Program for homeless men thrives with mix of compassion, accountability

For more than a decade, a program that treats homeless men with compassion but expects a great deal from them as well has produced striking results in Charlotte, N.C. A former counselor with the program tells Addiction Professional that she was accustomed to seeing participants “completely do a 180” under the SABER (Substance Abuse Education and Recovery) initiative.

“When these men see that this is a safe place, where we follow through on our promises, they become happier, and have more internal motivation,” says Bailey MacLeod, who now works in private practice but maintains ongoing contact with the program. “The percentage of people who complete the program and go on to find a job is astounding.”

A program of the Charlotte-based Urban Ministry Center, which offers numerous supports to help people emerge from the cycle of homelessness, SABER grew out of research that program director Marilyn Furman was involved in during post-doctoral work at the University of Alabama-Birmingham. The nine-month program consists of three months of intensive therapy and six months of continuing care that is focused on landing stable employment. Participants are housed in donated apartments, but must remain substance-free and meet other program requirements in order to stay in the free housing.

The program's foundation lies in a contingency management approach that offers incentives (mainly Wal-Mart gift cards for personal expenses) for maintaining sobriety and attending treatment sessions and 12-Step meetings. MacLeod explains that the populations served, and the philosophy of treatment, differ between SABER and the commonly used “Housing First” model that exists within other programs serving the homeless population in the Charlotte area.

She says that the programs espousing a Housing First approach tend to work with a more chronically homeless population, enacting few rules and following more of a harm reduction model. SABER participants are not receiving disability benefits and are expected to be able to work full-time; they receive food stamps to assist in their food purchases.

The program, funded through a combination of donations to the Urban Ministry Center and grant funding derived from state alcohol retailer monies, also does not work with groups that already have several other community programs devoted to their needs, such as veterans. Participants must be referred to SABER, and referrals come from sources such as detox programs and a local men's shelter.

Transformation for participants

Crack cocaine, marijuana and alcohol are generally the most prevalent substances that have been used in the population served by SABER, says MacLeod, who gave a presentation about the program this month at an American Counseling Association conference. Most of the participants have experienced treatment in the past. “This is not their first rodeo; they often come in jaded,” she says.

The first three months of intensive outpatient treatment keeps clients busy. Besides individual and cognitive-behavioral therapy sessions, participants are required to attend job training sessions, twice-weekly yoga classes, and regular gym visits. In the continuing-care phase, they are able to stay in their apartments as long as they continue with their vocational activities. At this stage of the program, “Their job is to find a job,” MacLeod says.

Participants often are able to stay in the apartments at a reduced rent after they complete the program, or are referred to other low-income housing opportunities in the community.

“I absolutely loved working there,” says MacLeod, adding that she fit in well in a program that asks for accountability but does not take a confrontational approach with participants. “The guys really make it a support community,” she says of the participants.

Given the multiple challenges facing this population, the outcomes that SABER has achieved since its inception in 2006 appear exceptional. At a cost of only around $500 per person per month, the program sees a 57% completion rate for the full nine months, with 92% of the completers finding employment. (A total of 84% of participants are able to complete the first three months of intensive treatment.)

MacLeod is quick to point out that while the program's framework is significant to this success, it is the participants themselves who do the pivotal work.