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Multicultural Organizational Program Improvement:

Guilford County Winter Emergency Shelter

Cherie Bohaboy, Katherine Foster, Tydelia Hunt, Helena McGovern

Organizational Context of Clinical Social Work Practice

Dr. Mathieu Despard

UNC Greensboro and NC Agriculture and Technology University

March 10, 2020

Multicultural Organizational Program Improvement: Guilford County

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Winter Emergency Shelter

Problem Description

Weaver Extension is a winter emergency shelter organized by Greensboro Urban

Ministry’s (GUM) Weaver House (WH) which operates the coordination of additional shelter

spaces throughout a variety of community partners in Guilford County. The extra shelter beds

accept applications in November to complete the intake process ahead of the opening of the

program from December 1st to March 31st. This shelter option is available every night

throughout this timeframe to account for the bulk of the expected winter weather in this region.

The Weaver Extension (WE) shelter is a reliable and consistent option throughout the coldest

season for individuals to expand the shelter bed capacity in our community where there are

limited affordable housing options that result in a strain on shelter services (NC Housing

Authority, 2019).

Weaver Extension shelter follows rules and regulations in order to participate in the

program that states that WE shelters are dry beds, meaning no substances or intoxication is

permitted, which is consistent with Weaver House policies. While they typically follow a

warning protocol prior to exiting a guest, this policy is not sensitive to our neighbors who are

battling addictions while experiencing homelessness. Substance use is a medical disease

(American Society of Addiction Medicine, 2019) but unlike other illnesses, it is treated as a

choice individuals make that can result in them losing shelter mid winter.

In an assessment of barriers to temporary shelter for people experiencing substance use

disorders, it was indicated that substance use is roughly 10% higher in the unhoused population

and among the 50 shelters surveyed, 12 (24%) did not admit inebriated individuals even during

extreme temperatures (Homeless Rights Advocacy Project, 2016). In a limited housing and
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shelter community, temporary shelter can be competitive and this practice is marginalizing

persons experiencing substance use disorders.

This WE practice comes from an agency policy to not allow intoxication and/or

substance use on the shelter premises. This is a policy that is enforced year-round by Weaver

House and is extended into the WE beds. If a guest is found to have violated this policy, it is

typically addressed with three warnings followed by being exited from the program, but each

case is handled on an individual basis. In dangerous weather conditions such as WE shelter is

designed to protect from, the only criteria should be that the individual is experiencing

homelessness and needs shelter.

As Social Workers we hold ourselves to standards we want to see throughout the

societies we serve and are looking for ways to better what we do and how we do it. The shelter

system does a lot of good for communities such as Greensboro where people are experiencing

housing insecurity, but the WE shelter has the opportunity to better what they do by looking at

how the current practice matches with the NASW Code of Ethics (NASW, 2013). Two standards

to highlight from this program are discrimination (standard 4.02) and social welfare (Standard

6.01). Discrimination in this case is happening per a person’s experience with addiction, which is

a mental illness that requires medical and psychological treatment. This is discrimination of

individuals from shelter opportunitiy because of their substance use mental disorder, an illness

that requires physical and psychological treatment. The mission of temporary shelters to provide

shelter and food to those in need is directly in an attempt to improve the social welfare of others,

thus this discriminatory practice is violating that standard (6.01). Because substance use is a

disorder, these individuals should not be excluded from services, but should be offered resources

and connections to services to get treatment. In shelters, they have the opportunity to extend the
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social welfare they offer their guests by offering an intervention to these identified users rather

than putting them back on the streets.

Action Plan

The objective is to change this policy in order to expand the WE shelter services provided

to individuals with substance use disorders during the dangerously cold winter months. Although

substance use is defined as a medical disease (ASAM, 2019), is treated as a choice made by the

individual when there are punishments and repercussions in direct response to the symptoms of

the illness in an agency setting. Changing this policy offers basic human needs to these

individuals as well as opens opportunities for interventions to occur. Changing discriminatory

practices per written policy and education of these disorders will help to create physical and

figurative safety to vulnerable persons in our community. A person experiencing homelessness

and being rejected from shelter does not necessarily mean ready for change in their substance use

but that they are cold and have nowhere to go. This leaves sick individuals on the street, leading

them to make decisions based on a roof over their head rather than any stage of change they are

in. (De Biaze Vilela, et al., 2009).

