Extra Effort Will Be Needed to Protect New York City`s Most Vulnerable

The damage that COVID-19 has inflicted at the epicenter of the crisis can have a particularly shattering impact on the target groups of New York human-services organizations. For those experiencing or at imminent risk of homelessness, for example, the virus poses another serious threat in lives already plagued with daily disruption.

An organization that since 1978 has prioritized strategies to transform the lives of New York City's most vulnerable is working to maintain critical connections with its clients at a time of greater physical separation. Nadjete Natchaba, vice president of treatment and recovery services at Services for the Underserved (S:US), tells Addiction Professional that the organization's leaders need to monitor client and staff well-being simultaneously.

“We are bracing ourselves for the worst,” says Natchaba. “We expect to be working harder and engaging people more. The most important thing is for our workforce to stay healthy, to have the capacity to serve. We're already seeing referrals increase.”

S:US has 2,400 staff members and delivers services in behavioral health, intellectual disabilities, HIV/AIDS and other health areas. Much of its funding comes from government contracts and Medicaid payment. It operates behavioral health clinics in three New York City boroughs and has assertive community treatment (ACT) teams working in Manhattan and Brooklyn.

Natchaba says clients with substance use issues face a particularly complex set of challenges during this public health crisis. Many of the old adages don't fit at a time of distancing from others while hunkering down at home. The “people” component of the “people, places and things” that usually should be avoided in early recovery suddenly might be the only contacts a person has right now, Natchaba says.

For those actively using street opioids, the harm reduction message of “don't use alone” must be modified to reinforce safer use at a time when close contact with others is discouraged.

Harm reduction strategies remain critically important at this time, Natchaba says. “We can't assume everyone has moved to abstinence,” she says. Syringe services programs that assist some of the same clients S:US serves have sought to maintain effective operations during the crisis.

Encouraging phone contact

S:US has been equipping more clients with mobile phones loaded with prepaid minutes as a safer means for their staying in touch with staff during the crisis. Natchaba says some clients are elated that they can receive a call at home, while others still would prefer face-to-face contact with a peer and some have flatly refused to accept phone contact.

“They are not comfortable with sudden change,” she says of the latter group. A shift to phone contact can be jarring for an individual whose typical home is a shelter or the street.

Staff members also can express feelings of anxiety over how the nature of their work has changed, as well as the constant barrage of news about the virus. “We see the importance of being honest and having transparent communications,” Natchaba says. “There's a lot that we don't know, but what can we do that is in our control that allows us to gain back a little bit of power?”

For concerned staff, “We give space for them to talk about it,” she says. “It's about normalizing what people are feeling.”

Similarly, S:US has to acknowledge the added disruption clients are experiencing, and do its best to help them adjust. Some clients who were working with S:US primarily on vocational training now have their plans on hold. Others may be experiencing the loneliness that comes with not being able to see a trusted professional.

“We are being bombarded with phone calls,” Natchaba says. “The alert is heightened.”