docPrincipy spolupráce s ženami v sociálně tíživé situaci
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Principy spolupráce s ženami v sociálně tíživé situaci
Sborník z konference Ženy Principy spolupráce s ženami v sociálně tíživé situaci In IUSTITIA Jako doma ROZKOŠ bez RIZIKA Praha 2015 sobě Sborník vznikl v rámci projektu Ženy sobě č. projektu CZ.1.04/5.1.01/B2.00001 podpořeném z prostředků OPLZZ. Vydaly In IUSTITIA, o.p.s., Jako doma – Homelike, o.p.s., ROZKOŠ bez RIZIKA, z.s. Obsah Úvod 4 Principy spolupráce s ženami v sociálně tísnivé situaci (z příspěvků na konferenci sestavila Alexandra Doleželová, Jako doma) 5 Dramaterapeutické techniky pro práci s ženami v tíživé sociální situaci (Kateřina Jungová) 9 Jak podporovat ženy bez domova s ohledem na jejich traumata / Trauma informed approaches to women’s homelessness support (Esther Sample, St. Mungo´s Broadway, UK) 13 Na cestě k začlenění: podpora lidí bez domova respektující jejich gender a sexualitu / Towards Inclusion: Gender and Sexuality Aware homelessness support (Jammie Hickling, St. Mungo´s Broadway, UK) 32 Evaluační nástroj Outcomes Star aneb jak sledovat vývoj společné spolupráce / Outcomes Star - a tool to evaluate the process of cooperation (Esther Sample, Jamie Hickling, St. Mungo´s Broadway, UK) 59 Představení zapojených organizací a kontakty 98 3 Úvod V červnu jsme organizovaly konferenci Ženy sobě – Principy spolupráce s ženami v sociálně tísnivé situaci, kde jsme chtěly zprostředkovat zkušenosti a nová témata z dvouletého projektu Ženy sobě. Ten si kladl za cíl vyvinout nástroje pro práci s ženami v sociálně tísnivé situaci, které zažívají (sexuální) násilí, a/nebo se ženami, které poskytují placené sexuální služby, ať už formou zajištění si obživy či za jiné protislužby (nocleh, drogy aj.). Konferencí se tématicky prolínaly čtyři základní principy, na kterých by podle nás měla stát spolupráce s ženami v sociálně tísnivé situaci a které otevírají témata, o nichž se ve společnosti málo mluví - partnerský přístup, posílení (empowerment), genderová citlivost a bezpečné prostředí. Protože jsme chtěly sdílet zkušenosti a nápady z konference dále, přinášíme vám tento sborník a doufáme, že pro vás bude užitečnou inspirací. 4 V prvním příspěvku si můžete přečíst shrnutí ze společné diskuse nad výše zmíněnými principy. Esther Sample z partnerské britské organizace St. Mungo´s Broadway v dalším příspěvku mluvila o tom, jak při spolupráci s ženami bez domova brát v potaz jejich trauma. Jammie Hickling upozornil na problematiku LGBT lidí a bezdomovectví, téma v ČR naprosto přehlížené. V posledních dvou příspěvcích si můžete přečíst praktické tipy a aktivity, jak spolupracovat se ženami v sociálně tíživé situaci pomocí dramaterapie, či jak je možné komplexně sledovat vývoj spolupráce díky nástroji Outcome Star. Příspěvky britských partnerů jsme nechaly v prezentované verzi a anglickém jazyce. Principy spolupráce s ženami v sociálně tísnivé situaci Konference byla zahájena diskuzí nad čtyřmi principy spolupráce s ženami v tísnivé sociální situaci, které se v rámci projektu Ženy sobě snažily uplatňovat organizace Jako doma, In IUSTITIA a ROZKOŠ bez RIZIKA. Jednalo se o partnerský přístup, posílení (empowerment), genderovou citlivost a bezpečné prostředí. Účastníci a účastnice konference se rozdělili do čtyř skupin, aby následně představili své představy o zmiňovaných přístupech. Jejich pohled byl doplněn vždy jedním připraveným příspěvkem1. Partnerský přístup Dle skupiny, která se tématu věnovala, je pro zajištění partnerského přístupu zásadní: nevnucování našich (rozuměj služby/organizace – pozn. red.) představ, dlouhodobý vztah, nesnažit se být odborník na život. Své zkušenosti s partnerským přístupem představila spolupracovnice Jako doma Zuzana Kříčková, která má několikaletou zkušenosti s bydlením na ulici, ale také se spolupráci s organizacemi, které se problematice (nejen) bezdomovectví věnují. „V současné době pár organizací staví svoji práci na spolupráci s námi – lidmi bez domova. Mám tu čest být jedním z těchto lidí. Být brána jako „spolupracovník“ a ne „klient“ je pro mě moc důležité hned z několika důvodů. Jedním z nich je např. sebedůvěra a neméně pak pocit, že vás někdo bere za člověka a ne za „cosi z ulice“. I my umíme na oplátku dát do placu odpovědnost, znalost některých věcí, umíme přijít včas… Jednou z organizací, která s námi spolupracuje, je Jako doma – vaříme a prodáváme jídlo, chodíme povídat na různé konference a nový projekt „terénních pracovnic z řad žen bez domova“ mě zaujal a baví asi nejvíc. Protože můžu alespoň část pomoci, která byla dána mně, předat dál. 5 Další organizace, se kterou spolupracuji, je Pragulic – netradiční prohlídky Prahou na téma drogy a bezdomovectví. I já mám jednu z tras a dvě poslání: 1. říct dětem, že je lepší život než na ulici a na drogách, 2. říct dospělým, že dostat se do problémů, na ulici a konec konců i do závislosti může každý z nás. Dalším podobným projektem je Živá knihovna Amnesty International, kde chodíme povídat do škol a žáci si nás mohou „zapůjčit“ a číst v nás jako v knize a dozvědět se něco o našich životech. U všech těchto aktivit jsou vidět výsledky, posun a mají smysl. Pro mé „šéfy“ jsem spolupracovnice, někdy snad i kamarádka, důvěřují mi, zvedají mi sebedůvěru a já doufám, že je nezklamu. Nezklamu pak ani sebe.“ Empowerment – posílení Posílení kapacit, zvyšování sebevědomí, tak by se dalo přeložit anglické slovo empowerment. Ale nikdy to nebude úplně přesné. Účastnice a účastníci konference se zamysleli nad tím, jaké podmínky je potřeba vytvořit, aby žena bez domova mohla být „posílena“. Jedná se o bezpečné prostředí, informace, možnost rozhodování, respekt, podpora, sebedůvěra, partnerský přístup a další. Co znamená „empowerment“ pro ROZKOŠ bez RIZIKA, organizaci, která pomáhá ženám pracujícím v sexbyznysu představila Jana Poláková, manažerka sociálních služeb. První princip, na kterém je postaven „empowerment“ v organizaci R-R, je respektování volby/rozhodnutí žen pro práci v sexbyznysu. Empowerment chápe jako posilování klientek k vědomí držení si svých hra6 nic v profesi i osobním životě (např. jaké typy služeb chce/nechce žena poskytovat). Pod termín „empowerment“ patří i zapojování klientek do práce organizace – do výzkumu/ohniskových skupin, účast v médiích, zapojení do připomínkování, tvorby článků apod. Zástupkyně organizace R-R mluví se svými klientkami o bezpečnějším sexu, komunikaci se zákazníkem, pracovních podmínkách, násilí v sexbyznysu a ve vztazích, odpovědnosti a možnosti ze sexbyznysu odejít. Genderově citlivý přístup Zástupkyně skupiny věnující se genderově citlivému přístupu zmínila, že bezdomovectví žen bývá často neviditelné, žena se za svou situaci stydí, proto veřejnost vnímá bezdomovectví žen jako tabu. Vzhledem ke svému postavení se ženy dostanou do krize snáze, mohou být závislé na partnerovi, mají nižší příjmy, častěji pečují o děti. Ženy se mohou bát být samy na ulici, bez zázemí, a proto jsou zranitelnější a závislejší na partnerském vztahu. Ženy více čelí násilí, ať už sexuálnímu či jiné formě zneužití. Na druhou stranu ženy dle představitelek skupiny více vydrží a to kvůli dětem, pro které udělají vše. Proto skupina navrhla následující doporučení: • zvyšovat sebevědomí a kompetence žen bez domova • vzájemné sdílení příběhů a zkušeností mezi ženami bez domova • vyvářet bezpečné prostředí Příspěvek doplnila Jitka Kolářová z Jako doma, která se genderovým studiím věnuje dlouhodobě a která zdůraznila, že i práce s muži má svá genderová specifika a nemůžeme dělat rovnítko mezi gender a žena. Potvrdila ovšem, že životní dráhy žen a nároky, očekávání a stereotypy kladené na ženy, stejně jako nerovné postavení žen ve společnosti se promítají i do ženského bezdomovectví. Ať už se jedná o feminizaci chudoby, nižší platy, typ práce, která se ženám bez domova nabízí, genderově podmíněné násilí/násilí na ženách, role žen jakožto matek, jakožto pečovatelek o domov a domácnost apod., to vše má vliv na jejich situaci. Pro genderově citlivý přístup k ženám bez domova je důležité vidět, že jejich problémy, traumata a potřeby jsou často odlišné od těch, co mají muži. Jedná se o traumata spojená s násilím – v rodině, často od partnera – domácí násilí jako příčina ztráty domova i jeho průvodní jev, znásilnění aj. Kromě péče o materiální zajištění žen (jídlo, ošacení, hygiena, bydlení) je důležitá práce s jejich traumaty. Další důležitou osou pro řadu žen bez domova jsou vztahy s dětmi. Pro řadu matek je traumatizující fakt, že o svoje děti přišly. Nemohly se o ně postarat, tak je daly do dětského domova, nebo jim byly děti odebrány. Kromě této ztráty se musejí vyrovnávat s tím, že nesplňují normativní představu „dobré matky“. Pocit selhání nejen jako člověka, ale i jako matky pro ně může být velmi traumatizující. Jitka Kolářová poukázala na mnohonásobnou diskriminaci žen z důvodů barvy pleti, původu, zdravotního stavu, sexuální orientace, věku, které ovlivňují přístup společnosti k jednotlivým ženám. Jak na to? Jak zajistit genderově citlivý přístup? Jitka Kolářová doplnila již zmíněná doporučení o tři tipy: • Sociální pracovníci a pracovnice by měli mít povědomí o tom, co je gender a genderové stereotypy, a sami by měli pracovat na tom, aby je nepoužívaly. Také by měli mít povědomí o tématech, které ženy řeší. • Poskytovatelé sociálních služeb by měly nabízet i služby čistě pro ženy – bezpečné a otevřené jejich potřebám (měly by je vést ženy, měly by být na místě a v době, která ženám bude vyhovovat). • Pokud pracujete se ženami bez domova, umožněte jim se síťovat a tak se vzájemně podpořit v bezpečném prostředí - např. společné aktivity, pravidelná setkávání, svépomocná skupina... Bezpečné prostředí Bezpečné prostředí je zásadní pro rozvoj dalších již zmiňovaných principů. Dle účastníků a účastnic konference se rozděluje na materiální a nemateriální, které dále představili. Pod nemateriálním bezpečným prostředí si představují: osobní a rovný přístup, prostor pouze pro ženy, podpora sebevědomí, finanční jistota, možnost ubránit se apod. Eva Kundrátová, pouliční živel a spolupracovnice Jako doma ví o nedostatku bezpečného prostředí své a proto nám k němu na konferenci mnohé pověděla. „Bezpečí? Bezpečný pobyt je luxus, který si na ulici dovolit nemůžeme! Spát s jedním okem otevřeným a stále ve střehu, to proto, aby vás venku nezbili nebo neokradli. Pokud spíte někde ve stanu, tak dokonce nepodpálili. Jako bezdomovci jste terčem pro každého. Vadíte všem lidem, i policistům. Bezpečí, to znamená přijít domů a zavřít za sebou dveře. Na ulici nám ale dveře chybí. Jediné bezpečí tedy zbývá na noclehárně nebo na azylovém domě, pokud se na ně dostanete. Na noclehárně je vás však na pokoji 11, tak si to zkuste představit. Tady o bezpečí a soukromí nelze vůbec hovořit. Ať se otočíte doleva či doprava, stále na někoho narážíte a někdo na vás kou7 ká. V klidu se nenajíte, nevykoupete, ale ani na WC nemáte klid. Stále jsou kolem vás lidé a všichni něco chtějí a potřebují. O něco lepší to bývá na některých azylových domech, tam už je počet klientů na pokoji menší, pohybuje se mezi dvěma a šesti lidmi. Sice stále nic moc, ale už je to přeci o něco lepší. Ideální by bylo buď být sama, ale takových pokojů je minimum. Nebo ve dvou lidech, to už se dá říci, že by se na pokoji dala vytvořit bezpečná atmosféra a i tak trochu soukromí. Každý klient si může vytvořit svůj koutek v jedné části pokoje a mít tak své soukromí. Ideální by také bylo, kdyby azylový dům měl nejen kvalifikované vychovatele, ale také psychologa či psychoterapeuta. To proto, že na ulici se stres zažívá určitě ve větší míře než v běžném životě. Bylo by dobré popovídat si s někým hned a ne až v nějaký určitý den a hodinu. Do té doby se může odvaha promluvit si ztratit. Měla by být po ruce též duchovní útěcha. je toto místo spíše utrpením. Občas se stane, že na denní centrum pronikne někdo pod vlivem alkoholu ale i drog. Huliči jsou tam na denním pořádku. Slyšíte samé sexistické narážky a urážky. Je to nepříjemné i ženám, které se s násilím nesetkaly, nebyly týrány ani zneužity. Slabší jedinci bývají předbíháni, vyhazováni z místa. Dalším místem jsou denní centra, kde je to úplně katastrofální. Pro ženy, které prošly jakýmkoliv násilím, Z příspěvků na konferenci sestavila Alexandra Doleželová, Jako doma. Bylo by dobré, aby se alespoň někdo trochu zamyslel a pomohl zrealizovat denní centrum a noclehárnu jenom pro ženy. Toto zařízení v Praze chybí. V noclehárnách je pro ženy pouze minimum míst. Pernerka, Hermes a Armáda spásy mají dohromady 77 míst. V létě, když loď na dva měsíce odtáhnou nebo když stoupne v létě voda při dlouhých deštích či v zimě, kdy se nahrnuly kry, se musí loď odtáhnout, sníží se toto číslo na nějakých 22 míst. Takže ženy musí zpátky do ulic. A je po bezpečí!