How Compassion and Relationships Reduce Chronic Stress

At the Core of Care

Published: November 7, 2022

SARAH: This is At the Core of Care, a podcast where people share their stories about nurses and their creative efforts to better meet the health and healthcare needs of patients, families and communities. 

I'm Sarah Hexem Hubbard with the Pennsylvania Action Coalition and Executive Director of the National Nurse-Led Care Consortium. 

As part of our special training coverage, we’re turning over the microphone to my colleague Jillian Bird, Director of Training and Technical Assistance at the National Nurse-Led Care Consortium.

Through a wide variety of ongoing programming, Jillian and her team help support providers working in community health centers across the country.

So on this episode, we’re going to hear a conversation about the impact of chronic stress on personal and community health. Jillian will talk with two longtime community health professionals about their experiences working at the community level. They’ll also discuss the lessons they’ve learned and how relationship building is key.

JILLIAN: Thanks, Sarah. Our guests for this conversation are Jeneen Skinner and Uzuri Pease-Green. Both are joining us by zoom from different areas of the country. Jeneen works in Camden, New Jersey, where she is the senior clinical manager for care management initiatives for the Camden Coalition of healthcare providers. And Uzuri is the Executive Director of Community Awareness Resource Entity or C.A.R.E. in San Francisco.

Welcome Jeneen and Uzuri to At the Core of Care.

JENNEN: Thank you, Jillian, thank you so much for having us on here. today. I'm excited to be able to talk about chronic stress and the impact on our community.

UZURI: Yes, thank you very much. I am excited to be on here to talk about the stress and how to collaborate and come into community and work with community. So thank you very much for having us.

JILLIAN: Before we dive into our conversation, let's first hear how both of you became interested in community health. And why you do the work you do? Jeneen, want to lead us off?

JENNEN: Community health was not initially my first priority as a nurse. I worked with a lot of people who went into subacute. And you know, I got to see a lot of med-surg happening and recovery, and things of that nature. But what I was most passionate about was something that was very near and dear to my heart. And that was to work in the city where I was able to receive my nursing education, the city where I grew up. And it was important for me to be able to care for the people in my own community. And so I had the opportunity to work with a local FQHC, where I got to work with people who were experiencing homelessness. I got to make sure they had care, coordinated access to primary care. And then I had the opportunity to work for the Camden Coalition. And it has been just a tremendous wealth of knowledge for me as a nurse, both personally and professionally to be able to see people go from where they are to where they want it to be.

JILLIAN: Thank you, and how about you, Uzuri?

UZURI: Oh, my goodness. So living in community, and having the like, I'm in recovery. Now. I've been in recovery for 14-15 years. And so understanding that drugs and alcohol and just everyday life, especially stress can take a toll on one's body, and sometimes things happen to where it becomes so normalized. And so once I got clean and sober, and then I realized also that people were normalizing just everyday life. And in how do I help people? How do I help you to maintain and move on and have a better life? So like, my mom is on dialysis. My dad died of pancreatic cancer. I have neighbors who have were healthy yesterday. And then now they have to be helped because they've had a stroke or asthma. And so this is something that I live and breathe, and it just happened organically. And it's like how do I help to change the narrative and how do I help change people's way of thinking from the foods we eat, to just of the foods that we grow to not doing the things that we used to do? So mine's a little bit different from a nurse and a doctor because I live it every day. I got my phlebotomist license, and I was a CNA. And it's just being able to do everyday life. And so changing the culture in the community, where I live, and showing people organically.

JILLIAN: Thank you. It’s so important to know where you come from. So for listeners who may be unfamiliar with the organizations where you work, could you each give a brief description about the mission and main focus of your organizations?

JENNEN: The Camden Coalition is a multidisciplinary, nonprofit organization in Camden, New Jersey. We work to improve care for people with complex health and social needs. And we also work to advance the field of complex care by implementing person-centered programs and piloting new models that address chronic illness and social barriers to overall health and well-being not only in Camden, New Jersey, but also nationally.

JILLIAN: And Uzuri?

