Bread for the City

Our team of staff and clients leaves for the AMC tomorrow. Please make a gift to support their trip today!

The first time I attended the Allied Media Conference (AMC) was in 2011, as a BFC client. But back to my story. In 2011, I was excited to have an opportunity to learn skills that would help me be more efficient in my work with Valencia’s It is What It Is Mobile Talk Show. The show is an online platform for people in communities in the Washington, DC metropolitan area who don’t often get media coverage or a chance to share their stories, unless a tragedy happens. I was excited to have an opportunity to meet with other media makers and activists from all over the country. I had no idea that it would actually change my life.

The conference had a smörgåsbord of sessions facilitated by activists from all over the world who were sharing what they knew. I met people like me who are dedicated to creating social change by living it. For the first time in my life I witnessed artists, musicians, farmers, computer whizzes, chefs, seamstresses, and dancers learning skills from each other and strategizing to work collaboratively to change our society for the better.

When I received my booklet with the session descriptions, I felt like a kid in a candy store. I highlighted the sessions I wanted to participate in and tried to attend them all, even though some of them were happening at the same time. I coordinated with people who were going to sessions that I wanted to go to and attended half of one and then “switched classes” with them at the break and went to the other.

The atmosphere at the AMC was very inviting and I noticed the intentionality of conference organizers in making sure that everyone felt welcome. I participated in a workshop on good listening skills, then attended sessions where people shared their stories and discussed  the similarities of the “human story” that exist regardless of culture or ethnicity.

At the “Thousand Kites” session I learned about the Prison Industrial Complex and watched powerful interviews with people who have incarcerated family members with whom they are unable to communicate. A few months later, during a Holiday Family Photos event at Bread, I interviewed Ms. Thomasina Bennett, a client of the SE Center and submitted her interview to Thousand Kites:

The intergenerational learning spaces at the AMC present valuable skills and information in a way that encourages participant involvement. I was awed at the resilience of native Detroiters who had and were experiencing the financial breakdown of their city and were literally developing communications infrastructures for people with no money. I created my first gmail account in Computer Skills for Elders (which in today’s world of ever-evolving technology is anybody over 40) and learned how to use Google Calendar and Google Drive at Shawty Got Skillz. I attended a session on video blogging, or vlogging, and created a Tumblr account to share my knit and crochet creations with other crafters worldwide. I attended a session on video camera skills that showed how to create alternative lighting and set up impromptu props.

The AMC changed my life by making me feel less alone in my zeal for creating social change. I met people there who I stay in touch with on a regular basis who are working to create positive social change where they live. Since attending the AMC in 2011, I have gone from being a  BFC client to being employed in the Advocacy and Community Engagement Department. I’ve taught a crochet class, received a citywide activist award, trained dozens of staff and clients on media tools, and facilitate and coordinate the Wellness Space. I am excited to be using the skills I learned at the AMC in my day-to-day work.

The AMC is an experience that truly enriched my life and I’m glad that Bread for the City is investing in more people like me, who will bring the skills and relationships back to the BFC community and beyond! We need your help to send another 6 clients to AMC this year. Please give today!

Typical teen-aged boys spend their weekends hanging out with friends and playing video games. There’s nothing wrong with that. But Griffin Shapiro set out on a different track when he ventured out to our orchard one Sunday afternoon in spring 2012 to get down in the dirt to help us plant more than 1,000 fruit trees — the benefits of which will stock our food pantry for DC’s low-income families!

Griffin first got involved with the orchard through his synagogue, the Washington Hebrew Congregation. “There was a project to go out and plant Asian pear and apple trees. I decided to go, and I really liked it,” he said. “After I did that, I really liked Bread for the City, so I wanted to do more.”

Not long after helping us plant fruit trees at City Orchard, Griffin celebrated his Bar Mitzvah. And, again unlike most teens, Griffin decided to use his Bar Mitzvah gifts to help those less fortunate. Remembering his experience with City Orchard, he reached out to us and — on his own — sponsored a full crop of 2,300 strawberry bushes with a gift of $5,000. Planted just this past May, this collection of growing strawberries is now affectionately known as Griffin’s Patch.