“ Jak vnímají východiska realizátoři projektu naleznete popsané v publikaci Ženy sobě: zkušenosti se skupinovým setkáváním žen v sociálně tísnivé situaci. In IUSTITIA, Jako doma, ROZKOŠ bez RIZIKA. Praha 2015. Ke stažení: http://jakodoma.org/wp-content/uploads/2015/07/metodika_final.pdf 1 8 Dramaterapeutické techniky pro práci s ženami v tíživé sociální situaci Ženy bez domova jsou jako jiné ženy. Jakkoli triviálně to zní, tak je důležité to na začátku zmínit. Řeší podobné problémy jako každý člověk. I do jejich života patří rodina, partnerství, přátelství, práce… Co je odlišuje, je větší míra rizikových, krizových a traumatických situací, které zažily a přitom je neměly možnost zpracovat, protože se tak v mnoha případech dělo intenzivně už od dětství. Pohlavní zneužívání, závislosti či jiná vážná onemocnění rodičů, život v dětských domovech (i po několik generací), nejrůznější druhy domácího násilí… tak vypadá realita žen bez domova. Myslím si proto, že má velký smysl nabídnout těmto ženám prostor, v němž by se mohly dostat do kontaktu samy se sebou. Zejména práce ve skupině se jeví jako velmi vhodná (mají mnoho společných témat), a tak mohou některé skupinové aktivity působit podpůrně, úlevně a tedy do jisté míry i terapeuticky. Avšak skutečnou terapii by měl vést jen patřičně teoreticky i prakticky vzdělaný terapeut. Nicméně každý, kdo se bude pokoušet se skupinou žen bez domova podpůrně pracovat, se musí připravit na to, že se setká ve vysoké koncentraci s mnoha nezpracovanými, často potlačenými a vzájemně souvisejícími problémy (umocňovanými ještě relativně špatnou zkušeností s psychology a terapií, jenž mnoho z těchto žen i apriori odmítá). Je tedy třeba si dobře vymezit cíle, k nimž má skupina směřovat a vybrat vhodné společné aktivity, jimiž se má zabývat. Dnes jsou samozřejmě volně dostupné informace o nejrůznějších expresivních terapií včetně terapeutických postupů a cvičení, jejich využívání však patří výhradně do rukou profesionálního terapeuta. Přesto si myslím, že je možné i potřebné s ženami bez domova v rámci skupinových aktivit pracovat a využívat k tomu veškeré expresivní prostředky, které nás napadnou či nám jsou blízké. Jedinečným médiem je hra - dramatická, pohybová, hlasová, hudební, rytmická… Hry přinášejí často potřebné uvolnění a odreagování. Ale jejich prostřednictvím je možné také sdílet nelehké obsahy, k jejichž zachycení pak můžeme využít různé 9 výtvarné prostředky, vytvářet obrazy či objekty, jimiž se prožitky externalizují, což působí úlevně. Ráda bych také upozornila na některé důležité zásady a principy práce se skupinou žen bez domova. Za důležitý považuji zejména partnerský přístup. Osvědčilo se mi je v průběhu celého procesu stavět do partnerské role. Dá se začít hned na začátku, kdy se celá skupina pokusí určit pravidla, v rámci nichž bude fungovat a jimiž budou společná setkání regulována. Ke každé člence skupiny je důležité přistupovat se skutečným respektem k ní i jejím životním zkušenostem. Celý proces by měl postupovat pomalu, nikdo by neměl být do ničeho nucen. Ženy samy by si měly určovat a kontrolovat míru sdělení, sdílení a veškerého svého zapojení do aktivit. Je to důležité hlavně proto, že se tak mohou učit stanovovat hranice, za něž je pro ně neprospěšné nebo dokonce nebezpečné jít. Mnoho z nich toto ve svém reálném životě nedokáže, a právě to je jednou ze zásadních kompetencí, které mohou v rámci skupiny získávat. Pozvolnost a dobrovolnost jsou základními principy, jenž zajišťují bezpečí celé skupiny. Bez něj nevznikne ve skupině důvěra tolik nutná pro práci s citlivými zkušenostmi. Důvěra je vázána na skupinu stabilní, až když se budou moci ženy ve skupině pomalu poznávat, začnou si důvěřovat, a pak také poskytovat porozumění a podporu. Na závěr teoretické části chci ještě připomenout, že každý vedoucí skupiny by si měl před začátkem práce se skupinou ujasnit své cíle a ty by samozřejmě měly být v souladu s jeho odbornou způsobilostí. Je zásadní zůstat v úrovni, která je pro všechny bezpečná, kdy si např. ženy poskytují úlevu sdílením nebo dochází prostřednictvím tvůrčích zážitkových aktivit k odreagování od jejich tíživé životní situace. A teď už prakticky. Níže uvádím ukázku bloku, v němž nalezneme kombinaci různých přístupů (her, společného vyprávění, improvizací), které mohou být vý10 chodisky pro dramatický způsob práce se skupinou žen bez domova. Jde o aktivity vhodné pro zahájení práce se skupinou, kdy je především potřeba poznat její témata. Rozkrývání témat je dlouhodobý proces, vyplatí se zde nic neuspěchávat i za cenu toho, že delší dobu zůstaneme v tématicky obecnější rovině - může to být nutná fáze pro vytvoření důvěry ve skupině. Při vytváření programu setkání se vždy snažím pracovat v určitých blocích, kdy jedno cvičení či hra rozvíjí druhé, aby tak mohl být vzniklý materiál dál rozpracováván, konkretizován, propátráván… 1. Hra Každá ve skupině se zamyslíme nad tím, co bychom v současnosti nejvíce potřebovaly. Snažíme se to zformulovat do jednoho či dvou slov. Potom se celá skupina shromáždí u velkého papíru a každá žena řekne a na papír zapíše svou potřebu. V další části hry dostane každá žena ve skupině stejný malý předmět. Mohou to být míčky, kelímky a nebo také svíčky. Svíčky je dobré zvolit, pokud hru hrajeme za tmy. Zapálené svíčky jsou pak nejen předmětem hry, ale i jediným zdrojem světla v místnosti. Ale ať už máme svíčky či jiné předměty, vydáme se s nimi do prostoru a začneme se setkávat s ostatními. Jakmile se dvě ženy setkají, musí si své předměty vyměnit. S tím, jak si vyměňují předměty, si vymění i potřeby, které si na začátku hry zformulovaly a zapsaly na společný papír. Když si předměty a potřeby vymění, jde každá s novou potřebou a předmětem k další ženě. A opět se s ní setká a vymění si s ní předmět a potřebu, které získala v předchozím setkání. Dál pak nese opět novou potřebu a předmět, které dostala od ženy při posledním setkání. Takto se tedy všechny setkáváme a předáváme si předměty i své potřeby. Je důležité se na každé setkání soustředit (dobře si zapa- matovat potřebu, kterou nově získávám a také se přesvědčit o tom, že dotyčná zase převzala potřebu, kterou jsem jí měla předat), aby se žádná potřeba neztratila. Není to zcela jednoduché. Po určité době vedoucí skupiny předávání ukončí, každá žena by měla mít jeden předmět a jednu potřebu, které k ní výměnami doputovaly. Na závěr se skupina opět shromáždí kolem společného papíru, kde jsou zapsány všechny potřeby, a každá žena nahlas řekne potřebu, která u ní skončila. Tak se zjistí, které potřeby skupina udržela a které se poztrácely. 2. Společné vyprávění Společně vybereme několik potřeb z minulé hry (např. tři). Měly by to být takové, které rezonují s větším počtem žen ve skupině a na nichž se shodneme. Tyto potřeby poslouží jako témata společného vyprávění. A tak jestliže jsme si vybraly jako jednu z rezonujících potřeb např. ticho, vyprávíme společně na toto téma příběh. Všechny si tedy sedneme do kruhu a jedna z nás začne vyprávění. Vypráví naprosto svobodně, jediné, čeho se musí držet, je téma. Až bude chtít, může vyprávění zastavit. V té chvíli musí na její vyprávění navázat sousedka. I ona vypráví, snaží se držet tématu, ale také se snaží navazovat na vyprávění, jak ho rozvinula předešlá vypravěčka a přidat něco ze své fantazie. Takto se postupuje po kruhu, dokud se příběh nepodaří uzavřít. Totéž opakujeme s ostatními potřebami / tématy. Potom je dobré otevřít diskuzi a mluvit o způsobu spolupráce při vyprávění, o pozornosti, navazování i o pocitech, které hra vzbudila. 3. Průběžné sochy I toto cvičení tématicky navazuje a rozvíjí předešlá. Skupina se dle své velikosti rozdělí na dvě až tři početně vyvážené části. Každá skupinka si pak vybere jedno z témat, na jehož základě byly vyprávěny příběhy v předešlém cvičení. Na dané téma skupinky vymyslí jasnou situaci. Ideální je, když se mohou inspirovat příběhy, které vznikly na základě toho kterého tématu v předešlém vyprávění. Případně je možné sáhnout k rezervoáru témat, která vznikla při první hře se svíčkami a z nich si nějaké vybrat. Skupinky pak společně určí postavy, jejich vztahy, místo, problém či konflikt. Přítomnost problému nebo konfliktu je pro cvičení velmi důležitá. Tuto situaci se pak jednotlivé skupinky pokusí převést do sousoší. Takže musí najít taková uspořádání soch v prostoru a taková gesta, grimasy a postury, které vystihují podstatu dané situace. Když tento úkol skupinky zvládnou, vzájemně si sousoší ukáží. Přihlížející se pak mohou snažit sousoší interpretovat, hledat význam gest, grimas, vztahů… Diskutuje se. V další fázi má každá skupinka k dané situaci vymyslet další situaci a to situaci, která by řešila problém zobrazený v prvním sousoší a která by byla happyendem původní problematické situace. Když si tuto situaci skupinky formulují, opět ji převedou do sousoší a vzájemně si ji ukáží a opět o významu sousoší diskutují. Jako poslední se hledá situace, která by propojila situaci úvodní problematickou se situací závěrečnou - happyendovou. Poslední, třetí situace vlastně hledá cestu od problému k jeho řešení. Když skupinky takovou situaci najdou a převedou ji do sousoší, každá skupinka ukáže všechna tři sousoší bezprostředně po sobě. Jako první tedy sousoší, které zobrazuje problematickou situaci. Jako druhé sousoší, které ukazuje cestu řešení problematické situace. A jako poslední sousoší, které zobrazuje úspěšné řešení. Když jsou jednotlivé série sousoší předvedeny, je dobré o nich diskutovat. Ujasnit si význam situací i celku, hledat sdělení, která jsou tu obsažena… Práce se sochami umožňuje jasné a expresivní vyjádření, je pře11 hledná a pro skupinu, která nemá předešlou zkušenost s dramatickými formami, je jednoduše přístupná a jako iniciační dramatická aktivita velmi vhodná. 