The values of Weaver House states “We welcome all through an open door where

neighbors can connect, serve and grow” (GUM, 2019). If this is a value of Weaver House and

WE shares the same mission, vision and values, this could get clients the help that they need.

Those that are battling substance use are not welcomed during the cold nights because they may

be intoxicated or smell of alcohol, but if WE were to abide by their values, it could lead to help

for the individuals.

According to GUM strategic planning of 2018, a strategic priority of theirs is to “To offer

programs and services that effectively meet the immediate needs of clients and identify solutions
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that promote their long-term stability” (GUM, "Newsletters / Reports", 2019). Not serving or

helping the clients because of the state that they’re in when it comes to substance use is not

meeting the immediate needs. The immediate need in that moment is providing shelter during the

cold nights.

The discriminatory practice change will be introduced as a pilot project. A pilot project

will allow for trial-and-error. This will allow for the change to be implemented and if it fails, it

will give a chance for changes to be made before making a whole organizational change. If this

discriminatory practice were to change, it would help individuals/clients in many ways. It would

alleviate the number of people who are stuck on the streets during the harsh winter nights. It

could possibly get some individuals connected to resources to help with their substance use.

The Approval Process To Enact The Change

1. Educate WH Executive Director on evidence-based research of trauma

informed leadership (Esaki, 2019, see References and Attachments A, B, C & D).

2. Request leadership training for Board of Directors and key staff on ACES, and

providing trauma-informed care. Include a social work perspective on service and

ethics (NASW, 2017). Advise on inputs, activities and outcomes (Attachment B).

3. Introduce shelter policy review and make recommendations for policy change.

4. Assessment of key obstacles includes:

i. Cost concerns to buy-in to the theory of change and become a low-barrier

trauma-responsive shelter with top-down leadership training.
ii. Social stigmas of our unsheltered neighbors with: Alcohol Use Disorder;
Substance Use Disorder and Mental Illness.
iii. Other Stakeholders attitudes toward social stigmas (Board, staff,
community partners, and clients).
iv. Real or imagined concerns about safety/violence.
v. Unforeseen obstacles.

5. Request feedback on steps 1 through 4 from the WH Executive Director.

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6. Make changes based on feedback from Step 4.

7. Request WH Executive Director partner with like-minded Board Members to

share JMSW Social Workers item for upcoming meeting agenda.

8. Monitoring And Evaluation (See Appendix C & D).

Legacy Item

A legacy provided by an intervention, ensures that continued service is provided for years

to come, essentially passing on the tangible service to the next group of shelter patrons and

giving the WE a honorable identity. The goal is providing a service to community members by

way of offering shelter to everyone who needs a bed on a given night. As policy states that no

substances are permitted on the premises and that no individual should be intoxicated during

WE, by reducing discriminatory practices and allowing for inclusion of everyone regardless of

their presentation, a legacy will be established. To be respectful to those patrons who do not use

substances, or are in recovery, a team of trained individuals will be on staff every night to assess

and help those who need assistance. By educating each staff member about the effects of all

substances on the body, a guarantee can be given that each patron is given a warm place to rest, a

place to feel safe, and a guarantee that their interest is of importance. Staff members will include:

● On-site supervisor who has also gone through the extensive training that all other staff

members are required to take. They must be fully vested in working to achieve the goals

of the shelter when working with this unique group.

● Peer Support Specialists are available to speak with patrons to offer knowledge and

aspects of their journey to recovery. This aims to empower the patron to find strength

from within to achieve their thoughts.

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● Minimally medicinally trained individuals who are aware of distress signs from

intoxicated individuals, that include signs of vomiting, poor balance and coordination,

loss of consciousness or black-out, seizures, pale pallor, and low body temperature.