“Clients are really excited about this new addition,” says Jeffrey Wankel, BFC’s Urban Ag Specialist. “I mention strawberries, and their eyes light up.” It will take a year for these strawberries to grow to full harvest potential, but what’s great is that they’re an everbearing variety, meaning that we’ll be able to reap at least two full harvests per year as opposed to a single harvest in May.

Griffin’s parents are so proud of their son for giving back. “My husband and I are thrilled that he has been able to volunteer and put in some of his own effort rather than just giving funds,” says his mom, Nell. She added, “We really support the initiative, creativity, and healthful eating emphasis behind the notion of an orchard dedicated to helping those in need.”

When Griffin returned to volunteer in the orchard this past spring, he was so excited to see the fruits of his labor — literally. “I could actually see the stuff that I had planted and see how much it had grown,” he said. “It’s so cool to look at something that’s real, that’s there — something you can point to and say, ‘I made that happen.’”

You sure did, Griffin, and we can’t thank you enough!

Interested in volunteering or sponsoring a tree in City Orchard? Find out here how you can get involved.

The last three years, we’ve sent a group of staff and clients to the Allied Media Conference in Detroit, MI. The AMC offers training in a wide range of media practices — from video editing to performance art — in order to equip grassroots organizers and social justice movement-builders with the communications tools they need to make big change happen.

When we got back last year, one of our organizers, Zachari Curtis, blogged about why we go to the AMC:

“To really accomplish our anti-poverty goals we had to find ways to directly address the justice issues at the root of poverty. To do this we need to build power among the people affected most by the problem. Our formula for building power among clients and their communities is relationships + skills building. Our relationship building is the foundation on which we connect clients to the skills and resources they need to be engaged members of the justice seeking community.”

One example of this is Donald Monroe. For the last two years, Don has been a member of our Client Advisory Board. (As well as active in the NW Garden Club, Participatory Action Research project, and Wellness Space.) Just before we went to the AMC last year, Don was finishing up CompTIA, a computer repair certification course at Byte Back. He says, “I didn’t feel truly comfortable with what I’d learned at Byte Back until I had a chance to do some of the hands-on stuff at the AMC. I was able to upgrade my skills.”

The last day of the AMC, Donald was at a DiscoTech (or Discovering Technology) session with Jessie Posilkin, staff in Bread’s IT department. His excitement was contagious, and when the team got back to DC, Jessie invited him to volunteer with her. She says, “It was a risk — we rarely use volunteers at all due to the sensitive and expensive nature of our work. We’d definitely never had a client volunteer before.”

The risk paid off in spades. Don started coming twice a week and eventually also worked with Andre Saliba (also in IT) on upgrading Bread’s computers. Andre shared, “Don’s always energetic and willing to work. During one round of upgrades, he stayed with me until 1 in the morning! He loves technology and loves to learn, and it encourages me to give him more and more responsibility.”

The ripple effect is dramatic. According to Jessie, “Because of Donald’s help, we were able to accept a donation of 15 computers, because we knew we’d have the people power to refurbish them. Then we turned around and gave 15 client leaders access to new technology!” Last week when I happened to walk by as one client leader was getting a computer, I overheard Jessie say, “Donald was working on the repairs, because he’s better at the hardware than I am.”

My favorite part is how much Donald loves it: “The skills I learned help me and others stretch dollars by rebuilding computers up to modern day standards. It’s good for the environment too! The AMC was excellent in conveying valuable concepts, which will help promote our mission — to be a media platform for our communities in a way that will cause social change.” With so much cross-pollination, it’s no surprise that Donald’s values echo the Detroit Digital Justice Coalition’s principles.

