In the spring of 2006, a UC Berkeley undergraduate named Naseem Bazargan conducted an extensive study of the Suitcase Clinic’s Youth Clinic drop-in center. Informing her investigation was a lengthy and exemplary volunteer record with the Suitcase Clinic, having served with tremendous distinction as Youth Clinic Coordinator and Health and Medical Sciences 98/198 Class Coordinator. Her painstaking research ultimately culminated in her honors thesis for the department of Sociology, a thoughtfully crafted document titled “Chaos and Control: A look into the radical culture of the Suitcase Youth Clinic.” Her work contributes richly to the inherited culture, ethos and intellectual tradition of the Suitcase Clinic. All of our volunteers, along with anyone interested or invested in the fields of Public Health and Social Welfare, are encouraged to learn from her study. The Suitcase Clinic is proud to have received her devoted attention, and greatly benefits from her findings.
The entirety of the study can be read below in a search engine-friendly format:
UNIVERSITY OF CALIFORNIA AT BERKELEY
CHAOS AND CONTROL: A LOOK INTO THE RADICAL CULTURE OF THE SUITCASE YOUTH CLINIC
A THESIS SUBMITTED TO THE DEPARTMENT OF SOCIOLOGY IN CANDIDACY FOR THE DEGREE OF BACHELOR OF ARTS
By: Naseem Bazargan
Berkeley, California
May, 2006
INTRODUCTION:
One of the most underserved and infrequently studied populations is transition aged, street-identified homeless youth. The National Coalition for the Homeless defines homeless youth as individuals under age 18 who lack institutional, parental or foster care . Alameda County and the city of Berkeley, including the Suitcase Youth Clinic around which I focus this paper, define “transition” homeless youth as 18-25 years of age. The Alameda Countywide Shelter and Services Survey (ACSSS) reported between 355 transition homeless youth in the county in 2004, and this statistic is still understood to be conservative in its estimate. The National Alliance to End Homelessness credits the great number of homeless youth in the nation to family breakdown and systems failure, meaning failures in child welfare, mental health facilities and juvenile corrections. According to a survey conducted at YEAH, a shelter serving Berkeley’s homeless youth, 36% of the youth self-reported that they were in the foster care. These institutions process myriad homeless minors without any continuity of care, only to release them into the “real” world at age eighteen without social supports and with a negative experience of the bureaucracy that encapsulates most social service organizations. How are social service agencies to successfully provide further care for de-institutionalized homeless youth if the youth are already alienated by and weary of bureaucracy?
On a day to day basis, Berkeley’s homeless youth deal with not only their past experiences of bureaucracy but also the every day reminders of a powerful system above and beyond their reach. Constantly within the public eye, street youth encounter police officers, business owners, students and tourists who often treat them with hostility and at best, with indifference. A street-youth described his experience with the police as follows: “They harass us all day for anything that could be ticket-able. Last time they came up to us it was because someone was rolling a cigarette. I’ve seen them pull out their code violation books and just read it and look at us to see if there’s anything in there that they can get us for” (Frazzle). Constant harassment from the police not only cycles street youth in and out of jail but also serves to reinforce negative experiences of authority and bureaucracy that many of these youth experienced earlier in life. Another street youth stated, “Bureaucracy sucks and there’s a lot it everywhere. School, religion; how we teach our children, how we raise our children, how we teach them to go out in the world blindly” (Thompson). Many of Berkeley’s homeless youth are in need of continuity of care and a safe space to escape from the constant exposure of the streets and receive much needed human rights and services different from their previous experiences of bureaucratic institutions.
This paper is concerned with the attempts of a homeless youth organization, the Suitcase Youth Clinic, to address the issue of organizing to provide much needed social services without alienating the client base. In the following pages I analyze the Youth Clinic’s attempt to create an organization with a chaotic and humane face while simultaneously creating enough structure to maintain itself and provide youth appropriate services. Based on my research, I have found that the implementation of an alternative health care model encouraging bottom-up organization over top-down administration created a radical culture, case working model and internal structure antithetical to bureaucratic norms. I go on to discuss the challenges that arise from the creation of such an organization. Essentially this paper is about how the youth clinic strives to escape the reputation of social service organizations to produce “system failures” partially responsible for alienated homeless youth. A description of the organization follows as necessary background to this study.
THE SUITCASE CLINIC
For almost four years now I have been working at an organization called the Suitcase Clinic. Founded in 1989 by medical students and doctors from the UC Berkeley and UCSF joint medical program, the Suitcase Clinic defines its mission as “to promote the health and overall well being of homeless and low-income individuals through service provision, cooperative learning, and collective action among community and professional volunteers, students and participants” (HMS 98/198 Reader 2003: 9). Since founding, the clinic has evolved into three separate drop-ins, each open one night per week and run entirely by UC Berkeley students and professional volunteers (HMS 98/198 Reader 2003). With a philosophy around the right to healthcare for all human beings, regardless of ability to pay, Suitcase Clinic volunteers try their best to improve the life of low income and homeless people with a holistic approach. In other words, well-being means not just curing an ear infection or bandaging a wound, but rather a complete state of physical, mental, emotional, social and sometimes even spiritual well-being. The clinic deals not only with curing but also with preventing illness, with empowering rather than perpetuating dependence, with accessibility rather than red tape.
The three divisions within the Suitcase clinic include the general clinic, the women’s clinic, and the youth clinic. My involvement has been entirely with the Youth Clinic (YC), serving in different capacities over the years, as volunteer, as coordinator, as continuity of care advocate. Taking place on Monday nights year round at St. Mark’s Episcopal Church, located conveniently near Telegraph Ave, Shattuck and the UC Berkeley campus, the drop-in serves anywhere from 20 to 50 homeless and low-income youth weekly. Since the year 2000, the Monday night drop-in, as our clientele affectionately call us, provides not only company and shelter, but also free medical services, legal help, acupuncture, foot-washing, optometry referrals, hot dinners and snacks, hygiene supplies, pet food, health education, harm reduction supplies, and oftentimes chiropractic care and homeopathy.
Before I continue with my analysis of the youth clinic’s attempt to balance chaos with organization, I would first like to provide a discussion of the existing literature around serving homeless youth. I have found no literature that provides a resolution to the tension between organization and chaos, or how to create an organization both sustainable and successful, yet not bureaucratic or constraining. The literature acknowledges the central tension between organizational efficiency and individual human interaction but offers little advice for reconciliation. The literature offers plenty of evidence of a bureaucratic model of a social service agency achieving little besides the reproduction of the belief that the homeless or the poor belong on the outsides of society, stigmatized and de-valorized. My research attempts to fill in the gaps and create some noise where the silence lives. It is not a study to be generalized to all homeless youth, but rather a study that stresses the importance of not only the political and economic impacts on social service organizations, but also the importance of knowing who you are working for, knowing how to create an inviting and safe environment where the result is not constraining and straining but rather productive and insightful. I hope to uncover the unique quality and holistic approach of the Suitcase Youth Clinic in working hard to parallel its organizational culture with that of its clients, in working to reconcile a structured organization with a clientele that prefers chaos. I want my reader to understand better the intricacies and the almost revolutionary quality of such a clinic and how it affects its participants.
