Caramore, Part 2

Those of you following the blog may recall Jerri’s interview at Caramore Community back in October –the one cut short when she confessed she’d smoked crack the day before. Yep. Not one of her more stellar moments. If you’re new to the blog, you can catch up here.

I’m sort of crushing on Caramore. I know, I know. It can’t possibly be ALL THAT but what I’ve read and observed is truly impressive. Caramore is a structured, residential support program for adults with mental illness that uses a step-up approach to empower independence and community employment. Not sure why this is such a novel approach–but trust me, it is– no one else seems to be doing it. Caramore puts brain disorders in their place; chronic conditions to be managed as you get on with the business of living your life.

At first, participants establish a daily work regimen, 30 hours a week, as employees on Caramore’s janitorial or landscaping work crews which provide services to the community. The janitorial crew, for example, cleans churches, businesses, and homes. Participants live in Caramore apartments where Residential Advisors supervise and help them establish personal goals like sticking to a budget or improving social skills. There are 4 participants to an apartment. Everyone has his/her own bedroom, shares a bath with one other person, and shares the kitchen and den with all housemates. Chores are assigned and everyone contributes to maintaining the living space.

Participants earn minimum wage which is applied to their housing. Disability income goes into a savings account which after several months is enough for a deposit and first month’s rent on an apartment outside the program.

As you progress in the program, there’s gradual lessening of supervision and Caramore helps you secure employment in the community at sponsoring businesses. A HUGE shout out to Lowes, Target, Whole Foods, and UNC for being Caramore employers.

After 3 or more months of steady employment, participants move into community apartments. Many split the cost with housemates they met at Caramore. Slowly, Caramore’s services are reduced and eventually phased out. Eventually, participants “graduate” but can continue to network and get support from other alumnae.

Did I mention Caramore has a 90% success rate?

At first glance, it might appear Jerri doesn’t need this kind of program. After all, she’s already able to live fairly independently. She takes her medicine on her own, does her own shopping, pays bills, and has her own apartment. Still Caramore has a lot to offer. Jerri’s not great with money and spends it all within days of getting payed. Probably as a technique to remain clean (if she doesn’t have any money, she can’t buy drugs) and perhaps as a post-traumatic stress response (if she doesn’t have any money, no one can steal from her.) Caramore could help her work through money issues. Jerri is also ready to get a job but fears losing disability and the possibly of getting sick again. Caramore has experts in disability law and can help navigate this. On her own, she lacks the discipline to get up every morning and go to work. Plus she has a felony on her record and that makes it difficult to even find employment. Lastly, her social skills aren’t great. These are all challenges, Caramore can help address.

After the botched interview back in October, Jacob, the Admissions Director, said typically new admissions have to be clean and sober for 6 months prior, however, he would cut that to 3 months for Jerri and scheduled another interview for January 8th. Jacob has since had a promotion and on the 8th, Jerri met with Blake, the new director. The interview went well – no drama this time – and Blake scheduled a trial visit for Jerri to test drive the program.

That was this past week. Trial visits are supposed to be 5 days but with Martin Luther King day on Monday and the ice storm on Friday, Jerri’s visit lasted only 3. She worked on the janitorial crew mostly vacuuming and complained of backaches daily. She described the other participants as “heavily medicated” and likened the experience to “being in a mental hospital” because Caramore dispenses all medications and you have to take them while they watch. When I pressed for one positive thing about the experience, she said “everyone is really nice to me.” She also felt better about the visit after talking to her Residential Advisor for the week.

Yesterday morning, we sat down with Blake and discussed the visit. He said the 3 days really hadn’t been enough time for Caramore or for Jerri to fully assess whether the program was a good fit. Jerri is concerned she might not be physically able to vacuum for 6 hours a day, 5 days a week. (Ha! Who among us is?) So Blake asked her to do another trial visit, for a full week, starting Monday.

For my part, I’m trying my best to remain objective. To me, Caramore seems like a life-saver. On the other hand, what could possibly be worse than ending the relationship with Telecare (her current mental health provider), letting her apartment go (for which there was a waiting list to get in), and moving all her stuff to Caramore only to receive a call 2 weeks later saying it’s not going to work out? Jerri has said as much. “I want to be sure I can physically do the work before I commit.” She was seriously doubting herself when I picked her up yesterday.