Having medical personnel on-site to monitor the health and well being of the patrons

provides a sense of safety.

● Staff trained to look for and know the difference between the stages of alcohol

intoxication to include euphoria, excitement, confusion, and stupor.

● Harm reduction staff to offer advice to individuals who would like to live a sober life.

Staff should engage in pragmatic endeavors when advising. Staff also made aware of the

need to implement cold weather response when appropriate and the consequences of not

doing so. (Zhang et al. 2019)

● Housing Team to offer resources and guidance relating to permanent housing. (Young &

Manion, 2017)

● Referral system to offer resources to individuals who are new to the area or experiencing

homelessness for the first time. This can include staff coordinating and working with

other Greensboro resources to offer a concise and up to date guide.

Implementation of the new policy would need assurance that the appropriate number of

staff be employed and replaced upon departure of each position holder. This is essential to ensure

continuous success of the policy.

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References

American Society of Addiction Medicine. (2019, September 15). Definition of addiction. In

Quality & Science. https://www.asam.org/resources/definition-of-addiction

Esaki, N. (2019). Trauma-responsive organizational cultures: How safe and supported do

employees feel? Human Service Organizations: Management, Leadership &

Governance, 1-8.

De Biaze Vilela, F. A., Jungerman, F. S., Laranjeira, R., & Callaghan, R. (2009). The

transtheoretical model and substance dependence: Theoretical and practical aspects.

Revista Brasileira de Psiquiatria, 31(4), 362–368. Retrieved from https://doi-

org.libproxy.uncg.edu/10.1590/S1516-44462009005000010

Greensboro Urban Ministries ([GUM] n.d.). Mission, vision, values. Retrieved from

https://greensborourbanministry.org/about/mission-vision-and-values/

GUM (2018). Strategic planning survey results. Retrieved from

https://greensborourbanministry.org/wp-content/uploads/2018/07/GUM-StratPlan-

SurveyResults-web.pdf

National Association of Social Workers ([NASW] 2017). NASW code of ethics.

https://www.socialworkers.org/About/Ethics/Code-of-Ethics/Code-of-Ethics-English

NASW (2013). NASW Standards for Social Work Practice with Clients with Substance Use

Disorders (pp. 7-8). Washington, DC: Author.

https://www.socialworkers.org/LinkClick.aspx?fileticket=ICxAggMy9CU

%3d&portalid=0

Young, M. G., & Manion, K. (2017). Harm reduction through housing first: An

assessment of the
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emergency warming centre in Inuvik, Canada. Harm Reduction Journal, 14(1). doi:

10.1186/s12954-016-0128-8

Zhang, P., Wiens, K., Wang, R., Luong, L., Ansara, D., Gower, S., Bassil, K., & Hwang,

S. (2019). Cold weather conditions and risk of hypothermia among people experiencing

homelessness: Implications for prevention strategies. International Journal of

Environmental Research and Public Health, 16(18), 3259. doi: 10.3390/ijerph16183259

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Attachment A
Greensboro Urban Ministries’ Weaver House Winter Extended Shelter
Policy Change to Allow Intoxicated Members to be Admitted

