Outreach to People Experiencing Homelessness

A Curriculum for Training Health Care for the Homeless Outreach Workers

Module 2 Navigation: Preparation – "Starting on Solid Footing"

  1. Connecting Values and Visions

  2. Self-Care for Outreach Workers

  3. Worker Safety - Precautions & Interventions

  4. Culturally Competent Outreach

Module 2B: Self-Care For Outreach Workers

Purpose To highlight the importance of taking care of oneself in order to provide effective outreach and engagement services

Recommendations for Instructors The learning activities in this section are designed to engage participants with the subject material using informative and interactive approaches. Instructors will need to determine which, if not all, of these activities to carry out depending on a) participants’ learning needs and interests, b) the focus of the training, and c) time available.

Instructors are encouraged to prepare for each activity by reviewing the handouts to be given to participants and by reading the recommended resource papers and materials that are listed. These papers and materials, along with other relevant resources, will provide useful background information to assist in fulfilling the purpose of this section. The amount of time suggested for each activity should be adjusted as needed.

The following issues of Healing Hands, the newsletter of the HCH Clinicians’ Network, are recommended as background reading for the various activities in this section on self-care.

Sustaining Hope in Poverty Medicine (June 1998)

Coping with Stress, Creating & Maintaining Hope (December 1999)

Resiliency and Renewal in Our Work (February 2002)

ACTIVITY 1 Self-Care: The Great Debate (Skit)

Purpose: To acknowledge the "mixed messages" we often hear about self-care in our lives and work settings

 

Time: 12-15 minutes

 

Materials: Handout: Self-Care: The Great Debate

 

Preparation: Based on the handout, envision how you might stage this skit about the "debate" between the Voice of Self-Care Wisdom and the Voice of the Work. You will need two copies of the handout, some chairs, and possibly some props for the characters – use your imagination!

 

Procedure:

 

  1. Ask for 5-6 volunteers. Set up an impromptu stage scene using members of the participant group as characters. From these volunteers, choose one person as the Voice of Self-Care Wisdom and another as the Voice of the Work. The remaining 3 or 4 volunteers are a team of Provider Staff in the agency.

  2. On stage, the Voice of Self-Care Wisdom is leading a workshop for the Provider Staff. It should be a rather intimate and friendly scene with the staff paying close attention to the Voice of Wisdom. The "Voice of the Work" character can be positioned somewhere off-stage, perhaps even out of sight at the back of the room. Alternatively, the "Voice of the Work" might be positioned right in the midst of the Provider Staff representing both an internal and an external voice.

  3. The play begins with the "Voice of Self-Care Wisdom" welcoming the group to the workshop and then beginning to offer sage advice (from the handout) to the staff in an engaging, somewhat lilting voice: "Stop denying. Listen to the wisdom of your body. Begin to freely admit the stresses and pressures that have manifested physically, mentally, or emotionally." The group listens attentively to these words of wisdom.

  4. From afar in a disembodied manner, the "Voice of the Work" intones: "Work until the physical pain forces you into unconsciousness."

  5. Continue the scene in this back and forth manner as the Voices read their parts responsively. The Provider Staff should be instructed to demonstrate corresponding bewilderment on their faces as they listen to these "mixed messages."

  6. At the conclusion of the skit, ask the Provider Staff to comment on how it felt to be caught in the middle of these different "voices." The audience can be invited to participate as well.

  7. Comment that the voices of both wisdom and the work can come from attitudes and beliefs from within as well as from external sources. Either way, it is important to acknowledge that staff and the organizations for which they work both have legitimate needs that are sometimes at odds. Staff need to find a healthy balance between the two and be aware that this balance may shift at different times. Helping one another to monitor this balance is beneficial.

 

ACTIVITY 2 The Experience of Outreach

Purpose: To help participants appreciate the richness of the experience of outreach … for both its challenges and frustrations as well as its potential to be rewarding and life-giving

Time: 25-30 minutes

Materials: Handout: "Outreach …"

Preparation:

Read the handout, which describes the author’s experience of doing outreach. Reflect on your own outreach experience. Perhaps you have written down your own thoughts, feelings and insights in the past. If so, consider sharing these with the group. If not, take some time to jot down some of these reflections in preparation for facilitating this activity.

Procedure:

  1. Begin the activity by taking some time to speak from your own personal experience about what it has been like for you to do outreach. Share any relevant writing you have done, for example, poetry, lyrics, or journal entries. Talk about the reality and nature of outreach work from your perspective and the ways it has impacted and influenced you. You might also include observations from other workers’ experience as well.

  2. Introduce the interactive part of the activity by noting that outreach workers tend to experience their work as having "both/and" qualities – both challenging and rewarding. Read aloud from the handout: "Outreach … exhilarating and exhausting … drives me up a wall and opens doors I never imagined …" and so forth.