Donald’s intention for this AMC is to brush up on his repair skills as well as gain exposure to anything that will help him collaborate with our department’s media expert, Judy Hawkins, to facilitate more local skill-sharing with staff and clients. Don says:

“I’d like to get a computer class going in Southeast. I think there’s a connection with the Wellness Space, to help people use the internet to be proactive in their health concerns, whatever they may be. They can find out information about how they can heal themselves, as well as know more about the side effects of medications that they’ve been prescribed.”

Help Donald go to Detroit by making a financial donation to support our trip! We need $4000 to send 2 staff and 6 clients to AMC this year. Please give today!

This was a big week in the medical clinic.

If you passed by the clinic and looked around, everything looked the same. The waiting room was crowded, the phones were busy, the exam rooms were full and the dental clinic was a-buzz. People were getting shots and having their blood drawn in the lab. It looked like business as usual.

But for the first time since opening our doors in 1974, our patients without any health insurance were told that each visit at the clinic costs, on average, $140. And if they did not bring in proof of income, proof of residency and apply for health insurance in the next 4 weeks, we would ask them to commit to paying at least part of the cost.

This is a huge philosophical shift for us. We believe that healthcare is a right, and we have never charged for any services at Bread for the City. Costs were never discussed with patients.

But after looking at our financial books from every angle, we realized that if we wanted to expand the clinic then the only way we could do this was to become a Federally Qualified Health Center (FQHC). With this new designation would come extra federal dollars that would help us grow the clinic, provide more desperately needed primary care, and become a medical home to even more folks.

The clients, staff, and Board of Directors discussed this transition from a free clinic to an FQHC for a long time. We concluded that it made financial sense to make the change.

The FQHC brings extra federal dollars, but also has many requirements. One of them is to ask patients with annual incomes greater than 100% of the federal poverty guideline to help pay for their visit to the clinic.

We stand by our philosophy that healthcare is a right and money should never be a barrier to access to care. We explained to our patients that the visits cost money, and in order to provide even more services, we needed to ask them to help.

Patients with incomes between 100 and 200% of poverty are given a month to bring in proof of income so we can help them apply for public insurance. After a month, we will tell them the cost of the visit and ask for a payment based on their ability to pay.

To make this easier, we set up our own DC Uninsured Fund — a special fund that patients can access. For example, if the visit is $140 and they can contribute $20 that day, then they can access this fund to pay the difference.  At each visit, they can decide what amount they are able to contribute.

Norma and Moni, our enrollment and billing coordinators, talk to everyone and enroll folks in public insurance. They make sure to start every conversation by sharing our basic belief that our patients will be seen every time, regardless of their ability to pay. If they qualify for insurance, the faster they apply, the better it is for them and the clinic.  And those over income can access this special fund to pay for part of or the entire visit.

Our staff admit they were uncomfortable with the idea of having this conversation. But our patients understand that everything costs money and anything they can do to help with those costs help them and the clinic.

How does the Federal government define poverty? You can see the specific dollar amount in income that all the federal programs use to define poverty in this country.

Exciting News: BFC just kicked off a *new* Quality Assurance & Quality Improvement (QA/QI) program!

The concepts of Quality Improvement (QI) are not new to BFC, QA/QI has existed informally here for years and we’ve even blogged about it before. We think about making good things better and seeing better results for our clients all the time. We even use data-driven experimentation to focus on outcomes, efficiency, and client experience (we just might call it something different).

The overall aim of this new program is simple, to ensure the quality, safety, and effectiveness of BFC services. Since the first step toward improving quality is measuring it, we must formalize what quality looks like and how we share that information with our Board and clients. That’s where we are now.

Defining quality in a medical context is something that a lot of people have sculpted lives and organizations around, so we were able to steal from national health standards like Healthcare Effectiveness Data and Information Set (HEDIS) and Meaningful Use.

Here’s a sampling of what Clinical Quality measures look like:

• All kids seen in the clinic should receive certain vaccinations by age 3.
• All patients with high blood pressure should have BP readings within a safe and normal range.
• We  should talk to 100% of our patients about diet, exercise, and the harms of smoking.
• On the Safety front, we’ve decided to report things like temperatures to make sure our vaccines are held at a normal range and bacterial counts on medical equipment to make sure we aren’t putting people at risk of infection when they come here.