A REVIEW OF THE EXISTING LITERATURE
ORGANIZATIONS AS CONSTRAINING
On one hand, theorists characterize organizations as fundamentally constraining and more beneficial to elites than the passive citizens of an indirect democracy. Max Weber provides a working definition for bureaucracy that characterizes organizations in western capitalism. This is the bureaucracy that has us all born into an iron cage where all the magic of the world disappears and everything runs like a cold machine, which many of the Youth Clinic’s clients hope and try to escape. According to Weber, bureaucracy is the institution that optimizes organization. It is a set of means and procedures based on rational formulation of rules to attain complete efficiency, and it boasts “technical superiority over any other form of organization” (Weber 1946: 214). Weber argues that once established bureaucracy is permanent, “among those social structures which are the hardest to destroy” (1946: 228). It is ultimately constraining, not only in that it runs like an all-encompassing machine but also because the workers at the top of this machine are the wealthy elitists of society, backed by credentials and given support by a passive and indirect democracy. Essentially Weber’s bureaucracy is a top down form of controlling and constraining different sectors of society.
Bureaucracy has six essential features. First, through a set of official duties and rules is the “principle of fixed and official jurisdiction areas” over which bureaucracy stretches its authority (Weber 1946: 197). Second, bureaucracy creates a firm hierarchy of offices and authority so that lower offices are subordinated to higher ones. Third, the management of the bureaucratic offices is based on written documents, which necessitates all sorts of scribes and secretaries to document and organize loads of paperwork. Fourth, office management “presupposes thorough and expert training” to master the demands of bureaucratic positions (Weber 1946: 198). Fifth, there is the separation of work and family; the bureaucrat makes familial obligations secondary to “official activity” (Weber 1946: 198). Lastly, the office of the bureaucrat is managed through general rules which are “more or less stable . . . exhaustive, and which can be learned” (Weber 1946: 198). Bureaucracy is also characterized by those officials that run it.
Bureaucratic officials have a sense of “vocation,” or a sense of calling and ethical obligation toward their work. Officials enjoy social prestige, often linked with “the possession of educational certificates” (Weber 1946: 200). They are “appointed by a superior authority” rather than elected by the masses, which Weber believes too dense to elect a candidate based on merit rather than other superficialities. Tenure for life allows officials to carry out duties in a “strictly objective [manner] . . . free from all personal considerations” (Weber 1946: 202). They hold salaried positions “according to ‘status,’” and maintain a level of expertise and gain seniority as they carry out there vocation which increasingly becomes a “career” (Weber 1946: 203). To provide “pecuniary compensation” for officials, a money economy and taxation system with a tax base is necessary (Weber 1946: 204).
Michael Lipsky discusses street level bureaucracies in his book Street-Level Bureaucracy: Dilemmas of the Individual in Public Services in which his analysis of the bureaucracy of social service organization is in many ways a critique of Weber. He expands the view from Weber’s top civil servants to the far more constrained ranks of lowly bureaucrats who serve lowly clients. Lipsky talks about social service organizations that start out with the intention of distributing services from the government to the people, but due to resource shortage and an ever increasing amount of demand, becomes constraining in the name of efficiency. Street-level bureaucracies are organizations and agencies “whose workers interact with and have wide discretion over the dispensation of benefits or the allocation of public sanctions” (Lipsky 1980: xi). These organizations are arenas in which public policy plays out through the daily interactions and practices of workers and their clients. Although street-level bureaucracies and their bureaucratic officials have the intention of providing relief and invoking a model of human interaction as mediators in delivering governmental services, the result is ultimately a constraining system because of a fundamental contradiction in street-level policy: “On the one hand, service is delivered to people by people, invoking a model of human interaction, caring, and responsibility. On the other hand, service is delivered through a bureaucracy, invoking a model of detachment and equal treatment under conditions of resource limitations and constraints, making care and responsibility conditional” (Lipsky 1980: 71). Lipsky goes on to delineate problematic “working conditions” that street-level bureaucrats face in providing public service as pressures facing workers from within and without to conform to certain organizational or altruistic ideals.
The discussion of the tension between bureaucracy and human interaction plays out in Lipsky’s discussion of the conflict of client centered goals vs. organizational goals. A social service organization might declare in its mission statement to act in the best interest of the client, but this client centered goal is directly challenged by the organizations’ need to work within the constraints of limited resources and a constant supply of clientele in need. Therefore “the ability of street-level bureaucrats to treat people as individuals is significantly compromised by the needs of the organization to process work quickly using the resources at its disposal” (Lipsky 1980: 44). The ultimately constraining dilemma of street-level bureaucracies is an inability to provide “individual responses or treatment on a mass basis” (Lipsky 1980: 44). These seemingly minor conflicts are of tantamount importance because individual workers hold a high degree of discretion in practicing social work, and what the individual worker does or is influenced to do makes a difference in peoples’ lives and the way that citizens actually interact with and understand their government. Social service organizations are an arena in which “street-level bureaucrats must find a way to resolve the incompatible orientations toward client-centered practice on the one hand and expedient and efficient practice on the other” (Lipsky 1980: 45).
The constraining character of street level bureaucracies continues in Lipsky’s discussion of the tension in goal conflicts and role expectations of street level bureaucrats. Workers have to deal not only with the conflict of client centered and organizational goals, but also are prey to conflicting expectations of their individual roles and goals. Workers must appease expectations of organizational activity from the public, fellow workers, as well as clients. If the very fact that this conflict exists is not enough to convince one of the constraints of organizations, the fact remains that “although the organization claims to act in best interest of the clientele, however, in reality “clients are not a primary reference group of street-level bureaucrats” (Lipsky 1980: 47). This means that workers responsible for the well-being of clients and the distribution of public services succumb first and foremost to the community’s expectations and those of fellow workers and professionals. Clients once again fall into a system that places their voice on the periphery and provides them with little recourse in dealing with a bureaucracy much bigger and powerful than they are. Ultimately Lipsky proves that the typical street-level bureaucracy deals with conflicting goals of individual human interaction versus the pressures of functioning in a rational, efficient model of modern bureaucracy. In this struggle between efficiency and individual human interaction, efficiency wins out – our capitalist system not only guarantees these conflicting working conditions, but also the endless need for services by the poor. In Weber and Lipsky’s theories of bureaucratic organizations, empathetic human experience is constrained and sacrificed in the name of the smooth functioning of a modern western capitalist system.
MOBILIZATION OVER ORGANIZATION
The question then becomes, how does the Youth Clinic fight this tendency to become constraining and serve only as an unfair puppet of the government’s doomed attempts to allocate resources to its people? Piven and Cloward provide an alternative to this failure of bureaucracy. In Poor People’s Movements: Why They Succeed, How They Fail, Piven and Cloward study the birth, development and death of social movements throughout American history. They point to efforts to develop formally structured organizations with mass membership as a vehicle of political power as the main reason why movements fail. As an alternative, Piven and Cloward emphasize the importance of the energy and power of chaos, providing a different understanding of what it means to mobilize, rather than create a confining and constraining organization that ignores the voice of the people it wishes to serve. Mobilization, or getting a disparate group of people to take specific actions, is varying and finds success in its recognition of the social location and conditions of those people who wish to change their situation. This understanding is nearer to the model of the Youth Clinic, which essentially mobilizes every Monday night.
