Tuesday, September 9, 2014

The Ethical Dilemma Of Not Breaking The Chain Of Homelessness


                Anybody who has ever driven by a homeless person has contemplated “how did that person end up homeless?”  The simple response is “get a job” or “they are lazy and don’t apply themselves.” These are simple answers, convenient answers and for some homeless people possibly a somewhat accurate statement.  For some they are living out the consequences of a life of bad decisions.  Every time they came to a crossroads they invariably took the wrong direction.  They engaged in life styles that resulted in addictions and destructive behavior.  Most of these people grew up in “typical” U.S. homes with mom, dad, siblings and the dog.  It was their decisions that caused them to veer off course.  Is this true or a poorly conceived perception? 

three generations
                Then there are others who never lived in “Mayberry”.  Rather the family life modeled for them included dad out of the house, mom inviting a variety of abusive men into the home to share sex and drugs with and siblings running wild on the street while mom was absorbed in her own issues.  Police periodically arrived in the neighborhood and took someone away and occasionally someone in the neighborhood was shot or stabbed.  Most survived their wounds.  The stories shared on the front stoop of these homes talked about the addicted grandfather, the homeless uncle, the abused cousin, the drunken mother, the cousin who was never seen again.  This was multi-generational families living in poverty, addiction and homelessness.  For many of these children their “lot was cast”.  Bowman and Poppa’s data indicates that every year in the U.S. one in fifty students will experience homelessness during their K-12 school life (Bowman & Poppa, 2013).  Recognizing this cycle, is it ethical to allow the cyclone effect to continue to consume families?  How does society stand by and watch the next generation fall into despair?  Would we tolerate a family who lived in a hazardous home that resulted in multiple fatalities from past generations continue to dwell there before ordering the home demolished or restored?  Principle A, Do No Harm has been violated and Principle D, Justice are clearly violated in these incidents. 

help me find a house

                In 2012 Kilmer and his associates completed a research project which, in part, looked at how children of multi-generational poverty and homelessness were surveyed in how they perceived receiving public services (Kilmer, et al., 2012).   The sense of entitlement and normalcy to receive these services was significantly higher than those children who lived in more traditional home settings.

                The chain of poverty and homelessness is hard to break.  Clearly homeless people cannot generally do it themselves.  It requires their communities to come along side of them and help.  To not do so is unethical and immoral. APA Ethics requires the standards of conduct 3.4, Avoiding Harms  or 3.1, Unfair Discrimination.  Hopefully, the future will be brighter as communities chose to take their responsibility seriously and ethically.

References

Bowman, D., & Popp, P. A. (2013). Students experiencing homelessness. In E. Rossen, R. Hull (Eds.) , Supporting and educating traumatized students: A guide for school-based professionals (pp. 73-92). New York, NY, US: Oxford University Press.

Kilmer, R. P., Cook, J. R., Crusto, C., Strater, K. P., & Haber, M. G. (2012). Understanding the ecology and development of children and families experiencing homelessness: Implications for practice, supportive services, and policy. American Journal Of Orthopsychiatry, 82(3), 389-401. doi:10.1111/j.1939-0025.2012.01160.x

Monday, September 8, 2014

Homeless; Are All Men and Women Equal In Our Legal System Today?