4. Improvizace Nakonec můžeme zařadit improvizaci. Ženy z jednotlivých skupinek se pokusí improvizací rozehrát příběhy načrtnuté v sérii sousoší v předešlém cvičení. Je jednodušší, když improvizaci začnou jedna či dvě ženy a ostatní se postupně přidají. Improvizuje vždy jedna skupinka a ostatní se dívají. Nakonec o improvizacích společně diskutujeme. Improvizace je náročná na pozornost a schopnost pohotové reakce improvizujících. Bez jasných pravidel se může stát nepřehlednou a obtížně přístupnou. Na druhou stranu díky ní může vzniknout živelně a spontánně velmi zajímavý materiál a zúčastněné mohou zažít radost a uvolnění ze společné souhry. Důležité je sledovat improvizaci i pro přihlížející, kteří mohou vidět, jak se daří improvizujícím vytvářet situace (prostředí, postavy, vztahy) a jednat. Kateřina Jungová 12 Trauma informed approaches to women’s homelessness support Esther Sample Women’s Strategy Manager St Mungo’s Broadway Photo by Georgina Cranston: www.wherefromwherenow.org www.mungosbroadway.org.uk UK Women’s Homelessness Homelessness is a growing problem in the UK. Government figures show that the number of people accepted as homeless grew 10% between 2011 and 2012, and the number of people recorded sleeping rough has risen by 37% since 2010. Women make up 26% of people who accessed homelessness services in 2013, using approximately 10,000 bed spaces across the UK. 786 women were recorded sleeping rough in London in 2012/13, 12% of the total number. We believe many more women are ‘hidden homeless’, living outside mainstream support. How do the needs differ? St Mungo’s Broadway Data • 70 per cent of women have mental health needs, compared to 57% of male clients. • 38% of women had substance use support needs compared to 35% for men •27 per cent have a combination of mental health, physical health and substance use needs. •Over half are mothers and 79 per cent of clients who are mothers have had their children taken into care or adopted. • Over a third of female clients who had slept rough had been involved in prostitution. •Half of female clients have an offending history, and a third have been to prison. Women’s journeys to homelessness (Mayock and Sheridan, 2012) • 92% of the women in the study had experienced some form of violence or abuse during their lifetimes.72% during childhood and two-thirds had experienced intimate partner violence in adulthood (SMB data for domestic violence 50% women, 5% men) • 27% reported a history of state care. Women’s Strategy Background Cohort Starting Point on Star Older Male Drug Users 5.0 Younger Male Drug Users 4.9 Women 2.9 Clients Using alcohol 4.4 Dual Diagnosis (MH & SU) 4.1 Awaiting Flat 8.7 Women’s Strategy Aim: trauma/gender informed services for better outcomes for women • Philosophy, change of thinking: -Gender matters -Allow time to feel safe and process trauma • Service design and safety • Policies and training • Partnerships with specialist agencies • Increased opportunities for women- groups + training / employment • Client involvement Evidence of improvement: Mental Well Being: 82% of women arriving in precontemplation making positive progress compared to 50% before the start of our women’s strategy work in June 2011(Substance Use: 75% compared to 55%, Physical Health: 90% compared to 67%) Rebuilding Shattered Lives www.rebuildingshatteredlives.org • Launched June 2012 • 464 members from 3 continents • 221 submissions-practitioners /women Aims: • Raise awareness • Showcase good practice and innovation • Improve services and policy for the future Key Findings • Trauma and Abuse – Experiences rooted in traumatic childhoods, gender based violence • Complex and interrelated needs – Found with women across sectors/services • Relationships with children – Loss and separation key barriers to recovery • Stigma and Shame – Judged by societal expectations of women • Access to Services – Missed opportunities Recommendations: Service principles Quotes on trauma ‘I don’t think services address childhood trauma. My childhood was a bit messed up until about 3 or 4 years ago really. When I first came into homelessness services the focus was on sorting out the practicalities of moving forward rather than mentally looking back...When you get to that stage in life when everything is dislocated, it is because of a long history of events- life doesn’t fall apart in a day. It is futile to deal with the symptoms without looking at the Catalyst. I go to therapy every Tuesday and it has helped me a great deal- it is helping me move forward.’ ‘Things that happen as a child scar you for life. Moving on is about overcoming fear. Women need the option to talk about it but there needs to be no pressure, so they can start to deal with it but not be overwhelmed.’ ‘Talking to another woman needs to be an option for some, it might have been a man in childhood that did the abuse so they could be more comfortable speaking to a woman.’ ‘I think to tackle childhood trauma we need more support for parents, even things like nutrition and how to feed children well.’ Quotes on trauma ‘I had the best therapist and key worker but it wasn’t sufficient enough, I was using drugs for 20 years. It wasn’t until I was honest and saw all the different parts of myself- including the dysfunctional, the hurt and the confused areas. All these parts lead to isolation because of the shame and stigma associated with women and drug use.’ ‘In my experience if someone opens up about their emotions then goes back to somewhere where they are lonely or isolated then this can do damage. We need social support alongside counselling.’ ‘We should be able to access support groups to no longer feel isolated and judged and to learn from others. Counselling is not for everyone and key workers should help in a more informal way.’ Sex / Gender definitions Sex: Refers to the biological differences between men and women which are universal and do not change. A person’s sex is determined through their genetic makeup and chromosomes. Intersex: People born with "sex chromosomes," external genitalia, or internal reproductive systems that are not considered "standard" for male or female. Gender: A socially constructed system of classification that ascribes qualities of masculinity and femininity to people. It also includes expectations held about the characteristics, roles, responsibilities and behaviours of both women and men. These attributes are learned or acquired during socialization as a member of a given community, can change over time, and vary between cultures. Transgender: an adjective describing a person whose gender identity differs from the gender they were assigned at birth Trauma definition Post Traumatic Stress Disorder (PTSD) can be caused by: “exposure to actual or threatened death, serious injury or sexual violation.” The exposure must result from one or more of the following scenarios in which the individual: • directly experiences the traumatic event; • witnesses the traumatic event in person; The disturbance, regardless of its trigger, causes significant distress or impairment in the individual’s social interactions, capacity to work, or other important areas of functioning. (DSM5) Trauma can be triggered by a single event, or can be enduring, ongoing (complex trauma) “An inescapably stressful event that overwhelms people’s coping mechanisms” An event that evokes feelings of “intense fear, helpless[ness] or horror” “Life-threatening powerlessness” Trauma and gender As children, boys and girls suffer similar rates of abuse • Girls - sexually abused • Boys - emotional neglect or physical abuse. In adolescence, boys are at greater risk if they are gay, young BME men or gang members • Young men - people who dislike or hate them. • Young women – relationships; from the person to whom she is saying, “I love you.” Adulthood • Man - combat or being a victim of crime • Woman – relationship; the person to whom she is saying “I love you.” Source: Stephanie Covington, 2014 Complex Trauma • Complex PTSD - Distinguishable from PTSD by the sustained experience of abuse with no agency or means to escape e.g. childhood abuse, intimate partner violence, prolonged involvement in street based prostitution. •The impact of prolonged and repeated experiences of trauma manifest in many areas e.g. physical health, mental health, memory loss, flashbacks, belief threat is ever present, inability to regulate emotions and to keep self safe. •Coping mechanisms become disorganised and disjointed, the body and brain go into hyper-vigilant ‘fight or flight’ mode, releasing chemicals and hormones to help us survive. •Women may self medicate with substance use to dull the affects of trauma. Chrysalis- South London Women’s Project •‘Holistic services and counselling put in place to help the woman process traumas. Sensory activities can activate different parts of the brain and help move focus away from trauma response.’ •‘We also try to nurture the areas where a woman can function to a high level, achieve a guaranteed outcome in order to increase the moments where she can feel rewarded. ‘ Judith Herman’s Stages of Recovery from Trauma (1992): 1. Establishing safety 2. Reconstructing the traumatic story 3. Restoring the connection between the survivor and his/her community. Chrysalis- South London Women’s Project Phase one – security, stability and intensive support •18 bed women only hostel that provides intensive support including around involvement in prostitution, substance use and mental health issues. •Specially trained psychotherapists provide counselling sessions to help the women deal with the ongoing trauma of experiences •Psychologically Informed Environment (PIE) project, which creates an emotionally safe environment. Staff reflective practice Phase two – reflection and moving towards independence •Semi-independent abstinent project to help women develop independent living skills and engage with local services Phase three – living in the community •Commonweal Housing transitional flats and floating support Women’s Psycho-educational support • Women’s Psychotherapist as part of our ‘Lifeworks’ team to provide specialist 1:1 Counselling for women, using a gender and trauma informed approach • Women’s psycho-educational groups on gender and trauma- to learn it’s impact but not necessarily disclose own experiences: ‘Im really interested in being part of this – I want to learn more about trauma’ ‘I think this group helps women understand when and why they are in a traumatised state’ ‘I think these sessions help people understand that’s its not a weakness and it’s not your personality – it’s something that has happened to you’ ‘Id like to see a Trauma support group’ ‘Id like to know what to do to help people’ Feminism!!! Contact The full report can be downloaded at: www.rebuildingshatteredlives.org Contact: [email protected] Towards Inclusion: Gender and Sexuality Aware homelessness support Jamie Hickling Southwark Service Manager & LGBT*Q+ Network Coordinator St Mungo’s Broadway www.mungosbroadway.org.uk Demographics from 2013 research Peer Research: 63 women. The average age of our interviewees was 37 with a range covering 19 to 76 years old. 60% were in the 30-50 age group, this is very similar to the 2008 project. We asked interviewees to self-describe their own ethnicity and found that 32% described themselves as White British 8% as Black British and 18% as British/ English/ Scottish without specifying a colour. That leaves 42% non-British participants which is higher than 2008. Demographics from 2013 research 4% of women were identified by their key worker as lesbian and 6% as bisexual. In this research we found that 18% of our sample identified as bisexual (no-one as lesbian). Last time we found 23% and we can conclude therefore that it is highly likely that there are higher proportions of lesbians and bisexual women than staff are aware of. In terms of religion we found that 38% self-identified as Christian (of whom about half were Catholic), 12% Muslim and 25% ‘no religion/ atheist/ agnostic’. The remainder mostly didn’t answer at all. No-one mentioned religious issues under any of the questions asked. LGBT*Q+ Network g www.mungosbroadway.org.uk LGBT*Q+ Network Network Name: Delimiting Difference or Celebrating Commonality? After some discussions across the group we have decided to adopt LGBT*Q+ as our new name. This stands for Lesbian, Gay, Bisexual, Trans* (an umbrella term covering transgender, transsexual, genderqueer, third gender, two-spirit), queer and questioning. The plus symbol covers intersex, asexual, pan-sexual and other emerging groups. It also covers our LGBT*Q allies – heterosexual people or those who are comfortable in their gender assigned at birth who support LGBT*Q+ people and our associated issues. LGBT*Q+ Network Roles •Plan LGBT*Q+ Strategy •Developing LGBT*Q+ client work •Advice for people who Key Work LGBT*Q+ clients •Working with an LGBT*Q+ volunteer to do an audit of services •Re-launch of our LGBT*+ Allies •Developing expertise in LGBT*Q+ Domestic Violence •Organising Pride events / staff Developing our Social Media & Networking with others LGBT*Q+ Network Roles •Inter-network planning- Where LGBT*Q+, WAN, Disability, IFG, BAME and CEE diversity strands intersect •Age specific LGBT*Q+ •Health including mental health •LGBT*Q+ Service