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Many residents entering Belle
Reve will be suffering from the difficulties of adjusting to group living.
Mental illness, lack of socialization skills, developmental delays,
substance abuse, poverty, lack of medical care, battering, domestic
violence, and other conditions that are common in people who are homeless
are prevalent in the population served by Belle Reve. Residents coming from
substance abuse facilities, hospitals, shelters, or the streets are prone
to low self-esteem and depression. Belle Reve caters to a homeless population,
which is often composed of persons suffering from mental illness (possibly
causing their homelessness to begin with). As these troubled and sick
people must learn how to live in a group setting and abide by house rules,
behavior modification counseling and medication are essential to the
adjustment period. Approximately 90% of residents first entering Belle Reve
will require medication management for pre-existing conditions, depression,
and adjustment issues. Residents coming from an environment of battery and
abusiveness often will demonstrate high levels of anxiety and paranoia and
will experience trouble trusting and sharing with other residents. Some may
experience feelings of transference, and will associate other residents’
behaviors with those of family members or friends. (For example, “So-and-so
hogs the kitchen just like my mother does.” or “I can’t stand So-and-so
because he is bossy like my ex-husband.”) Those residents who are able to
adapt will be successful; therefore, the social work team at Belle Reve
must try to provide these residents with as much counseling and support as
is needed for them to be able to adjust. In spite of all efforts, sadly,
some needy residents will be unable to adjust to Belle Reve’s group living
environment and will be forced to find other housing options.
Belle Reve’s social
workers will refer out for mental health services for a variety of reasons
and conditions. A resident will be sent for immediate psychiatric evaluation
if the staff observes signs of severe depression and suicidal tendencies.
(For more information on Depression see “Depression (psychology),”
an article on Encarta.) Poverty is one of the greatest stressors causing
severe depression and suicidal ideation. All of Belle Reve’s residents are
far below the Poverty Line . Although Recovery Readiness is
required for every resident for a thirty-day period, with most residents
remaining in the substance abuse support group for a much longer period of
time, social workers will refer residents to other support groups, such as Alcoholics Anonymous or Narcotics
Anonymous. As many of our residents have come from
violent and unstable domestic situations, occasionally, a resident will
lose a close family member to disease or violence. When the need presents,
a resident will be referred to grievance counseling to adjust to the loss
of family members and friends. Additionally, some required HIV-fighting medications
might cause depression, dementia, confusion, or memory loss. (For more
information on Dementia due to HIV
disease, please
see the emedicine website on this.) These symptoms also might be
demonstrated by a resident who is withdrawing from an addiction. For
psychological side effects from medications or withdrawal symptoms, a
resident will be referred to a psychiatrist for medication management.
Residents needing
psychiatric and mental health services beyond what can be provided on-site
at Belle Reve will be referred to organizations such as FACES, the
Roman Street Clinic (also known as the HOP [HIV Outpatient] Clinic), and NO/AIDS Task Force.
Through Children’s Hospital, FACES provides Case
Management, support groups, medication management, and counseling for women
and children. NO/AIDS and the Charity Hospital HOP Clinic provide
counseling, support groups, and medication management for men and women.
Many residents will
express their needs openly, but will minimize the extent to which substance
abuse or depression is affecting their lives. When a resident is
experiencing problems or when he or she has been caught doing something
wrong, that resident may turn to his/her social worker for help, be it
through behavior modification counseling, substance abuse counseling, or
medication needs. A resident might experience an altercation with a Personal Care Attendant or another resident; he may have
mismanaged his money and cannot pay his rent (see Program Income); or he may
have been caught using substances on premises. In these types of cases, the
resident will turn to his social worker in hopes of having the chance to
fix the problem, rather than facing expulsion. Of those residents who choose
to turn to their social workers for help, advice, and counseling,
approximately 60% succeed in modifying their behaviors and adjusting to
life at Belle Reve.
Upon Belle Reve’s
opening in the early ’90s, many of the problems that currently exist concerning
behavior modification were a much smaller issue. When Belle Reve first
opened its doors, early residents were sickly, bedridden, too weak and ill
to demonstrate adjustment issues, to use drugs, or to argue with staff and
other residents. With advances in AIDS treatment, PLWAs are living longer,
feeling better, more likely to overcome an illness and return to
independent living, able to hold down part-time jobs, able to experience
life on a much more rigorous level than previously thought possible. With
new advancements in medication and improved quality of life, Belle Reve and
other institutions that serve the indigent AIDS population have had to
rethink and enforce new rules—rules that deal with both the positive and
negative aspects experienced by these AIDS survivors. To adjust, not only
has Belle Reve modified policies and created new rules, but on the more
positive side, Belle Reve has had to consider job-training programs that
assist the capable individual to transition back to independent living.
Belle Reve has been lucky enough to see several residents through a
physical, mental, and economical crisis; help the resident to achieve
stability; and assist the resident in transitioning back to independent
living. By providing a clean, stable place to live; access to all necessary
health care and medications; mental health counseling and medications;
access to job training assistance, disability benefits, independent
housing, rental assistance, and other Case
Management assistance, Belle Reve helps those who are physically
capable to return to independent living, while providing more assisted
living help to those who are not able to transition back to a more
independent life style. Mental health counseling is an integral ingredient
to returning residents to stability, independence, and self-sufficiency to
the greatest extent possible for each individual.
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