I needed, because my family is not here. Without support and people boosting up your self-esteem, I feel like that’s what makes people fall back down a lot, because they don’t have those positive affirmations all the time.
Khamyia – MOMobile Rapid Engagement Program Advocate
My family is accepting but it took them a while to get the pronouns and everything like that. Growing up in an African American family, a Christian family, it was a little rocky. After I came out as trans, we had arguments because they wanted to keep calling me by my old name and the old pronouns and l’m just like, ‘I respect you enough to call you Auntie and Uncle still, could you at least respect me enough to call me by the name and the pronouns that I would like to go by?’ One day I went back home to visit and I was getting introduced, “This is my niece” and I’m just like, wow. It was a lot of fighting I had to do to get to where I’m at today.
Now it’s way better. My family are like, ‘She’s this, she’s that, Armani, how are you doing?’ I’m considered one of the female cousins. I think it changed partly because of me being happier and just living my life. My family saw that and it was like, ‘Whoa, we have to love her for who she is.’ I woutheld say just me having the confidence and the attitude to be proud of who I am. My mom passed away before I came out as trans but she taught me to fight for that respect.”
The Ruth Ellis Center has helped me so much. I needed the help that any homeless person would need but more because I’m a working trans girl. It’s a stress thing. It’s like every day I’d wake up and if my room was not paid for, I’d have to hopefully get a client so let me bump my app, bump my awhipp. Once the room is paid for, I go back to sleep. Why? Because I’m up all night. So they’ve kind of taken that weight off my shoulder. I can come to a place where I can relax, where I can get that off my mind, like, ‘OK, I don’t have to do this for a little while.’ I’m thankful to be in a program like this to help people like me get out of being one of those escorting working trans girls who have to work, work, work, just to get her boobs done.
They said they would be able to help me start my hormones, they’re helping me get a place to stay, they’ve helped me build my confidence back up. They’ve helped me know that there are people who care they’re like a really big support system. It was a long fight for me but if I can make it six years of taking care of myself, being homeless, couch to couch, walking in the streets with six inches of snow during the wintertime all day and night, if I can make it, the next girl can make it. I’m never going to forget that journey that I had to take to get to where I’m at today, but I’m finally where I’m supposed to be.
I want to be able to speak out for the trans community on the issues and the topics that aren’t being talked about. I want to be a voice for people that are scared to come out and the homeless girls who are working like me. It’s the disrespect that trans women get. I’ve been called bitch, I’ve been threatened to get put in trunks, I’ve been threatened by people who want to fight me just because I didn’t want to have sex with them and other types of things. People don’t talk about those issues they just talk about how we get disrespected but they don’t talk about the reasons why we get disrespected. We have to have more trans women speak up about things like this.
LaDonna Smith – Executive Director, Serenity House
I work on our Overdose to Action grant so the main two things we focus on are opioid use disorder education and prevention and then overdose response. A big percentage of my job is doing street outreach. With people on the street, they know all about opioids so our delivery is more around how can we help you? Are you ready for treatment or how can we meet you where you’re at?
If you don’t want to talk to me about opioids but you want to talk to me about your dad, your daughter, or your trauma, I’m here, I’m listening. You build those connections where people eventually start to trust you and they start opening up to you. Then you’re able to better connect them to the resources that they need and maybe steer their life in a different direction.
When we talk to businesses about providing Narcan trainings, some people think that an overdose is never going to affect them, it’s never going to happen to the people that they serve. We try to come in and teach that it can happen to anyone—it doesn’t matter if you’re a supermarket or a convenience store, this education can apply to you. Stigma keeps people from talking about it but most people know someone who has overdosed or had issues with substance misuse.
If people are hesitant about Narcan training, we talk to them about their business and why it would benefit their employees to know how to respond to an overdose. Like for example the vape shop, they have close connections to the community and to their clientele so that’s what we would focus on. You know your clients better, you are in between the health department and the population—the people that we can’t reach you can.
Andressa conducting a Narcan training session at a local business.
DESK started in the same way a lot of soup kitchens and homeless shelters in modern America started: in the 1980s, people started seeing homelessness on the streets of urban America for the first time in a generation. This was due to the confluence of mental health facilities closing in the 60s, people returning from a very unpopular war without the veterans’ services they needed, an economic downturn and Reagan’s decision to defund social safety net programs, and then the crack epidemic. So we had this explosion of people sleeping out on the New Haven Green—they had no place to go.
The churches lining the green looked at this and said, ‘What can we do?’ They founded a cooperative group of organizations and one was the Downtown Evening Soup Kitchen. In those early days, it was people making potluck food at their homes and serving it on tables in church basements. Over the years it grew to a dinner program seven nights a week and a food pantry where people could get groceries once a week.