Piven and Cloward claim that organizations fail because ultimately they ignore the context and voices of the people they wish to help. It is therefore important to understand how protests and other forms of struggle are structurally precluded. People who protest, just like clients who access social service resources, are living within certain institutions that shape not only their understandings of the world and their experiences, but also provide boundaries and limitations to their voice: “It is the daily experience of people that shapes their grievances, establishes the measure of their demands, and points out the targets of their anger (Piven and Cloward 1977: 21). According to Piven and Cloward, the problem with organizations and their leaders is that they use their resources to maintain the organization. They blunt their political demands to get funding for the organization and leaders waste energy on organizational politics and lobbying. This blunder of organizations parallels Lipsky’s discussion of the lack of client voice in worker goals. A person without a voice cannot simply speak to invoke organizational change or lobby the state legislature of Congress, as a person without a job cannot go on strike. He or she can only riot or “storm” a relief center, and do what is most immediate and most practical to their institutional location (Piven and Cloward 1977). Organizations ignore this truth and remove people from the context of their every day lives and ask them to commit time and money to the maintenance of the organization instead of “[sensing] what it is possible for people to do under given conditions” (Piven and Cloward 1977: 22). It is of utmost importance for organizers to “contrive strategies that [do not] ignore the social location of people they seek to mobilize,” otherwise organizations and thus the social movements they seek to lead will fail (Piven and Cloward 1977: 36).
In providing an alternative to the constraints and failure of organizations, Piven and Cloward show us what the opposite end of the spectrum of organizations might look like: mobilization rather than leveling bureaucracy. They provide a theoretical basis for analyzing the YC’s attempt to understand the contexts of its clients and to mobilize in a way that includes and empowers homeless youth rather than ignore their voices and make them victims of bureaucratic red tape. Piven and Cloward put their faith in the energy that comes from chaos, the mobilization that precedes organization, as in the riots in the streets, the strikes, the sit-ins. Essentially they want to keep the power in the hands of the people, and in the peoples’ hands is where the most potential for change occurs. The YC falls closer to this side of the spectrum, trying to keep the environment from becoming cold and detached, to keep the energy of the youth in allowing them a space to do almost anything they want. The youth clinic is an experiment in meeting people where they are at, physically, emotionally, mentally, spiritually.SOCIAL LOCATION AT THE MICRO-LEVEL
Ruth Horowitz (1995), in her case study of a teen pregnancy GED organization, takes Piven and Cloward’s emphasis on identifying social location to the level of individual interactions, or the micro-level. In Teen Mothers: Citizens or Dependents? she (1995) studies the interactions between participants and providers to pinpoint exactly how the style and tone of service provision can either confirm client status on the periphery or elevate and empower participants to the center. In doing so, Horowitz (1995) identifies the practices of service providers that either promote autonomy in acting as mediators or forward dependency in acting as arbiters. Horowitz points out the difference between an organization’s mission statement and how exactly workers decide to carry out (or not carry out) those goals, otherwise called a loosely coupled mission statement. Workers under this system possess a considerable amount of discretion over how a client receives and interprets services. Horowitz (1995) also provides us with a theory of the value of embodied reasoning over disembodied reasoning: it is important, like Piven and Cloward suggest, to not only take one’s social location into account but also their emotional location – how one’s life will influence his or her decision making and how one interprets care based on these lived experiences. Valuing cognition as well as emotional reason is in effect a holistic approach to case working, and at the same time challenges the patriarchal system under which we live.
METHODS
For the purpose of this study I conducted fifteen interviews with Suitcase Youth Clinic staff. Of these fifteen were one licensed acupuncturist, one doctor who is also the faculty advisor of the drop-in, a lawyer, two medical students, two Americorps volunteers past and present, a social worker, and five undergraduate volunteers. Interviews were taped and took place either on site at the drop-in or in various coffee shops, restaurants and offices. Interviews lasted between 1-2 hours and were semi structured, organized by theme and generally took on the tone of a casual conversation. I transcribed all but three interviews. Furthermore, I incorporate my years of participant observation as a volunteer into the data.
I had no trouble accessing volunteers to interview as I myself have been volunteering at the drop-in for several years and over this time period formed relationships with my fellow workers. My immersion in the youth clinic, however, brings up two major drawbacks with this research. First of all, an outsider may have a less alienated understanding of the ongoing processes within the drop-in that I, an insider, may take for granted as objective realities. Second, I planned on interviewing street-youth to compare their perspectives with those of the staff, but only managed to do three interviews, and decided not to include the client voice into the paper. I believe their voice would provide a lot more insight into my research question, as well as insight into the degree of success achieved from our efforts to provide a different type of organization and social service experience.
FINDINGS
COMMUNITY ORIENTED PRIMARY CARE AS ALTNERTAIVE MODEL
In order to meet the alternative needs of the prospective client base, the founders of the youth clinic created a clinical model quite parallel to a structurally and functionally radical health care model implemented in South Africa by a young physician named Sydney Kark in the 1940s. This approach, called Community Oriented Primary Care (COPC), is a “way for communities to work with health professionals to identify and address health problems through a partnership” (Cashman, Fulmer and Staples 1994: 2). In this model, the health care establishment actively values and respects the knowledge, values and expertise of the people it serves, as community members are given a chance to contribute, learn and change the community, rather than receive as passive beneficiaries the services of professional health elites. The goal of COPC is to promote community and individual empowerment in a way that is both decentralized and personalized, bringing much needed services to the community bottom up. According to Cashman et al, the model has five simple steps. First it is necessary to identify and characterize the community to be served. Second, organize and involve the community to lay the groundwork for a community-professional partnership. Third, the community undergoes a needs assessment and resource inventory. Fourth, according to the identified needs and available resources, proper interventions and programs are developed and put into action. Finally, procedures are put into place to constantly monitor and evaluate the program. These steps function cyclically, constantly fine-tuning and remodeling in response to evaluations. This is an ultimately radical program in that the traditional health care model emphasizes “end-stage intervention over community-based primary care, health promotion and prevention” (Cashman et al 1994: 2).