UZURI: Yes. So C.A.R.E. Community Awareness Resource Entity is actually a nonprofit that my husband started here in Potrero public housing in San Francisco. And so we're residents who started our own nonprofit and we started it to deal with the shooters, the young men that were going around, and they were shooting each other, and we're trying to figure out how to help them stop. But then, life guided our footsteps, to where we connect people with other resources. And you don't have to just live in a public housing for us to help you and serve everyone. And so it's our way of bridging the communication gap between residents and SFPD. And so we are the after-hours for emergencies. And we also are just showing people a different way and working with community to bring more resources to community because we were actually a desert for resources. And there used to be a lot of poverty pimps, and poverty pimps and organizations that will come in, get their numbers and then leave. And then community was stuck wondering what happened. And so they were getting money to do nothing. And so our organization really works for other organizations to help better lives and help better the community.

JILLIAN: I hear a little bit in your story Uzuri, the importance of trust and building trusting relationships. And each of you have been working in this area for a while now and definitely have many stories to share. Can you share a little bit with how have maybe you've seen this field evolve over the past decade? And how attitudes around health care provision and also community-based resources, how those partnerships may have evolved?

UZURI: So we have a health center that is right up the street. And yet a lot of residents didn't go to that health center, because systems would send people in other places. And so we've worked hard to be able to have a wellness center right on site. But also people weren't even going to the doctors and get the help that they needed or they didn't know the questions to ask. And so we've had providers to be able to educate individuals and even sometimes go to the doctors with them. Then even bring in quality services, making sure that we don't allow people to come into the best of our ability that are only coming into use communities. So we've been able to bring in those that are very much ready to collaborate, and work with community, because people come in thinking that they're going to fix you, but we're not broken, you’re supposed to come in and try and work with individuals to get to them to where they're trying to go. And so the trust, it took a lot to build up the trust, like we would have the police chief in our office every month. That organically happened. And that's what the trust of the community to understand. And we've been doing this for like almost six years. Our offices have never been shot up, our cars had been fine. And because we've been very open and transparent about the meetings that we have, even bring it SFPD and having our community events, no one gets arrested at any of our community events, because that's the neutral zone. So we've had officers to say, I should be arrested that person for burglary right now. But I can't touch them because they're in a neutral zone. And that's very important. Because if you arrest somebody, every time they come to an event, then that makes for you don't have any trust. Now there are, if you have a stay away order that we came to agreement, you get some food, and then you have to leave, because that's just a little too, too blatant, and is disrespectful to the police officers, as well. So just finding that common ground and understanding it, everybody has their own lane. And we can't be in every lane, we're collaborating together to bring different culture and different resources and understanding that this is a melting pot. And so we may have a person who speaks no English at all. And so we have to adjust our services to be able to accommodate that person, and be okay with that, and meeting people where they are. So some people are still on drugs. And then you don't ask them not to come to something just because they're on drugs, you meet them where they are, and, and understanding. And that this is not a one size fits all, and that each community is different. And also none of our communities are nine to five communities. And that's where people make the mistake. Sometimes you have to stay till seven or eight o'clock at night. In order sometimes you have to do something on a weekend in order to accommodate and be able to reach individuals that normally you wouldn't reach. So it's all about building up trust. But you also have to, it's a two-way street, you also have to give respect in order to get respect as well.

JILLIAN: I feel myself nodding in agreement. I know Jeneen is nodding in agreement, meeting people where they are is such a principle, a guiding principle of nursing care. And I'd love to bring this to you, for your perspective, Jeneen. And I also heard, Uzuri mentioned this, fix it mentality. And if you can reflect a little bit, as we've known for a long time that fix it mentality when it comes to patients may not really be the best course of action. And I know there's been a lot of innovation at the Camden Coalition. Can you share with us a little bit about your particular approach and how that really is rooted in meeting individuals where they are?