A few years ago, we decided to focus more intently on the unsheltered population. We were finding that people were coming to us for dinner but that there was so much more that they needed. We didn’t want to start hiring case managers, social workers and outreach workers because there are so many other organizations in New Haven doing that. What we were doing well was providing a space, so food and other basic needs were serving as a hook to get people in the door. In 2017, we began partnering with organizations that provide those other services that could help move people beyond homelessness.
Many people who are on the street don’t know what the next step is, or they aren’t homeless yet but they’re teetering on the edge. Soup kitchens and food pantries are the first stop for many people so we have this opportunity to catch them before things get worse. By working with all these other organizations, we can provide those next level support services like healthcare, housing and shelter outreach, and harm reduction and mental health interventions right in house.
As DESK expanded, it became clear that we needed a space that was more accessible, in terms of location and time as well. We wanted to be open longer hours so that people could come to us in the middle of the day to use the restroom, or come in and get out of the cold. Not just a place for people to go where they felt safe, but a place for them to actually occupy themselves. That could be something as simple as hanging out and chatting, playing cards, or doing art classes, but it could also be support services like helping people work on job applications or connect to mental health and substance use treatment programs.
When we originally had this idea for a drop-in center, we brought together our partner organizations, about half dozen of our guests, and other community stakeholders, people who live and work downtown and are affected by homelessness and substance use and mental health issues on the street. We started with the premise of, if we were to create a downtown drop-in center servicing the homeless population, what would it look like and what would it have? We can’t be everything to everybody, but we’re going to try to create an advisory board where the people who are utilizing the services can lead the way. Instead of telling them, ‘This is what you need and this is what I’m offering,’ asking, ‘What do you need? How can we help you?’ I think that’s the best approach for this work.
Harm Reduction comprises a spectrum that views people who use drugs as more than their drug use.
One thing we’re trying to launch as part of our overdose education is a workforce development program, so not waiting for people to come to our training at a library at 7:00 pm on a Thursday night when they have other responsibilities but bringing it to their place of work. So going to liquor stores and other businesses that may overlook their connection to the crisis.
We’re also targeting our training to high-risk occupations like factories and delivery services. They’re often working all night long, trying to keep up with the demand and it’s physical work so they’re prone to injuries. They might be using stimulants to keep themselves active, and they need to be aware of the risk of overdose and the impact it’s having on various demographics.
A lot of people think substance use has nothing to do with them and that’s why we like to tailor our messaging based on our audience. If I’m out in the community saying, ‘Come to my Narcan training,’ most people don’t talk to me. But if I say, ‘Do you have any medications in your home you need to dispose of? It’s important to safely store medications and dispose of them properly.’ Or if I ask, ‘Did you know the medications in your home can be dangerous and accidental poisoning is a common thing?’ Everyone has medication in their home so easing into the conversation and making it relatable is key.
One thing we’re working on is a post-overdose response program. We see about 20 or 30 overdoses a week, but some people are too scared to call 911 and others are equipped with Narcan and have the capacity to respond themselves, so those overdoses may go unreported. So we’re trying to make sure that if we have the information, we’re following up with those people. It’s all about building those relationships and that trust.
It’s such a critical window after someone survives an overdose that we’re going in with a harm reduction approach. If you’re not interested in treatment, we’re going to give you some Narcan and make sure that you’re aware of what’s circulating through the area, how to respond to an overdose, and how to prevent one. But if you are ready for treatment, we have so many partners in the community that can help you and they all bring something different to the table.
So we can pick up the phone and say, ‘Hey, I have someone ready, can you start them on buprenorphine and explain the induction process?’ I think we’re doing a great job at establishing those relationships to make sure that we don’t miss an opportunity to engage with someone and potentially prevent a fatal overdose down the line.
I think people hear about Narcan and the opioid crisis and they think of heroin, but it’s so much more than that right now. We’re finding fentanyl being pressed into Xanax pills and mixed into cocaine and other stimulants. An approach that I’ve taken with a lot of parents is emphasizing how there’s a lot of pressure being a teen. You want to be successful, you’re going to do what you have to do to keep up. So if kids hear that someone is selling Adderall, they may think, ‘I could get that, that’ll help me get through this.’ It’s just that desirable effect without understanding that it could be dangerous and you actually have no idea what you’re consuming. You have to have these conversations with your kids.
Our campaign is ‘Connect Without Stigma,’ so Connecticut without stigma—really trying to address the ongoing stigma surrounding not only substance use but also mental health. In addition to messaging to share data, we created a website, connectgnh.org, to connect people to harm reduction and treatment resources in the Greater New Haven area.
I think there’s a lot of media attention on this person died of a drug overdose, but how did they get there? What happened to them? We need to understand more about what led up to that overdose and talk about success stories so people have a new way to look at addiction and see that recovery is possible. That narrative about different pathways to recovery still isn’t widely shared.
Participant in QVHD overdose education and Narcan training at a store in New Haven, CT.
I oversee a team of case managers, early intervention specialists, our care coordination team, and our patient navigator team. I help them navigate issues they may have problem solving with clients. We assist clients with services they need, from basic needs like food, housing, and transportation to their medical care or any other needs that they may have.