  3. Ask participants to spend some time in silence, reflecting initially on the question: What lays heavy, drains you, drives you up a wall, leaves you numb, breaks you apart in this work? Encourage them to jot down whatever comes to mind.

  4. After a few minutes, ask participants to consider the question: What feeds and inspires you, gives you joy, makes you feel alive, renews hope, and heals you in this work? Again, urge them to write down their thoughts.

  5. Have each person find a partner. Invite them to share with each other what came up during this time of reflection in regard to these two questions. Gauge the amount of time needed for this part of the activity by checking in with the group periodically.

  6. Reconvene the group and ask what themes emerged in these interchanges. As will likely become evident, note how the same activities, listening to clients’ stories for example, can often be the source of both a sense of burden as well as a gift of inspiration.

 

ACTIVITY 3 Signs and Symptoms of Secondary Traumatic Stress

Purpose: To identify some of the signs and symptoms that outreach workers commonly experience as a result of this work

Time: 15-20 minutes

Materials: Handout: Signs and Symptoms of Secondary Traumatic Stress

Preparation:

The nature of this work puts us in touch with considerable human trauma and suffering. Working with people experiencing homelessness is like working in "urban refugee camps." Many, if not most, of our clients have been traumatized not only by the circumstances of homelessness, but also by significant physical and/or psychological trauma experienced previously in their lives.

Mother Teresa once said, "Give not only your care, also give your heart." Many dedicated outreach workers do just that. Consequently, by entering into the painful reality of people’s lives, workers necessarily will experience some level of suffering in an indirect manner. This experience is variously referred to in the literature as vicarious traumatization, secondary traumatic stress, or compassion fatigue, all of which can lead to burnout.

The symptoms of secondary trauma are identical to those of post-traumatic stress disorder, except that the exposure to trauma is indirect rather than direct. Nonetheless, these signs and symptoms are quite real and very common among outreach workers. Laurence Miller states that "doing trauma (work) is not for everyone. It’s tough, grimy, demanding work that can take an exhausting toll on its practitioners." Though referring specifically to trauma psychotherapists, this statement is relevant for outreach workers as well.

Issues regarding secondary traumatic stress need to be acknowledged and addressed as part of training for outreach workers. This activity is designed to name some of the common signs and symptoms of secondary traumatic stress and to have participants reflect on their own past experience and to be aware of potential signals they might experience in the future.

Review the handout and complete it for yourself prior to doing this activity with your training group.

Procedure:

  1. Provide a handout to each participant and request that each completes it.

  2. Have participants discuss their comments, questions and insights that result from completing this tool either in pairs, small groups, and/or in the large group, whichever seems most "safe" and appropriate.

  3. In addition, discuss with the group practical steps they might take to address specific concerns when they arise. (The following activities in this section will be helpful in this regard.)

 

ACTIVITY 4 Self-Care ("Twenty Questions" Game)

Purpose: To spark suggestions and new ideas for ways to practice self-care through a playful, interactive game

Time: 15-20 minutes

Materials: Peel-off nametags that adhere to your clothes

Preparation:

Be sure you have as many nametags as there are people in the group. Each person will write a self-care activity on the nametag and then stick it on someone else’s back to start the game. The rules of the game are the same as the traditional Twenty Questions game in which each player, asking questions that can be answered only with a "yes" or "no", tries to guess what’s written on her/his nametag using as few questions as possible.

Procedure:

  1. Hand out the nametags and instruct each person to write any self-care activity they wish on the nametag. Urge them to consider self-care in broad terms, including the physical, psychological, spiritual, and social aspects of one’s being. The activity needs to be specific and stated succinctly, in five words or less. Each player is to print the activity in large letters on the nametag.

  2. To begin playing, instruct everyone to get up and stick the nametag on someone’s back as they start milling around the room. That individual of course should not know what the nametag says.

  3. Each player roams around asking different players questions that can only be answered with "yes" or "no" answers. From these responses, the player attempts to deduce what is written on the tag on her/his back.

  4. The responding player must have read the other person’s nametag of course in order to know whether to answer affirmatively or not.

  5. As each player correctly guesses the activity on his or her nametag, the tag is transferred from the back to one’s chest and continues to play by answering other player’s questions. The game continues until everyone has guessed (or given up guessing) the activity on his or her back.

  6. Take a few minutes to "debrief" the game experience to see what new ideas it might have sparked in regard to self-care.

 

ACTIVITY 5 Self-Assessment Tool: Self Care

Purpose: To use a self-assessment tool to rate yourself in the areas of physical, psychological, emotional, spiritual, and workplace self-care

Time: 15 minutes

Materials: Handout: Self-Assessment Tool: Self Care

Preparation: Complete the self-assessment tool yourself and think about your responses to the follow up questions listed below. Alternatively, do this exercise with another person, or small group, and discuss it among yourselves.

