Meeting the Needs of Vulnerable Populations

An Interview with Donna Colonna, S:US CEO and Richard Taylor, Peer Specialist, Blake Men’s Shelter

J.J. SUS is an organization that takes its name seriously, and literally: Services for the UnderServed. Put more casually, SUS is dedicated to providing services for people who often get the short end of the stick when it comes to the kinds of assistance and partnership, they need to build better lives. Where does “vulnerable” fit in to this equation, does “underserved” equate with “vulnerable?”

D.C. They fit together. Underserved means people and communities are not receiving what they need for health and well-being. S:US, with the purposeful colon is our way of emphasizing the US-our shared common humanity and our philosophical foundation; the organizational lens that promotes and nourishes the notion of community and partnership with those we support.

R.T. SUS is about serving people no matter who they are, and the people we are serving are definitely vulnerable. When we help people who just came out of jail, or people who are 20 years old and living in a shelter because their parents don’t want them and don’t love them, they are vulnerable. No question about it.

J.J. So how can you help people understand vulnerability? Or what we mean when we talk about vulnerable populations?

D.C. Vulnerable is a big tent word. People are vulnerable for multiple and different reasons. Communities are vulnerable due to complex and interrelated factors. It is useful to categorize vulnerabilities and understand the root issues that contribute to community and personal vulnerabilities so we can develop the right set of supports and interventions. We should not use the term to ascribe personal blame or to disempower people and communities. If you don’t have housing, or you don’t have access to food, or you experienced trauma – you’re vulnerable. If you are elderly and ill and not able to take care of yourself, you are vulnerable. People with disabilities are vulnerable.

J.J. Sticking with our name for a moment, SUS purposely put a colon in its name – to emphasize “us.” I suppose that’s another way of saying we’re all vulnerable at some point in our lives. Do you think that’s accurate, and if so, what does that say about the kinds of services and supports we’re working to provide?

R.T. All of us are ‘us’ together. When we’re all together, we all have different functions that make up the whole. We are the collective thing. We are men and women that serve men and women. Some people are fortunate, some people are not. We have to help “us” get better because there really is no single individual. I can’t – but we can.

J.J. Is it true that SUS has always seen itself as a community of people?

D.C. Yes. We work hard at creating community within S:US. Mutual respect is the foundation. We are all interdependent, and like Richard just said, nobody stands alone. The spirit of community is the basis for nurturing relationships. Promising and evidence-based practice are important, but respect is an essential ingredient.

J.J. How do you put all this into practice?

R.T. I’ve been through drug trafficking and addiction and am blessed today to sit on this side and share my experiences.

J.J. So it helps to be a peer?

R.T. No question about it. When I was at my worst, I first had a counselor I knew had no experience living the life. That didn’t work for me. I got a new counselor and at first, just because she was a woman, I didn’t trust her. I learned I was wrong. Every time I told her stuff I had done, she told me she’d been there, done that. I knew she got it. She’s the one who encouraged me to go to school, get CASAC training, get a job as a security guard and learn to be a counselor. She kept encouraging me. Sometimes things happen in your life without your permission. I just wanted to stop using but I didn’t know these riches were coming my way.

D.C. You are actually telling us how to harness the power of shared experience and the importance of respect and not judging.

R.T. Yes. Experience is the best teacher. My counselor told me: “You can be whatever you want to be.” And at some point, I started believing her. There’s something about inspiration from other people who have survived. It shows you it’s not impossible.

J.J. How do we know what really works for people?

R.T. Humility has served me well. I tell clients: I’m not better than you – but right now, I’m better off than you. Sometimes that’s important to hear. I know my #1 job is to build trust with clients. We can see the surface stuff but it’s what’s inside that we want to get at. You have to be respectful because if you can’t show that, they won’t want to even talk to you.

D.C. Humility has worked for S:US. Humility makes us continually look inward to asses if we are making a difference and how we can improve. First, we ask people how we are doing. And how are you doing? Do you feel respected and supported? This may sound simplistic and it is not the only data point but if you skip this step you really won’t be able to answer the question you asked. This approach is person-centered, and it should be and by using validated surveys we can also use the results to benchmark and improve our services.

J.J. Do we feel we are making a difference?

D.C. The short answer is yes. But how do we know we are making a difference is a more important question.

We create housing and access to housing for consumers and we know that the majority of individuals that access housing with supports stay stably housed. We collect data on homeless prevention. We collect data on the impact of our employment services. We study the impact of our services on unnecessary hospitalization, ER use and overall health. We played a significant role in ending veterans’ homelessness. I could go on but quantitative data and qualitative data are both important.

R.T. What SUS is doing is definitely working. Now, what we want to do is just make sure it’s working better. We can’t stagnate. We have to keep growing. For people coming out of jail who never had a home, we have to teach them how to “have a home” – how to manage money, pay bills, all the basics.

This is where supported housing, as opposed to just housing, comes in. Sometimes we over-professionalize supports- basic supports are important.

D.C. We know the work is hard, and no easy solutions. We employ evidence-based practices and interventions, but I agree with Richard we have to marry those practices with putting food on the table, getting a roof over a person’s head, social supports, employment. We know that access to healthcare and recovery services and treatment is important but without addressing what we now call the social determinants of health—housing, food, education, employment, meaningful social roles, social connections, etc.—our chances of supporting people toward well-being and quality of life are diminished. We have to do a better job of connecting the dots.

Our urban farms initiative is a good example of how we married meaningful work, training, healthful food, cooking, community and peer support. Our ICCD Clubhouse is a powerful peer-directed community. Our Parachute respite residence offers a low-cost supportive alternative to hospitalization.

J.J. People are afraid that managed care will result in fewer and fewer dollars to really provide the kind of person-centered care people need, especially vulnerable people. Are you concerned about that and if so, what are some of the specifics that you think will make the system even more fragile than it already is?

D.C. When managed care works it should be about better coordinated, integrated and person-centered services—especially important for people with complex needs. I believe that partnerships with enlightened plans and provider partnership have the potential to improve personal and health outcomes for people we serve. Paying for value or value-based payments offer a framework to do impactful work. Resource limitation is and will most likely continue to be challenging but finding a way within the value-based framework to pay for the social determinants of health and wellbeing is key to changing the narrative.

J.J. So to both of you – any parting words of wisdom?

D.C. We need to spend more time engaging with our customers about how the health transformation effort is working for them and how we can do better. Partnerships with consumers should occur at a systems development level and at a personal level. Focus groups with consumers have informed us that we need to do better at communicating all the systems changes and available service options and what all these changes mean for them.

R.T. No matter how many big words you use, always use small words. I’m proud to be giving back so I can do for somebody what somebody did for me. We try to save everyone, but if I can just help one or two people, that’s a plus. All we can do is put our best foot forward and hope and pray that someone will accept it. We can’t help you unless you tell us who you are.

D.C. Partnering with “vulnerable” people and communities to develop the right set of supports transforms vulnerable into empowerment. This work requires leveraging bold partnerships with individuals we serve, communities, the health care sector, the community-based providers and businesses. It is not the responsibility of any one sector to make things better for everyone. We need to figure it out together. We need to advance that goal. We can’t do perfect. We just have to keep trying.

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