Development •Managing our resources •Coordinating the Diversity Calendar •Coordinating peer research Trans* Inclusion: g www.mungosbroadway.org.uk Trans* Inclusion Staff should continuously strive to familiarise themselves with issues that are relevant to trans* clients beyond what is covered during Equality & Diversity Training, in order to provide a better service to trans* clients. For example, trans women are more like to be HIV+ and be involved in prostiution than other clients. Staff should also familiarise themselves with how other factors intersect with trans* people’s experiences, such as race and disability. Trans* Inclusion Staff within St Mungo’s Broadway will not make assumptions on people’s gender identity and / or their sexual orientation as trans* people may have any sexual orientation. Instigating discussion that makes assumptions about individual’s sexual orientation in the context of their gender identity will often give rise to offence and may contravene St Mungo’s Broadway’s diversity policy. Questions about next of kin must be asked in a supportive, respectful manner without making assumptions. Trans* Inclusion The plan will need to take into account the point at which the trans* client or member of staff’s new gender is formally established in terms of records. The right of the person to maintain confidentiality of their previous identity needs to be secured at this stage for both staff and clients. Many clients have files that contain information over longer periods of time, as do many staff’s personnel records and access to these records that reveal past gender identity must be strictly controlled. Trans* Inclusion An agreement plan between the manager, staff member and HR or the manager and clients must be reached with regards to the use of certain facilities for clients and staff who are transitioning to a new gender. These include: •Toilets •Changing facilities •Bathrooms and showers •Gender specific groups eg Men’s and Women’s Groups and Drop-Ins. •Gender specific areas eg Women’s Lounge or Female clusters. •Gender specific move-on Projects. Bisexuality Inclusion Guidelines g www.mungosbroadway.org.uk Bi considerations Bisexual denial for example, questioning the existence of genuinely bisexual men, or seeing bisexual people as ‘confused’ about their sexuality. Bisexual invisibility for example, assuming that people are either heterosexual or lesbian/gay, or assuming people’s sexuality on the basis of their current partner. Bisexual exclusion for example, claiming to speak for LGB or LGBT people but then neglecting bisexual specific issues, or including bisexual people in research but amalgamating their responses with those of lesbians and gay men. Bi considerations Bisexual marginalisation for example, failing to engage with bisexual people/ groups in policy and practice, or prioritising lesbian and gay issues over bisexual ones. Negative stereotypes for example, assuming that bisexual people are promiscuous, spreaders of disease, incapable of monogamy, a threat to relationships/families or sexually available to anyone. Bi Inclusion recommendations •Inform yourself about bisexuality and avoid stereotypes about bisexual people. •Liaise with bisexual communities on issues of equality and diversity in the same way that you liaise with lesbian, gay and trans communities. There are many bisexual groups and organisations who are willing to engage in this manner •Include bisexual representation in all relevant working groups and initiatives. Bi Inclusion recommendations •Include bisexuality within all policy and explicitly within the diversity implications section of every document and policy. •Don’t assume one unified bisexual experience. Many different types of relationships and sexual practices are found among bisexual people. The experiences and needs of bisexual people are also affected by their race, culture, gender, relationship status, age, disability, religion, social class, geographical location, etc. LGBT*Q+ need •Young people, presenting no other issues, are often thrown out of their family home because of their sexual orientation and/or gender identity and for no other reason •Young LGBT*Q+ people specifically suffer physical, verbal, and sexual harassment inside and outside the home because of their sexual orientation and/or gender identity •Older LGBT*Q+ people needing care or sheltered accommodation often find themselves marginalised or ostracised by care workers, support staff or other people with whom they live LGBT*Q+ need •LGBT*Q+ people of all ages are subjected to harassment and violence inside and outside the home; many experience this from their neighbours •LGBT*Q+ people often face homelessness due to suffering same sex domestic abuse, with no appropriate emergency housing provision and with the police more likely to record this as a dispute between “flat-mates” rather than domestic violence. Trans* and gender diverse people also suffer a disproportionate amount of domestic violence, and are less likely than non-LGBT*Q+ people to seek support. LGBT*Q+ need •Staff need to raise LGBT*Q+ issues with clients not simply in the context of sexual health and safer sex •However it is important that sexual health needs of LGBT*Q+ people within the projects are addressed by staff offering information or signposting people to other services. LGBT*Q+ Client Group g www.mungosbroadway.org.uk LGBT*Q+ Newham Project •New projects being set up now •2x 12 bed houses in the London Borough of Newham •Joint Venture with Stonewall Housing •Tailored support to vulnerable LGBT*Q+ clients •Fleeing Domestic Violence •Tailored support around Emotional, Mental, Physical and Sexual Health Run by LGBT*Q+ staff. LGBT*Q+ & Domestic Violence g www.mungosbroadway.org.uk Hierarchies of Oppression & Supporting all Women g www.mungosbroadway.org.uk LGBT*Q+ Activismctivism Web Resources •http://www.stonewall.org.uk/at_home/default.asp •http://stonewallhousing.org/about-us.html •http://brokenrainbow.org.uk/ Stay in touch: @MungosBwayLGBTQ [email protected] g www.mungosbroadway.org.uk Outcomes Star - a tool to evaluate the process of cooperation Esther Sample and Jamie Hickling St Mungo’s Broadway www.mungosbroadway.org.uk Photo by Georgina Cranston: www.wherefromwherenow.org The Stages of Change Model •The idea behind the stages of change model is that behaviour change does not happen in one step, but rather that people tend to progress through different stages on their way to successful change. •Prochaska and Diclemente originally developed the stages of change in 1982. •Each person also progresses through the stages at their own rate. The Stages of Change The Stages of Change Pre-contemplation - Not yet acknowledging that there is a problem behaviour that needs to be changed (Denial) Contemplation - Acknowledging that there is a problem but not yet ready or sure of wanting to make a change Preparation - Getting ready to change and small experimental behavioural changes Action - Changing behaviour Consolidation - Actively consolidating the gains made during action Lapse - Temporary loss of motivation caused by personal distress or social pressures The role of staff 1.Always be proactive, but also be patient and allow time. (Expecting behaviour change by simply telling someone, for example, who is still in the "pre-contemplation" stage that they must go to a certain number of meetings in a certain time period is likely to be counterproductive) 2.Identify together with the client the stage they are in, in relation to a given issue. 3.Support and motivate the client to enable them to move to the next stage, being led by their ideas and ambitions and planning together. Pre-contemplation Stages Pre- Contemplation Point 1 & 2 of Outcomes Star Often described as a pre stage Characterised by Denial - “Who, me?” Unaware or barely aware of a problem May wish to change but not seriously considering this Goals Role of worker Harm reduction Resist the natural tendency to try and Receives information "convince" clients, which on the consequences usually engenders of their situation resistance. Resistant to or no intention of Receives information Raise awareness of changing behaviour in foreseeable on available services discrepancy between future individual’s behaviours and their values and Not engaging with key worker, Questions beliefs includes not attending key work "What would have to meetings happen for you to Increase perception of know that this is a risks and problems Rejecting offers of help and even problem?" blaming others. Defensive/ Support on other areas argumentative if pressured "What warning signs client is able to address would let you know Could include: Physical and that this is a Concentrate on the mental health problems and/or problem?" development of a chaotic substance use trusting relationship "Have you tried to Feelings: frustration, hopeless, change in the past?" Active listening Contemplation Stages Contemplation Point 3 & 4 of Outcomes Star Characterised by Goals Aware of problem and seriously Deal with thinking about addressing it ambivalence, weighing pros and Not yet committed to preparing cons for and taking action Attempt to increase Experiencing ambivalence – motivation to weighing the pros and cons change Can remain stuck at this stage for a long time Feelings: fearful, anxious, hopeless, isolated confused Questions "Why do you want to change at this time?" "What are the barriers today that keep you from change?" "What things have helped in the past?" Role of worker Explore ambivalence Don’t take sides Statements of recognition of client strengths Create a “free and friendly space” to explore issues An accepting attitude facilitates change, pressure to change thwarts it Preparation Stages Preparation Point 5 & 6 of Outcomes Star Characterised by Committed to taking action and making concrete steps to do so Small experimental behavioural changes as ambivalence diminishes Actions: reduction in substance use, asking questions, listening /talking more, taking responsibility Goals Role of worker Setting reachable Support in creation goals and makes of realistic plan. specific plans Explore “how will you do this? & how will you know if you’ve been successful?” Build confidence in ability to change Offer information Feelings: relieved, anticipation, anxious Action Stages Action Point 7 & 8 of Outcomes Star Characterised by Commitment is clear Goals Consolidate and reinforce new Actively changes behaviour behaviour or environment to address problem Considerable commitment of time and energy is required First time that the change process becomes obvious to others Role of worker Encourage rightsized steps; explore “how is this working?” Support plans should focus on the stage that the client is really at. But often focus at this stage because action is the easiest stage to measure Consolidation Stages Consolidation Point 9 & 10 of Outcomes Star Historically called maintenance. However this is an active stage and Mungo’s wishes to enable people to continue to recover not just maintain them Characterised by Consolidating the gains made during action Stabilizing behavioural changes Effort to prevent lapse Increasing the strength, stability, or depth of the new behaviour Old support systems people/ substances maybe gone or reduced Feelings: enjoyment of the rewards, loneliness, boredom if giving something up Goals Lapse prevention / maintaining new behaviour Role of worker Support the creation of a lapse prevention plan, explore new behaviours Develop/strengthen new support Assist in identifying system networks high- risk situations Can learning be applied to other areas? Lapse Most people find themselves "recycling" through the stages of change several times ("lapsing") before the change becomes truly established. A lapse is: – A temporary loss of motivation Caused by personal distress or social pressures Can happen at any time during the stages of change “Lapse happens! A learning opportunity” From this approach come the ideas for lapse prevention, involving a strategy, coping skills development, cultivation of self awareness and self-monitoring. When appropriate the client should be supported in Identifying triggers to lapse and see it as a learning opportunity by asking Questions such as “What did and didn’t work?” “What can be learnt from this?” Motivating Clients Motivating clients to change Five Principles of Motivating clients (also known as Motivational Interviewing) GRACE: • Generate a Gap • Roll with Resistance • Avoid Argument • Can Do • Express Empathy Motivating Clients Motivating clients to change Five Principles of Motivating clients (also known as Motivational Interviewing) GRACE: • Generate a Gap • Roll with Resistance • Avoid Argument • Can Do • Express Empathy Scale example- Physical health 10 Looking after my physical health well 9 Lifestyle is reasonably healthy. Need occasional support to keep it that way 8 Changing my lifestyle to make it healthier but find it hard 7 Can see that when I look after my health, I feel better 6 Doing some things to look after my physical health 5 Realise I need to take some responsibility for looking after my health 4 Will go along with treatment provided for less pressing problems 3 Will get help when in pain or discomfort 2 Health isn’t great but so what 1 Not interested in my physical health - don’t want to talk about it Case study 1 - Sarah Sarah has recently moved into your accommodation. She spends a lot of time in her room drinking and in bed and does not speak to other residents. You are worried that she is experiencing depression and her alcohol use is having an adverse impact on her mental and physical health, however she says she is fine. She has told you that she has financial debts that she wants to sort out and also a daughter that she has no contact with that she wants to reconnect with. Case study 2 – Adeline Adeline has just been released from prison and is new to your accommodation service. She is 33 years old. In her 20s she was in trouble with the police as she was funding a drug habit through shoplifting and petty theft. She became drug free in prison but received treatment from the prison nurse for bipolar disorder. She has disclosed that she is bisexual and used survival sex in the past when homeless. Adeline finds her periods of mania creative and enjoys art, though she sometimes feels scared when she loses inhibitions. Adeline wants to develop support skills to help women who have been in similar circumstances to herself. St Mungo’s Broadway Outcomes Star Full Scale Descriptions You are free to share, to copy, distribute and transmit the work under the following conditions: You may not use this work for commercial purposes; No Derivative Works. You may not alter, transform, or build upon this work; For any reuse or distribution, you must make clear to others the license terms of this work. St Mungo’s Broadway acknowledges the role played by Triangle Consulting Social Enterprise Limited and the London Housing Foundation in creating the St Mungo’s Broadway Outcomes Star. Motivation and taking responsibility – the internal journey This scale measures an inner change of perspective, focused on increased motivation, and clients taking responsibility Put for themselves theirhere situation, along with increased self-confidence. It is at the heart of the scale and title changes described and measured by the other scales, which can be viewed as external manifestations of an inner change or growth. Not interested in talking to workers or in making change 1 • Appears totally stuck. There is no opening for key work • Will not engage in conversation about their current situation • May be too frightened of change or lack any confidence or belief that it is possible 2 Sometimes fed up with how my life is but nothing can be done about it • The first glimmer of dissatisfaction with their situation but effective key work still not possible • Engages in discussion and then breaks off or changes the subject Had enough of living like this and want things to change 3 • Says they are not happy with how things are (attitude changes) • Wants to do something about it but doesn’t follow through, for instance misses appointments • Doesn’t really believe that things can change for them and they are not doing much about it Will go along with help if other people can stop my life being like this 4 • Accepts help more consistently - asks for help and attends appointments sometimes • Goes along with what is suggested by others - behaviour changes • May know what they don’t want but not what they do want Know I need to do something to help myself move on 5 • Seems really engaged in key work • Starts to put things on the agenda rather than just responding • First signs of taking responsibility for their situation and feeling they can change it Know what I want and I’m starting to do things to get it – with lots of help 6 7 • Doing things differently, addressing issues in practice (behaviour changes) • Has more of a sense of how they want their lives to be • Change feels frightening and familiar ways are tempting; needs support and may say and do contradictory things. Their level of commitment to change may vary Understand how what I do affects what I get • Recognises that behaving differently has positive effects; sees the benefits (attitude changes) • May feel excited about new possibilities and what the future holds • First sense of feeling in control Like the way I live now but need help to keep it going 8 • Behaviour and habits changed substantially, for instance has new friends and daily routine • Makes more consistent positive choices; behaviour in line with what they want • Experiencing inevitable setbacks and needs support with these Comfortable with new lifestyle but need help now and then 9 • Confidence getting stronger as they get through setbacks • Able to judge when needs support rather than have it there all the time • New identity as someone who can cope and is in control but letting go of support may be frightening Independent of the agency: family, friends and generic services provide help if needed 10 • Confident in new life-style • Own support network in place Self care and living skills This journey is aboutscale how much the client is able to look after themselves and the accommodation they are Put title here in. It is about the basic living skills and self care: hygiene, keeping safe at home, whether they keep the accommodation at a basic level of cleanliness and are able to shop, cook and access the basics they need. Don’t have a problem with looking after myself - though others think I do 1 2 • Not able to keep themselves warm, fed, safe, clean, for example; if street homeless, may not be eating or washing regularly; in a flat there may be abandoned rubbish • Not possible to engage in discussion about self care • Self-neglect to the point of harming self or driving others away Don’t look after myself well but I can’t - that’s just the way I am • Will discuss self care and may acknowledge problems but refuses all help • Some glimmer of dissatisfaction with how things are Don’t like the fact I can’t take care of myself, I need help 3 • Sometimes agrees to letting worker help address issues, for example arranging to fit lock on a door if in a flat; having a shower and putting on fresh clothes, if in a hostel • Compliance with keyworker suggestions is patchy If others can help me look after myself better, I will go along with it 4 • Consistently accepting help with self care • Self care standards improve when a lot of support is given, for instance cleans room, eats regular meals, but are dropped as soon as support is withdrawn Want to be able to do more for myself - look after myself and my place better 5 • Starts to initiate conversations about self care • First signs of seeing cleanliness, diet, sleeping habits etc as being important to them • Actively wanting to develop skills, if they don’t have them 6 Doing things to look after myself and my place better, learnt more what to do • Does laundry, cleans room, cooks meals, for example, without prompting • Has reasonable skills for basic cooking and cleaning by this point, if not before See that when I look after myself and my place, I feel better 7 • Understands importance of self care, how it influences how they feel and how others react to them • As a result of positive choices, feels better and motivation increases 8 Have new habits and I’m doing more but sometimes slip back 9 Look after my place and myself well, just need occasional help • Self care good in some areas but there are blind spots in other areas • Change is difficult so needs support to deal with setbacks • Good self care but may let it go when things are difficult and needs help to get back on track Can look after my place and take care of myself without outside help 10 • Will notice if they have let something go • Never neglects an important area over a long period • Looks after themselves and their home well without support Managing money and personal administration This scale covers all aspects of managing money, from sorting out benefits and taking responsibility for them, through to budgeting, paying bills, managing and reducing debt, not lending or borrowing money inappropriately and living within income. 1 2 Don’t know how much I owe or who to – not willing to talk about it • Rent not paid and may have extensive debt and/or problems with the courts or those loaning money. Any money may be spent in one area, for instance drugs • Not willing to talk about money • Appears totally stuck, there is no opening for key work Money things are a mess but nothing can be done about it • May feel helpless around money, have no experience of managing money and/or be exploited by others around money • Unable or unwilling to prioritise or understand the issues Don’t want these money problems 3 • Accepts help with obtaining benefits or keeping a claim running • Wants to get rid of the pressure on them as a result of money problems but blames others or is very vulnerable to exploitation Will go along with help if my key worker can sort out my money for me 4 • In receipt of correct benefits at this point, if not before • Accepts help with sorting out debts and/or open to talk about it • Cannot go beyond this point without a payment plan for rent and service charges and bill payment plan in place, if they are needed Have plans in place and need to do something myself to sort out benefits and money 5 • First signs of taking responsibility for financial situation • If in debt, there is a sense that they want to understand their situation and address it • Attends appointments. Gives CAB and others information and permission to contact debtors Starting to sort out my benefits and manage with what I have got. It’s difficult 6 Takes responsibility for claims and debts at this point, if not before, and has some understanding of entitlements and benefit agencies • Awareness of budgeting, though often can’t maintain it. May have a written budget plan • If vulnerable and exploited by others with money, starting to address this • Rent arrears may be still be owed but non-payment is less frequent Can see things are better when I sort out my money and debts 7 • By this point (if not before) preventing further debt building up. Debts may be reduced • Can see that being responsible with money brings rewards – it is much better to have some money to spend and not to be receiving red bills • Regular payments made Able to avoid crises if I plan ahead – sometimes I need help with this 8 • Immediate problems dealt with and payments kept up. Starts planning ahead • Doing more for themselves but experiencing setbacks, for instance if there is a new form to complete, will attempt to do it themselves but may need help to finish it off Know when I need help to manage my money and