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Supporting Local Ideas for Improving Health

Images of a woman holding a newspaper and two people holding hands.

Overview

Homelessness is fraught with bias. It’s a challenge for caregivers serving those experiencing homelessness to have the right context in which to express empathy.

Community advocate Val Romness presented this concern to Dell Med’s Center for Place-Based Initiatives during its first Call for Ideas — for proposals for improving health in a community submitted by those who live and work there. As a result, the center partnered with Romness and Dell Med’s Department of Psychiatry, which received funding from the Hogg Foundation to further understanding about the social determinants of health.

Romness and the department developed a curriculum for a class to provide community members an up-close perspective of homelessness. Now, The University of Texas at Austin will offer a 12-hour graduate course to teach empathy for homelessness through experiential learning, with a special focus on the correlation between homelessness and mental illness.

How It Happened

In fall 2016, the Center for Place-Based Initiatives issued its first Call for Ideas. In response, Romness submitted her notes from testifying before the Texas Legislature. It was a laundry list of grievances she had amassed through her work as editor of street newspaper The Challenger, whose target audience is people experiencing homelessness.

One theme ringing throughout her testimony materials was the lack of empathy expressed by care providers — social workers, case managers, nurses, physicians, law enforcement — for this population.

“There isn’t enough understanding that homelessness puts people at risk for mental health issues and emotional trauma, and that mental illness colors the homelessness experience,” says Lourdes J. Rodríguez, DrPH, director of the Center for Place-Based Initiatives. “That makes it harder to move forward out of homelessness.”

The resulting idea was to cultivate empathy among front-line providers through the format of an experiential class.

The class, which includes six two-hour sessions, offers in-classroom activities, out-of-classroom experiences and guest lecturers who have experienced homelessness. It also measures changes in student perceptions about homelessness before and after the course.

Graphic image of people

Where Homelessness & Mental Illness Intersect

Mental illness is the third largest cause of homelessness for single adults. Twenty percent of cities say better coordination with mental health service providers is one of the top three things needed to combat homelessness.

Many people experiencing homelessness and severe mental illnesses are willing to accept treatment and services. Outreach programs do better when care providers establish trust through ongoing contact.

National Coalition for the Homeless, 2009

The Call for Ideas: When, Why, What

Dell Med’s Center for Place-Based Initiatives identifies local solutions to local problems in Austin, Travis County and Central Texas, with an aim to improve the health of communities and neighborhoods using scalable, customized support tactics.

“Anytime a project is for, by and about the target population, it floats to the top,” says Rodríguez.

In 2016, Rodríguez’s team issued its first Call for Ideas to build on home-grown innovation. The center seeks input from residents, community leaders, local businesses and employers, and public and private stakeholders to provide raw material that can be honed into workable, exceptional ideas; provides the support needed to realize ideas; and works to ensure their impact and sustainability in the community. It has since issued a second call, with plans in the works for a third in fall 2018.

The process is intentionally inclusive, incorporating the voices of the people who are at the heart of experiencing the problem to help create a solution.

The center selected nine initiatives from its first Call for Ideas. In addition to Romness’ empathy-building course, other ideas supported include:

  • A food truck providing nutrition education and practical how-to cooking instruction;
  • A test for new ways to promote good oral health among older community members to avoid future dental problems; and
  • A systemic integration of traditional Native American healing practices into various parts of a holistic health ecosystem.

Mental Health & Homelessness in Austin & Travis County

Among persons experiencing homelessness in Austin/Travis County:

  • 44 percent report current mental health issues;
  • 56 percent have experienced trauma or abuse; and
  • 61 percent access health care through an emergency room — or do not access health care at all.

Homelessness in Austin/Travis County: Current Needs & Gaps Report, 2017

Why It Matters

“Empathy is a skill that can be learned, if only we know what muscle to flex,” Rodríguez says.

Treating our idea originators as colleagues, instead of as just people we want to help, has led to productive and candid conversations, says Rodríguez. “They feel respected; we feel grounded.”