“What will you do, Jerri, if you decide you can’t manage the Caramore program? Just go back to watching TV all day?”

“No. Catherina will take me to Vocational Rehabilitation and I’ll try to get back into work that way.”

She’s got good intentions – I’m just concerned about follow-through. And likelihood of success without more structured support than what Telecare can provide. I know, it’s out of my hands. God, grant me the serenity . . .

Advertisements

Only You Can Prevent Forest Fires (or Caramore Part 1)

The office for Caramore Community was not what I expected. Think non-profit, low budget, scuffed up, battered furnishings, cracked and sterile floor, walls badly in need of paint. Instead, the office appeared interior-decorated. There were two large seating areas with comfy chairs surrounding over-sized square coffee tables. The walls were painted a warm caramel with matching plush carpet. Magazines and plants were scattered about. The receptionist desk was a long white affair that stretched across the length of the room. We were greeted promptly by Samantha who quickly found Jerri’s appointment and brought her coffee.

After a short wait, Jacob, the admissions director, greeted us and escorted us back to his office. He stepped out to get a copy of Jerri’s application giving us a chance to check out his digs. On the wall behind his desk was a portrait of someone who might have been Andrew Jackson. It was hung upside down. To the right was a credenza stacked about a foot high with piles of paper. Above this hung 8 to 10 apple green paper plates as if they were china. Above these, a bathroom scale had been hung and it took me a minute to realize it wasn’t a clock. On the opposite wall, a tree branch reached into the room, it’s base framed with an ornate white frame. Interesting!

Jacob, himself, was soft-spoken but exuded a sense of purpose and authority. He began the interview by saying this was an opportunity for us to learn about Caramore and for him to learn about Jerri. They are very protective about their community. They have limited space and receive hundreds of applications a year. They only have space for 30 individuals in their residential program and there is a 4 to 6 month wait-list. They only accept individuals who are not a threat to the community – you must be stable on medications, no history of violence, clean/sober for 6 months, ready and willing to work. He told Jerri that he would request records from Telecare and it was important that what she shared with him aligned with Telecare’s records. It was important for her to be completely honest with him because dishonesty was a warning flag and would raise concerns about allowing her into the program.

He asked if she wanted me present during the interview or if she would be more comfortable if I waited outside.

“My sister can stay. She knows everything about me so there’s no reason for her not to,” Jerri replied.

He asked about her diagnosis and how she was first diagnosed. Listening to Jerri tell her story was hard – it brought back a lot of difficult memories and all the emotions I’d felt at the time washed over me again. I don’t remember some things exactly the same way Jerri does, but I have a lot of gaps in my memory – things I imagine I’ve blocked because they are just too painful. Jerri talked about repeatedly running away and our parents checking her into Mandala, a private hospital, when she was 15. One of Mom’s friends had a daughter, Connie, who had “acted out” like Jerri and Mandala had helped her. Mandala diagnosed Jerri as having mental illness – the actual diagnosis is unclear – but my parents never accepted the diagnosis. She did not get medication or counseling.

After that she started using drugs and skipping classes with a 38 year old woman who hung out at the high school, buying drugs and alcohol for the kids, and taking them home. Debbie sexually molested Jerri – at the time Jerri thought herself in a relationship with Debbie. She believed she was discovering her true sexual orientation was lesbian. But as an adult, Jerri recognizes Debbie was a predator. Jerri was so desperate for attention and affection, she was willing to go along with Debbie in order to feel loved.

Jacob then delved more into the substance abuse. “When was the last time you used?”

“Four months ago,” she said and explained the situation.

“If that is true, and I have no reason not to believe you, then you don’t mind doing a drug test today, right?”

Silence. Jerri looked at Jacob and said nothing for what seemed like eternity. Her hesitation was a dead give-away. Finally she spoke. “You’ll find crack in my system. I smoked it yesterday.”

Ayyyyyyyyyyyyyyyyy! I could just strangle her. Why would she do something so STUPID? She knew Caramore required 6 months of sobriety to get in. She read it on the website and even talked to me about it beforehand. Did she really not want in the program? Was this some twisted passive-aggressive way to get them not to accept her? Was she purposely sabotaging herself?

