Month: September 2015

The Empathy Tool: Thinking Outside the Square

P1000936With income inequality, urban poverty and homelessness rising rapidly in New Zealand, creative and compassionate Kiwis across different sectors are banding together to do something about it. While in New Zealand this past month I ran across a series of innovative interventions: the Auckland-based Family 100 Project, its companion Empathy Tool, and the research report An insight into the experience of rough sleeping in central Auckland.”

The Family 100 Project was a collaborative research project co-led by staff from the Auckland City Mission and a group of researchers from Waikato University, Massey University, and the University of Auckland. The Auckland City Mission is downtown Auckland’s largest non-governmental social service agency focusing on people marginalized by poverty and homelessness. They provide safe shelter through their drop-in center, food parcels, social worker screening and referrals, a homeless outreach team, and a drug/alcohol treatment center. In conjunction with the Auckland Primary Health Organization and the Auckland District Health Board, they operate the Calder Centre, a low-barrier health clinic. Most all of their services are located in central Auckland near the Aotea Square, the main town square and heart of the city.

The Auckland City Mission staff became concerned with the growing number of people accessing their services on a long-term, versus a short term crisis basis as had been the norm. They wanted to understand more of the lived experiences of people in chronic poverty and homelessness. What prevents people from moving out of poverty? was the main question they had.  So several years ago they partnered with the university-based researchers, and drawing from their database of 15,000 clients they selected 100 families to follow for a year (2012-2013). Reflecting the demographics of their overall client base, the sample consisted of 80 female-headed households, 40 were Maori, 25 were Pacific Islander, 22 were European/white, and 13 were Asian. The research team completed frequent in-depth interviews and mapping exercises. The interviews and mapping exercises focused on housing, debt, food insecurity, health, education, and employment.

From what must have been mounds of data, the university-based researchers and Auckland City Mission staff analyzed and interpreted the results and then presented their findings in a series of fascinating scholarly articles (linked here at the end of the page) and in more easily accessible reports, including the summary report Speaking for Ourselves, and the intriguing and highly visual Demonstrating the Complexities of Being Poor: An Empathy Tool.

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The Empathy Tool was developed by Mondy Jera, Executive Researcher of the design consulting firm ThinkPlace. I visited Mondy at her ThinkPlace office in Wellington to find out more about how the tool was being used and evaluated. Mondy and her team were also responsible for the design of the rough sleeping in central Auckland report, which has a series of wonderful graphics including the ones shown here.This was based on a research study focusing on the experiences of rough sleepers in central Auckland and was completed in February 2015. She said that a homeless rough sleeper man in Auckland pulled the report out of his backpack and showed it to a librarian at the Auckland Central Library and told her he uses it to help him navigate services. Not an intended use of the report, but a very clever one. P1010063

She also told me that the library staff saw ‘library’ on her graphic of a house (shown here) representing research findings on what happens when public and private domains meet on the street. The library staff decided to set up special training for them on how to work effectively with rough sleepers, and they have started a movie night at the library for their homeless patrons.

The Empathy Tool is being used in ongoing training with housing groups in Auckland, with Maori Affairs, and in special poverty sensitivity trainings with staff of the New Zealand Ministry of Finance, which is responsible for setting economic policy for the country.

Mondy, who has a Masters in Public Health from Otago University and a bachelor’s degree in sociology (criminology) from the University of Utah, designed an 8-week ’empathy experience’ for a group of eight people from the Ministry of Finance. They first did classroom training using the Empathy Tool and practiced role-playing scenarios. She then gave them each $2 NZ to take the cross-city bus to the soup kitchen for lunch. Most of them had not taken a city bus since their college years and by the time they figured out transportation to the soup kitchen, the kitchen had run out of food. So they pooled their money and bought a communal lunch at the grocery store, commenting on how expensive any healthy food choices were and how time-consuming it was to meet basic needs while ‘being poor.’ They then did a series of on-the-street intercept interviews with people in more impoverished sections of Wellington and finally had an in-depth de-briefing session to talk about their experiences. They were then tasked with designing an innovative intervention to address a common poverty-related problem. They completed this training program a year ago and Mondy plans a follow-up evaluation of it soon.

The Kiwi ‘Can Do’ Community Cafe

IMG_5776As I prepare to leave New Zealand to return to my hometown of Seattle, I reflect on some of  the innovative programs and people working to address the growing problem of homelessness here in the land of milk and honey (and insanely good chocolate).