And we really care about the client experience, so Client Satisfaction data will be something we measure in several different forms:

• We have developed an organization-wide client satisfaction survey and are thinking about how we can expand opportunities for continual ways of collecting client feedback.
• We are tracking formal client grievances received by program directors so we can be sure that complaints are acted upon in a way that helps us do better.
• And another element of safety and quality we’ve identified is just tracking incidents, unusual occurrences that happen at Bread, like when a patient gets their hand squished in a door, or someone backs their car into the building, or a staff person identifies a privacy concern.

But measuring safety, effectiveness, and quality must extend beyond the Medical Clinic. And that’s why as we set Annual Program goals this year, each program will be identifying at least one quality measure to add to our QI/QA Board Committee Data Dashboard, so we can tout the good work we do and learn from the data where we might improve.

What does quality look like… for Legal services? Social services? Food? Social change work? For our Finances and Human Resources? Client and Staff Satisfaction are two areas we know we need to develop, but what they look like and how they are implemented are questions we will need to explore.

Do you have ideas about how we might define and measure quality across the agency, or know of resources that might help us grapple with any of these questions? Know of other organizations that have tried to measure this stuff?

Need a fun and unrelated data visual?!

Ladies, gentlemen, and everyone else! Step right up to the advocacy and client engagement circus!

Earlier this month, our staff were joined by BFC’s Client Advisory Board at an important all-staff meeting. Resident videographer Judy Hawkins prepared a video to give you a taste of the feats of daring collaboration, soaring acrobatics of coordination, and unbelievably strong accountability we witnessed that day:

This past weekend, my church held our biggest community outreach program of the year, The International Vegetarian Food Fair. This fair helps the church introduce itself to the community, engage with its neighbors, and invite people to learn more about our mission. There is food from the four corners of the earth, and everything is amazing!  To help promote the fair this year, the church requested help from Seventh Day Adventist Reverend/Executive Chef Mark Anthony (you can see him on YouTube, 38BN. Vegetarian Cooking Artistic Creation.)

Mark has been an Executive Chef for many years.  His talents range from the home cooked meal to the highest gourmet productions.  He has been an Executive Chef at 7 different properties, starting when he was just 23. He’s really an incredible talent, and while I love all of his food, my favorite dish is his “Beefless” Wellington; check it out!

Beefless Wellington

For the patties:

• ¾ cup vital wheat gluten flour
• ¼ cup rice flour
• 1 cup water
• 3 tbsp low sodium soy sauce
• 1 tbsp granulated garlic
• 1 tbsp powdered onion
• 1 tbsp vegetable base
• 1 package All Purpose Vegan Pastry Dough (or the equivalent of one 18 inch dough sheet)

For the saute items (veggie filling):

• ¼ cup sliced onions
• ¼ cup sliced mushrooms
• 2 tsp olive oil
• 1 tsp rosemary
• 1 tsp thyme

For the gravy:

• ¾ c. vital wheat gluten flour
• 1c. water
• 1 Tbsp. beefless base/vegetarian broth
• 1 c. BBQ sauce
• 6 cinnamon sticks

- To prepare the vegan beef patties, mix the wet ingredients together and then add the dry (through vegetable base).  Form into mock steak patties about ½ inch thick, either in bite size servings or palm size for an entree portion.  Bake steaks at 350 degrees for 7 to 10 minutes on both sides, until firm.  Set aside.

- For the saute items, heat olive oil over medium heat and saute the veggies and herbs until soft, about 5-7 minutes.

- To make the gravy, combine all gravy ingredients in a saucepan and simmer until it gets nice and thick. Cool slightly.

- To build your Beefless Wellingtons, top steaks with sauteed mixture, add a tablespoon of gravy and then wrap each patty with puff pastry dough, just like a gift. Bake at 350 degrees for about 40 minutes, until golden brown.  Serve with extra gravy on the side.