The founders of youth clinic, whether consciously or not, implemented a model very similar to that of COPC. The community in question was the street identified transient youth who spent most of their time on Telegraph and Shattuck Avenues, panhandling, selling art, playing music, doing many things to pass the time. The loci of Telegraph and Shattuck Avenues span only a couple blocks each and draw students, tourists, and homeless people alike, forming a community constantly in interaction with one another, both physically and culturally. The founders, including UC Berkeley students Shawn Mattison, Jessica Woan and Brian Moyers spent almost two years talking to the homeless youth to create trust and establish an informal partnership in hopes of specifying needed services to open an appropriate and successful drop-in. Shawn spent time at a homeless day time drop-in “just being there so they recognized [him] and then started asking if someone wanted to do a clinic would that be any good, what would it looked like, questions like that.” These steps are very similar to those steps identified in establishing COPC, the essential similarity being the valuable partnership between community members and health providers in creating a bottom up system implemented according to community identified needs. Jason Albertson, the clinic social worker for several years related that:
Very specifically we tried to set this clinic up as a clinic that was in partnership with its recipients and would specifically try and do some political education and some development work with its clients so that it would not just be a service environment but would be an environment where the people who use the services could determine what the services should be and how the services should be provided.
Shawn also found it critical to let the street youth identify what they wanted out of a drop-in and “that was in a lot of respects pretty radical. And the fact that if there was punk rock that was playing, that was their prerogative, if it was gangster rap that was playing, that was their prerogative. As long as they were still places where we could take people aside and give them a service or otherwise.” When the Monday night youth drop-in opened at St. Mark’s Episcopal Church in 2001, it was a product of much time and effort in getting to know the community of homeless youth and incorporating their opinions, needs, and wisdom as well as their participation in setup, cooking and cleaning, “because the more people felt like it was their space, the more they trusted us . . . It was more kind of internally regulated. And there were more of the folks saying don’t fuck this up, we got this cool church we can hang out in” (Shawn). A radical model of forming a clinic in partnership with the clients informed youth clinic’s planning and structure to include and appeal to the homeless youth’s negative experience of bureaucracy and need for control, dignity and respect in receiving social services.
COMMUNITY ORIENTED PRIMARY CARE IN ACTION
Part I: Physical Presentation of Drop-In Space
The YC today is community oriented primary care in action, where the culture of the drop-in is informed by the needs of the youth. The most overtly radical aspect of the Monday night drop-in’s organizational culture is the actual physical space where clinic takes place. Our faculty advisor Dr. Alan Steinbach described in an interview how the clinic might appear to the typical adult service provider upon first arriving:
They turn off of the street and into St. Mark’s through the back entrance walking past trash containers, dog shit, kids looking furtively over their shoulders and hanging out on metal stairs that are way too unsafe […] to climb particularly if [they] can’t hang on the rail if there’s a dog on it, and then coming into a room that looks a little like a high school gymnasium with music that [they] have no understanding of at all . . . with people at the back doing services of some vague sort, and you can’t tell who is who because no one has a name tag, [and] the whole thing is antithetical towards the organizational framework of the average straight medical doctor who might be walking in there.
The environment is truly sub cultural and youth appropriate in the appearance of the clients and even some of the volunteers; many sport piercings, dreadlocks, mohawks, colored hair, torn clothing spotted with patches and metal spikes, baggy pants, some barefoot, others with political buttons or simply offensive ones, such as “Oops, I forgot to go to college.” Often times one cannot differentiate between a participant and a volunteer or service provider. Nobody wears any sort of uniform, formal wear or scrubs. Volunteers organize the room with four tables; one with food, another with art supplies, the third with hygiene supplies and health-ed info, and the last with legal clinic volunteers. Acupuncture takes place behind sheets converted into curtains in the back of the room. In the kitchen both students and clients are busy chopping and cooking. People wander about the room while some kids sleep and others sit around talking, laughing, yelling, playing music or receiving services. It is not typically a space where one would expect to receive or give social services.
Part II: Model of Interaction Including Volunteers and Services
In addition to the unconventional setting of the drop-in, the youth clinic runs under certain models of interaction to create a more humane clinic experience, including embodied reason realized through culturally sensitive service provision; the valorization of the relationship through repeated exposure and peer caseworkers, and strengths based model of case working reinforced through interaction. The principle of embodied reason emphasizes valuing an individual’s rational as well as emotional knowledge (Horowitz 1995). This means taking into account substantive rationality, or emotional intelligence arising from lived experiences, and rejecting the Weberian model of focusing only on formal rationality that “increases efficiency, helps calculate the future, and is handy to assert control,” which increases as bureaucracy predominates (Horowitz 1995: 246). Emotional intelligence pertains to “lived experience, which includes not only verbal intellect but the human body and emotions, feelings, and sentiments” (Horowitz 1995: 247). This means the lived experiences of the participants may have lead to emotions such as fear, insecurity, abandonment or anger that inform how they will interpret service provision. Our former social worker Jason Albertson described the homeless youth as a retractive population: “Retractive is what a snail does when you touch it, it curls up into itself. These were the folks who probably had every single chance at services elsewhere but for whatever reason hadn’t been able to access them or didn’t want to access them or felt they were being provided in a way that did not enhance their dignity or self respect.” At the youth clinic, volunteers try to take into consideration participants’ life experiences and value their emotional reason as well as their cognitive reason to create a holistic case working experience very different from traditional street-level bureaucracies.
In the case of homeless street youth, embodied reasonableness then means bearing in mind the participants’ possibly negative experiences of bureaucracy and discomfort with accessing adult services. The youth clinic’s lawyer, Osha Newman, discussed this in interview: “their tolerance for bureaucracy is almost nil and their experience of bureaucracy as valuable and welcoming to them is almost nil. They get nothing but rejection or call back later . . . I think there’s such a deep level of alienation and deep distrust of anything organized.” This patterned distrust of bureaucracy is evident in the homeless youths’ refusal to access adult services, which take on aspects of typical street-level bureaucracies. One youth clinic founder noticed “youth weren’t coming to general Suitcase Clinic [for adults] and we saw them everyday out on Telegraph but we didn’t know where they were getting medical care and found out that they weren’t” (Shawn). In a study of sheltered homeless youth in Baltimore City, Jo Ensign and Joel Gittelsohn found that “health clinics which mainly serve adults are not perceived as appropriate sources of health care by homeless youth” (Ensign and Gittelsohn 1998: 2096). Valuing emotional intelligence creates a high level of cultural competency among volunteers that informs the youth clinic’s creation of a radical and alternative organizational culture with a humane and friendly face.
Reinforcing the model of embodied reasonableness are the various youth appropriate services provided in a culturally competent manner that takes into consideration the alternative needs of street youth. For example, the drop-in offers homeopathic care and acupuncture in addition to allopathic care. According to Josephine Ensign (2004: 5) in a study of Seattle homeless youth, participants are “more willing to go for health care first from complementary medicine such as naturopathy or acupuncture, and later would be willing to be seen by allopathic providers who were co-located in the same clinic.” Youth clinic providers strive to offer their services in a noninvasive and youth appropriate way. Our acupuncturist, Hope McDonald, ran a clinic in San Francisco for HIV positive homeless street youth in the 90s and developed a sound understanding of street-identified youth. In interview, she identified her foremost attempt at being youth appropriate in physically bringing her supplies and services to the drop-in, essentially meeting the youth halfway. She does not require youth to fill out paperwork, does not ask their real names, and dresses informally to reduce signs of class differentiation. She stated the importance of meeting clients where they are at and with respect:
When they’re lying on the table, they become vulnerable and they just tell you their stuff, so you’re a counselor, a confidante, you’re an advocate, so you have that bond. It’s not just needles into their back . . . I think that we’re [meeting them where they’re at] physically and that’s why I think it’s been successful, but also to see where they are in their situation . . . Deal with your clinic situation or your environment with mutual respect. That’s what I try to do in any situation dealing with people. Show mutual respect and expect that to be reciprocated. And if it isn’t, you need to talk about it. There should be feedback and communication on both sides.