JENNEN: Absolutely. Uzuri, you took the words right out of my mouth, you know, of some common themes that I heard, again, getting out on a fix it framework, right? Because it doesn't work. We are not like you said, I love that people, we are not broken. The people that we serve are not broken. They need support. And that's where we come in, right we come in, we observe what people do well. We highlight strengths. So can this person schedule a transportation appointment? Can they schedule, a doctor's appointment, but before we even get to any of that, there's trust that has to be built. There's a relationship that has to be in place before people will open up to you and say, This is the area where I need more support, and how can you help me get there? And what I've learned is, for me, what was important was to really get to know a person because our engagement strategy is to from our triage process, we identify people who are eligible for our program. And if they are eligible, we have a team who will go out to the hospital and engage people at the bedside to talk about the programs and services that they offer that we offer, and hope with the hopes that people consent to saying yes to our program. But that relationship building piece starts right at the bedside. And if you think about when people are admitted to the hospital, they're telling the same story over get telling this story in the emergency room, to telling the stories of nerves, they're telling the story to the doctor, or whatever specialist is going to come in. And I know for personally, I got sick of telling my own story to people. And I said to myself, why don't people just ask me, am I okay? Right. And so it was important to really get to know a person because I walk into a hospital room, and I'll say, and they'll bail immediately because of the repetition that happens during admissions. This is why I'm in the hospital, this is what happened to me. And I'll say, You know what, we can get to that. But I want to know who you are, as a person, what brings you joy, tell me what makes you smile, and what puts a smile on your face and what makes you happy. And that is what opens up the door for people to be able to say, oh, maybe this is a person that really genuinely cares about me and my wellbeing and I open up a little bit. So that door starts to open, that relationship begins to be built. And then you can have conversations with people about what the barriers are that they're experiencing, whether medically or socially. And the other thing that we do, which I absolutely love, which is, you know, not something that I would say we had in the beginning, which was we created this coach model, in collaboration with the CHOP Policy Lab. And what we did was, it's a set of five foundational behaviors where we are able to help people, again, go from where they are to where they want to be. So they create this vision of what they want their health and their life to look like. And we use a set of care planning cards, where people create their own care plans versus us creating the care plans for them. Now, before we got to that point, when we talk about the fixit framework, we did everything for everybody. We were like, Oh, yes, let's just go to this home visit. Let's schedule your appointments. Let's call it get these medication refills, you know, let's make sure to doctor's appointments are scheduled. But we did that because we knew that it would get done. Right. And so when we graduated, people are discharged people, people weren't as successful with that process, because we didn't give people to tools that they needed to be successful, which is why coach came to be the care planning cards, because we want to make sure that when we engage people, and we bring them in, that we're setting them up to be successful to navigate those systems and those barriers that were in place so that they can not only help themselves, but help the other people in their circle as well.

JILLIAN: Uzuri, I'd love to hear your thoughts about how Jeneen is framing the way that they approach working with others individuals seeking care.

UZURI: That is wonderful. And I was like, Oh, my gosh, breath of fresh air that somebody is actually doing this. And it's also people looking at individuals and then bringing in their own biases. I remember going to the hospital, me and my husband both pointed out for, let's say, to an emergency room. Yes, when we were in our addiction, my feet, bad, his knees, bad, but they literally thought and just assumed that we were there just for pain pills. And when we insisted on the X rays, once they got the X rays back, they can understand how I was still doing this much walking. I was I was doing because I had a hammer toe and a bunion and my feet were going my toes are going like this. And my husband, his he needed a knee replacement because it was bone to bone. And so just pushing for that extra, that extra step and then them having to, they didn't even apologize, but just having that preconceived of, oh, you only want this. I love the work that you guys are doing that makes a lot of sense of being able to have folks explain what's going on and what they need, and actually listening, because a lot of people don't listen. And they try and tell you. And it's so disheartening, because then that's why a lot of people don't come back, or they don't go in the first place. I used to hate to go to the hospital.

JILLIAN: I'm curious too. When we think about individuals with complex medical needs, they might have very real complicated social needs, are living in life, which these days is not easy to live in. There's just generally a lot of stressors and then you have environments where folks are really disempowered. They may be living unsheltered and having to navigate that type of world they may be living in, you know, uncertain housing where they don't know where they'll stay one night to the next is guaranteed. And that can create a lot of stress, of course. And I'm wondering, Jeneen when you implement this type of work with individuals, can you sense a change in stress or navigating stressors and the impacts that that stress has on individuals?

