Wednesday, May 27, 2015

GI Joe and Obesity

When I was a kid, I loved the GI Joe cartoon. Each episode ended with a self-evident parable (don't stick a fork into a light socket, or it's not a good idea to get into a van with 'Free Candy' painted on the side, etc). With the assistance of a main character, some child would glean one of these kernels of truth and then look into the camera and declare, "And now I know," to which the American Hero would retort, "And knowing is half the battle." End scene; end of the episode.

There is a lot of truth and insight to that phrase. Indeed, knowing what to do is important because a foundation is laid for following through. But, if we are content to simply know what to do but never act on it, we are not only neglecting half the battle, we are losing the war.

Knowing how to spot and diagnose obesity is part of the battle, but we still have a ways to go in claiming victory in the war. Obesity increases the risk for serious health conditions like type 2 diabetes, high blood pressure, and high cholesterol — all once considered exclusively adult diseases. Obese kids also may be prone to low self-esteem that stems from being teased, bullied, or rejected by peers. Younger children deal with self esteem issues in their adolescence that can shape their entire outlook on life. Kids who are unhappy with their weight may be more likely than average-weight kids to:

Develop unhealthy dieting habits and eating disorders, such as anorexia nervosa and bulimia.

Be more prone to depression.

Be at risk for substance abuse.

Overweight and obese kids are at risk for developing medical problems that affect their present and future health and quality of life, including:

High blood pressure, high cholesterol and abnormal blood lipid levels, insulin resistance, and type 2 diabetes.

Bone and joint problems.

Shortness of breath that makes exercise, sports, or any physical activity more difficult and may aggravate the symptoms or increase the chances of developing asthma
restless or disordered sleep patterns, such as obstructive sleep apnea.

Tendency to mature earlier (overweight kids may be taller and more sexually mature than their peers, raising expectations that they should act as old as they look, not as old as they are; overweight girls may have irregular menstrual cycles and fertility problems in adulthood).

Liver and gall bladder disease.

Cardiovascular risk factors present in childhood (including high blood pressure, high cholesterol, and diabetes) can lead to serious medical problems like heart disease, heart failure, and stroke as adults. Preventing or treating overweight and obesity in kids may reduce the risk of developing cardiovascular disease as they get older. Next we will examine some common causes contributing to obesity.

Monday, May 25, 2015

Remember Memorial Day

Memorial Day, originally called Decoration Day, is a day of remembrance for those who have died in service of the United States of America. Over two dozen cities and towns claim to be the birthplace of Memorial Day. While Waterloo N.Y. was officially declared the birthplace of Memorial Day by President Lyndon Johnson in May 1966, it’s difficult to prove conclusively the origins of the day.

Regardless of the exact date or location of its origins, one thing is clear – Memorial Day was born out of the Civil War and a desire to honor our dead. It was officially proclaimed on 5 May 1868 by General John Logan, national commander of the Grand Army of the Republic, in his General Order No. 11. “The 30th of May, 1868, is designated for the purpose of strewing with flowers, or otherwise decorating the graves of comrades who died in defense of their country during the late rebellion, and whose bodies now lie in almost every city, village and hamlet churchyard in the land,” he proclaimed. The date of Decoration Day, as he called it, was chosen because it wasn’t the anniversary of any particular battle.

Honoring our fallen veterans is important to Samaritan House, so on behalf of all the staff, we would like to express our respect and gratefulness to those who have served this country so honorably and made to greatest esaxrifce of all the--- giving of their own lives.

Wednesday, May 20, 2015

Lead by Example

One of the greatest things about being human is our ability to adapt and evolve as our environments change. We can think on our feet and use our opposable thumbs to navigate whatever obstacles we face. We have invented the wheel, harnessed the power of fire, created Seinfeld, and produced the Snuggie. It is obvious we are capable of brilliance when we are interested in something. And this is a good thing, because preventing our kids from becoming overweight means adapting the way we family eats and exercises. We will have to reexamine how we spend time together. Helping kids lead healthy lifestyles begins with parents who lead by example. This needs to be a classic case of 'do as I say, not as I do.'

One problem when dealing with obesity is recognizing who is and isn't obese. How do we know who falls into this category? Body mass index (BMI) uses height and weight measurements to estimate a person's body fat. But calculating BMI on your own can be complicated. An easier way is to use a BMI calculator.