The drop-in also offers free legal care with lawyer Osha Newman to deal with myriad tickets and other forms of harassment from law enforcement. Osha has been working with homeless people around social justice for years and also brings much experience to the table, and provides the only free legal care for homeless youth in Berkeley. Like our acupuncturist, Osha physically brings his services to the youth, dresses informally and sets up without an office because he “want[s] to be accessible, out in the open, and its sort of fun.” Here, Osha describes his attempts to be youth appropriate:
It’s certainly not the traditional lawyer thing, […] mainly it’s like oh yea the cops suck, it sucks what happened, I can’t believe they did that. But you also have to make sure someone there gives the info they need to have . . . And then we do a certain amount of paperwork but we try and keep it unobtrusive. We don’t lead with paperwork, we don’t lead with a big form, what’s your name, social security, date of birth . . . at some point we need to do some of those statistics. The other thing we do is fill out a retainer agreement. It’s an agreement, an understanding of what we’re agreeing to do and what we’re not agreeing to do and what the responsibilities are. . . It’s partly because if we take a case with somebody and they don’t show up, we need to have authorization to plead guilty or not guilty . . . We really try and go the extra mile. I go out on the street and try to find people, go where I think they’re sleeping to try and find people.
Another unique service offered is foot washing. Participants, often on their feet all day in worn out shoes can sign up to have their feet washed by a student volunteer. Not only is this a unique and soothing experience, but also a symbolically significant activity. Although not discussed openly, foot washing holds religious significance. In Chapter 13 of the Gospel of John, he describes how Jesus washes and dries the feet of his disciples just before the Passover Feast, saying “I tell you the truth, no servant is greater than his master, nor is a messenger greater than the one who sent him” (NIV John 13:16). In biblical times, feet were deemed low on the hierarchy of clean and desirable body parts, making feet washing the job of only a servant. By washing the feet of his disciples, Jesus sets an example of humility, servitude and equality. By repeating this practice weekly at the youth clinic, volunteers seek to construct a uniquely human face to the organization by recognizing the participants as human beings and not simply as undeserving clients. With no waiting room, no lines, and no red-tape, participants can hang out, eat, talk, play games or make art while they wait for their name to be called. Over all, the drop-in offers genuinely accessible youth appropriate services in a cultural sensitive way and in return demands nothing.
The second model of interaction valorizes the relationship between participant and volunteer as more important than quantifiable outcomes. Many social service organizations receive funding and continue to operate based on performance measures, or how many clients are “helped,” whether that means put into shelters, onto welfare, into jobs. Caseworkers at the YC, however, do not focus on outcomes, as the drop-in relies very little on funding. In fact, volunteers record no numbers except for how many people the doctor sees for statistical purposes. According to Lipsky it is not enough that a certain number of participants be assigned to a social worker or given seats in a classroom, because what is most important, and most difficult to measure, is for participants to be “processed with a degree of care, with attention to their circumstances and potential. Thus there may be no relationship, or an inverse relationship, between quantitative indicators of service and service quality” (Lipsky 1980: 167). Moreover, focusing on outcomes leads to the alienation of participants as street level bureaucrats reduce focus from individual participant needs and instead direct “their activities in ways that will improve their performance scores” (Lipsky 1980: 166). One volunteer medical student described in an interview this fundamental difference of focus between the youth clinic and another youth drop-in:
The Homeplate drop-in, they got closed down because in order to be there you had to access four of the main services: housing, job, substance abuse and mental health. For some people it’s like, they may not be looking for that that day, they may just want something to eat, or they just want to make a phone call or they just want to use the computer . . . The problem with Homeplate and the reason that they weren’t getting results, is that they were based on a model that if you motivate people to access the services, you’ll see results, and I don’t think that’s true. I think that the services have to be there for when people are ready to do whatever that they’re gonna do. The crisis can be whatever but the opportunities have to be there when that crisis happens . . . Conceptually, the fact that we don’t expect anything; we just are like hey if you want to get hooked up with these services then we’ll try to help you versus in order to be here you have to leave homelessness. The thing is people aren’t ready to do it, and they don’t want to and we can’t force them.
Furthermore, focusing on the relationship between participant and volunteer is ultimately impossible to quantify into measurable outcomes. Our lawyer Osha poised this question in our interview:
How do you quantify the fact that if we weren’t there, somebody might be in a worst state or in a worst emotional state? […] But if you see that just providing that space and a friendship and making a relationship is what your job is, and to be alert for those moments or those places where the person is ready or wants help.
Creating these relationships with participants provides a degree of continuity of care unavailable in highly bureaucratic organizations, which “tend to impose a logic of increasing the quantity of services at the expense of the degree of attention workers can give to individual clients” (Lipsky 1980: 100). Rather than give in to the pressures of efficiency, Youth clinic volunteers focus on individual relationships with the youth.
In valorizing the relationship between volunteer and participant instead of counting outcomes, the youth clinic redefines success in service provision and therefore provides an alternative experience of a social service organization for Berkeley’s homeless youth.
With the relationship between participant and volunteer as the center of the case working experience, volunteers take steps to facilitate this process of building trust and opening lines of communication through repeated exposure to and interaction with participants. Keeping in mind the participants distaste for organization and their comfort in chaos, it is necessary for the youth clinic to implement covert methods of order – essentially to provide consistency in the chaos. Our acupuncturist, also a former social worker and CPS worker stated:
People, especially people who have limitations on social skills or mental health problems, they need something to bounce off of, they have chaos in most the rest of their lives. If they don’t have something, and it doesn’t have to be strong hard fast rules, but if they don’t have something to bounce off of, then they’re lost . . . Consistency is what can keep people on the edge more sane, more together.
The most obvious and important form of covert order and consistency is the stability of volunteers and services year round. Volunteers work every Monday night to familiarize themselves with participants. Of the five undergraduate student volunteers interviewed, four have been volunteering for at least two years. Volunteers also take walks along Telegraph Ave. and participate in street outreach handing out hygiene supplies and snacks to reiterate their familiarity among participants. According to a medical student volunteer, “the thing that really proves accessibility here is people knowing who you are. The fact that people know who I am means that they’re more likely to ask me a medical question when I’m trying to talk to someone […] I think its just presence. They see me at clinic, and they know I’m part of the medical, or at least they know I’m part of Suitcase.” Furthermore, the drop- in offers the same services every week, rather than bi-monthly or once a month. For example, two years ago doctors practiced only every other week. Not even volunteers, let alone participants, could remember which weeks doctors would be available, and this lack of consistency truly reduced the amount of participants willing to access medical services. Doctors are absent “maybe less than ten times a year which is pretty good out of 52 weeks. It would never happen that one of us [medical students] isn’t there. I don’t think it has ever happened” (Marcela). When the drop-in was forced to relocate for a couple months due to construction on the church, the number of participants dropped from an average of thirty per week to around ten. Although numbers are not the main focus of the drop-in, they still serve to demonstrate the importance of consistency in establishing accessibility.