Jacob closed his folder and said, “I’m going to end the interview now. If I continue the interview it’s not going to go well with you and could prevent you from ever getting into our program. I’m going to reschedule the interview for 3 months and you will need to provide evidence of 3 months sobriety in order for the interview to occur. It concerns me greatly that when I asked when you last used you said 4 months ago which was not the truth. The truth is you used yesterday. Maybe you lied because you want into the program so badly. But if that is the case, the way in is through sobriety. This development delays when you could be considered for the program. If you are serious about changing your life, I’ll see you again in January. There are some people I’ve worked with for years to get them ready for the program. This is not a ‘no’. It’s a ‘you are not ready.'”

I could learn a lot from this man.

He refused to accept any of Jerri’s excuses. She said, “I don’t crave drugs any more. I wouldn’t use if people weren’t knocking on my door offering it to me for free.”

Jacob’s response: “No one held you down, forced the pipe in your mouth and made you inhale. Even when they bring it to your door, you have to take responsibility and say no. Even in Carrboro, crack is available. It will always be accessible no matter where you live. You can’t use that as an excuse. You are lying to yourself when you say ‘I wouldn’t use if I lived somewhere else.'”

As you might imagine, the drive home was a bit strained. Jerri couldn’t explain why she’d done it. I could feel myself disassociating.

“Here’s the thing, Jerri,” I said. “If you really aren’t interested in Caramore, you should have just said so. I took half a day off from work for this interview, and believe me, come January, I will not do it again if you use at all between now and then. What you did was inconsiderate of everyone – you, Jacob, and me.”

“I knew I’d made a big mistake the minute I did it. I don’t know why I did it. I was just so surprised when he handed me the pipe. I didn’t know how to respond so I just took it.”

“Jerri, the way your life is now is the way it will always be unless you choose to change it. That is if you’re lucky because right now you are dependent on the government and they could pull funding at any moment making your life even more challenging. You need to be dependent on you. You need to make a choice – do you want simply to exist? Or do you want to live? No one can make that choice for you. Only YOU can prevent forest fires.”

20121013-095105.jpg

That’s right. Everything I ever needed to know about personal accountability, I learned from Smokey the Bear.

Many of the bad things that happen in our lives are a direct consequence of choices we make. I’m not saying that we are responsible for EVERY bad thing that happens. Bad things happen all the time to good people out of no fault of their own. Last time I checked, 100% of us can expect to experience something devastating in our lifetime. The untimely death of a loved one. Debilitating illness. Estrangement. Divorce. Bankruptcy. Down-sizing. A crime against us. Abuse. We live in a broken world and no matter how good we are, how religious, how smart or careful or risk-adverse, there is no magic formula. Bad things happen, period.

But some bad things are avoidable. If I make my car payment, my car will not be repossessed, for example. I won’t lose my job because I don’t have transportation to get there. Smokey teaches me that if I don’t light a match and throw it into the woods, I won’t start a fire that may eventually consume me.

“If God wants me to get into Caramore then He will make it happen,” Jerri said.

Really? Because I don’t think so. God forgives but I can’t think of a single time that he supernaturally revoked the consequences of someone’s bad choices. He’s not going to, for example, plant the notion in Jacob’s head to rescind the sobriety requirement just for Jerri.

So the visit to Caramore did not go as planned. Jerri continues to talk about the program as something she wants to do. We’ll just have to see how the next three months unfold.


Down and Possibly Out of Durham

Having Jerri in my life has opened my eyes to a whole world of evil that I’d previously been able to pretend didn’t exist. Two weeks ago today, Stan and I took Jerri to buy a scooter. She’d found one for $750. We told her if she saved up half, we’d match it. For two months, she ate at the nearby shelter to save the $200 she normally spends on food for the scooter. She was so proud of herself for saving that money. “I’ve never saved up for anything in my whole life,” she told me. I was proud of her too. I was worried about the ultimate fate of the scooter, worried that she would tire of bringing it into her apartment after riding or that she’d get lazy and forget to put the lock on the tires when she left it in a parking lot and someone would steal it. But we talked about those things and she agreed she had to be vigilant. Ultimately, there are lessons in life that all of us have to experience for ourselves.

What I’d never even considered is that while she was stopped at an intersection waiting for cars to pass, someone would come up behind her, knock her off the scooter, and take it out from under her. That’s exactly what happened on Tuesday afternoon.