benefits and how to get it 9 • Budgets well; no need to prompt to pay bills, understands income and outgoings and isn’t usually vulnerable to exploitation by others or loaning money inappropriately • Occasional problems, still needs support to get back on track Can manage my money fine and don’t need support with it 10 • Fully understands entitlements, benefits process and how to maintain a claim • Able to forward plan and deal with crises • May still have debts but is repaying them and can manage situation without support Social networks and relationships This journey is about relationships – who the client mixes with, whether their social circle supports them in achieving the things they want in life and whether they feel they can trust and rely on people. It may be a journey from being on their own to having some contact with others, or from spending time with people who keep them stuck in old ways to people who support them positively. That’s how life is – you can’t trust anyone 1 • Completely isolated or only associating with a street, addiction and/or offending community • Any relationships may be exploitative, lacking in trust or regard • Doesn’t see a problem with how things are Sometimes fed up with being alone or with people I can’t trust 2 • Some awareness that their relationships are not as they would like them to be • Starting to feel isolated and not wanting to be • Still only relating to people who support destructive life choices Don’t like feeling isolated, or, the people around me aren’t good for me 3 • Recognises relationships aren’t satisfying and supportive and may be exploitative but doesn’t know how to change them • Doesn’t know how to find people who will support them in any change Talking to new people but don’t really like or trust them 4 • Engages with staff and/or people outside peer group but very warily - testing people out • Starts to engage in activities in accommodation Have found someone I can talk to and trust. I want to address my family issues 5 • Starts to value and trust key worker or another staff member, which gives them a sense of how relationships could be and reinforces dislike of exploitative relationships Feeling in-between - left old friends behind but don’t have new ones yet 6 • Moving away from previous peer group but tentative in making new relationships and as a result very dependent on key worker or other trusting staff relationships • Needs support in recognising constructive relationships • If naturally private, may be able to express desire for privacy in a less hostile manner Have some sense of who I can trust and starting to understand family issues 7 • Able to establish positive contact with friends and/or family by this point, if not before • Has made some new relationships with people who support their more positive life choices • Recognises the destructive effect of some past relationships • May be making first steps to re-establish contact with family, if this is appropriate Enjoying my (new) friends and/or family but sometimes we have difficulties 8 9 10 • New relationships deepen • Inevitable difficulties arise such as conflict or feeling let down; needs help to deal with them and learn from them • Building ability to communicate; can say yes and no, and live with differences • Sometimes misses their old community or isolation which was less demanding Have people I can rely on but need help in this area now and then • Relationships feel more secure • Greater sense of being able to deal with difficulties but still needs help sometimes • Willing to explore and take risks with new people • May be helping old associates change themselves Have the friends and contacts that I want and need and have no major family issues Substance use This journey deals with the client’s use of illegal drugs and misuse of alcohol or prescribed drugs. It deals with their behaviour and also how well they are dealing with any substance misuse issues or addiction such as: whether they are aware of the impact it has on their life; whether they are reducing the harm and what steps they are taking to understand and overcome these issues. If the client is at different points for different drugs or alcohol, focus on the substance of most concern at the time. Don’t have a problem with alcohol or drugs - though others think I do 1 2 • Alcohol and/or drugs causing harm to client and/or other people • Life totally organised around alcohol and/or drugs, nothing else matters • Not possible to engage in discussion about addictive behaviour Sometimes see that it’s a problem but I can’t change it (or don’t want to) • Some engagement with staff but refuses all help • Some glimmer of dissatisfaction with how things are • May avoid some harm, for instance by using a needle exchange Need some help with alcohol and/or drug issues 3 • Fed up with the negative consequences of the alcohol and/or drugs use • Wants change but may not believe it is possible, often misses appointments • Justifies behaviour, blames others, not taking responsibility Will go along with things my worker and doctor say will help 4 • Agrees to harm reduction measures, for instance scripting or money managed by others • Compliance with these measures dependent on enforcement by others • Accepts referral to alcohol and/or drugs service if needed but is not fully engaged with it See that I need to make changes myself to tackle my alcohol and/or drug use 5 • Recognises that addressing alcohol and/or drugs will require change on their part • Less chaotic and more willing to engage in discussions about options to help • A sense that they are ‘up for it’ Doing some things myself to address my alcohol and/or drug use 6 • May reduce level of alcohol and/or drug use or abstain completely for periods • More regular attendance at appointments (key work and specialist) • Alcohol and/or drug use still has an impact on their life but not severe Understand why I had/have a problem and what I need to do 7 • Fewer lapses by this point, if not before, and able to learn from lapses • Explores triggers for alcohol and/or drug use and reflects on causes • Feels more confident about ability to live without drugs or misuse of alcohol Getting control. I have choices about what I do and mostly choose well 8 • Feels a greater sense of control – understands they have choices about what they do • Further reduction in alcohol and/or drug use or longer periods of abstinence • Finds new ways to cope with feelings and situations that lead to alcohol and/or drug use 9 Drugs and alcohol have no negative effect. I may need some support 10 • Very little or no alcohol or drug use • Doesn’t need much support but appreciates knowing it is there No problem with alcohol or drugs • Able to access support in future as needed Physical health This journey is aboutscale how welltitle the client looks after him or herself – noticing when they don’t feel well, Put here whether they are doing whatever they need to do to deal with long-term conditions and living a healthy lifestyle so that they can enjoy a good quality of life. In the earlier stages it is about avoiding serious harm, and in the later stages it is about greater self care. Not interested in my physical health - don’t want to talk about it 1 2 • Will not discuss health issues • Doesn’t attend to immediate health issues, for instance ulcers, chest infection • May neglect to the point of self-harm Health isn’t great but so what • Some glimmer of concern about themselves • Will discuss health but refuses any help offered Will get help when in pain or discomfort 3 • Acknowledges pain or discomfort and wants to do something about it • Accepts help with acute problems but ignores less severe or obvious ones Will go along with treatment provided for less pressing problems 4 • Accepts help through their GP or internal health services • Will see doctor regularly, if needed, but only if someone else organises it • Passive compliance with treatment resulting in some health improvements Realise I need to take some responsibility for looking after my health 5 • First signs of taking responsibility for their health • Engages in discussions about health rather than just going along with them 6 Doing some things to look after my physical health • Takes some initiative, for instance attends GP appointment on their own Can see that when I look after my health, I feel better 7 • Takes more responsibility • Makes the link between getting treatment, leading a healthier lifestyle and feeling better • As a result, motivation to care for own health increasing • May say they are feeling physically healthier, though not necessarily Changing my lifestyle to make it healthier but find it hard 8 9 • Improving lifestyle towards better physical self care and healthy choices • Self-medicating by this point if not before • May change diet, start exercising or try to stop smoking • Change is difficult so needs lots of support Lifestyle is reasonably healthy. Need occasional support to keep it that way • Feels as good as they have ever felt • Still needs occasional support or encouragement Looking after my physical health well 10 • Independent and responsible approach to own health • Reasonable level of self care, diet and exercise • Knows when they need to access help and how to do so Mental well being This ladder is about how you manage your mental well being. This is not necessarily about not having any more symptoms or medication, though this may happen. It is about learning how to manage yourself and your symptoms and building a satisfying and meaningful life which is not defined or limited by them. No hope. Feeling the full force of symptoms. No control 1 2 Feeling full force of symptoms but moments of awareness May spend most the day in bed and/or self harm. May be in manic phase See no possibility of change and no hope and unlikely to engage meaningfully in project Likely to appear withdrawn, maybe as a self-defence mechanism As 1 but moments of awareness e.g. that it’s not always been like this. Moments not sustained enough to be helpful Reaching out for help - sustained awareness that things are not okay 3 Moments of awareness that things are not okay are now sustained Some sense that it might be possible for things to be different Seek or accept help to feel less bad or if manic to address manic behaviour May be the point of consciously becoming a MH service user Requires courage to embrace and fully acknowledge that things are not okay Engaging with treatment and support to help me manage 4 Engage in services and setting and achieving small goals but may lack sense of autonomy/ own power to recover Can become stuck at this point, with a danger of dependency/ becoming institutionalised/ disempowered Believe a different future is possible for me – scary but want to make it happen 5 Key turning point of looking ahead with vision and hope; not constant but sustained enough to effect behaviour Appears to actively buy-in to recovery (responsibility awakening). May include actively learning more about the mental illness and rights as MH service user A big and difficult step so may experience both excitement and also fear and resistance May feel vulnerable, with low resilience Feeling the fear and doing it anyway 6 Taking significant action - doing things differently, trying new things – including learning about what can be helpful in recovering from their particular mental illness Taking risks which can be scary and lots of support may be needed May become more assertive in relationship with service as becomes aware of rights Re-building my life - learning to effectively manage my mental health 7 8 Awareness of MH illness and how to manage it to stay well Achieving some goals and thus more belief in their own ability to recover and sense of what recovery means. Able to effectively advocate for self within the service Understanding own triggers and symptoms and how to manage them This brings sense