JENNEN: I think, from my experience, when I think about the stress that people are experiencing, you don't always get the full picture of what's happening in someone's life, when they're admitted to the hospital, or when they're at the doctor's appointment, because there's limited time, you know, the doctors have time constraints, you know, when they can see a participant or a patient. And, you know, at the coalition, we are fortunate, and that we have that flexibility to go into someone's meeting people where they are, as you just Uzuri stated, we literally meet people where they are. So whether it's active in an addiction, whether it's just being discharged from the hospital, whether it's whether it's unstable housed, we meet people where they are, and we go in, and we sometimes see that, you know, a person can't go to the doctor's because they're caring for their mom, they can for their dad, they're caring for other people around them, and they prioritize themselves last. And so for us, it's important to find out the total picture so that we can help people and sometimes that means helping the family as well, because they are not, people are not going to focus on what's important to them, or what we think they should be focusing on, especially when it comes to health if home is chaotic, you know. If there are food insecurities, if there's somebody who doesn't have access to medications, if mom or dad or whoever's living in the home don't have the support they need, then sometimes that means as a team, we have to make sure that the family has the whole family has support before we that person will say, now I can focus on myself. And that's important to people. You know, I think about, again, there's so many stories that I could share. And I just remember just seeing people in their own environment is something about seeing people in a place that's comfortable and feel that feels safe to them is something about those walls or those doors opening and those conversations that are being had where people are saying, because people and I'll say this to people aren't always going to tell you that the real story upfront one, because they gotta know that they can trust you to even share that information. Because e some people are afraid that you know, and of course, we are mandated reporters. So if we see anything that's happening, we're honest about that. We will tell people, you know, this is something that, as a practitioner or provider, we have to cheer. But a lot of times we're saying to people, how can I help you? How can we help you get to where you want to be?

JILLIAN: And Uzuri, how does Jeneen’s experience line up with your outlook? Is it similar or different?

UZURI: It’s very much similar. I'm also a mandated reporter in living where I live. I have to look at that gray area sometimes and sometimes I have to really look at what is in the best interest of the person and the child. And sometimes what looks like should be reported sometimes is not what should be reported and sometimes things that look like they shouldn't be reported should be reported. I've had to report my neighbors in, in a way to where I do it in a loving way. They don't know I'm the one that has done it. But a family member will know. And so making these decisions and understanding that many people where they are, sometimes what is uncomfortable for you, is totally comfortable and safe for that person. And so you have to be able to be uncomfortable with being uncomfortable. And a lot of service providers aren't because there's a team that’s uncomfortable being in community, and they're very blatant with it. And it's like, so my response to an email was, you have to do better if you're going to be better than and be very apt to do better. And when you come into community, you have to actually come into community and understand that you're coming more people live. It's not my job to stop this guy from doing donuts at the bottom of the hill, because that's a safety issue. You have to have realistic expectations. And so it's sometimes it gets hard, and it gets frustrating. Because when you're doing your part, and then systems don't do their part and create all this red tape for individuals. That makes it really hard. And that stresses people even more. And no offense, but especially how white people come into community, because a lot of white people come into community and think it should be this way, because they're used to living in their community where certain things don't happen is like, no, like gunshots. It's like, okay, a whole team closed up and went home because they heard gunshots, and I said, then you'll never be at work. Because nobody ever got shot, and you just look at where you're coming to. And so just and then understanding that you can't always and do not allow people to use your whiteness against you to have you do things that you don't need to be doing, or to make promises that you don't need to make. And I'm very open with that. And that's a really honest thing in community, because sometimes people do that with service providers. And so, I mean, no disrespect, but that's just a reality. There are people who will guilt you into doing things that you know you should not be doing, or guilt you into not doing something that you know you should be doing.

JILLIAN: Thank you for sharing that. And I think in this time, not that it should have been not happening prior to now. But the opportunities to speak openly and to try to understand and learn that we do have varying bias. We come from different places we carry these things with us. And I think some of the failures of how you know our conventional medicine has been functioning is that there's a power dynamic ultimately that's playing out and we are charged in many respects to dismantle that as individuals working within health care. You know, hearing what Uzuri has shared. Jeneen, I'm just curious if you have any perspective that you would like to offer on this, we are particularly about what does it mean to come into community and in any community is going to have a moment of pause when someone's coming in. Are there any strategies or you know, what might be a crucial foundation that that you have explored in your in your practice or that you've seen be successful?