Once your child's BMI is known, it can be plotted on a standard BMI chart. Kids ages 2 to 19 fall into one of four categories:

underweight: BMI below the 5th percentile
normal weight: BMI at the 5th and less than the 85th percentile
overweight: BMI at the 85th and below 95th percentiles
obese: BMI at or above 95th percentile

BMI calculations aren't used to estimate body fat in babies and young toddlers. For kids younger than 2, doctors use weight-for-length charts to determine how a baby’s weight compares with his or her length. Any child who falls at or above the 85th percentile may be considered overweight.

BMI is not a perfect measure of body fat and can be misleading in some situations. For example, a muscular person may have a high BMI without being overweight (extra muscle adds to body weight — but not fatness). Also, BMI might be difficult to interpret during puberty when kids are experiencing periods of rapid growth. It's important to remember that BMI is usually a good indicator — but is not a direct measurement — of body fat.

If you're worried that your child or teen may be overweight, make an appointment with your doctor, who can assess eating and activity habits and make suggestions on how to make positive changes. The doctor also may decide to screen for some of the medical conditions that can be associated with obesity. Depending on your child's BMI (or weight-for-length measurement), age, and health, the doctor may refer you to a registered dietitian for additional advice and, possibly, might recommend a comprehensive weight management program.

Next week we will look at some practical tips for eating healthy as summer approaches and school comes to an end. Typically, kids are delighted to be free from the shackles of higher education, but often that feeling fades as the reality of 'what to eat' becomes an issue. At school, meals are provided, but what happens when kids are left unsupervised for hours at a time?

Monday, May 18, 2015

Obesity in America

Nutrition is a tricky topic in America. We live in a culture where we are bombarded with food as entertainment. On one channel you can watch a supermodel eat a cheeseburger on the hood of a car only to be followed by any number of talk show hosts singing the praises of a gluten-free existence. It's overwhelming. And what about exercise? With school ending in a few weeks, many children will be unsupervised for a large portion (no pun intended) of the day.

The percentage of overweight children in the United States is growing at an alarming rate, with 1 out of 3 kids now considered overweight or obese. Many kids are spending less time exercising and more time in front of small, portable devices. Sports are still an important part of our identity, but sometimes it seems like baseball, soccer, and football have been replaced by Minecraft, Pintrest, and Instagram.

In today's economy, it is not too uncommon for both parents to work, so as a result busy families have fewer free moments to prepare nutritious, home-cooked meals. When time becomes a factor, culinary convenience is expedited at the expense of healthy choices. Dinner is nuked in the microwave, or picked up from a fast food joint, or thawed and preheated. From fast food to electronics, quick and easy is the reality for many people.

And I get it. In a perfect world we could all spend time preparing dinner in the kitchen as a family. Mom would shuck corn and dad would peel potatoes while Tommy sets the table and Ginny churns butter. Reality does not work this way, though (unless your least name is Wilder), and we often have to do the best we can on limited budgets and even more limited time. Changing the culture of unhealthy eating and obesity takes work, and it is especially difficult for the homeless, whether they are living in shelters or in camps or outside during the summer. Children seem to suffer more because they are often powerless in the whole eating process.

The next few blogs will offer some (hopefully) helpful tips and information to help combat the epidemic of obesity that is advancing slowly and steadily. This is not just an issue for the homeless, although trying to maintain a healthy diet without permanent housing is incredibly difficult. If we truly believe in the importance of our children's future, then we must take the necessary steps to educate ourselves in what it means to help them reach adulthood.

Wednesday, May 13, 2015

Housing First, Part 2

All Housing First providers focus on helping individuals and families move into permanent housing as quickly as possible, based on the premise that social service needs can best be addressed after they move in to their new home.

The services provided to Housing First participants vary according to need, which is one of the reasons it can be adapted. Sometimes, Housing First programs assist only with crisis intervention and re-housing, and then link the new tenants to services in the community. On the other end of the spectrum, those tenants with more intensive and chronic problems may require long-term, housing-based services. The goal is to provide just enough services to ensure successful tenancy and promote the economic and social well-being of individuals and families. The capacity of programs to provide supportive services following a housing placement is largely determined by, and determines, who is targeted for Housing First services.