of efficacy and control which feeds motivation and confidence and helps with taking further risks Feeling reasonably robust. Learning to effectively manage life’s ups and downs Similar to 7 but more so. Increasing resilience, coping skills More able to deal with small difficulties without being knocked right back Self-reliant – know how to use support if needed 9 10 Good awareness and tools for coping with what life throws up, including set backs in mental well being Mainly recognises early warning signs of deteriorating MH and takes appropriate action Still need service support for more difficult MH issues Proactively managing my mental well being Own networks in the community for on-going support May access support for MH from services as needed Meaningful use of time This journey is about how the client spends their time – whether they find the things they do interesting and satisfying and, if not, being clear about what they would like to do instead. It covers building the skills and confidence they need to do those things. For some clients, this may mean moving towards education, training and/or employment, though this will not be appropriate for all. 1 2 Won’t talk about work, training, study, learning new skills or having hobbies • Not possible to engage in discussion about how they use their time • Avoids structured leisure activities • Confidence very low (this may be apparent or hidden behind façade of not caring) Sometimes get bored or fed up but there’s nothing that can be done about it • Occasionally will discuss this topic but not motivated to change Don’t want to spend my days like this any more, it’s boring and not satisfying 3 • Signs of motivation for change but not consistent • Doesn’t like how things are but doesn’t have a sense of what else is possible • Agrees to things (for instance seeing specialist worker) but doesn’t follow through Going along with things that others suggest 4 • Follows through on actions agreed in key work, if there is lots of encouragement • May take part in activities within accommodation but expresses dissatisfaction • Knows what they don’t like but not what they want Know I need to take the initiative and think about what I want to do 5 • More meaningfully engaged with key work process • Wants to talk about the future and the options available • Able to identify things they want to do and has some sense of the direction they want to go Getting clearer about my goals and taking steps towards achieving them 6 • Able to set and meet short-term goals • Starts doing small things themselves • More able to sustain interest and activities, though still needs a lot of support Using my time in a more meaningful and satisfying way 7 • Trying new things out and discovering what works and what doesn’t • Starting to get a sense of satisfaction from achieving small things • Addresses blocks to progress, for instance literacy • Sometimes loses confidence or runs into problems (for instance conflict with others, poor time-keeping, personal presentation) and needs help – reassurance and constructive feedback Getting closer to my goals and how I want to spend my time 8 • Has some kind of regular activity which works for them, for instance voluntary work, training • Encounters difficulties but with support can learn from these to improve employability and ability to achieve own goals Satisfied with the way I spend my time – occasionally need support with it 9 • Has personal and social skills to maintain activity without professional support • Still needs help occasionally, for instance if circumstances change or a course comes to an end and they need to make new arrangements Satisfied with the way I spend my time – I don’t need any extra help 10 • Can manage activities on their own and access help as required • Able to organise new activities, training and/or work as and when necessary Managing tenancy and accommodation This scale is about the extent to which the client complies with the responsibilities and rules of the hostel, tenancy or other accommodation they are in, including dealing with any issues or crises that come up, getting on with their neighbours and taking responsibility for visitors. Not interested in your rules and regulations – go away! 1 2 • At risk of eviction, for instance due to non payment of rent or anti-social behaviour • Won’t discuss issues or acknowledge there is a problem • If in own flat, may refuse access to the property • If in hostel, may not cooperate with getting claim running Don’t care what happens, nothing can be done. No one can evict me anyway • Will discuss issues but refuses to take action or accept help • Some awareness that people are talking about eviction but not fully taking it on board Don’t want to lose my accommodation 3 • Realises that they are at risk of eviction so decides to ‘play the game’, for instance co-operates with getting claim running or talking about debt repayment and budgeting • Won’t take action unless forced to Will go along with things to keep accommodation and/or get move-on accommodation 4 • Compliance with action plans to address issues (for instance rent payment and debt repayment) but if given a choice (for instance money paid direct to them) then may stray • If antisocial behaviour is a problem, this may still be present Want to change behaviour to keep accommodation or get move-on accommodation 5 • First signs of taking responsibility for accommodation situation • If in debt, there is a sense that they want to understand their situation and address it • If anti-social behaviour is a problem, then there is now interest in addressing it 6 Starting to do things to keep or get the kind of home I want 7 Life is better when I take an active role in managing my accommodation • Opens post and gets help with forms, bills etc, for example • Gets help with behaviour issues, for instance takes an anger management course • Difficulties lessen and client starts to see that being responsible brings rewards – it is much better not to be in conflict with neighbours or getting red bills Can avoid crises but need some help with things like planning ahead 8 • Immediate problems dealt with but need to ensure they don’t arise again so learns about budgeting, cleaning, dealing with the housing provider and/or benefits agency etc. • If in flat, may develop positive relationships with neighbours or begin community involvement • Doing more for themselves but experiencing setbacks Managing well - know when I need help and how to get it 9 • Managing accommodation well, avoiding crises and planning forward but may have occasional problems or particular areas they find difficult and still need support with, for instance an entrenched problem with a neighbour Can manage my accommodation without external support 10 • No risk of eviction • Able to forward plan and deal with crises • May still have debts but is repaying them and can manage situation without support Offending This journey is about the client and the law – whether they have got into problems with the law, how they scale title orhere are complyingPut with any legal orders terms that they are under, whether they understand what causes the difficulties and are making changes to stay within the law. If the client doesn’t have any issues relating to the law, they are at point ten. Not willing to talk about problems with the law: it wasn’t my fault! 1 • Suspected of offending regularly but won’t discuss it or acknowledge there is a problem • May be in contact with police or courts; may have an ASBO or injunction 2 Fed up with being in trouble with the police but that’s just the way it is 3 Wish I didn’t have these problems - want to get them off my back • Acknowledges current situation (if in contact with police and/or courts) but won’t discuss • Not in contact with police and/or courts but hints they might be breaking the law • Unhappy with the negative consequences of their offending or anti-social behaviour • Not accepting responsibility for the situation Would like help to sort out issues with the police, courts and/or probation 4 • Accepts help with court or legal order but • Not willing to fully acknowledge or address offending pattern • May break terms of legal order 5 Want to change – it’s not worth living like this 6 Mostly play it by the book but sometimes slips up. It’s hard to change • Recognises that they need to make changes to really get out of their difficulties • Willing to acknowledge and discuss offending pattern • Takes some initiative to comply with terms of legal orders • Reduces offending behaviour; this could be linked to tackling addictive patterns Understand how and why I get in trouble and how to stop 7 • Will discuss triggers for offending and how to avoid high-risk situations • Actively considers other lifestyle changes that may support abstinence from criminal activity, for instance social circle, addictive behaviour • Considers help they might need in managing their behaviour, for instance managing anger Changing my life to keep within the law 8 9 10 • Avoids high-risk situations and has strategies to avoid triggers leading to further reduction in criminal behaviour • Builds skills and makes lifestyle changes to support abstinence from criminal activity • Change is difficult, so client needs support to keep going Staying on the straight and narrow – with occasional help • Has not offended for at least three months • Still finds some situations difficult, so benefits from occasional support No offending or anti-social behaviour and no need for support in this area St Mungo’s Broadway Outcomes Star Scale Summaries You are free to share, to copy, distribute and transmit the work under the following conditions: You may not use this work for commercial purposes; No Derivative Works. You may not alter, transform, or build upon this work; For any reuse or distribution, you must make clear to others the license terms of this work. St Mungo’s Broadway acknowledges the role played by Triangle Consulting Social Enterprise Limited and the London Housing Foundation in creating the St Mungo’s Broadway Outcomes Star. 1 Motivation and taking responsibility This ladder is about your feelings about making changes - whether you are ready to make changes, whether you are going along with help or are actively creating change yourself. Think about where you are in your journey on this ladder at the moment. If things change a lot from day to day, or hour to hour, then where would you say you are this week? Where are you on your journey? 10 Notes Independent of the agency: family, friends and generic services provide help if needed 9 Comfortable with new lifestyle but need help now and then 8 Like the way I live now but need help to keep it going 5 Know I need to do something to help myself move on 4 Will go along with help if other people can stop my life being like this 1 2 3 Not interested in talking to workers or in making change Sometimes fed up with how my life is but nothing can be done about it Had enough of living like this and want things to change 6 7 Know what I want and I’m starting to do things to get it – with lots of help Understand how what I do affects what I get 2 Self care and living skills This ladder is about how well you are able to look after yourself and your home. It is about basic living skills and self care, such as keeping yourself and your home clean, keeping safe at home, shopping for the things you need and cooking healthy meals. Where are you on your journey? 