Yesterday I had lunch, a terrific soy latte, and community fellowship at Auckland’s Lifewise Merge Cafe on Karangahape (‘K’) Road. Lifewise is an Auckland-based community and social development agency that works on issues such as child abuse, domestic violence, addictions, disabilities, poverty, and homelessness. They provide direct services and also lead advocacy activities. One of their current advocacy campaigns is to urge the New Zealand government to change the age of ‘aging out’ of foster care. Currently, foster care ends on a young person’s 17th birthday; Lifewise is advocating that age to be increased to 21. They have ample evidence to show that this policy change would help many young people avoid ending up living on the streets.

Lifewise operated a soup kitchen for homeless people in Auckland since 1885. By the early part of this century they were serving over 40,000 meals a year. They realized that their soup kitchen was effectively maintaining rather than solving the issue of homelessness. So in late 2012 they closed the soup kitchen and opened the Merge Cafe on K-Road. The Merge Cafe is one of the few community cafes in the world. They say this of the cafe:

“The café aims to support Lifewise’s one-stop-shop approach to tackling homelessness by connecting patrons with wrap around support services that would in turn provide pathways out of homelessness. Secondly, the café aims to provide both the homeless and the housed alike, the opportunity to enjoy meals alongside each other, in an environment that embraced choice, dignity and respect.”

From what I saw, heard, and experienced there yesterday, the Merge Cafe is a success on all these fronts. They have tables set up to be longer community tables, not the typical isolating small tables. I sat next to a Maori middle-aged man, who told me that he had become homeless at age 16 when he ran away from an abusive home in a rural part of the North Island. He then became involved with a gang–“They gave me a sense of family that I didn’t have growing up”–but through outreach from Lifewise workers he got a “real job” and an apartment ten years ago. “I come back here to this cafe because it’s friendly and I remember what it’s like to be homeless.”

IMG_5777The cafe had a cozy corner ‘book nook’ lined with bookshelves full of paperback books and magazines to read in their comfy-looking chairs. A hot lunch consisting of an entree and a vegetable and roll cost $4 NZ ($2.50 US). The cafe was full of people eating and talking and seeming to be from a cross-spectrum of race/ethnicities, and socio-economic levels. People in the all black business suits so common in New Zealand. People in ‘high-viz’ orange vests of the road crews taking their lunch breaks. Flamboyant, paint-splattered artist-types. Jeans-wearing ‘suspiciously social worker-looking’ but laid back staff mingling around. And many familiar faces of the many rough sleepers I’ve seen around downtown Auckland.

The community cafe. What a great concept. Perhaps we should try to create one in the University District in Seattle? A worthwhile Kiwi can-do spirit souvenir to pack in my suitcase and take back home.

Rough Sleeping in the Land of Milk and Honey

HomelessnIMG_5722ess, literal on the street homelessness (‘rough sleeping’ in the local and UK vernacular) and doubling up/less visible homelessness, is on the rise in New Zealand. New Zealand, the world’s first welfare state, the land of milk and honey. What’s going on here?

When I visited here two years ago there was little attention paid to homelessness by government or non-governmental agencies. I met some homeless adults who were using the Auckland Central Library and there were a few people sitting in doorways along Queen Street who were asking for spare change.

This time, especially in and around Auckland–including here in the public library–people who are experiencing homelessness  are very much in evidence. So much in evidence that our University of Washington students on a study abroad program commented that between the prominent Space Needle-like structure (the Sky Tower), the amount of construction of high-rise condominium buildings, and people who are homeless, they felt as if they were still in Seattle instead of in Auckland.

A few studies have been done recently looking at the rise of homelessness in Auckland. Their version of a One Night Count found 68 rough sleepers within a 3 kilometer radius from the Sky Tower. A similar count in January 2015 found 147 rough sleepers within the same geographic area; the largest increase in rough sleeping was in young adults ages 18-25 years. New Zealand government and community members I’ve spoken with about this say that homelessness in New Zealand is a recent phenomenon. They attribute it to the country’s rapidly rising income inequality (the fastest increase of any industrialized country), neoliberal government policies weakening the country’s social support system.

Despite these distressing trends, I have found a refreshingly creative and ‘can do’ attitude towards addressing the problems of rising poverty, homelessness, and income inequities. In a series of subsequent blog posts I’ll share some of the most innovative I’ve come across while here in New Zealand.