I drove over after the robbery to check on Jerri and talk with the police. One of her neighbors had given her a Klononpin to calm her down but Jerri has weird reactions to benzodiazepines and she came off as totally wasted. Its really frustrating to me that Jerri’s first reaction to anything difficult in life is to self-medicate.

While we waited for the police, Jerri said (slurry but no less sincere), “This is a terrible place to live. How can I ever better myself here? I can’t get a job without transportation. I can’t have transportation if anyone can just knock me off a scooter and take it. What am I supposed to do now, Terri? It was really hard saving up that money. I went without food for it. I don’t know if I can do it again. And he was so mean, Terri. He was so mean the way he took it from me and the things he said. How can people be so mean?”

It’s a honest question. I feel a little shell-shocked over the whole incident myself, like an incendiary device has just exploded in my face. I can not understand the pure evil that invades a person’s soul and justifies yanking a scooter out from under a tiny, skinny, white woman with mental illness who is obviously quite poor herself. It fills me with such rage that people can be so mean, so self-centered, so evil, that WE can be so unloving to each other. In my head, I’ve downplayed how dangerous a neighborhood Jerri lives in. I’ve driven around there in my Lexis, by myself, at twilight. I’ve told myself that these people are poor, that doesn’t mean they are evil. But there is a certain desperation that breeds in extreme poverty. One that discounts even the life of other human beings. One that says, I’m going to get mine by whatever means and the end will justify it. I’m reminded how far we have fallen from the world God originally intended.

Later in the week, I had the privilege of sitting next to a distinguished, older gentlemen on a flight back from Albany. He is 68, divorced, and an architect for a prestigious firm that is rebuilding downtown Durham. I was surprised by his age. He is dark-skinned and if I’d had to guess, I would have estimated 55. When I commented on this, he confided that he was quite frankly surprised to still be alive. Both of his parents died young; his father was in his thirties and his mother in her fifties. He saw everyday as a gift. His firm designed the Durham Bulls Park. He lives in a condominium downtown and loves what is happening in Durham. He has lived here since 1971. As we talked about the revitalization of downtown, I mentioned that there are still some areas that are quite dangerous like Liberty Street where my sister lives. His eyes widened and he said, “I have two grown children and I’ve always told them there are some places you never need to go. You just don’t. And Liberty Street is one of them.”

I called Catherina, Jerri’s case worker, and told her what happened. “We need to find Jerri a place to live in a safer neighborhood. She’s too vulnerable here. She’s too easy a target.”

“Well you know she’s on the waiting list for Stuart Heights. That’s actually the best place for her. The other places where she qualifies have had a lot of shootings. I don’t think we want to move her to a place where there are shootings.”

Duh. You think?

“I’ll check with one of my coworkers about other options. She really specializes in housing. Maybe there are some new options I don’t know about.”

In talking to Jerri about it, she raised Caramore as a possibility. The Caramore Community was an option I’d identified not long after Jerri moved to Durham. Its a structured program for people with mental illness which prepares them and transitions them back into the community. As part of the program, you work 30 hours a week, first for Caramore and then eventually you transition to a job in the community with an employer like Lowes, Target, or Whole Foods. When I first investigated Caramore, Jerri was not sold on the option. She was not sure she was physically able to work 30 hours a week. And she wasn’t that stable on her medications. But now the timing seems right. She is mentally and physically healthier than I’ve seen her in years. She has an interest in working. She’s concerned about losing her disability but Caramore has financial advisors that work with members to ensure that doesn’t happen.

Caramore is located in Carrboro about a half hour from Durham. Joining the program would get Jerri out her neighborhood as she would be living on the Caramore campus. Telecare has been an absolute lifesaver from the perspective of getting Jerri stable and keeping her from homelessness. But they seem to be not so great at transitioning their clients to independence. Caramore excels at that and is a logical next step in Jerri’s recovery. Caramore would become her mental health provider from a Medicaid perspective and since Medicaid won’t cover both, we’d have to leave Telecare behind.

So this week, instead of succumbing to depression and wrapping herself up into a tight cocoon of despair like she did when her laptop was stolen, Jerri called and asked me for the phone number for Caramore. She spoke with the Admissions Director and then called me back.

“Would you like a birthday present, Terri?”

“Sure, whatcha got for me?”

“An appointment at Caramore on your birthday at 10 am. Can you take me?”

Absolutely.