Are all men (and women) really equal in the eyes of the law?  Many in people in the U.S. would argue that women, minorities, children, homosexuals and many other groups of our citizens do not have the same access to our legal system or the same standing if and when they find it.  Tragically, there is a group that ranks even below our “second class” citizens; that would be our homeless, the people with no voice.  They don’t have political action committees, they don’t have Hollywood’s attention, and they don’t generate controversial social issues that can equal votes for politicians.  All they really have is what they shove into a backpack or pile into a stolen grocery cart.  So are all men truly created equal?  Sadly, the answer is no.  This is an ethical dilemma.  Principle C; Justice,  calls for fair access to services .
"who is going to represent me"
                In a study conducted by Mark Stoner he states in his article The Civil Rights of Homeless People; Law, Social Policy and Social Practice that the homeless are grossly underrepresented in our legal system today (Stoner, 1995).  It could be reasonably argued that access to our legal system is diminished when you don’t possess a regular address, you already mistrust the government and institutions that represent it, you suffer from emotional and mental issues that impact your ability to function among others or you simply don’t have the resources to obtain quality representation.  But that is not an excuse for a society to at least have a process in place when someone manages to find their way into a local courthouse, public defender’s office or legal clinic.  Much like with healthcare access, when they do find their way they are met with an unwelcoming tone and the shifting of waiting room patrons trying to move away from the stench of street life.  These acts violate standard 3.01, Unfair Discrimination or 3.03, other harassment.
                How could this be corrected?  It is not an easy fix.  However, when veterans began experiencing issues with the court system related to PTSD and Traumatic Brain Injury (TBI), the courts adjusted and found methods of adjudicating casing that were sensitive to how the veterans were responding to law enforcement and the judicial system.  Why couldn’t a similar strategy be used for homeless people?  Why couldn’t a court system employ social workers to make sure that plaintiffs and victims are being cared for and basic needs being met as their case moves through the system?  So often in criminal cases transient victims don’t show up for important hearings and ultimately the bad guy gets away with victimizing another person with no punishment.  We offer temporary shelter and accommodation to many groups of people why not the homeless who have business with our courts? 
                Advocacy groups offer similar services to their plaintiffs when class action suits are filed for their prospective causes.  Why can’t volunteer advocacy groups offer shelter to those seeking justice?  What if local churches opened their doors to these people as they learn how the judicial system works?  This violates our standard to Avoid Harm, 3.4.  Tragically, it’s easier to look the other way.  After all you generally don’t see public service announcements about homeless people or information commercials about hungry children in the U.S..  Those images are reserved for un-adopted pets, foster children and Africans with bloated abdomens as they slow starve to death or die of AIDS. 
Courthouse sign:SHOES AND SHIRTS REQUIRED, "Now What?"
                Fortunately, there are some groups taking action.  In Philadelphia there is a volunteer group called Homeless Advocacy Project (HAP).  This group of volunteer attorneys has begun meeting the homeless where they are to offer free legal services.  Their offices have become the counters at soup kitchens and shelters.  They meet clients at bus stops and under bridges.  In addition they have set up relationships with local shelters and service providers to help their clients as they work with them through their complex legal issues.  While most of this blog discusses the unethical failures of our society this group is a shining star of ethical behavior in Philadelphia, the “city of brotherly love”.  It is nice to end a blog on a positive note once in a while!
References
Stoner, M. R. (1995). The civil rights of homeless people: law, social policy, and social work practice. The Civil Rights Of Homeless People: Law, Social Policy, And Social Work Practice,
Simone, D. (2014), Homeless and legal aid. Internet home page and mission statement.
                Retrieved from http://homelessadvocacyproject.org, 2014.


Wednesday, September 3, 2014

Homeless People and Transportation; Is it Ethical to Provide Services With No Way to Get There?


     
"I have no place to leave my belongings"
Homeless; these are the people we view through our warm, comfortable car windows on our way to work.  These are the people that turn away from the cold wind and seek shade in the heat of the summer.  These are the people who we refuse to make eye contact with when they tap on our window and ask for the loose change in our cup holders.  While it only takes us five minutes to zip across town to visit our doctor the homeless person requires several hours to make the same journey.  We sip coffee and listen to the morning news while they lug 30 pounds of personal belongings as they walk in shoes long worn out by the previous owner.  A study conducted in West Haven, Connecticut of 1832 clients showed that homeless people provided with either reliable transportation or stable housing accessed public services at a significantly higher rate than those who remained transient (Rosenheck, et.al, 1998). Is a public service really a public service if the neediest are unable to access the service?  This is the ethical dilemma and is in contrast with APA's Ethical Principle regarding Justice.


"this is better... my shoes are shot!"

            A truly ethical approach to this situation would be to incorporate a more holistic approach to providing meaningful services to the homeless.  Within the holistic model a community would design a system that would take the homeless person from the curb to the service and back again or onto the next service the person requires.  Transportation could be provided by providing free public transportation vouchers or utilizing volunteer drivers through  non-profit cooperation.  A recent article in the American Journal of Public Health noted that when programs related to homelessness take a long term approach verses just providing temporary housing that the local rate of homelessness is reduced.  Simply put, when programs approach the problem with a holistic approach the outcome is far better (Henwood, Cabassa, Craig & Padgett, 2013).