Happy eating!

You’re a good person. You like to volunteer, you give when you can, and you’re always there to offer a helping hand. Another way we know you’re a good person? You’re always looking for ways to do more. And, while you might never be able to make the zillion dollar gifts to charity that you wish you could, you know that you can make an enormous impact if you can get your whole community organized to act together to make a difference. Power in numbers — it really works!

Like Van Gogh said, “Great things are done not by impulse but by a series of small things brought together.”

So, what if you and all your neighbors coordinated an effort to make a difference in your community — all together, all in one single day?

That’s what Do More 24 is all about! The United Way of the National Capital Area has organized Do More 24 on June 6th as a way to mobilize our community to make a ton of small gifts to help organizations like Bread for the City in a big way.

On June 6th, we want you to make a modest gift of $12, $24, or $48 (or more, if you’re so inclined). Our goal is for 1,000 of our community members to come together to raise $24,000. These funds will go directly toward hiring a new doctor for our medical clinic, meaning that we’ll be able to provide life-saving healthcare to 900 more patients each year.

So, let’s go 1,000 strong for Bread for the City on June 6th, and make healthcare available to more of our neighbors in need!

How else can I help on June 6th?

• Join and invite friends to our Facebook event!
• Donate your Facebook status: “Join me in giving to Bread for the City for #DoMore24 to increase healthcare access for people in need! http://goo.gl/2zB0X”
• Tweet about Do More 24: “Join me in giving to @BreadfortheCity for #DoMore24 to increase healthcare access for people in need! http://goo.gl/2zB0X” Tweet this!
• Donate your gchat status: “Give medical care: http://goo.gl/2zB0X. #DoMore24″
• Send a text to five friends: “Hey! I’m giving to Bread for the City for #DoMore24 to make sure people in need have access to healthcare. Give $12 here: http://goo.gl/2zB0X.”

When most people hear of social security disability benefits, they probably think of physical disabilities. Shoulder injuries, severe arthritis, and heart palpitations: these are the things that we intuitively know prevent people from working.

However, people don’t immediately tend to think of the fastest growing disabling condition: mental illness. And, yet, almost all of the social security clients that I have worked with at Bread for the City’s legal clinic have been diagnosed with some form of mental illness.

This isn’t surprising given that the Social Security Administration’s most recent statistics show that of the over 6 million people receiving SSI in the United States 60.4 percent of those people receive benefits because of mental disorders. Of those, 23 percent are mood disorders, which include depression and bipolar disorder.

As psychiatrists and primary care physicians continue to diagnose people at alarming rates, there continues to be cultural stigma and confusion surrounding people living with mental illness — stereotypes that people with mental illness are weak or lazy. Although more and more people are popping anti-depressants and seeing therapists, many continue to be skeptical that mental illness is a disability. As evidenced by recent negative reactions to the release of the DSM-V, the so-called “bible” of mental disorders, even mental health professionals are concerned that we are medicalizing normal human reactions to stress, such as loss and trauma.

Here in the legal clinic at Bread for the City, I see firsthand how this stigma and confusion affects clients. One of the first clients that I represented had been diagnosed with depression, bipolar disorder, and post-traumatic stress disorder. Part of the reason Lisa kept being denied benefits was that she had a history of being non-compliant with her medical treatment. She missed countless psychiatrist appointments, often didn’t follow up with her community support worker, and would let her prescriptions run out without getting them refilled.

This was my first case in the legal clinic, and it was frustrating. According to Lisa’s medical records, she was often able to function normally when she adhered to her treatment. But the moment she stopped taking her meds or stopped seeing her community support worker, things fell apart. Why couldn’t she just go to her appointments and take her pills?