JENNEN: That is a great question. And Uzuri, everything that you spoke about, I was nodding in agreement. I think one of the most important things for us is hiring the right people. Right, because you don't want to bring somebody onto the team who's going to re traumatize people who's going to continue to build up those walls and mistrust. And it's so important for us at the Camden Coalition to make sure that we hire the right people. And our hiring process is very extensive. There are several steps to even becoming a part of the team. It involves a group interview, if I could just sum it up really quickly. I mean, I love it, though. Because when I think about the chemistry one of the team, right. And then in longevity of the team, we have people who have been on a team anywhere from three years, up to 12 years, this is my 10th year. And it speaks a lot to how we hire and the structure that we put in place. We start with a phone screen. And I know a lot of organizations do that. So there's a phone screen, there's a group interview, there is a group interview that involves a case study. And so we put people in groups to have a conversation about how you prioritize this particular case. And then after that, there's an interview with the executives at the organization. And if people are able to be successful during that process, then the potential candidates, we then tap them shadow us on a home visit, right, because we want to see how people are going to interact with people that this is going to be somebody that you're going to potentially be assigned to work with. So we want to make sure that it's not only a good fit for you, but a good fit for the people that we serve, because we just we can't have that because people have gone through so much already. And the last thing that we need to do is to bring somebody into our organization that is just unfortunately not going to work well. So I love that we have this process in place. Because again, we are able to make sure that people come in with the understanding of this is what we do here. Now for me. And I always laugh about this. I when I started at the coalition, I was working with a local skilled nursing agency. And in my mind, I was like, Oh, I could do this, we're going to do home visits, you know, I do this on a regular, this is not a problem for me. So my first day, I went on a home, I went to my first participants home. And I walked in, and I was like, Oh, this is this is not the same thing. This is not the same thing. But I love it. And I just began to learn all that I could about what that person was experiencing. And it just made me just kind of reflect on the way that I've seen people over the years. Because again, you get one story in a hospital, you get one story at the doctor's office. But then when you go into a person's home, you get the total picture. And it's like, no, this is so then you're able to advocate for people and say, This is what's happening, of course, asking that person's permission to share it but saying, This is what's happening at home. Right? This is what we're seeing with the medications. This is what we're seeing with social barriers, with utilities, with lack of food resources with lack of transportation, this is what we're seeing. And so, again, for us, it's important to bring the right people into the organization and consistent training, whether it's on mental health one on one, substance use, trauma informed care. Of course, that is like the priority because again, we don't want to traumatize people. And so I would say hiring the right people, and then bringing in people with various talents, whether it's people who are licensed professional or people with lived experience, and bringing those worlds together. Oh my goodness, there's so much that can be done to help people.

JILLIAN: Uzuri, what would you want to see happen? Or levels of training or the type of individuals that are coming into community? Is there anything for you that feels really paramount? Feels really foundational?

UZURI: Culturally competent people, oh, my goodness. People come in, and they need to be honest with themselves. so that if you're honest with yourself, and this is not the environment you want to work in, that's fine. I can respect that. But when you're in this environment, and then you come up with these different excuses that make no sense whatsoever, it's so disrespectful. I mean, people really need training, but then also, I think community should be part of the patterns for hiring individuals that are going to be in the community. And then I think what somebody puts on paper, in actuality, is sometimes not reality. And it's really being honest about your, the capacity you can do and what you cannot do. And I see that a lot. Now we're dealing with that, and understanding that it is and that it is okay, for community to call you out and say no, that's not okay. And don't be offended. Because we're and I say we, because I live here, we are going to speak up for ourselves. Because then, like a lot of times I become the angry black woman, now an angry black woman, because I said it to you nicely, four times. But now when I put a little base in my voice on the fifth time, oh, now you have attitude, no, I said, it's even four times in a very nice, elegant way. And you didn't get it, because you're bothering my community, and you're disrespecting the community. And so it is really hard when you re-traumatize community, over and over again, traumatized enough. And your job is to come in and help get people you'll never be healed. And you will need to understand you will never be healed. But what it is, is to get you to a place to where you're not triggered. And when you are triggered, be able to deal with that trigger, and that in a different way than where you used to.

JILLIAN: It sounds to me when I'm listening to you both, you know, Uzuri, you're a strong advocate for your community. And I hear Jeneen really situating herself or yourself as an advocate for the individual. And you know, when we look at and consider these systemic barriers, and they're still, they're still in the way, and we need to do better addressing and dismantling these systemic barriers to move forward in our health care. I'm wondering, you know, when you're advocating for an individual or for community, and you're coming up against those barriers, what are some of those strategies to kind of bring that person back into focus and continue to build within their capacity to heal, and to receive the care that they need? And Jeneen, I guess I can kick that to you.