In addition to providing consistent volunteers and services, the Youth Clinic also
strives to remain consistent within the nightly routine. Doors open at 5:30pm every Monday night throughout the entire year, with a couple exceptions for holidays when enough volunteers are not present to operate. We serve dinner at 7:30pm and always precede with announcements consisting of a thank-you to the cooks and a reiteration of clinic rules, which are short and simple: no violence, no unconcealed weapons or drugs on church grounds, and no vandalism of church property. We also ask participants to bus their own dishes. Breaking down of chairs and tables and general cleaning begins at 8:45pm, and doors are shut at 9:00pm. As a former volunteer related, “I think YC helped by being routine, by having familiar, face, and by being open and non-discriminatory/non judgmental. I think that, in itself, is and was amazing.” These subtle consistencies allow for the drop-in to wear a chaotic and radical face while providing continuity of care and reliability for participants.
The use of student volunteers from UC Berkeley in a peer-to-peer case working model addresses the participants’ discomfort of authority by creating a non threatening clinic environment, further facilitating the development of the volunteer-participant relationship. Typical street-level bureaucrats hold authoritative positions of high social prestige backed by educational certificates. These bureaucratic officials along with their abundance of power and authority typically upset and intimidate homeless youth, making the development of a relationship difficult and therefore social services inaccessible. Rather than highly trained professionals with degrees and specialties, we have student volunteers trained through a service learning course called “The Suitcase Clinic: HMS 98/198” at UCB. In service provision the giver attains a degree of status or power, essentially “debasing” the one who receives “especially if there is no possibility of reciprocation” (Bond 2002: 54-55). Having students rather than professionals assists in distilling “a power dynamic which says to the clients that you are here to be helped and we are here to help you” (Jason). Accordingly, this peer-to-peer model attempts to reduce the power dynamic and create an alternative and non-judgmental environment for participants, as a medical student explained:
We’re run by people the same age as they are. Almost all of the services come from, even the lawyers, the interns that are there are students. It makes it way less threatening. For the most part we listen to the same music, you know? It’s not their parents; we’re not symbolizing their parents or authority figures. How much authority can we have it’s we’re the same age . . . We don’t look down on people necessarily for being homeless and I think that’s really important. Its like okay they’re homeless but they’re the same age as we are and I know if my life had been different I could very well have been in the same place they are.
Volunteers, conscious of their similar age with clients and their lack of authority are generally “a little bit scared of the clients and don’t approach too much and don’t require them to access the services and don’t do detailed intakes with a lot of biographical information,” further playing down the power differences (Jason). Moreover, even UCB graduate students mediate the service transfer between the professional volunteers and the homeless youth to provide comfort as well as continuity of care. Between the doctor and the patient are medical students from the UCB/UCSF Joint Medical Program. Between the lawyer and the client are Boalt School of Law students. Having participants and volunteers of almost equal age facilitates the process of forging meaningful relationships with participants and creates an atypical experience of service provision where participants are not subordinated to the service providers.
In addition to the unconventional focus on and valorization of the relationship between volunteer and participant through exposure and consistency is Youth Clinic’s third model of interaction, or the use of a strengths-based approach to case working. Rather than use a medical based framework focused on a client’s problems and pathologies, a strengths-based approach focuses on interventions that tap into client resources, talents, knowledge, motivation and environmental assets. Ruth Horowitz (1995) describes this approach as the difference in two separate case working approaches among the staff of a GED program for teen mothers. According to Horowitz (1995), being an “arbiter” means interacting with participants in a manner that perpetuates dependence and client status. On the other hand, “mediators” interact with participants under a strengths based model promoting agency and self-sufficiency. Horowitz writes “The helper may communicate a variety of messages; while some may communicate meanings that exacerbate the dependence and vulnerability of the clients, others may help to minimize dependence and increase autonomy . . .” (Horowitz 1995: 40). With the arbiters, the flow of help is unidirectional and “participants have little or no say in what they would like or need from the relationship” (Horowitz 1995: 40). The relationship constructed by the mediators instead is based on exchange “with the participation of the participants who communicate what they need to the personnel and together negotiate what is to be given by personnel . . . [this approach] recognizes the client as an independent, self-motivated actor” (Horowitz 1995: 40).
At the Youth Clinic volunteers act as mediators and empower participants through interaction, ultimately blurring the line between volunteer and participant that furthers the creation of a community clinic in partnership with the population served. Volunteers include participants in cooking, setting up, cleaning and meetings. One volunteer believes “what can make a community clinic successful is to incorporate [participants] into the cleaning up, the food stuff …If they own the clinic, if they participate and not just be waited on, I think it means more to them.” For example, a street youth stood at the helm of the kitchen for six months, sifting through available ingredients to conjure up hot meals weekly and coordinating the help of volunteers in the kitchen. Through his participation, his position as a participant or volunteer blurred, essentially increasing his autonomy and minimizing his identity as a client. For the past year another street youth shows up almost every Monday night to help set-up tables, carry equipment and arrange supplies. His extensive participation eventually led to his participation and incorporation in a council of city officials to organize a highly successful youth specific day of services sponsored by the city and mayor of Berkeley. Once again the line between participant and volunteer blurs as volunteers work to highlight participant’s talents and strengths.
Furthermore, volunteers often initiate art projects where showcase their artistic skills and entrepreneurship. Providing avenues for artistic expression allows participants to demonstrate the artistic abilities so prevalent in their alternative lifestyles. One volunteer helped a participant put together a zine, or a do-it-yourself book showcasing writing, poetry, and drawings. The same volunteer brought a button making machine and stacks of magazines for youth to create their own buttons to sell on Telegraph Ave. Another volunteer brought spray paint, cardboard and Exacto knives for participants to create their own stencils to decorate clothing and accessories. I am currently working on recording a compilation of participants’ music onto a CD. These artistic activities show the participants that the volunteers at the drop-in value and respect their artistic abilities and hope to empower participants to pursue these talents, ultimately promoting agency and self respect.
All of these models of interaction work together to create a truly alternative experience of social service provision where individual human interaction is not sacrificed in the name of efficiency or outcomes. These models and the volunteers and services reinforcing them essentially redefine success, in that the creation and sustenance of a relationship between participant and volunteer is the most valuable service the drop-in offers. In this relationship volunteers work to empower the street youth while providing essential human rights including food, health care, and comfort from the toils of living on the streets. As our formal social workers stated, the objective of the youth clinic is to “provide a space where people can rest recuperate and get instrumental needs met and then go from there. You’re in the position of trying to self inform the idea that they’re life doesn’t have to be confined to poverty drugs and sexual abuse on the streets and helping deal with the meat of what it means to edge into services.”
