First Step Home

Karen Chao, Summer 2013

There are several adjectives to describe my summer with Urban Health Project and First Step Home: unexpected, compassionate, humbling, and revealing.

When the previous UHP interns bragged about their experiences, I was skeptical about how wonderful it really could be. Were they exaggerating? Were they just trying to make UHP sound better than it really was? How wrong I was to doubt their wise words! I have come to realize just how lucky I have been to be able to be a part of Urban Health Project. It has taught me so much about the history of Cincinnati, its people, and the compassion the city has continually shown for its downtrodden and underserved population. From the Hamilton county safety net to the 20+ non-profit organizations participating in Urban Health Project, these agencies run the gamut of services and provide for the needs of the citizens who need them.

My site, First Step Home, really concentrates on the word "home." It is a comprehensive treatment program that slowly transitions women back into society, providing them with addiction counseling, group therapy, and individual therapy that has been proven time and time again to be the model met with the most success. For the past 20 years, First Step Home has given recovering addicts a safe place to live and tools to rebuild their lives. The women start in a 30 day residential program during which time they and their children live in the Big House. First Step Home tries to normalize this experience as much as possible, giving every woman household chores like cooking and cleaning. Though the first 30 days are supervised by a 24 hour staff and the residents are restricted to the house except for medical and judiciary appointments, the women often welcome this sort of supervised freedom, at least for the first few weeks. They understand that it is this controlled environment that will help them stay on their path to recovery. For many of them, this may be the first safe place they have ever been in. Once they have demonstrated some stability and the staff trusts that they will most likely not go back to using without such supervision, the women switch to a 6 day outpatient therapy program where they can live in transitional housing located in one of the four houses surrounding the Big House, or they can make their own living arrangements. Slowly, as the women demonstrate further stability, they are encouraged to look for jobs and their own housing and are weaned down to a 3 day outpatient treatment program and finally a 1 day outpatient program. The whole program takes about 9 months to complete.

My internship at First Step Home has been so enriching, as a person, as a future physician, and as a human being. It continually humbles me to be surrounded by these women who have experienced more trauma, violence, shame, and depression than most people will experience in a lifetime. Their resilience is amazing and the strength they have shown in wanting to turn their lives around for themselves and their children is inspiring. The staff who serves them, year in and year out, interact with them with such compassion and a caring spirit that I am often struck with awe that they have not become jaded and burnt out. These are the role models for my future in medicine. The clients I have come to know will serve as willful reminders of my future patients who are capable of change and learning, if given the chance.

Specifically as an intern at First Step Home, I worked primarily with the new Maternal Addictions program. I attended groups the first two weeks of my time there so I could get to know the clients in the program and the way groups ran. Every day was a struggle not to shed a few tears during these groups as these women shared their life experiences. Their openness with each other and with me surprised me; it truly is a way for these women to support each other through a trying time. First Step Home had two UHP interns this summer, and our time was divided between developing a curriculum and teaching health classes on STDs, hepatitis, HIV, and the physiology of the body on the various clients' drugs of choice (i.e. heroin and opiates, cigarettes, marijuana, and crack and cocaine) and delving into research on opiate maintenance treatment and pregnant women. Additionally, we created a database and are conducting an internal study with the clients in the Maternal Addictions program, asking them specifically about their personal and drug histories, and what is or is not working for them in treatment. Separately, for our UHP project, we co-developed Starting from Scratch: A Curriculum on Nutrition and Cooking for Women in Recovery which was a series of six classes that was split between learning how to cook a new recipe using various cooking styles and different food topics such as meal planning, reading nutrition labels, food budgeting, micronutrients and supplements, and fad diets. It may sound cliche, but my time at First Step Home has taught me so much about humanity and myself, and I know I will be one of those wise second years singing the praises of UHP next year.