JENNEN: I think what we do is really just support the person through the process, and we make sure that people know, we are here for you. And we're going to advocate for you every step of the way. Whether it's getting connection to a doctor, whether it's access to benefits, whether it's a legal issue, whether it's medication, access issues, we are there to genuinely help people. And and honestly to say we're frustrated, too. Because that comes with the process. We, you know, people always say to us, they've said to us, you guys are able to do this and get that done. And I'm like, You know what, this is validation. This is very frustrating. But we're going to work through this together. And if we can't find a solution, we're going to take it to our leadership because this is an issue that needs to be addressed across the board, because I'm pretty sure that the person we're working with is not the only person experiencing those barriers. So whether it's again, we have a lot. So out of this, what has happened again, I started, you know, with the coalition in 2012. And the evolution of what we were able to or have been able to support people with has been so amazing to watch. And I go back to this fix it thing where again, we did everything, and it felt good for us. We were like, Oh, my goodness, we got this person. doctor's appointment medications, now we can discharge them, but the issues were still there. So what did we have to do different, and it was the frustration I'll never forget coming into our care planning meeting. And our our manager at the time, she said, Well, we have x amount of people who are experiencing homelessness, but you guys have not been able to get in contact with them. What's going on with that, and I was like, we want to work with people, we can't find them. There is an issue with access to housing, we want to work with people, we just don't know where they are, because they don't have a permanent place to stay. And so taking that, and having leadership really listened to the team who were boots on the ground, to say this is an issue, not only in Camden, New Jersey, but across the country where people don't have access to housing, once they're discharged from the hospital or discharged from, you know, sub acute people do get vouchers and things like that to go to the local shelter or maybe a hotel stay. But that is a temporary solution. So how can we as an organization address the bigger issue. And so a lot of those conversations turned into our housing first program, where we were able to successfully housed people who, prior to us coming in, needed a lot of support with getting access to permanent housing. And the the see, the joy of a person who puts the key in the door and opens that door for the first time is just something that will forever be embedded in my mind. Because sometimes we take that for granted that we have access to a bed and electricity and food and we can walk into our homes. But the people that we are serving, they don't have that. And it doesn't feel good when we're trying to help people. And people are are being labeled as quote unquote, non compliant. But you got to find out what the real story is. Because they're not going to tell you a lot of times that they don't have access to certain things. But when we find out, we as an organization, and as a community, have to make sure that we put those things in place, and have those conversations and help to get those laws changed to make sure people have access to what they need in order to be healthy.

JILLIAN: Thank you.

UZURI: Thank you. I was listening to you. And you just honestly, for us, it's a little, it's just a tad different because some of them is lived experiences. So I've been homeless and slept on the sidewalk in a cardboard box and been into prostitution and into drugs and into jail. And so I understand in a very truthful and honest with people to understand that I'm not judging you, because I've been there right there, where you where you are. And even when I give somebody $1 or $5. As I'm driving in us, the homeless person, I always tell them, I've been where you are. I used to be homeless too. And I say that so that they can know that. I'm getting it as but you can, it can get better. It can get better.

And I get emotional, when I think about it. Because I remember sticking the key in the door here going from the shelter, to putting the key in the door to it's ours, my husband just got out of jail, he didn't even know about the apartment, we have the key and walked in. And we slept on the floor for a couple of weeks, we moved in with a TV, a pillow. And I mean a little bitty black and white t TV, a couple of blankets and a pillow. And that was heaven, sleep on that floor was the best thing. And understanding that people when they get their own place, they still have to have that support. Because some people don't know how to sleep in a bed. Some people have never slept in the bed they haven't done that is so long. It's uncomfortable. And it's weird. You know, it's weird to have your own place, and that nobody's going to come kick in the door and tell you to get out. And that that's your key. And so keeping that in mind, it helps to continue with the work when you deal with the ones that because you can't help everybody. You cannot help everybody. And not everybody wants to get off drugs and not everybody wants to be clean. And not everybody wants to live in a place. And we have to be okay with that. To help those that do man. it's just an amazing, it's an amazing feeling. And sometimes I'm like, I don't even know why I'm doing this. And then something will happen. I'm like, Oh, that's right. That's why I'm doing this, you get that little booster shot.

JENNEN: Uzuri, thank you for sharing your story. I mean, it's just amazing. I think about one of the things that you mentioned where you stated, We can't help everybody. And we can't, and not everybody is ready for the help that we have to offer. But like you said, we have to be okay with that. And realize that, again, there's so many layers to people. And when you come in as whether an organization or an individual and you come in and you're saying to people, this is what we can offer you that's overwhelming for people, especially if they if they've never had any but sometimes they've had we've had people say to us, you guys are probably going to be like the last person who said that they were going to help me. And because of that people are very hesitant and resistant to engage. But when you show up when you say you're going to show up when you call when you say you're going to call when you accompany somebody, when you say you're going to accompany them, that's when those walls start to come down and they can share with other people. No, they aren't like that these people genuinely care about you as a person, they care about your family and they care about what happens to you. And so, again, you're gonna have people you know, you engage and then they're gonna fall off. And that's okay. We just again have to be okay with people not being ready to work with us.