Part III: Radical Internal Structure
A radical internal structure supports the YC’s tolerant and somewhat chaotic organizational culture. Although the youth clinic is a division of the greater Suitcase Clinic, it has developed its own mechanism of internal organization free of hierarchy. Typical bureaucratic organizations utilize a firm hierarchy to subordinate lower officials to senior ones (Weber 1946). This type of hierarchy, discussed by anarchist Colin Ward in Anarchy in Action, stifles the creative potential of lower officers “precisely because the power to initiate, to participate in innovating, choosing, judging, and deciding is reserved for top men” (1973: 44). The YC, similar to anarchist collectives, organizes volunteers without a chain of command. Volunteers do, however, elect three clinic coordinators for three semester commitments who oversee the smooth running of the drop-in. These individuals, despite their title, do not have any greater weight in clinic decisions than other volunteers.
Communication between volunteers occurs in the form of de-briefings every Monday night after the drop-in closes, during which street youth are also welcome to participate in the meetings, although this only occurs with the street youth most consistently and frequently active in running the drop-in. Debriefings are structured according to “small group process,” a process developed by faculty advisor Dr. Alan Steinbach and brought to the youth clinic as a method of administrative coordinating that gives all participants an equal voice and equal opportunity in developing clinic processes and procedures. Small group process occurs in a series of steps: first, someone volunteers to facilitate the process, or preside over the meeting. Every week a different person volunteers to facilitate, giving everybody the opportunity to participate. The facilitator also reiterates our short list of agreements: no hitting, amnesty, and confidentiality. Whatever is said during the meeting will stay in the meeting and any disagreements between volunteers will be forgiven afterward. Second, each person checks-in, meaning they introduce themselves and give a short summary of the night. If a volunteer feels unwell or incapable of participating fully in the meeting, this is his or her opportunity to inform the rest of the group. Third, we produce a “hot list,” or the names of individual street-youth who seem to be in a more serious situation and require extra attention. Fourth, we create an agenda for the night, which includes any announcements that volunteers might have. And finally we decide on a time-contract for all agenda items, along with a time keeper. This small group process allows the youth clinic to maintain organization without being hierarchical or authoritative. Dr. Steinbach expressed the need for an egalitarian process “because the overall structure cannot be oppressive because it will be viewed as that immediately and people will not engage the process.” This method of communicating and meeting creates an active democratic environment consistent with the radical culture of the Youth Clinic; it serves as an alternative to bureaucracy in its lack of top down administration.
CHALLENGES
As the YC strives to create an organization with a humane and chaotic face with enough structure to maintain itself, certain challenges arise. These challenges include volunteer and service retention as well as boundary breaking. Basing a case working model on exposure and interaction rather than outcomes oftentimes makes service providers and volunteers feel as though they are not “doing anything” to help, when in reality the help is inherent in the relationship with a participant. Since the results of these relationships and connections are not quantifiable and performance measures not used, volunteer retention is low. In the past year we have had only one new volunteer continue to work consistently and regularly after the first required semester. In the same time period we have lost our mental health counselor, homoeopathist, and a social work student, all of whom left within one semester without any explanation. How to integrate new volunteers has been an issue of debate since the founding of the drop-in according to one founder:
We debated from before the clinic opened to at least two years after it was open whether to have official case working roles because a lot of people would kind of show up and be like alright what do I do? I’m here. And people would get lost. One of the main things we did to prepare the volunteers was to let them know you’re gonna spend a lot of time kind of hanging out. And that’s part of what’s important about the clinic. Just being there enough that your face gets recognized eventually and eventually people will start talking to you. But if you’re just showing up once a month you’re not going to have much depth of conversation with the folks you’re supposedly trying to work with. . . For me personally when I used to go to the drop in, it was six months, nine months, a year before some of the people there acknowledge my presence at all, much less started having meaningful conversations with me.
In addition, having a rather chaotic and unstructured organization means tasks are not always clearly designated, or instead, “clearly defined as ‘whatever needs to be done’, which is not clear” (Ionas). Without a rigid hierarchy of officers, volunteers occupy themselves with any task they see fit, leaving new volunteers to discover their own role without very much direction. In interview our acupuncturist spoke of this problem:
The original set of students were very resistant to any kind of structure whatsoever, there weren’t job titles or roles or specific chores set up, and I think it set us back a lot because when new energy would come in, which was great, there was always a new crop of students every semester, but they would come in and be flailing and not have any clue what to do and they’d just stand around for maybe weeks and just got frustrated and left.
The unclear role of new volunteers requires of them a good deal of initiative in order to feel helpful. These challenges speak to the still developing organizational structure of the youth clinic, pointing to many possible improvements in maintaining the engagement of new volunteers through better recruitment and training.
In addition to volunteer and service retention, boundary breaking also afflicts the YC. Boundary breaking results from a special recipe including the following ingredients: 1) a group of intensely empathetic individuals with a dedication to care, 2) the same age as participants, 3) minimally trained, 4) working under a loosely coupled mission statement, and 5) attempting to fill the gap where resources should be available. The last two ingredients, a loosely coupled mission statement and resource constraints provide the most interesting analysis of the boundary breaking rampant at the youth clinic, but first a working definition of boundaries is needed.
The National Association of Social Workers (NASW) defines one of the fundamental goals of social work as “to help people in need and to address social problems” and to do so in an ethical manner that respects the dignity and self-worth of all human beings. Boundary breaking consists of anything that surpasses the traditional caseworker/client relationship that may result in an exploitative or harmful situation. The NASW Code of Ethics describes boundary breaking as follows:
Social workers should not engage in dual or multiple relationships with clients or former clients in which there is a risk of exploitation or potential harm to the client. In instances when dual or multiple relationships are unavoidable, social workers should take steps to protect clients and are responsible for setting clear, appropriate, and culturally sensitive boundaries. (Dual or multiple relationships occur when social workers relate to clients in more than one relationship, whether professional, social, or business. Dual or multiple relationships can occur simultaneously or consecutively.)
The fundamental problem in this situation pertaining to the YC is the obvious fact that student volunteers are not social workers, nor are they trained as such, yet they are placed in a chaotic organization with few rules and in the position of social workers in which their responsibility is to engage in meaningful relationships with participants. As our acupuncturist said, “there have been a lot of dedicated students, a lot people of with big hearts. It’s a hard thing to take on and it’s hard to build up boundaries. It’s really good in a way to have peer youth with youth but it’s a hard thing for people to get boundaries. It’s a very challenging and rewarding thing at the same time.” A more systematic analysis of boundary breaking, however, points to structural causes as responsible for creating fertile grounds for students to cross boundaries.