Determining the effectiveness of Housing First programs relies on capturing outcome data. Among the primary outcomes that should be assessed in a Housing First program are individual or family housing outcomes. How rapidly are families being re-housed? Are individuals and families remaining housed? Do families or individuals re-enter shelter?

Programs may want to capture outcomes on family or individual well-being. Programs serving families may include employment and earning outcomes and school performance of children. Programs serving chronically homeless individuals might examine increases or decreases in hospital stays, involvement with law enforcement, or engagement in employment. Cost reduction can also be an important metric.

It is also critical to examine the impact of Housing First in reducing overall homelessness in the community or city. This can be done through regular counts of homeless people. Another possible metric is to assess whether the average length of a homelessness episode is being reduced.

A growing body of research documents the effectiveness of the Housing First approach when used in working with homeless people who have serious behavioral health and other disabilities. This research indicates that the approach is effective both at placing and retaining people in permanent housing and at reducing the costs associated with these individuals within the health care and judicial systems.

Housing First also works for people with less intensive needs. Recent research in the United States demonstrated the high cost of shelter and transitional housing stays for homeless individuals and families, especially relative to the cost of housing. A significant recent U.S. investment in Rapid Re-Housing will provide much more information on the efficacy and cost of this intervention for a wider group of homeless people. The Housing First approach, across all populations and categories of need, is clearly having an influence, and communities across the United States are beginning to re-engineer their homeless and mainstream systems to focus on the promotion of housing stability.

Moving forward, it is important to embrace the Housing First approach as one that might greatly contribute toward ending homelessness much more rapidly for individuals, families and the nation.

Information courtesy of

Monday, May 11, 2015

Housing First

This week we will wrap up the discussion on Housing First, in two parts. Today will focus on the bigger picture of the concept and how it works.

The idea of placing people into housing to produce stability might sound a little backwards, but the more we explore this concept we can find merit in some of the ideas behind it. Housing First is an approach that is built on the principle that a short experience of homelessness and rapid stabilization in housing are best for homeless people and most effective in ending homelessness.

It places homeless people in housing quickly and then provides or links them to services as needed, rather than the more customary approach of services first, then housing. It is important to remember that housing people is not done in isolation and there is assistance to link people with different services. In essence, the person is not 'abandoned' to housing, but instead becomes part of a process designed to implement personal responsibility.

While not assuming that housing is sufficient to solve all the problems that people have, Housing First does assume that housing is a necessary platform for success in services, education, employment, and health: in short for achieving personal and family well-being. There is a focus on helping individuals and families access housing as quickly as possible and the housing is not time-limited.

Housing is not contingent on compliance with services but consumers must typically comply with standard requirements of living on their own such as paying rent and utilities. While there is a wide variety of program models, Housing First programs or systems typically include two philosophies knows as assessment and targeting. In the assessing phase, individuals and families receive an in-depth, up-front assessment before being referred to or receiving services from a Housing First provider. This allows providers to ascertain both the needs of the consumer, and whether the available programs can meet those needs.

The level of assistance programs are able to provide most often shapes who a community can target for Housing First services, which completes the process in a pragmatic way. Specific resources are not wasted by painting each person with a broad and generic brush. Checklists are replaced with intentional and customized services.

The combination of housing linked to services can help a wide variety of people exit homelessness more rapidly. This is supported by research that demonstrates that most formerly homeless families, including those with significant challenges, will retain housing with the provision of a long-term housing subsidy. It is also supported by evaluations of Housing First interventions with chronically homeless individuals, which have found that many who have remained outside of housing for years can retain housing with a subsidy and provision of wraparound supports.

Finally, it is supported by emerging research that lower-need individuals and families who become homeless can exit homelessness rapidly and avoid repeat episodes with even small amounts of housing subsidy and linkage to community services.

While the concept of Housing First seems concrete, there are substantial variations in how its providers meet the housing needs of the individuals and families they serve.
Some Housing First programs provide only minimal financial assistance, such as assistance with security deposits and application fees.

Other programs are able to provide or access longer term or permanent housing subsidy. Some Housing First programs rely solely on apartments in the private rental market. Others master-lease apartments that they then sub-let to program participants, or purchase or develop housing themselves for sub-lease to participants.