UZURI: And tell them you can still come in some people will come to you. And then for whatever reason, they disappear, and then they come back a year later. And you can't say Oh, well, because you disappeared last year. Oh no, I can’t mess with you, no, you'd be like, Oh, I'm glad to see you back. Are you ready now? Are you halfway ready? Get to toe in the water. Okay, well, well, let's start with your toe in the water for right now and see where we go with that. But just having a level of compassion with people and understanding that people don't wake up the next day is a wake up think that night, oh, I think I'll be homeless tomorrow. Oh, this is something I really want to do. It's a process and it progresses. And some people don't have, they're ashamed. And if people do the drugs to numb the shame in that feeling, because they don't know how to get out because they've had so many different places to tell them they were going to help. And then they didn't do it. And so you do have to tear down those walls. It's like peeling an onion a little bit at a time until they see that you actually are going to be there. Or you really do want to help me. And that takes time. And you gotta have the patience to understand is going to take time it's not going to happen in one day. Why some people might get it in at one day, they might be like, you just click it and suddenly you just click to where they just, they just trust you and they're like, I'm going to give you I'm going to trust you there's one last damn time. But if you mess up and let me now they'll never trust anybody else again.

JILLIAN: It's amazing, the frequency in our conversation which I really am grateful to both of you for sharing such you know, very deep and honest stories of your own personal lives and also your journeys professionally and as clinicians and what I'm hearing over and over as for saying, you know, people are capable when you give them support, and you get you help direct them or you provide the resources that they need, but behind those resources are behind the that support and the bridge Uzuri that you used that term and I love that. Those are other people, there are people under each of these efforts there, you know, the organizations that are there as a resource are people there to connect with other people. And I think that's a really amazing simplification, like, when it comes to the system behind the system, there are other people there. And when can we treat each other and see each other and be with each other as people, it seems, in your stories, at least to have made huge impacts, change lives, and given people a sense of self, a self of self assurance and self competence that they can navigate their life the way they want to. And it's beautiful, and I really appreciate you both and just want to acknowledge you both for spending this time with me today. And if there's any, any final thoughts that you'd like to share with any of our listeners, I'd love to invite you please to help wrap up with that.

UZURI: I would just say, to not judge a book by its cover. And that beauty is in the eye of the beholder. And just to really look at individuals, and see through them, and look at the soul and see the beauty that's in that soul, that might be ugly on the outside for a minute. But if you just smile a little more, have a kind word that goes a long way into a person's heart. And saying that you have to embrace your past, to understand your present to see your future. And so just be kind. And just understand that things don't happen overnight. And that you're not fixing a person, you're just helping them to get to their reality and get to where they’re trying to go and be compassionate.

JENNEN: And I would say in addition to that, be your authentic, professional self. Show up when you say you're going to show up, build a relationship with people, build a relationship with those organizations who are going to help the people that you're serving, because that's so important. And I will also say that it's important to not promise people anything, because they're going to hold you to it. And I would also say as Uzuri stated, to be kind, compassionate, and look at people as a person, and not their medical or social complexity.


JILLIAN: Thank you Jeneen and Uzuri for joining us on At the Core of Care and sharing your experience and reflections with us.

UZURI: It was an honor to be on her and this was actually a real true booster shot for me. So thank you very much.

JENNEN: Likewise, thank you so much for having us on here. It has been great to talk about the work that we do. And I love to hear the passion that Uzuri spoke with about the work that she does. And it's just been an amazing conversation today.



Support for this episode comes from the Health Resources and Services Administration (or HRSA) of the U.S. Department of Health and Human Services (or HHS). It is part of an award totaling $550,000 with zero percentage financed with non-governmental sources. The contents of this podcast are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS, or the U.S. Government.

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At the Core of Care is produced by Stephanie Marudas of Kouvenda Media and mixed by Brad Linder.  

I'm Sarah Hexem Hubbard of the Pennsylvania Action Coalition. 

Thanks for joining us.