In recognition of her ability to work with community partners, Vanderbilt University Medical Center’s Michelle Southard was recently awarded the Team Player Award by the Nashville Homeless Coalition. Photo by Joe Howell
Imagine being able to offer housing to a 63-year-old man who has been sleeping on the floor of a transmission shop for years only to receive the response, “No, I’m OK, thanks.”
This was the first patient Michelle Southard, homeless housing navigator at Vanderbilt University Medical Center, helped to find transitional housing, and his surprising response was the first of many similar reactions by patients.
“I had worked with him for a while, and I finally got him into some housing. It was transitional housing, but it was a bed, and it was warm. I was so excited. I told him all about it, and I went to pick him up at the transmission shop to sign the lease, and he wasn’t there,” Southard recalled. “And I just couldn’t understand why he wouldn’t come to this — why wouldn’t he want housing?”
This interaction was one of the first that helped Southard realize there were many barriers — both external and internal — that keep individuals experiencing homelessness from being housed. From obtaining forms of identification to establishing a support system that enables patients to feel comfortable sleeping alone in their new place, the process of breaking through these barriers can take years, and the transition can be stressful for those enduring it.
Southard’s position at VUMC was created three years ago, while Vanderbilt’s Homeless Health Services program — a comprehensive program founded and directed by Sheryl Fleisch, MD, assistant professor of Psychiatry and Behavioral Sciences, that provides hospital, shelter and street-based psychiatric care to persons experiencing homelessness — was just beginning to take shape. As a mental health specialist in the former Psychiatric Transition Unit in Vanderbilt’s adult Emergency Department (ED), Southard learned about the program Fleisch was developing through passing interactions each time Fleisch visited a patient in the ED.
“It was really exciting to see the progression,” said Southard. “When I was helping homeless patients in the ED, I felt like I was just applying pressure to a wound — like I wasn’t able to actually help the people who were acutely in need. I started thinking about how I could make the situation better for these patients.”
“When people are experiencing homelessness, they typically form their own community, and they become close. They look out for and take care of each other.”
Southard became the first homeless housing navigator in the country to be integrated into a hospital system, which brought its own set of challenges. Because this role had not previously existed, Southard shadowed housing navigators at other local organizations to understand what individuals experiencing homelessness face when they try to establish housing.
Through her experience, she learned that each patient is unique. Some are ready for housing — meaning they have all the necessary documents and just need to connect with a housing provider — while others may have debilitating medical and psychiatric issues such as uncontrolled diabetes, substance use disorders or other mental illnesses, or even ventricular assist devices (VADs), which power the patient’s heart, keeping them alive.
For this reason, housing may come in different forms, including finding independent or shared living spaces, helping patients move back in with family, utilizing long-term substance use programs or even moving them across the country.
“Everybody is different, and we need to be mindful of that from the start,” said Southard, who typically manages a caseload of 10-15 patients at a time.
Patients are identified as being homeless through a registry within the Medical Center’s electronic health record that was created by Fleisch and her team. Fleisch then screens each patient and makes referrals to Southard based on need.
“This position has made me more understanding, kind and tolerant overall, and the part of this I value most is that I’m able to teach that to my kids.”
Although it’s common for patients to feel uncomfortable in their provided housing initially, several months of working through internal barriers typically leads to success.
“I have housed 53 people over the last three years, and maybe two of them actually chose to stay in the apartment the night it was ready. There’s always this transition. It’s almost like it’s just as traumatic for them to be housed as it was for them to become homeless,” Southard said.
Southard has been assisting a woman for more than two years who was sleeping on a bench in Centennial Park. When they first met, the woman had a substance use disorder and had been staying in hotels. When her family resources ran out and forced her to live on the street, Southard picked her up from the hotel, brought her to a site she had personally scouted out and helped her set up a camp.
“She was so tearful and upset at the realization that on this night, she was going to be sleeping outside,” said Southard. “We worked through that, and about a year and a half later, I was able to get her into her own apartment. I went to where she had been sleeping in the park at 6 a.m., woke her up and said, ‘How would you like to spend the first night in your own place tonight?’ She was so excited.
“I came back later to pick her up. We signed the lease, went to the store and got her an air mattress so she could comfortably come back to the apartment that night, and she only slept there about two nights during the first six weeks. She still slept in the park,” said Southard, who added that the woman began sleeping in her apartment about two months later.
Southard attributes much of her patient’s reluctance to what she calls “survivor’s guilt.”
“When people are experiencing homelessness, they typically form their own community, and they become close. They look out for and take care of each other. She doesn’t feel like she deserves to be in an apartment while her friends are still suffering, and you see that a lot,” said Southard. “That’s probably the No. 1 reason why people lose their housing — because they’re letting their friends stay there and shower there.”
Southard finds housing opportunities by establishing relationships with providers in the community. If she follows up on an application with an apartment complex and doesn’t receive a response, she’ll drive there to meet the provider in person.
Southard became the first homeless housing navigator in the country to be integrated into a hospital system, which brought its own set of challenges.
In recognition of her ability to work with community partners, Southard was recently awarded the Team Player Award by the Nashville Homeless Coalition.
According to Southard, her work wouldn’t have as much of an impact if she didn’t have the support of her team and her mentor, Fleisch.
“I think the reason I work so hard is because I believe in Dr. Fleisch — I believe in her mission, I believe in what she’s doing, and I believe that it matters,” said Southard. “She goes so far above and beyond in everything she does, and that keeps me motivated.”
While she enjoys making a lasting impact on the population she serves, Southard most enjoys the personal shifts she feels in her outlook on life through the work she does at VUMC.
“This position has made me more understanding, kind and tolerant overall, and the part of this I value most is that I’m able to teach that to my kids,” Southard said.
“When we’re in the car and we pass somebody who’s selling the newspaper, sometimes people will say, ‘Don’t make eye contact, because that person will think you’re going to give them something,’ but all anybody wants is just to be acknowledged.
“I encourage my kids, ‘Wave! Say hi! Say good morning!’ My son makes little packages with granola bars and always makes sure we have water to give, and I like that. I really hope some of that is because I’m learning to be humbler in this job.”
