Women speak: healing the wounds of homelessness through writing. (Women Speak writing project, MGH Institute of Health Professions, Boston, Massachusetts)(Successes in Community Outreach)

The growing ranks of women in the homeless population in the United States challenges nurses to think creatively about health care and to explore new opportunities in their practices. The Women Speak writing project explores the use of writing as a therapeutic process with homeless women at an urban drop-in center. The project grew out of a community health rotation for graduate students at an entry-level masters degree program at the MGH Institute of Health Professions in Boston, MA. The focus of the community health clinical rotation was on community care for homeless populations. Students participated in a community assessment of an urban homeless community. Pairs of students worked with a variety of programs for the homeless including since shelters, drop-in programs, day care for homeless children, family shelters, and a foot clinic for substance abusing homeless men and women.

For many women, homelessness follows years of

violence and abuse

Women make up over 25 percent of the homeless individuals seen by Health Care for Homeless projects nationally (Brickner, Sharer, Conanan, & Scanlan, 1990). Despite the diversity of their individual stories, "the lives of homeless women share the common thread of poverty and loss" (Brickman, et al., 1990, p. 139). For many women, homelessness follows years of violence and abuse which undermines their self-esteem, contributes to the pain of powerlessness, and reinforces the social invisibility of their lives. The complexity of factors behind homelessness poses challenges to health care providers serving homeless women. Homelessness raises a "chicken or egg" question for women, as their lives on the streets and in the shelters are often marked by greater vulnerability to violence such as rape and exacerbation of mental illnesses such as depression. While health care services for homeless women may be accessed through shelter sites in urban areas such as Boston, which include specifically targeted programs such as "Health Care for the Homeless Outreach," barriers to their effective use may be rooted in the powerlessness resulting from homeless women's lack of self-esteem and inability, to trust service care providers.

"What brought you to this shelter?"

The opening of a new drop-in center for homeless women provided an opportunity for two students to join in the building of a "safe" place and a support community for the women. The framework for the clinical practice experience was drawn from the person-centered approach of Werner and Bower (1982). Based on the work of Brazilian educator, Paulo Freire (1993), the approach applies the principles of "Conscientization," which have been widely used in Latin America, to the problems of urban U.S. health care. The guiding principle of this approach is that the provider's primary job is to help people gain greater control over their health and lives. Central to that effort is "awareness raising." …