To get people housed, Housing First programs have to help people overcome barriers to accessing permanent housing. This includes helping them to resolve outstanding credit issues, address poor tenant histories, and collect needed paperwork. It also involves actively helping them identify housing by reaching out to landlords, housing management companies, public housing authorities, civic organizations, and religious congregations.

Information courtesy of

Wednesday, May 6, 2015

Public Homelessness

Homelessness is more than a word; it's a lifestyle. Living without a fixed residence entails a life marked by survival, not sustenance. And while it is difficult enough to try and live without an established place to call home, life is made even tougher when bans are put into effect that limit where a person can live outside. Some states have banned the homeless from camping in public, making it illegal.

Many homeless people have jobs and nearly 40 percent have some type of paid employment, often day-labor. If people are incarcerated under these types of ordinances, they will miss work, which leaves them at greater risk for losing their job and creating staffing losses for their employers. Without a steady source of income, moving out of homelessness becomes much more difficult, if not impossible.

there are also collateral consequences of having an arrest or minor offense on one’s record, as it can result in difficulty in obtaining future employment. Citations given for minor offenses often have a fine attached. When these fines go unpaid, they can result in jail time. In a recent survey of mostly larger employers, over 90 percent performed a criminal background check on some or all job applicants.

When cities target homeless people through criminalization measures or sweeps, they frequently move them from locations where homeless service providers can regularly reach them – thereby wasting precious resources and making it that much more difficult for homeless people to move out of homelessness

Often, those arrested might be engaged in a program, receiving or eligible for public benefits, or receiving services from a local provider. When those homeless individuals are incarcerated, they will be unable to access longstanding medical appointments and other services, public benefits, or maintain contact with the service provider.

This also outs an incredible strain on law enforcement officers because they are not sufficiently trained to deal with the issues of homelessness, mental illness, and substance abuse. While six percent of the general population suffers from a serious mental illness, the Substance Abuse and Mental Health Services Administration has reported that approximately 39 percent of people who are homeless have a mental disorder. In addition, an estimated 50 percent of adults with serious mental disorders who are homeless experience a substance abuse disorder as well.

Using the criminal justice system to address homelessness can be a very costly approach. The costs associated with criminalizing homelessness include law enforcement costs, court costs, and jail costs. These costs vary from county to county, but are generally higher than the cost of providing shelter or permanent housing. People are often jailed even when the underlying offense for which they are cited does not carry a jail penalty, because failing to pay the fine can result in jail time. Since the original offense was not punishable by jail, they are often not entitled to legal representation by the Public Defender’s office.

As summer begins to emerge in the Flathead Valley, keep in mind the idea that many chronically homeless people will also emerge.

Monday, May 4, 2015

The Chicken or the Egg?

Sometimes timing and location are everything. I was sitting in my living room working on an article for this week when one of the national news programs featured am intriguing report on homelessness. Normally, I don't work from my living room and it is extremely rare that I work with background noise. How fortuitous that the abandonment of 2 of my preferences put me in the position to hear some interesting news.

There has long been debate about a concept in social services that focuses on providing housing for homeless people before they have a job. Proponents of this idea say it will lay a foundation for pride and responsibility that will propel people to work hard to find employment so they can get their lives back on track. Opponents believe this incentivizes laziness and a person should have a job prior to having a place to live. It is the proverbial homeless "chicken or the egg." Which needs to come first?

This particular report focused on Utah and that state's decision to house chronically homeless people before they had a job. People were given a place to live, usually a small apartment for singles and a larger (2-3 bedroom) apartment for single parents or families. The only stipulation was the commitment on the part of the homeless person to pay either 30% of their monthly income, or $50 per month. Over time, Utah saw a 91% decline in the number of chronically homeless living there. Most people were rejuvenated by this process and kept steady employment.

Of course the financial impact of this decision needed to be weighed. On average, chronically homeless people in Utah racked up nearly $20,000 a year on hospital and medical charges that went unpaid. By comparison, the state found it spent just under $8,000 a year for each housed person. This amount also included state-provided case management. The state actually saved money by going to a housing-first philosophy.

This idea is often contentious and advocates on both sides have valid points to support their position. But at least different communities are having this discussion as to which should come first.