1. Homelessness and Brain Injury Dave Katzenmeyer, Geoffrey Meyer, Kris Helgeson

2. People Incorporated Street Outreach What we do: People Incorporated Street Outreach Team and Drop-in Common Mental Health Diagnosis we encounter: Anxiety, Depression, Schizophrenia, Bi-Polar I and II, and a variety of Personality Disorders. Substance Use Disorders: Meth use, Heroin, Alcohol, Marijuana, Bath Salts, Prescription Medication. General Demographics of our Clients and Participants The Intersection Between: Mental Illness and Physical Health Substance Use and Mental Illness

3. Substance Use and Homelessness  “A common stereotype of the homeless population is that they are all alcoholics or drug abusers. The truth is that a high percentage of homeless people do struggle with substance abuse, but addictions should be viewed as illnesses and require a great deal of treatment, counseling, and support to overcome. Substance abuse is both a cause and a result of homelessness, often arising after people lose their housing.”  From National Coalition for the Homeless.

4. Barriers to Care for the Homeless  Have you seen my client?  Sheltered and un-sheltered clients and program participants  Making Appointments  Being available and flexible  Balancing caseloads and availability.  Needing additional time or attention  Finding the RIGHT providers  Awareness of brain injury, homelessness, substance use disorders, physical health, mental illness, trauma……..

5. Engagement Strategies  Taking a Person Centered Approach;  What does that mean in the Homeless Community? Long-term Engagement Motivational Interviewing Techniques Engaging with Community Supports Advocacy Trauma Informed Care Harm Reduction

6. Engagement Strategies- Long-term Engagement  LONG-TERM ENGAGEMENT Complex situations take time Loss of trust usually engrained over years Common misconceptions: People will jump at “help” Housing will fix everything

7. Engagement Strategies- Motivational Interviewing Key Points  Motivation to change is elicited from the client, and is not imposed from outside forces.  It is the client’s task, not the counselor’s, to articulate and resolve his or her ambivalence.  Direct persuasion is not an effective method for resolving ambivalence.  The counseling style is generally quiet and elicits information from the client.  The counselor assists the client in examining and resolving ambivalence.  Readiness to change fluctuates and is affected by the interpersonal relationship with the counselor.  The therapeutic relationship resembles a partnership.

8. Engagement Strategies- Motivational Interviewing Lack of Motivation and Initiative  I can’t motivate you. Only you can motivate you. Black and White Thinking  Often the change we suggest is abstract thinking. Argumentative  Can’t argue with yourself as easily as you can argue with me.

9. Engagement Strategies- Engaging with Community Supports  Building a network of help around the client/participant to better enable to “flow” of care.  Who are the Care Providers equip to help clients with Brain Injury and also experiencing Homelessness?  Learning where and how to connect client to better services.  Services and referral “telephone” to other providers to maximize effectiveness

10. Engagement Strategies- Advocacy  Homelessness and Advocacy  Explaining how they need help; how if may be different form others.  Brain Injury and navigating the complicated system of Community Supports and Social Services on their own.  County Services  Probation and Parole Officers  Mental health and Chemical health Professionals  How to teach our clients, ourselves, and those around us how to better advocate!

11. Engagement Strategies- Trauma Informed Care  What is Trauma Informed Care?  Primary and Secondary Trauma  How do our clients experience Trauma?  What different types of Trauma are there?  How do we recognize Trauma in our clients?  Complex Trauma  https://www.psychologytoday.com/blog/compassion- matters/201207/recognizing-complex-trauma  Other Types of Trauma  http://www.samhsa.gov/trauma-violence/types http://www.samhsa.gov/trauma-violence/types

12. Engagement Strategies- Harm Reduction Key Points  Accepts that behaviors are part of our world and works to minimize harmful effects rather than ignoring or condemning them.  Recognizes a continuum of behaviors from abstinence to severe abuse and that some levels of behavior are safer than others.  Establishes quality of individual and community life over abstinence of all behaviors as criteria for interventions and policies.  Calls for a non-judgmental, non-coercive provision of services and resources to people who participate in behaviors and the communities in which they live.  Ensures that people who participate in behaviors or have a history of participating in behaviors have a voice in the creation of programs and policies.  Affirms the people themselves as the primary agent to reducing harm to themselves and their community.  Recognizes the realities of poverty, class, race, social isolation, past trauma, gender, and other social inequities affect people vulnerability to and capacity for effectively dealing with harm.  Does not attempt to minimize or ignore the real and tragic harm associated with behaviors.

13. Engagement Strategies- Harm Reduction Impulsive Behavior  Abstinence is not an impulse Poor Judgment  Limited ability for long-term projection  Limited long and/or short-term memory Risky Behavior  Limited ability for long-term projection  Limited long and/or short-term memory

14. Questions? Contact Us! Geoffrey Meyer Division Director of Homeless Services People Incorporated Mental Health Services 317 York Ave, St. Paul, MN 55130 (651) 288-3536 Geoffrey.Meyer@PeopleIncorporated.org Dave Katzenmeyer Supervisor Street Outreach, Homeless Services People Incorporated Mental Health Services 317 York Ave, St. Paul, MN 55130 (651) 228-3932 David.Katzenmeyer@PeopleIncorporated.org Kris Helgeson, MA LADC Supervisor Project Recovery, Homeless Services People Incorporated Mental Health Services 317 York Ave Ste 5E, St. Paul, MN 55130 (651)228-3941 Kristen.Helgeson@PeopleIncorporated.org