Preface

This curriculum is written on behalf of the members of our human community who wander our city streets, live in wooded areas, dwell under bridges, and otherwise inhabit the edges of the landscape of our lives. It is written especially for those individuals for whom homelessness is not a transitory experience, but has become a fixed condition. These people, our neighbors, experience severely disabling conditions and face seemingly impervious structural barriers in moving from the street to stability. They are the ones for whom hope is a distant dream.

HCH workers go out to shelters, into the city streets, wander into wooded areas, poke their noses under bridges, and seek out those people who live in our midst, but who too often are "hidden in plain sight." Outreach workers are the ones who help build trust and hope, overcome barriers, and bring care to people experiencing chronic homelessness. The intent of this curriculum is to prepare and equip outreach workers for this compelling and challenging work.

Chronic homelessness is a real life drama about being caught among the forces of extreme poverty, a lack of access to adequate resources and services, the experience of illness and disability, and feelings of estrangement from self and community. It is a drama with a cast of tens of thousands, a true American tragedy.

Chronic homelessness unrelentingly erodes the human spirit and will, causing individuals to become increasingly entrapped in feelings of hopelessness and diminished self-worth. It forces men, women and children into a daily struggle for survival and robs them of the ability to live more full and meaningful lives.

The overarching goal of outreach is to help break the bonds imposed by homelessness. Outreach, at its best, helps people move toward a life of greater health and personal stability. In so doing, they are able to discover more fully their own sense of identity and purpose, find meaningful work and activity, and establish a sense of place and belonging in the larger community.

Outreach to people experiencing homelessness is about being a neighbor in a radical way to those who are "strangers in the land." It is about compassion translated into concrete action. It is about regarding all human beings as intrinsically valuable. For some, outreach is an outward expression of their work for social justice. For others, it is simply about doing what is right. Yet for others, it is envisioned as helping to bring healing to people broken in body and spirit, and making strangers into friends. Outreach is about all these things, and more.

In the early stages of writing and assembling this curriculum, I came across this quote by Albert Einstein: "Everything should be made as simple as possible, but not simpler." I’ve attempted to make this a guiding principle in my work. In identifying and describing the various aspects of doing outreach, I’ve tried to present the content in an accessible way. But I’ve also been wary about succumbing to oversimplification. It has been said that human relationships, which are fundamental to outreach, are among the most perplexing challenges we will ever encounter in our lives, perhaps even more confounding than "rocket science!"

In many respects outreach appears compellingly simple. To the untrained eye, outreach workers are "human kiosks" who strategically position themselves in the community to dispense information and make referrals. If only it were that simple! What is unseen is the involvement of the outreach worker in the careful and painstaking process of building a bond of trust with human beings who are profoundly distrusting. Such a trust relationship is, of course, the necessary foundation upon which all other outreach activities are based.

To provide outreach services effectively, there is a great deal of preparation to be done. This requires careful inner work as well as extensive outer preparation. The worker must be aware of what he or she brings to the work in regard to his or her own strengths, style, challenges and vulnerabilities. The worker must also have knowledge and competency in multiple arenas.

Too often, outreach workers have received inadequate training and have been put out on the streets literally to "learn by experience." While this "shoe leather" approach to learning can indeed be an effective teacher, it is often both insufficient and inefficient.

The intent of this curriculum is to help workers gain a fuller understanding and appreciation for outreach work. There is no set formula, but it is hoped that by exploring the process and content of outreach from a variety of perspectives, workers will become more effective in their efforts to assist people toward greater stability.

At one level, the curriculum attempts to outline the minimum basic training and knowledge requirements that all outreach workers must possess. At another level, its intent is to help workers develop increased self-awareness, empathy and interaction skills in order to use their knowledge effectively.

Outreach activity engages one’s whole being. It touches us at many different levels of human experience. The work of outreach can be very difficult to put into words because language is often limited in describing the "realness" of the experience. Sometimes, as singer/songwriter Bruce Cockburn says, "Those who know don’t have the words to tell; those with the words don’t know too well."

The subtlety of a gesture, a small step risked, the joy or despair on someone’s face – these cannot easily be described with language. Perhaps this is why many outreach workers find that music, poetry, dance or silence best describes their daily experience. Hopefully, this curriculum will allow you to touch and help transform many lives through your outreach efforts, and in turn be touched and transformed personally by the work itself.

Is there truly a need for a curriculum to teach people how to do what people have been doing since the beginning of time – interacting, encouraging and providing help to one other? It appears the answer is yes, especially when it concerns people experiencing homelessness.

Unfortunately, in a culture in which the values of individualism and self-reliance hold sway, these natural inclinations and capacities to help seem to have diminished. This is particularly true as people experiencing homelessness have been increasingly pushed towards the extreme margins of community life. In a world that has become increasingly complex, disparate and unsafe, so has the ability to care for one another become more difficult. Thus, the need for specially designated workers to reach out and connect with those on the edges, in order to bring them closer to the center of care and life in the community.