We pretty much advocate for our clients. For example, if a client runs into a situation where they’re about to lose their housing, we step in and help them find resources around the area that can possibly help them either pay their past due rent or possibly move them to a new location. So we just try to help them navigate stuff that they’re not able to or connect them to services they didn’t know Genesee county may offer.
Sometimes clients are not willing to talk to their doctors, and a lot of times doctors may only discuss their medical care, not knowing for example that this person is homeless. So we’re there to help them with things like, ‘OK, you have some medical needs right now but your priority might not be that. Let’s see what we need to do to get you housed and get you stable, so we can go back and look at your medical care.’ We don’t turn them away and say, ‘Well, we can’t help you.’
I just try to have that connection with my clients because sometimes they might not have someone that actually cares enough to be concerned about what else is going on in their life. So let’s talk about the problems that you have at the moment and then once we work through that stuff let’s talk about getting you back into medical care. We also go to appointments with our clients. If they don’t feel comfortable speaking to a doctor or if it’s somebody they’re not used to, I will go with them and talk to the doctor so we can build a relationship and break those barriers that we’re having with providers.
Jenna Mellor – New Jersey Harm Reduction Coalition Executive Director
When I was living and studying in New Brunswick, I noticed how large the homeless population was and I often struggled with feelings of privilege and wanting to do more to provide for people who don’t have as much. Even just helping out today, I’ve seen how much people need: some form of shelter, tents, coats, blankets, and obviously meals. I volunteer with SHILO (Supporting Homeless Innovatively Loving Others), which partners with the New Jersey Harm Reduction Coalition and other groups to help take care of people in the community.
It was great to see how comfortable people felt coming up and directly asking for things they needed, like Narcan or condoms or wound kits. Some people talked about how they had used these items to help others and wanted more supplies so they could be prepared in the future. By distributing these resources in a way that respects human autonomy and dignity, the stigma gets chipped away and it becomes a lot easier to help more people.
New Jersey Harm Reduction Team distributing essential supplies to community residents.
I became homeless out here in the streets about two years ago. I went to a soup kitchen and that’s when I connected with Jason and more recently SWAN. When they got their van, they started coming out every week. I mainly rely on them for the clean needles because I do know some people that have contracted certain diseases. With intravenous drug use, there’s a lot of risk we take so they alleviate that by providing clean needles and information on where to go if you need help with treatment. So it’s a great service, they help out a lot and I’m very appreciative that I was able to connect with them.
I always carry Narcan in my backpack, the nasal and the injection one. I have Narcan’d nine people just this last winter. Unfortunately, one didn’t make it but the others were able to survive so I was grateful that I was able to possibly save a life. Without that Narcan, they might not have made it. I don’t like seeing someone overdose but you can’t turn a blind eye out here because it happens and people need the help.
Steve talking with Downtown Evening Soup Kitchen volunteer Marsha.
Through our Healthy Babies program, we work with babies that have been affected by prenatal exposure to substances or in other ways affected by parental substance use. We follow the baby and the family during pregnancy up until the baby is a year old and make sure that whatever needs they might have we can support them. That could be safe sleep education, pregnancy and breastfeeding education and also case management—linking them to benefits such as WIC and making sure that they have a doctor for their prenatal, postpartum and pediatric care. If they’re in treatment for substance use, we make sure that they can get there. We’re kind of like the glue that keeps the client connected with all of the resources that are going to support them. We use a community health worker model, so a lot of our staff come from the same communities and share similar languages and oftentimes similar culture, so they can build trust more easily than somebody who might be from another world.
With neonatal abstinence syndrome, the research and the evidence has been changing very quickly. At first, they were using a lot of medications with the babies. Now they have discovered that the best medicine for a baby with NAS is proximity to their mother and the breastfeeding and the nurturing. So we help mothers cope with some of the symptoms and if they were using medication assisted treatment, just validating that and supporting them in a non-judgmental way.
Our new MOMobile Rapid Engagement program is about finding women who might otherwise have fallen through the cracks and being able to support them as early on as possible in their pregnancy or after they’ve given birth. Sometimes clients might not be ready for treatment and we help them with some harm reduction resources. If they are in treatment we’ll encourage them and help them stay engaged. But our focus is really on parenting and celebrating their successes in that area, and building confidence and self-esteem.
Taylor – New Jersey Harm Reduction Coalition Volunteer
We organize twice a week deliveries of bulk harm reduction supplies to street-based sex workers, most of whom use drugs. The idea is that you have secondary distribution so the supplies also get to their friends and community members. The core supplies are for drug use and sex so things like condoms, lube, wound care, Narcan, syringes, smoking kits, and now hand sanitizer and PPE and pepper spray, if we can get it. But it’s definitely an evolving thing based on what people are requesting and what we’re able to obtain.
Christine – SWAN Outreach Worker