By: Nick Falvo, PhD
Jeannette Waegemakers Schiff has written a new book titled Working with Homeless and Vulnerable People: Basic Skills and Practice. I’m proud to call Jeannette a friend and colleague, but I’ve agreed to write a critical reflection of the book.
This is a ‘must read’ for anyone in North America wanting to do front-line work in the homeless-serving sector. This book covers a vast array of topics, which is a huge undertaking for one person. I’m especially impressed that the book is written for audiences in both Canada and the United States. Few authors have the background to understand both contexts.
I spent 10 years doing front-line work with homeless persons in Toronto. I had virtually no ‘social work’ education at the time and learned ‘on the job.’ I wish I’d read this book before taking on that work.
Here are ten things to know about this book:
- The idea for this book was conceived when its author was involved in starting a course for workers in Calgary’s homeless-serving sector. That course is now taught at the University of Calgary’s Faculty of Social Work, in partnership with the Calgary Homeless Foundation (my employer). This course is still going strong today; more information on it can be found on it here.
- Chapter 3, which focuses on homelessness and health, is very strong. The book’s chapter on health is both comprehensive and nuanced. It discusses high mortality rates among the homeless, the impact of stressful life events and common physical health problems among homeless persons. I like that Table 3.4 (p. 66) contrasts the needs people have when ill with the realities of conditions in a homeless shelter. My only disappointment about this chapter is that it didn’t discuss the Street Health Report 2007, one of the most comprehensive health reports even written about homeless persons. (Full disclosure: I worked at Street Health when that report was written and helped with the report’s preparation.)
- The book says very important things about ‘burnout prevention.’ I saw a lot of burnout in the homeless-serving sector; and in retrospect, I think 10 years was too long for me to stay on the ‘front lines.’ In Chapter 3, I like that workers are encouraged to ‘say no.’ The same chapter also encourages regular exercise. And Appendix 2 even features a survey instrument that helps workers gauge the extent to which they may suffer compassion fatigue and burnout. (I personally think the same chapter should have also singled out the importance of doing yoga, but I’m hugely biased on this front: not only do I do yoga several times a week, but my partner is a yoga instructor!)
- You can always count on Jeannette to deliver a thoughtful, historically-grounded consideration of housing first; and in this book, she doesn’t disappoint. Jeannette knows more about housing first than anyone I know, having previously worked as Director of Research at Pathways to Housing in New York City. If you want to know more about housing first, read Chapter 6 of this book!
- Chapter 5 skillfully distinguishes which level of government handles which area of social policy that’s relevant to homelessness. It also makes the distinction between Canada and the United States. Many authors would shy away from trying to cover the social welfare systems of two different countries, but the author’s work experience in both countries allows her to do this.
- Not every approach offered in this book will appeal to every worker. When I worked with homeless people, my co-workers and I worked with smokers the way we did anybody else; often, we joined them. Chapter 2 of this book—which is available free of charge online here— offers an approach to working with smokers that I would not choose myself. The reader is encouraged to ‘explore the positive’ by asking “When do you most enjoy smoking? Can you think of other ways in which you could have the same pleasant feeling” (p. 44). And if that approach doesn’t work, the reader is encouraged to ‘explore the negative’ by asking: “What comes to your mind when you think about an unpleasant part of smoking? Have you thought about how to deal with these unpleasant parts? Is quitting the only way” (p. 44)? Many public health officials will thank the author for this section; but I suspect some homeless persons would find the above line of questioning a bit condescending. Likewise, Chapter 5 encourages the use of something called a genogram—i.e. a family tree for the homeless person. By sketching it out, the notion is that the worker will be able to better “understand the many different people that are part of the client’s life…”(p. 149). Again, when I was a worker in the homeless-serving sector, I would not have opted for this approach. Admittedly though, every homeless person and every worker is different; if a client and their worker mutually agree that such a map is helpful, I shouldn’t judge.
- Chapter 7’s discussion of mental health has some solid content, but misses a great opportunity to discuss the need for workers to advocate with clients vis-à-vis psychiatrists. I spent seven years working as a mental health outreach worker with homeless persons in Toronto. While I don’t think my work gave me a complete view of the mental health system, I was often struck by how little psychiatrists liked to talk to my clients (i.e. their patients) about the adverse side effects of psychotropic medication. The book ignores this problem. I wish it had drawn on this excellent book by Dr. David Healy. I also wish it had discussed some the excellent self-help initiatives that exist in Canada, including the Empowerment Council and Toronto-based Sound Times.
- The book’s treatment of politics and public policy could have been a bit stronger. I’m disappointed the book didn’t discuss neoliberalism, which I personally think helps explain rising homelessness across North America in the 1980s and 1990s. I’ve previously discussed the way this played out in Toronto here. Much smaller point: the book perpetuates the myth that Canada is “the only G-8 country without a national housing policy” (p. 166). Regrettably, most G8 countries lack a national housing strategy. (For more on how Canadian housing policy stacks up against housing policies in other affluent countries, see this 2009 report by Greg Suttor.)
- I’m disappointed the book doesn’t give more attention to harm reduction. Chapter 8 focuses on addictions and does discuss harm reduction (an approach to practice that helps reduce the harms associated with drug and alcohol use while not necessarily requiring complete abstinence); but it devotes just half a page to this topic. Material the chapter could have had drawn on to enhance this section of Chapter 8 include: this resource, which was designed specifically for social workers; this training manual designed for frontline staff; and this report on a successful Calgary-based harm reduction program run by Alpha House (an organization whose work I admire very much and that receives funding from the Calgary Homeless Foundation).
- The book doesn’t talk about unions; I think it should. Many workers in the homeless-serving sector receive low wages, few (if any) benefits and little job security. Unions have the potential to change this. Considering the book’s focus on self-care and burnout prevention, I’m surprised it didn’t discuss the important role that unions can play in improving working conditions (for more on the potential benefits of being in a union, see this 2014 report by the Parkland Institute). Some Executive Directors will be grateful for this omission; union organizers, not so much.
Despite the shortcomings identified above, I wish to emphasize that this book is a ‘must read.’