10 Notes Can look after my place and take care of myself without outside help 9 Look after my place and myself well, just need occasional help 8 Have new habits and I’m doing more but sometimes slip back 5 Want to be able to do more for myself - look after myself and my place better 4 If others can help me look after myself better, I will go along with it 1 Don’t have a problem with looking after myself - though others think I do 2 3 Don’t look after myself well but I can’t - that’s just the way I am Don’t like the fact I can’t take care of myself, I need help 6 7 Doing things to look after myself and my place better, learnt more what to do See that when I look after myself and my place, I feel better 3 Managing Money & Personal Administration This ladder covers all aspects of managing money, including filling in forms, sorting out benefits and taking responsibility for them, budgeting, paying bills, managing and reducing debt, lending and borrowing money appropriately and being able to live within your income. Where are you on your journey? 10 Notes Can manage my money fine and don’t need support with it 9 Know when I need help to manage my money and benefits and how to get it 8 Able to avoid crises if I plan ahead – sometimes I need help with this 5 Have plans in place and need to do something myself to sort out benefits and money 4 Will go along with help if my key worker can sort out my money for me 1 2 3 Don’t know how much I owe or who to – not willing to talk about it Money things are a mess but nothing can be done about it Don’t want these money problems 6 7 Starting to sort out my benefits and manage with what I have got. It’s difficult Can see things are better when I sort out my money and debts 4 Social Networks and Relationships This ladder is about your relationships - who you mix with, whether your social circle supports you in achieving the things you want in life, and whether you feel you can trust and rely on people. You may start the journey on your own and end it having contact with others, or you may start the journey spending time with people who keep you stuck in old ways and end it with people who support you more positively. Where are you on your journey? 10 Notes Have the friends and contacts that I want and need and have no major family issues 9 Have people I can rely on but need help in this area now and then 8 Enjoying my (new) friends and/or family but sometimes we have difficulties 5 Have found someone I can talk to and trust. I want to address my family issues 4 Talking to new people but don’t really like or trust them 1 2 That’s how life is – you can’t trust anyone Sometimes fed up with being alone or with people I can’t trust 3 Don’t like feeling isolated, or, the people around me aren’t good for me 6 7 Feeling inbetween - left old friends behind but don’t have new ones yet Have some sense of who I can trust and starting to understand family issues 5 Substance use This ladder is about whether you use drugs, whether your drinking has a bad effect on your life and how you are dealing with any drug or alcohol issues. It is about how aware you are of any problems you have with drugs or alcohol and whether you are working to reduce the harm it may cause you. What are you doing to overcome these issues? If you do not use drugs, or drink much alcohol, you are at step ten. Where are you on your journey? 10 Notes No problem with alcohol or drugs 9 Drugs and alcohol have no negative effect. I may need some support 8 Getting control. I have choices about what I do and mostly choose well 5 See that I need to make changes myself to tackle my alcohol and/or drug use 4 Will go along with things my worker and doctor say will help 1 2 Don’t have a problem with alcohol or drugs though others think I do Sometimes see that it’s a problem but I can’t change it (or don’t want to) 3 Need some help with alcohol and/or drug issues 6 7 Doing some things myself to address my alcohol and/or drug use Understand why I had/have a problem and what I need to do 6 Physical health This ladder is about how well you look after yourself - noticing when you don’t feel well, doing what you need to do to deal with any long-term conditions and living a healthy lifestyle so that you can enjoy a good quality of life. Where are you on your journey? 10 Notes Looking after my physical health well 9 Lifestyle is reasonably healthy. Need occasional support to keep it that way 8 Changing my lifestyle to make it healthier but find it hard 5 Realise I need to take some responsibility for looking after my health 4 Will go along with treatment provided for less pressing problems 1 2 3 Not interested in my physical health - don’t want to talk about it Health isn’t great but so what Will get help when in pain or discomfort 6 7 Doing some things to look after my physical health Can see that when I look after my health, I feel better 7 Mental well being This ladder is about how you manage your mental well being. This is not necessarily about not having any more symptoms or medication, though this may happen. It is about learning how to manage yourself and your symptoms and building a satisfying and meaningful life which is not defined or limited by them. Where are you on your journey? 10 Notes Proactively managing my mental well being 9 Self-reliant – know how to use support if needed 8 Feeling reasonably robust. Learning to effectively manage life’s ups and downs 5 Believe a different future is possible for me – scary but want to make it happen 4 Engaging with treatment and support to help me manage 1 2 No hope. Feeling the full force of symptoms. No control Feeling full force of symptoms but moments of awareness 3 Reaching out for help - sustained awareness that things are not okay 6 7 Feeling the fear and doing it anyway Re-building my life - learning to effectively manage my mental health 8 Meaningful use of time This ladder is about how you spend your time - whether you find the things you do interesting and satisfying and if not, how clear you are about what you would like to do instead. It’s also about building the skills and confidence you need to do these things. For some people this will mean moving towards education, training or employment. Where are you on your journey? 10 Notes Satisfied with the way I spend my time – I don’t need any extra help 9 Satisfied with the way I spend my time – occasionally need support with it 8 Getting closer to my goals and how I want to spend my time 5 Know I need to take the initiative and think about what I want to do 4 Going along with things that others suggest 1 2 3 Won’t talk about work, training, study, learning new skills or having hobbies Sometimes get bored or fed up but there’s nothing that can be done about it Don’t want to spend my days like this any more, it’s boring and not satisfying 6 7 Getting clearer about my goals and taking steps towards achieving them Using my time in a more meaningful and satisfying way Managing tenancy and accommodation 9 This ladder is about how well you comply with the terms of your tenancy - things like paying rent and bills, getting on with your neighbours and taking responsibility for visitors. Where are you on your journey? 10 Notes Can manage my accommodation without external support 9 Managing well - know when I need help and how to get it 8 Can avoid crises but need some help with things like planning ahead 5 Want to change behaviour to keep accommodation or get move-on accommodation 4 Will go along with things to keep accommodation and/or get moveon accommodation 1 Not interested in your rules and regulations – go away! 2 3 Don’t care what happens, nothing can be done. No one can evict me anyway Don’t want to lose my accommodation 6 Starting to do things to keep or get the kind of home I want 7 Life is better when I take an active role in managing my accommodation 10 Offending This ladder is about you and the law – whether you have got into problems with the law, how well you are complying with any legal orders or terms that you are under, whether you understand what causes difficulties and are making changes to stay within the law. If you do not have any issues relating to the law, choose ten. Where are you on your journey? 10 Notes No offending or anti-social behaviour and no need for support in this area 9 Staying on the straight and narrow – with occasional help 8 Changing my life to keep within the law 5 Want to change – it’s not worth living like this 4 Would like help to sort out issues with the police, courts and/or probation 1 2 3 Not willing to talk about problems with the law: it wasn’t my fault! Fed up with being in trouble with the police but that’s just the way it is Wish I didn’t have these problems want to get them off my back 6 7 Mostly play it by the book but sometimes slips up. It’s hard to change Understand how and why I get in trouble and how to stop Představení zapojených organizací a kontakty Jako doma – Homelike, o.p.s. Sídlo: Holečkova 63, 150 00 Praha 5 Kancelář: Vinohradská 146, 130 00 Praha 3 E-mail: [email protected] Tel.: 773 480 560 Web: jakodoma.org FB: jakodomaos ROZKOŠ bez RIZIKA Sídlo: Vlhká 10, 602 00 Brno Pobočka Praha: Bolzanova 1, 110 00 Praha 1 E-mail: [email protected] Tel.: 224 234 453 Mob.: 602 180 180, 777 180 107 Web: www.rozkosbezrizika.cz FB: občanské sdružení Rozkoš bez Rizika Organizace Jako doma – Homelike, o.p.s. spolupracuje se ženami bez domova, neviditelnými superhrdinkami dnešní společnosti. Spolu s nimi se učí, jak jim pomoci, co je trápí i jak změnit obraz lidí bez domova. Specificky se věnuje ženskému bezdomovectví, protože o něm chybí informace a ukazuje se, že je jiné než to mužské. Cílem organizace je tedy upozorňovat na genderový aspekt bezdomovectví a poskytovat podporu ženám bez domova. Dále pak měnit pohled na bezdomovectví ve společnosti, dávat hlas ženám bez domova a zahrnovat lidi bez domova do rozhodovacích procesů. R-R je nestátní nezisková organizace založená v roce 1992. Posláním organizace je zmenšit sociální a zdravotní rizika nejen u cílových skupin, ale následně i u širší populace. Cílovou skupinou jsou zejména ženy poskytující placené sexuální služby. Konkrétní činnost R-R spočívá v prevenci, diagnostice a léčbě sexuálně přenosných infekcí, v poskytování sociálních a terapeutických služeb a prosazování práv žen pracujících v sexbyznysu8. 98 R-R provozuje tři poradenská a zdravotnická centra (Praha, Brno, České Budějovice). Devět terénních týmů působí ve 12 krajích České republiky v místech, kde se poskytují placené sexuální služby. K terénní práci R-R využívá i mobilní ambulanci s malou venerologickou ordinací. R-R pravidelně pořádá akce pro veřejnost, např. AIDS day, kdy nabízí poradenství a testování na HIV zdarma, připravuje besedy, přednášky, ale i divadelní představení, kde hrají klientky a příznivci a příznivkyně organizace. In IUSTITIA, o.p.s. Sídlo: Rybná 24, 110 00 Praha 1 E-mail: [email protected], [email protected] Tel.: 212 242 300, 773 177 636 Web: www.in-ius.cz FB: In Iustitia In IUSTITIA byla založena v roce 2009 s cílem otevřít specializovanou poradnu pro oběti násilí z nenávisti, která v ČR do té doby scházela. V roce 2013 se stala In IUSTITIA registrovanou sociální službou a akreditovanou službou k poskytování právních informací obětem trestných činů. V současné době má působnost na území celé ČR a poskytuje služby v přirozeném prostředí obětí. Na 3 pobočkách poskytuje od roku 2014 služby obětem obecné kriminality (Kladno, Brno, České Budějovice), čímž se snaží o rozšíření právní pomoci všem obětem trestných činů. V roce 2015 se pracovnice In IUSTITIA zaměří na ženy bez domova na území města Prahy, které jsou ohroženy násilím či jsou obětmi jakéhokoliv násilí. Oběti násilí z nenávisti mají v porovnání s oběťmi jiných trestných činů specifické potřeby, jež nejsou vždy zohledněny představiteli veřejné správy. Ve vztahu k projektu je násilí z nenávisti chápáno jako všechny formy násilí na ženách (od domácího, přes rasově motivované, po sexuální). Právě oběti trestné činnosti a oběti domácího násilí jsou cílovou skupinou projektu. In IUSTITIA této skupině poskytuje nejen právní pomoc, ale usiluje též o zlepšení praxe orgánů činných v trestním řízení v případech násilí z nenávisti. Detailní kontaktní informace o poradnách Justýna v Praze, Kladně, Brně a Českých Budějovicích najdete na webových stránkách. 99 In IUSTITIA | Jako doma | ROZKOŠ bez RIZIKA Praha 2015