"I have lost all self respect... I'm desperate"
As we consider the lack of transportation we can see the ethical challenge it is clear that communities fail to provide Justice.  The requirements of the Justice principle require that we strive to provide all people fair, equitable and appropriate access to treatment and benefits.  Communities would also be violating the Respect for People’s Rights and Dignity Principle by failing to recognize how undignified it is to the homeless as they struggle to find their way to appointments and life changing services.  Remember, these are the people we stare at as we drive by; these are the people that we turn away when they tap on our windows.  Is this human dignity? Is this ethical?  

References
Henwood, B. F., Cabassa, L. J., Craig, C. M., & Padgett, D. K. (2013). Permanent Supportive Housing: Addressing Homelessness and Health Disparities?. American Journal Of Public Health, 103(S2), S188-S192. doi:10. 2105/AJPH.2013.301490
Rosenheck, R., Morrisey, J., Lam, J., Calloway, M., Johnsen, M., Goldman, H., & ... Teague, G. (1998). Service System Integration, Access to Services, and Housing Outcomes in a Program for Homeless Persons With Severe Mental Illness. American Journal Of Public Health, 88(11), 1610-1615.


Tuesday, September 2, 2014

Homeless Seeking Healthcare; Are Our Communities Failing This Ethical Challenge?



homeless man at a clinic

The homeless in our society often suffer from a lack of healthcare services.  While it is true that many  homeless refuse medical care due to addictions, low cognitive function, mistrust of people of authority or intellectual disabilities there are still those that desire to seek care but cannot.  If a person were to view this problem with a cold cursory look they might conclude that "you can lead a horse to water but you can't make them drink".  While this may be a true statement it does not release a modern society from fulfilling its obligation to its citizens.  Would we consider allowing an elderly person with dementia knowingly walk into traffic?  Would we sit by and allow a sick child to forgo going to the doctor because they "don't like the taste of the medicine?"  Surely not!  Yet, we allow a homeless person caught up in addiction or low cognitive skills to deteriorate before our eyes while doing nothing?  Tragically, that is what many communities do.  It is at this crossroads that we find an ethical dilemma.  APA Ethical Standards would indicate our failure as a society to cause no harm, Principle A: Beneficence and Nonmaleficence. 
"Everybody avoids me!"
Of those homeless that eventually make their way into the lobby of a doctor’s office or Emergency Room they often perceive a sense of not being welcome.  People stop and stare.  People don't engage them in conversation like other patrons; People take a wide girth around them as though they have some terrible disease.  These unwelcome signs are generally not spoken words but by how people react.  Others change seats, stare, hold their noses or move their children away.    "They smell, they are scary, they might try to hurt me, I don't want them touching me" fellow patrons remark when asked.  In 2007 a study was done of homeless perceptions of being welcomed at health care facilities in Toronto, Canada.  Perceptions there should be even more diminished than in the U.S. since the entire issue of healthcare coverage would be void due to socialized medicine in Canada.  Yet, even in that setting the homeless people surveyed over 60% felt unwelcome and avoided (Wen, Hudak & Hwang, 2007).
 In many communities far more concern is placed on a stray dog dodging in and out of traffic than a homeless person slowing cars down as they attempt to push their grocery cart containing all they own across the street.   Principle B, Fidelity and Responsibility is also violated as we fail to be faithful to the most vulnerable.     Finally, I believe Principle E, Respect for People's Right's and Dignity is violated in this situation as well.   Our communities  have failed to treat the homeless with respect and recognizing their rights afforded them under the law and by most moral and ethical codes.
References
Shane, P. G. (1996). What about America's homeless children? Hide and seek. Thousand Oaks, CA, US: Sage Publications, Inc.
Wen, C.K., Hudak, P.L., Hwang, S.W. (2007). Journal of General Internal Medicine, July, 2007, Volume 22, Issue 7, pp. 1011-1017, 06 April 2007.