A loosely coupled mission statement implies “slippage” between an organization’s stated mission and actual organizational practices and in the case of the youth clinic leads to boundary breaking (Horowitz 1995). Individual discretion occurs “in interpreting, enacting, negotiating, modifying, or simply ignoring explicit organizational policies” (Horowitz 1995: 29). Individual volunteers interpret the organization’s mission as well as their personal mission statements in a manner that may validate or rationalize crossing boundaries. Sometimes personal enactment of organizational goals stops short of even knowing the clinic’s mission statement. None of the undergraduate volunteers interviewed knew the clinic’s mission statement. This lack in and of itself speaks to the chaotic culture of the drop-in, and allows volunteers to act on their own ideas of how best to care for participants, often including boundary breaking.
Boundary breaking occurs not only because of a loosely coupled mission statement, but also because of the lack of sufficient resources to meet the needs of the street youth. In Lipsky’s discussion of street-level bureaucracies he states that the fundamental problem in service provision is the strain on workers and ultimately clients arising from resource limitations. When applied to the city of Berkeley as a whole, constraints or even a total lack of resources exist in youth appropriate shelter and transportation. The only shelter specifically for youth, called YEAH, receives funding to run only November through March. Although disabled bus passes are available to individuals who can get a doctor to vouch for them, most busses won’t allow pets aboard, and a majority of street youth have pets. This makes it difficult for youth to get to court dates, doctor’s appointments, social welfare offices for food stamps and other forms of welfare, and around town in general. Volunteers at the drop-in recognize the faults of Child Protection Services (CPS) and the foster-care system and refuse to contact these agencies in some cases when pregnant women or parents who have trouble caring for their children. Two other youth drop-ins, Jubi Spot and Berkeley Ecumenical Chaplaincy for Homeless, closed during the past year due to lack of funding. With all the other agencies closing and city money lacking, the youth clinic as well as other city agencies are glutted, perpetuating the problem of resource constraints. Youth clinic volunteers, with their inflated sense of altruism and alternative foundation of social service provision break boundaries to fill the gap of resources to help the street youth combat the strains of poverty. A description of boundary breaking occurring at the youth clinic follows.
About nine out of ten student volunteers interviewed acknowledge participating in some sort of boundary breaking activity during their time at the drop-in. At least eight volunteers I spoke with allowed a participant to spend the night and in some situations even live with them. In one situation, three volunteers took on the responsibility of housing two homeless minors whose mother was temporarily incapable providing adequate care. Volunteers drove the kids to school, provided meals, helped with homework and even once attended a parent-teacher conference. One former Americorps volunteer spoke of her extra effort in caring for participants: “I did allow two clients to come to my house. I did drive clients to appointments, the ER, social services, Jubi Spot, etc. I never directly gave money to a client – I did buy food, bus tokens, BART cards for youth.” At least three volunteers admitted to engaging in a romantic relationship with at least one participant. Overall, volunteers more often than not tend to bend over backwards to care for street youth who access the drop-in’s services, despite the ethical issues doing so raises.
Whether or not boundary breaking is an appealing characteristic of the drop-in is often debated among volunteers. One volunteer spoke of the appeal of breaking boundaries as “humanizing” participants rather than treat them as clients with pathologies in need of reforming. One long-time participant of the youth clinic spoke of this humane treatment:
You guys treat us like you are our friends, not like we are clients. You know what I mean? That’s why it’s so awesome. Everywhere else its like, this is like the lady who works there, I don’t feel that with you guys. I see you guys on the street and I’ll run over and say hi or you guys will come and kick it for a while. We’re not going there for a service almost, we’re going there to be comfortable and kick it with a friend.
One volunteer “consciously tried to break down [his boundaries] in any way I could that was safe and reasonable and good for service provision and to humanize folks.” Other volunteers acknowledge the possibly exploitative outcomes of boundary breaking, yet continue to do so because they feel compelled to help the street youth the best way they know how. Another interview with a volunteer revealed this pattern:
Volunteer: I think for the most part people get the boundaries, they understand what they are and they understand when they are breaking them. It’s not like anyone is like, ‘Oh it’s not a good idea to have people sleep at your house?’ And I think that people usually get that, and when they do it they do it in cases that they’ve thought about. I mean, are we looser on it than other agencies? Sure, you know?
Me: Do you think our flimsy boundaries bring anything unique or positive to the clinic experience?
Volunteer: Yea actually I was gonna say that, I think so. The fact that you’ll come in and get a hug . . . I think we treat them more like humans.
Interestingly enough, despite the humanizing quality of boundary breaking, no volunteers recommended boundary breaking as a model for other drop-ins. Volunteers understand that boundary breaking is often exploitative of their own resources and care, emotionally trying and sometimes unsafe: “People would go and take women away from their pimps on the streets at night. And some things started happening that just were not safe and we kind of met as a staff group at clinic and said we can’t be doing this, this isn’t safe” (Shawn). As expressed by our acupuncturist, ultimately boundaries are necessary to provide participants with consistency and to reduce the levels of chaos in their lives.
There needs to be some boundaries set . . . Some people will always push the boundaries, push the limit. And you have to do that to save yourself, to save the clinic and to have consistency. And they need that consistency. And I know that’s been a huge contention especially with the founding students, that you know, let them do whatever they want.
Boundary breaking results from a combination of structural constraints and the mobilization of extremely empathetic volunteers and street youth of the same age in a still young organization that holds chaos and a radical culture as its point of success and attractiveness.
CONCLUSION
Throughout my time at the YC I have learned first hand the power and energy of chaos in motivating people to come together and act, whether action means putting together a community zine or piling groups of people into my car to transport them through the pouring rain from the street to the drop-in. Valuing the alternative lifestyles and subcultures of homeless youth rather than castigating them creates a community space where homeless youth have the opportunity to escape the streets for a little while. In volunteering at the YC, UC Berkeley students form a community with Berkeley’s homeless street-youth and get a glimpse at the resilience of so many homeless individuals who have built their homes in the most untraditional places with a family forged not by blood but through companionship. In providing these basic human rights, volunteers and providers take a step toward forming a more just society and reforming the street youth’s impressions of organizations trying to “help.” I hope that this paper is worthy of some social significance; it may not be generalizable to other communities but the overarching theme of truly valuing individuals and their experiences in providing care holds true for all service providers. Too often we feel stifled by the inaccessibility of bureaucracy and feel helpless in both receiving care and in inciting change, whether we are homeless or not. Participating in an organization as chaotic and empowering as the Youth Clinic has come with its share of struggle and hardship, but my relationships with street youth as well as fellow volunteers and service providers has taught me to value my emotions and to process and learn from them, rather than right them off as irrational. I only hope that the street youth gain as much as I have gained from affiliation with the Suitcase Clinic.
In closing I would like to quote a street youth, also a friend, who has been frequenting the drop-in since before my time. I spoke with him for about an hour regarding the YC to try and gauge how the street kids felt about us:
I just want to let this tape know that we are fucking people and just because we look and smell funny it doesn’t make us animals. We are the same as everybody else, we just don’t live inside. We have the same wants and needs, we like doing the same things and we do. We are fucking people just like everyone else, don’t be afraid. Go with your gut, like my mom always said. If you get a good feeling about somebody then go with it. Just because they carry a backpack and have dirty close, doesn’t mean they’re not worth your time.
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