Expanding What ‘Counts’ as International Service-Learning

P1000535 (1)Entering our fourth and final week of this university study abroad in New Zealand program, “Empowering Healthy Communities,” I continue to reflect on how to incorporate service-learning in an international setting, and how to incorporate it in an ethical and meaningful manner. By service-learning with a community health focus I use Serena Seifer’s definition:

“Service-learning is a structured learning experience that combines community service with preparation and reflection. Students engaged in service-learning provide community service in response to community-identified concerns and learn about the context in which service is provided, the connection between their service and their academic coursework, and their roles as citizens.”(Seifer SD. 1998. Service-learning: Community-campus partnerships for health professions education. Academic Medicine, 73(3):273-277.)

Within a community health and health professions context, service-learning focuses on student engagement in non-clinically focused service work. Thus, our typical community health nursing clinical rotations are not technically considered service-learning, although the lines can get blurred at times.

In a health systems course I teach for senior nursing students, I have included a service-learning option. Students in my course have concurrently volunteered as emergency youth shelter overnight workers, assisted in food banks, and served as buddies for hospice patients. Through this work they can step out of their ‘learning technical skills’ nursing student roles and begin to make systems-level connections and practice critical thinking skills. It has worked well because I’ve partnered with our wonderful University of Washington Carlson Leadership and Public Service Center. They do all the legwork in establishing and nurturing community partnerships, defining student service-learning placements, and monitoring student progress.

Including service-learning in study abroad university-level programs can make for high impact educational experiences. Studies indicate that inclusion of service-learning in study abroad programs significantly increases students’ sense of connectedness with a wider world community. It also helps students confront their own biases and prejudices, and increases their comfort in working within diverse communities. But those benefits come from well-designed study abroad programs that include pre-departure workshops/readings, embedded critical reflective writing by students with faculty feedback, and debriefing sessions after service-learning activities.

Done poorly, international service-learning can be exploitative and can deepen cultural arrogance and economic disparities. As Sara Grusky points out in her article “International Service-Learning: A Critical Guide from an Impassioned advocate,” most international service-learning study abroad programs from the U.S. are done in poor countries, and can become nothing more than ‘poverty tourism.’ (From the American Behavioral Scientist. 2000. 43: 858-867.)

New Zealand is not a poor country and it continues to rank much higher than the U.S. on many health and wellbeing scales. Yet it suffers from rising socio-economic and health inequities. During our study abroad program we have visited a variety of communities–some have been in higher socio-economic brackets, but most have been within impoverished, multi-ethnic and Maori communities. Before doing any community-based service-learning projects, we’ve first learned about the local and national context, including cultural, political, and socio-economic factors impacting the community. Students learn this through carefully chosen readings, and from talks by community leaders.

My co-leader for this program, Jim Diers, is a social worker and an international consultant on community-led, asset-based development. He has a decade or so experience working with various communities throughout New Zealand. So between his contacts and those of the New Zealand based community-development group, Inspiring Communities, we developed this study abroad program. Jim believes in more upstream thinking, policy-changing work versus direct service. It’s an important point, but I think there is room for both in life and in educating university students for their role as civically-engaged change agents. Students have stated that they are now more interested in knowing about and getting involved with their own ‘home’ communities, and of doing service-learning in the Seattle area.

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Spontaneous musical jam session with young people at the Te Oro music, dance, and art center in Glen Innes in East Auckland. We had spent the day on the Ruapotaka marae (Maori land and meeting house) and were planning to help with stream restoration but it rained too hard–stream flooded, so we did this instead.
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Girls from the Baking Club at the Waitangirua Community Services center challenged our male students to a fitness test. This is their pre-contest strategy huddle. Our guys lost and so they had to do a line dance/song. Everyone was laughing so much our faces hurt afterwards. But this was all initiated by the girls of the community. This is part of the Wesley Community Action program in the greater Wellington area.
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This photo is of a very spontaneous and unexpected service-learning project our students engaged in. We visited a community-primary school center in Epuni, north of Wellington. They have a huge school garden and this arts and crafts center where they bring together community elders with the children to share stories and teach craft skills. Our students were asked to help knit squares for blankets for the children. The students who knew how to knit taught our non-knitter students, who in turn taught other students. Amazing.
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Donning our borrowed gum boots and getting down and dirty weeding, turning compost, and double-digging vegetable beds at the community Fruit and Vegetable Co-op headquarters in the heart of Cannons Creek, Porirua, Note the recycled glass paneled greenhouse (minus the roof)–they are from cast off phone booths.