I. Educate WH Executive Director with evidence-based research on:

A. Adverse Childhood Experiences, Trauma informed care and Trauma responsive
organizations (see attached reference list)
B. Definition of the problem:
i. The current policy is discriminatory toward the most vulnerable populations,
substance use disorder, alcohol use disorder and the mentally ill.
ii. Our ethical concerns. Social workers combat discrimination on the basis of
“race, ethnicity, national origin, color, sex, sexual orientation, gender identity or
expression, age, marital status, political belief, religion, immigration status, or
mental or physical ability” (Standard 4.02), and, advance social justice (Standards
6.01, 6.04). Social workers promote the social welfare of the people in the
community (Standard 6.01) but fall short for our neighbors with substance use
disorders.
iii. The policy needs to align with the GUM mission”to express the love of God to
our neighbors in need by offering food, shelter…(GUM, 2020)” and the NASW
code of ethics.
C. Solution to the problem: Change the WE shelter policy to remove the sobriety
requirement to become nondiscriminatory, save lives, and create a safe environment for
case management services which provides cost savings (see Appendix B) and can
increase rehousing rates.
II. Request leadership training for Board of Directors and key staff on ACES, and providing
trauma-informed care. Include a social work perspective on service and ethics.
III. Ask the Board to consider a shelter policy review in view of new training. Introduce
recommendations for policy change with inputs/outputs/outcomes (see Appendix B).
Request removal of sobriety policy to reflect for admission to the WE shelters.
III. Assessment of key obstacles includes:
A. Cost concerns to buy-in to the theory of change and become a low-barrier trauma-
responsive shelter with top-down leadership training.
B. Social stigmas of our unsheltered neighbors with: Alcohol Use Disorder;
Substance Use Disorder and Mental Illness.
C. Other Stakeholders attitudes toward social stigmas (Board, staff, community
partners, and clients)
D. Real or imagined concerns about safety/violence
E. Unforeseen obstacles
IV. Request feedback on “key obstacles” from WH Executive Director
V. Advise WH Executive Director of edits on procedure based on feedback regarding above
items from Step I.
VI. Request WH Executive Director partner with like-minded Board Members to share the
Field Social Workers concerns for upcoming Board agenda.
VII. Monitoring And Evaluation (See Appendix C)

Attachment B
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MULTICULTURAL ORGANIZATIONAL PRACTICE IMPROVEMENT

APPROVAL PROCESS
Issue: Shelter excludes persons with substance use disorder
Goal: Shelter policy change to admit those who are intoxicated

Inputs Activities Outcomes

What we invest What we do Who we reach Why this project

● Research · Provide food and · Unsheltered neighbors · Saves lives

· Board shelter · Undiagnosed/ · Saves money from
· Staff · Train leaders as diagnosed alcohol use social costs (health care,
· Volunteers trauma informed disorder unsheltered emergency room visits,
· Partners and trauma · Undiagnosed/ and policing, judicial,
· Time responsive diagnosed substance use legal and, penal costs)
· Materials organization disorder unsheltered · Improves individual
· Equipment · Facilitate access to ·Undiagnosed/ and community welfare
· Technology information and diagnosed mental illness · Advocates for the most
· Money resources unsheltered vulnerable
· Conduct · Public at large · Reduces stigma
workshops and · Educates: Board, Staff,
meetings Stakeholders and the
· Housing First community at large
Model · Learning: Awareness,
· Public Relations knowledge, attitudes,
skills, opinions,
aspirations, motivations

*Wogan, J. (2017, Dec 6). Study: Housing the homeless can drastically cut the government's health care costs. TCA
Regional News.
# Bartolone, P. ( 2018, October 18). Hospitals invest in housing for homeless to reduce ER visits. In Health Care
Finance. https://www.healthcarefinancenews.com/news/hospitals-invest-housing-homeless-reduce-er-visits
^ Bryant, M. (2018, January 2). Hospitals tackling homelessness to bring down costs. In Healthcaredive.
https://www.healthcaredive.com/news/hospitals-tackling-homelessness-to-bring-down-costs/510631/
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Attachment C

Monitoring
BOARD SELF ASSESSMENT

Instructions: Indicate the extent to which each item listed is applicable to your
Board. Honestly evaluate the statement without overthinking your response. Use the
scale below.

3 = Always True 2 = Sometimes True 1 = Never True

1 We have been trained about ACEs

2 We have been trained about trauma-informed care and we are

considered a trauma-responsive organization

3 We have learned about systemic oppression of minorities and

marginalized populations

4 We currently have high barrier eligibility for our shelter

5 Our community is better served as a low barrier shelter

6 We need to change to low barrier eligibility for our shelter

7 We have the resources required to become a low barrier shelter

8 We can raise the resources to become a low barrier shelter

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Attachment D