Where the Heart Is
Finding a place to live isn’t the end of the story on homelessness—for participants in Christine Helfrich’s life skills intervention study, it’s just the beginning. Helfrich, an assistant professor of occupational therapy in the College of Health & Rehabilitation Sciences: Sargent College, is working with residents at two agencies in Boston, HomeStart and the Pine Street Inn, to determine what skills they need to know, and how those skills are best acquired, in order to stay housed longer and to improve their quality of life.
“When you talk about homelessness, there’s the issue of finding housing and the issue of maintaining housing,” says Helfrich. “Someone who’s been on the streets for thirty years, you might put them into an apartment, but they still might not sleep in their bed. They might take all the blankets off and sleep in a corner of the room, because that’s what they’re used to.”
Helfrich first began developing a life skills intervention curriculum for formerly homeless populations in Chicago more than a decade ago. Now her curriculum has evolved into four modules, addressing Money Management; Food and Nutrition Management; Home and Self Care; and Safe Community Participation. Study participants can choose to complete one or all four modules, depending on their interests and needs. They are assessed regularly before, during, and after the intervention, which consists of six group classes and six optional individual sessions with an occupational therapist, to track their progress. The goal is to help participants transition out of survival mode and into a more functional form of daily living that incorporates activities that most people take for granted.
“It takes a certain amount of skill and cognitive ability and wherewithal, a lot of problem solving and strategizing, to survive on the streets.” Christine Helfrich
At the conclusion of the study, Helfrich will have data from a continuum of people who are on the streets, in group homes or single room occupancy, and who have moved out into the community, which will help her see where the intervention is most effective, and how it might be modified at different stages.
Helfrich and occupational therapist Andrea Halverson, who graduated from BU’s Sargent College last year, use group classes to foster social learning among study participants. “Andrea might come in and talk about food kitchens, or where you can get low-cost or free food,” says Helfrich, “but the people in the group really know a lot more than she does. Because of that, everybody has something to share, something they can teach people, and everybody is learning something new at the same time.”
Group classes work best, Helfrich says, when participants come from a range of backgrounds. All of those enrolled in the study, which is funded by the National Institute on Disability and Rehabilitation Research, have self-identified disabilities ranging from substance abuse, schizophrenia, depression, PTSD, and head injuries, to blindness, diabetes, and other physical impairments. But they bring very different work experiences and different reasons for becoming homeless.
“It’s not the stereotype of the high school dropout, or the drug addict on the street,” says Helfrich. “One of the things demographically that’s really surprising is the education level of participants. About 90 percent of people have at least a high school education, and 60 percent have a college education.” By comparison, approximately 87 percent of all Americans age 25 and older hold a high school diploma, 56 percent have some college experience, and 39 percent hold a bachelor’s or associate’s degree, according to the U.S. Census Bureau. Helfrich isn’t sure exactly why her study participants are so highly educated, though she suspects a process of self-selection—the intervention involves attending classes—plays a role. She also emphasizes the challenging nature of living without a home.
“It takes a certain amount of skill and cognitive ability and wherewithal, a lot of problem solving and strategizing, to survive on the streets,” says Helfrich. “It’s not an easy thing to do. You hear people’s life stories and you think, could I have ever survived all that, and done that?”
That capacity for empathy guides what Helfrich calls a “very strong harm reduction approach to life skills.” The nutrition module, for instance, covers the USDA's nutritional advice in a realistic way, by planning a balanced diet over the course of two weeks, rather than trying to incorporate protein, fiber, and dairy into meals each day. Participants also gain and share practical tips about “what you can eat more nutritiously at McDonald’s, how to know when food is spoiled and not spoiled, and which businesses will give away food at closing time.”
Helfrich is eager to help participants move to the next step in terms of stable, healthy, and housed living, but to do so, she says, “We really try to meet people where they’re at.”