Ensure you have a copy of the tool for each participant.

Procedure:

  1. Hand out a copy of the self-assessment tool to each participant and request that each one takes about 5-7 minutes to complete it. Emphasize that this is not an all-inclusive list, but a representative list of self-care activities. In addition, it should not be inferred that everyone should be doing all the things mentioned here. This tool simply provides a snapshot of one’s current state of self-care.

  2. Once completed, discuss in pairs, in small groups, and/or as a large group what ideas and issues it raised. Below are some possible questions to which participants might respond:

  • Were there any surprises? New ideas you hadn’t really thought of before?

  • Which activity ideas seem like they would be more a "burden" than a benefit to you?

  • What are you already doing to practice self-care in the physical, mental, emotional, spiritual, and workplace realms?

  • What activities particularly spark your interest? How might you incorporate them into your life sometime in the future?

  • What is one activity or practice you would like to "try on for size" starting now or as soon as possible?

 

ACTIVITY 6 Mindfulness and Self-Care for Outreach Workers

Purpose: To identify some practical methods to integrate mindfulness into everyday life and work as a way of handling ongoing stress

Time: 15 minutes

Materials:

Handout: Mindfulness and Self-care for Outreach Workers

Resource Paper: Mindfulness and Mastery in the Workplace: 21 Ways to Reduce Stress during the Workday

Preparation:

Read the resource paper and the handout. The handout was inspired by and adapted from the Mindfulness and Mastery in the Workplace paper.

Ensure each participant has a copy of the handout.

Procedure:

  1. Introduce the topic by explaining that self-awareness/mindfulness is foundational to self-care, which is foundational to caring for others.

  2. Share any insights you may have gleaned from the Santorelli resource paper. Read or tell the Little Green Dots story as an example of mindfulness and mastery in the work setting.

  3. Have the group take some time to review the "modest proposals" on the handout: Mindfulness and Self-care for Outreach Workers. Facilitate a group discussion focusing on which ideas resonate with them, ideas they find intriguing and want to explore further, and other additional ideas participants they might have.

 

ACTIVITY 7 Self-Care in the Workplace

Purpose: To identify specific self-care practices for agency staff to implement in the work setting

Time: 30-45 minutes

Materials: None

Preparation: Read the activity instructions below and prepare accordingly.

Procedure:

  1. Form small groups of about 4-6 participants.

  2. Each group is to envision themselves being at a staff retreat with a focus on self-care in the workplace. The task of each group is to come up with a proposal for a staff self-care plan for the coming year. Encourage the groups to think imaginatively and brainstorm specific ideas that could be implemented.

Some examples:

  1. After brainstorming ideas, each group is to prepare a presentation for the larger group about their plan. The following conditions apply to the presentation:

  1. Give each group approximately 15-20 minutes for brainstorming ideas and planning their presentation according to the conditions noted above. Then have them make their presentations. Consider giving prizes for the most creative, clever, and humorous self-care ideas and/or presentations.

  2. Conclude the activity by discussing the most viable ideas that were raised and challenge participants to consider ways to implement them in their own work settings.

 

ACTIVITY 8 Video: "Blaze of Glory Should Not Equal Burnout"

Purpose: "In this highly engaging presentation, psychologist Dr. Terry Tafoya describes how clinicians can effectively channel the stress associated with burnout into positive personal growth." (from the video jacket)

Time: Running time is 82 minutes. Add at least 10 minutes for discussion.

Materials:

TV/VCR player and a copy of the video "Blaze of Glory Should Not Equal Burnout: Caring For the Caregiver"

This is a videotape of Dr. Tafoya’s presentation on self-care at the First Health Care for the Homeless Clinicians’ Network Meeting in Washington, DC June 6, 1996. The video was produced by the Bureau of Primary Health Care, Division of Programs for Special Populations, in collaboration with the HCH Clinicians’ Network.

Contact the Health Care for the Homeless Information Resource Center - Video Library at http://www.bphc.hrsa.gov/hchirc to borrow the video.  A limited number of copies are available for sale through the National HCH Council.  Call 1-615-226-2296.

Preparation:

Preview the video if possible so you’ll be better prepared to discuss it. As you watch it, note the humor and wisdom as it’s conveyed through symbols, sayings and stories.

Procedure:

  1. Introduce and show the videotape.

  2. Take ample time afterwards to discuss some of the main themes presented in the video and their relevance for the participants.

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This project was funded through a Cooperative Agreement with the Health Care for the Homeless Branch, Division of Programs for Special Populations of the Bureau of Primary Health Care/HRSA January 2002.