Here are photographs and brief descriptions of various service-learning activities the students have been involved with during the program. Some of the activities were planned ahead of time and others ‘just happened’ spontaneously. All of them were driven by the community members. They have expanded my notion of what ‘counts’ as international service-learning.

 

 

 

 

 

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Helping bag fruit and vegetables at the Salvation Army in Cannons Creek, Porrirua, north of Wellington. This is part of a fruit and vegetable co-op in one of the more impoverished areas of New Zealand. But as the residents told us that day–the government calls them impoverished… The New Zealand public health unit helps fund this innovative ‘non-charity’ project.

Study Abroad: The Evidence

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Signpost near the Waiheke Island(New Zealand) ferry landing. Photo credit: Josephine Ensign/2015

Until recently, the effects of study abroad experience on college students were mainly anecdotal in nature—more in the form of personal testimonials from students about what they gained through the experience: “Such a blast! Best bar scene ever and their drinking age is 18–how cool is that?!” and “Did you bungy jump yet off the Kawarau Bridge in Queenstown?” to the more serious “It opened my eyes to the way Americans are perceived in other countries.” But parents, university administrators, and funding agencies increasingly want hard evidence on the cost-benefits of study abroad experiences.

The number of U.S. students studying abroad has more than doubled in the past decade. During the 2013/14 academic year (latest stats available), 289,408 students studied abroad for at least a month for academic credit. (Source: Opening Doors, an initiative of the Institute of International Education.) The Institute of International Education recently launched the Generation Study Abroad campaign to double the number of U.S. university students who study abroad by the end of the decade. The campaign also aims to increase the diversity in race/ethnicity, academic disciplines, destinations (the UK and European countries are the vast favorites), and gender. Racial/ethnic minority students, first-generation college students, and STEM majors are underrepresented in study abroad programs. In addition, 65% of study abroad students from the U.S. are female. Are young women more adventuresome somehow?

Here are some intriguing findings from recent studies on the benefits of study abroad programs. Controlling for prior GPA, credit-taking, and SAT scores, a student who studies abroad has a 10% greater chance of graduating in four years than a student who does not. Why would that be, I wonder? It does run counter to what many parents–and even some academic advisors–worry about with study abroad, that it will complicate a student’s credit requirements and therefore delay their graduation. In my own case with a ‘junior year’ study abroad experience, the summer semester’s worth of credit allowed me to graduate a year early. Perhaps through study abroad experiences, students see the value in completing their undergraduate degrees as quickly as possible and getting on with the rest of their lives.

Study abroad experience has been shown to increase students’ self-reported cultural sensitivity, self-confidence/adaptability in dealing with complex, unfamiliar living/working/studying conditions, and knowledge of world geography. The American Association of Colleges and Universities identify intercultural understanding as an essential learning outcome for contemporary university liberal arts education. Employers and graduate school admissions committees place value on prior international study abroad and other international experiences (such as volunteering). For health professions students, study abroad experiences would seem to be ideal for helping to increase cultural knowledge/humility, as well as perspective (and humility!) on the failings of our U.S. healthcare system.

Before our study abroad program started this summer, I asked our current group of twenty-two university students who are here in New Zealand studying community health, to write down at least four personal goals they have for themselves. While a month is not a lot of time for a study abroad experience, it can be impactful, plus I have found it is more accessible to a broader demographic of students who otherwise might not get to have a study abroad experience.

We have an amazing and quite diverse group, many of whom are in (or going into) health professions education, including nursing, social work, medical anthropology, global health, pre-med, and pre-physical therapy. Here (paraphrased to protect identities) are some of what they wrote/shared with me in terms of their goals for this study abroad experience: “To find my place as a global citizen.” “To be able to problem-solve bravely and maturely.” “To learn new ways to manage my stress.” “To let the fire in my heart truly burn for global health.” “To get the chance to slow down and really reflect on where I have been and where I want to be in the future.” “To be able to practice cultural humility and greater global awareness.” “To push my boundaries and push myself outside my comfort zone; deal with difficulties in a mature manner.” And finally, from one of our many ‘first time out of the U.S.’ students, “I hope to have culture shock and awkward moments where my ‘Americanism’ shows.”

If our students accomplish even a few of these personal goals during our study abroad program, I will consider it a grand success.

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