The purpose of this outreach curriculum is to provide a comprehensive overview of the principles, knowledge, and issues relevant to doing outreach in the Health Care for the Homeless context. In addition to providing information, it is intended to engage the participant by using various modalities and activities that appeal to different learning styles.

As with any curriculum, this particular one won’t meet "all the needs of all the people all the time." In HCH projects throughout the country, outreach activities are practiced by clinicians with differing backgrounds and experience, in settings that are varied geographically and culturally, and that provide an array of services targeted to different sub-populations of homeless people. Thus, the training needs of workers in each program will differ and must be tailored to the individual worker as well as to the specific goals of that program.

It is anticipated that workers will have been thoroughly oriented to their respective agencies prior to receiving the training outlined in this curriculum. Trainees should be familiar with the agency’s mission and goals, personnel policies and procedures, relevant contracts and collaborative agreements, supervisory structure, their own job description, data collection and documentation requirements, code of ethics, grievance procedures, and other relevant information specific to their job.

In addition, this curriculum presupposes that trainees will have received training specific to relevant laws, statutes and requirements that govern their practice. Because each state and locale varies in regard to its social and health service structures and laws, much of the training that outreach workers require will necessarily be locale-specific. For example, financial programs and entitlements can differ greatly from state to state. The same is true for involuntary commitment laws for mental health and substance abuse.

This curriculum is intended to serve as a guide for anyone involved in facilitating training for outreach workers in Health Care for the Homeless settings and other outreach programs. It is anticipated that non-HCH projects and clinics providing outreach to homeless people will find it to be a valuable resource and adapt it as needed.

It is envisioned that the curriculum will be used primarily in local settings for orienting and training outreach workers. Thus, local issues, case examples, sites, and resources can be incorporated into the training to make it as relevant as possible. The curriculum will also prove to be a useful resource for providing outreach training at regional and national levels.

The curriculum is designed for use with small groups or teams of persons involved in outreach. It can also be used with larger groups, for example, with outreach workers from various agencies in a particular city or region. While it could be used conceivably with one or two individuals at a time, as in a new employee orientation, it is likely to be more effective when taught within a group context where ideas, perspectives and experiences can be shared among participants.

There are a number of ways this curriculum might be used to benefit HCH projects and workers:

• To orient and train newly-hired outreach workers
• As a resource for in-service/continuing education sessions within an agency
• To bring together outreach workers from various community organizations for training and networking
• To review, and possibly rewrite, job descriptions for outreach workers
• To create a mission statement for an outreach program
• To use the curriculum resource papers and handouts to create or contribute to an "outreach library" in the agency
• As a self-study guide for individual workers
• To use selected hand-outs taped on refrigerators, doors, walls as reminders for workers
• To "train trainers" in using the curriculum to teach others about outreach
• To use for writing grants and position papers
• To inform education and advocacy activities regarding resources and policy changes
• To try to explain to your family and friends "what you do"

Facilitators who plan to use this curriculum will find that some aspects of it resonate well with their personal teaching style while other sections may not engage their attention so readily. This is to be expected. Because it is important for instructors to "own" the material they’re teaching, it is encouraged to view the curriculum as a set of resources from which to draw. It is anticipated that trainers will utilize what works well for them and adapt other approaches as needed.

Experiences, stories, and anecdotes are seen as integral to making this material come alive for trainers and for participants. Trainers should share their own experiences liberally and also draw upon those of participants. It is equally important that facilitators rely upon a teaching style that is within their own personality and comfort zone, in which they inject their own unique sense of humor, and relate to others in the ways that are comfortable.

The curriculum has been written so that the content and flow of material constitutes a comprehensive package. It is designed to be taught in its entirety. However, it is recognized that this may not always be feasible. In such cases, it can be approached as a menu from which various entrées can be chosen. Instructors can select those learning topics and activities that are most relevant to the group and that fit within the training time allotted. Preferably, this will be done in consultation with the training participants themselves.

It is also acknowledged that this curriculum cannot cover the training aspects of outreach that are specific to a certain organization and locale. For example, knowledge of agency policies and procedures, local service organizations, targeted outreach areas, cultural characteristics, and other unique features of the locale are obviously an important part of any orientation and training. Nor does the curriculum pretend to provide the education and training needed to understand the myriad medical and psychiatric conditions encountered in outreach.

• Pay attention to the training/learning setting. Create a hospitable environment that is welcoming and friendly. Envision it to be more like a retreat setting than a traditional classroom.
• Choose a space with good lighting, heat and ventilation. Arrange the seating in a manner that is conducive to easy dialogue. Circles work well as does the use of round tables. Provision of some light food and drink is always recommended.
• For those who need something to do with their hands, provide items such as different colored pipe cleaners, modeling clay, little plastic animals, or other toys. Not only will this help some people pay attention, but also some very interesting art will be produced!
• Use the streets or shelters as your learning environment if possible. Include a walking tour or a windshield tour of the outreach territory. There is no better substitute than this "in vivo" approach. For a newer outreach worker to be able to accompany and observe a more experienced outreach worker in action is also invaluable.

This curriculum was supported through a grant from the Health Resources and Services Administration, U.S. Department of Health and Human Services. June 2002.