After bringing her in to talk about her mental health, I finally started to understand that Lisa’s situation was complicated and messy and difficult for outsiders to understand. Lisa’s history was full of tragedy: suicide attempts, childhood abuse, chronic feelings of worthlessness. No wonder she had difficulty getting out of bed in the morning, let alone holding down a steady job. I don’t know many people who could have gone through what she went through and still found the strength to make it in for a single legal clinic appointment, let alone follow up consistently with her medications and multiple doctor visits.

Now, when I meet with clients living with a mental illness, I try to unpack my own internalized prejudices. Mental illness, from my perspective, is every bit as debilitating as a physical disability. For me, legal clinic clients are no longer the picture I draw from analyzing their medical records. This may sound cliché, but it’s important to understand: People suffering from mental illness are people, deserving of compassion and understanding. They are not their mental illness, nor are they to blame for living with it.

It’s time for afternoon clinic at Bread for the City. Salsa classes are finished in the waiting area, and patients are filling the chairs. I look through the glass door and see my one o’clock patient, Fatima. She has been a patient since 2009, but today was the first visit since the birth of her first  baby girl. I was excited to see them. I called her name, and she stood cradling her 2-month-old baby on her chest. I met her eyes, which were slowly filling with tears. She came back to the room, and says, “I just had to come and see you. I feel so sad, I did not know this was going to be so hard.” She proceeded to tell me how she is having a hard time caring for her baby. She can’t help but cry all day. She was afraid to be alone while  her boyfriend and mom were out working, so she came to Bread. We called her mother and boyfriend, and we made arrangements for them to care for the baby. The rest of the time we spent time talking and initiating her treatment for postpartum depression while our social services staff helped her access community resources for new Spanish speaking moms.

Running a little behind, I go to greet Maria. She walked in for a medication refill. She is a diabetic and reports that she has been out of medications for several months. After probing and trying to figure out why, she tells me she has felt so depressed she did not want to leave the house. Today was the first day she had been out in a while, and she was grateful to be seen. She has been suffering from depression for years after enduring and finally leaving an abusive marriage, but  she is not seeking help for that today; she just wanted to pick up her medications.

Primary care is an important bridge between mental health assessment and treatment. More than 40% of patients with mental health problems seek initial care with their primary care provider. Many patients both new and old have diagnosed, non-diagnosed, treated, untreated, and partially treated mental health problems — the most common being anxiety, depression,  and post traumatic stress syndrome. As per the Health Report by the US Health and Human Services, from 2005 to 2010 adults living below the poverty line were 4 times more likely to be depressed when compared to those living 400% above the poverty line. We also know in primary care people with mental illnesses are five times more likely to have co-occurring medical conditions. And, for severe mental health problems, mortality is much higher than the general population largely due to treatable medical conditions, which are left undetected or untreated.

What do we do at Bread for medical patients with mental illness? Simply put, we develop relationships and we listen. Primary care is a place where conversations happen, trust is built over time. We know that treating their medical conditions can’t be independent of their mental health. We’re always getting to know our patients, assessing and reassessing their mental health status. Some patients come to us, like Fatima, seeking help, while others like Maria do not want help. However, with some patients like Maria, we know that if we cannot try to treat their depression then their diabetes may never be controlled. She may never walk into a psychiatrist’s office, but she will come to the clinic for her diabetes care.

And, yes, doing this work is not easy. It requires flexibility, patience and being present — having your doors, heart, and ears open. Working specifically with Latinos, speaking Spanish and understanding cultural differences in reference to mental health is essential. It takes time for histories of domestic abuse, substance abuse, and loss to emerge. Many people are lucky to have escaped or survived their past, but it does not leave them. Seeing a consistent, familiar face of someone who speaks their language can strengthen the relationship and ease the path toward healing. It also helps to have bilingual and culturally competent staff in our other departments at Bread, such as legal and social services staff who can help assess additional factors contributing to depression.

So at the end of the day, many patients are seen in our medical clinic. We understand the link between primary care and mental health and the population seeking care. So when patients come in, the answer is yes. We will help when you are ready. And yes, you can see your provider because we don’t want to miss a good day or a bad day.