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    t3 Threads: Changing the Conversation

    To Providers Who Do their Best: Thank You!

    I often write about relationships between providers and people they serve. It is very easy to look at services and write about what is wrong and what needs fixing. However, I do think that there are more respectful and caring providers and agency personnel than not.

    As a young adult, I was homeless. I had been in and out of hospitals and was discouraged about my chances of being successful in therapy. My moods were all over the place, and I was having intrusive memories. I was trying very hard to find housing. I showed up for appointments. I was so scared and angry at the possibility of being turned down that my intolerance for disappointment was reflected in my attitude. I was anxious and certain that no one wanted to help. 

    Role of Relationships in Substance Use Recovery

    Human connection is an integral part of social and emotional health and well-being. Think about the many connections, friendships, and relationships that shape your daily life. When you are in need of support, these relationships are key to providing guidance, happiness, and stability.

    Social supports act as a crucial determinant for shaping health outcomes. Research suggests relationships are a significant factor in determining substance use and recovery outcomes. Studies of adolescents suggest that family support and involvement acts as a protective factor against substance use. A study of women experiencing homeless found that those who had less social support were more likely to engage in illicit substance use. A common affirmation in the recovery community— people, places, things—points to how important people can be in impacting one’s journey to recovery. Social networks, including family, friends, community and kinship ties, can act as risk or protective factors in determining an individuals’ path toward recovery.

    Recovery Benchmark: Sustaining Relationships

    Recovery outcomes are valued goals of services throughout the nation. Relationships that empower and encourage choice and self-direction are hallmarks of all activities that support recovery. 

    It is a beautiful Sunday morning. A friendly visitor is coming to my house today. She is a young person studying at a university in Boston. I am looking forward to our meeting. She is just starting out in life. I am in the older stages of life. When we are having coffee, I realize we are speaking the same language. The generation gap is not evident in our communications. She reminds me to be energetic and hopeful. She makes me laugh. She is a bright spot in my day. I trail off in my thinking…I wish I had family and children in my life. I am alone most of the time. I actually like my company, but occasionally I lament that along the path to recovery I did not construct my own family. I realize the importance of relationships and quality of life in promoting recovery.

    Helping Children Respond to Homelessness

    My kids have known about homelessness since the moment they knew about things. They are currently 5 and 8 years old and were gestated, born, and grew up while I was running a drop-in center for homeless young adults. In addition to constantly hearing about my work and people with whom I worked, they came to picnics, holiday parties, talent shows, and many other community events connected to the drop-in center.

    They knew by name some of the young adults who lived or panhandled on the streets of Harvard Square. They made pictures for my clients who moved into housing “so they have something pretty on the wall." Their room is decorated with artwork created by homeless young adults; they say “I hope I can be that good at art one day.” One rainy and cold fall morning, my oldest – who was 6 at the time – looked at me over breakfast and said “Rain, rain, go away. Mama’s friends have nowhere to stay.” My children are aware of homelessness, poverty, and injustice – understanding this is part of understanding their mother.

    Providing Quality Minority Mental Health Care

    Research on “health care disparities,” the euphemism for unnecessary deaths and adverse outcomes among people from low socioeconomic groups and from communities of color, often attribute them to individual characteristics and structural barriers within mental health systems. Most often an individual’s use of services as well as the way services are arranged and delivered are cited as causes.

    I want to begin by commenting on what is going wrong and then discuss what is hopeful in the provider-client relationship. Although research is taking place, there is little agreement about best practices and ethical standards in minority mental health care. The issues of staff bias, racism, institutional racism, prevailing practices, and methods of prioritizing who gets time and attention are omitted from the discussion. Also, questions of discrimination that stem from preconceived notions and racial profiling of African American people and/or questions of how stigma influences medical decisions are absent, if not actively avoided, in discussions of healthcare disparities.

    Gaslighting: A Story of Trauma and Resiliency

    Gaslighting typically happens very gradually. In the beginning, the gaslighter’s actions seem harmless, if a little bizarre. Over time, however, abusive behaviors escalate. Subtly dismissive language and loving platitudes give way to mockery and blaming. “I didn’t say anything. You must be hearing things," gives way to “You never take responsibility for your actions,” to “Clearly, I can’t trust your account of things.” You start to doubt your own memories, experiences, and feelings. Friendships frost over. You become quiet, but your mind never stops buzzing.

    Gaslighting is an abusive tactic defined by the “systematic attempt by one person to erode another's reality by telling them that what they are experiencing isn't so, and the gradual giving up on the part of the other person.

    Trauma Therapies Support Enduring Sense of Safety

    Trigger Warning: Trauma re-enactment

    I am 65 years old and a trauma survivor. When I entered therapy, I was labeled as having an adolescent adjustment reaction. Years later, the mental health label was changed repeatedly—from schizoaffective disorder to post-traumatic stress disorder (PTSD) and major depression and then later to dissociative identity disorder, paranoia, and bipolar disorder. It was clear to me that my trauma symptoms determined the diagnosis. I wanted a cure and a reduction of my symptoms, instead of a variety of methods to merely manage them.

    My commitment to making therapy work was matched by the efforts of my therapist. She is a learner spirit and as tenacious as I am. Even so, it has taken a lifetime to arrive at an enduring sense of safety and freedom from the daily derailing of my consciousness by the intrusion of trauma memory content. Therapy changed as new knowledge of the impact of trauma emerged. I wondered if there was a way to combine therapies to improve the quality of my life and speed recovery.

    Elder Homelessness: Acknowledging the Need and Responding

    We see the need almost every day. As we move through our daily routines, we encounter people who are experiencing homelessness. Occasionally we will drop change in their cup or walk on the other side of the street. On any particular day, we may be on our way to Starbucks or to the grocery store when we notice a person who is experiencing homelessness. We sadly lament…it is horrible that a person is elderly and homeless. We stop and think about the horrors of homelessness, especially for elders. Then we continue on our journey...

    Substance Use: Innovative Prevention & Early Intervention

    The opioid crisis has reached epidemic levels, with nearly half of Americans now reporting they personally know someone who has been addicted to prescription painkillers. Despite growing recognition of the problem and concerted efforts to drive practice and policy solutions, significant challenges remain.

    While people often begin using alcohol or other drugs during adolescence and young adulthood, only 10 percent of 12-17 year olds who need substance use treatment actually receive services. When they do, they are much more likely to receive services while in the criminal justice system rather than through other avenues, such as their school or health care provider. These sobering statistics speak to the difficulty of identifying and helping at-risk teens before their substance use becomes a problem.

    5 Tips to Help People Experiencing Homelessness in the Heat

    Most people know the impact of winter weather on people experiencing homelessness, but few realize the risk that summer heat places on those living on the streets. With temperatures rising and few places to escape from the heat, experiencing homelessness in the summer months is not only uncomfortable, but can be an extreme health hazard. Asphalt and concrete heats from the suns rays, posing a danger to those who may have no other option but to make a home on the street. Hot summer temperatures increase the risk of dehydration, sunburn, and disorientation. Data suggest that heat-related illness is more likely to impact individuals from lower socioeconomic backgrounds and that “very poor, and socially isolated individuals are disproportionally affected by heat waves.

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