Bringing Maine Women “Home for Good"

Avesta Housing and Preble Street work to end homelessness.

“No one ever said being homeless is easy, but you shouldn’t have to die from it.”

In the weeks of late December and January, excitement rose as Preble Street staff visited women at the City of Portland homeless shelter to describe a plan to open a shelter just for them.  This was the first step to permanent housing at Florence House, a comprehensive center for homeless women. 

Florence House is an ambitious partnership between Avesta Housing and Preble Street. It will provide permanent housing and emergency shelter for homeless women.  Avesta and Preble Street recently announced the location of the project on Valley Street in Portland, as well as funding commitments from MaineHousing.   It is slated to begin construction in early 2008.

With the recent closing of the YWCA, the need to find housing options for homeless women became even more acute. Preble Street responded by offering the use of their day shelter as an overnight women’s shelter.  On January 31, Preble Street closed its drop-in center at 6:00 p.m.  Staff then scrambled to scrub floors and bathrooms and showers; move tables and chairs out; set up and make 43 beds; and turned the lights down low.  At 7:00 p.m. they re-opened as an overnight women’s shelter. 

That night was the first time in 20 years that homeless women in Portland (outnumbered by men 4 to 1) did not have to sleep on mats on the floor in the city shelter.  That night was also the first step toward ensuring that homeless women in Portland have a safe, respectful, and dignified permanent place to live. 

The women welcomed that night are among the most vulnerable of people on the street.  When they first heard about the new women’s shelter, many were wary.  Although they had often felt unsafe on the streets or uncomfortable in the cramped quarters at Oxford Street, adjusting to new surroundings was intimidating.  However, since opening day, the women have started to create a sense of community that didn’t exist before.  Women who were once isolated now look out for each other.  A young woman struggling with alcoholism has found comfort and peer support.

“The sense of ownership is inspiring,” according to Amanda Wells, who is the women’s shelter coordinator.  “One woman in her 70s, who has been homeless for years, is working to organize a chores list so clients can help keep the shelter clean.”

When I left the Preble Street Soup Kitchen this morning, there were 182 people.  60 were women: some were homeless girls who stay at the Preble Street Lighthouse Shelter; others were women as old as 70.

Two days ago in that same space, we held a memorial service for Jennifer, a 37-year-old woman who died outside - homeless and alone - one night in December.  Her friend, also a woman struggling with homelessness, shared warm words about Jennifer and then added, “No one ever said being homeless is easy, but you shouldn’t have to die from it.”

Florence House will keep women alive.  ‘Housing First’ models work.  At Logan Place we’ve been able to document success.  People who were homeless no longer are.  Women who experience horrific, debilitating mental illness begin to feel safe.  Reduced hospital costs; reduced police, fire, and ambulance costs; . . . [and] most importantly, reduced fear of dying on the street in a parking lot next to a dumpster.

from remarks by Donna Yellen, Preble Street Adult Services & Advocacy Coordinator

While the situation of homeless women is improved, the long-term goal is to finally end chronic homelessness in Portland. It is a journey Preble Street and Avesta began two years ago when they opened Logan Place, a 30-unit apartment building for homeless people.  Logan Place succeeded beyond all expectations in its impact on the welfare of the tenants, and the well-being of the community. 

The next milestone will be achieved when Florence House opens.  Florence House will provide these women with their own home and support services to help them maintain their stability.  In the meantime, Preble Street is creating relationships with the women who will ultimately live in Florence House, relationships that will facilitate the transition to Florence House. 

The response from women clearly indicates that Florence House is moving in the right direction.  A resident that has been on and off the streets for more than a decade remarked, "This has been a wonderful change.  It's changed people's attitudes.  It's changed how people feel."

The Florence House Development team includes a team of dedicated young professional women in Portland: 
Amy Donahoe, Preble Street
Amanda Wells, Preble Street
Debora Keller, Avesta Housing
Rebecca Dillon, Gawron Turgeon Architects
Betsy Melrose, Mitchell & Associates Landscape Architects

This article is the first in a series that will track the new women’s shelter and the development of Florence House. 

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Successful Losers

by Beth Quinlan

A positive attitude is fundamental to the rest of Susan’s recommendations. Successful losers believe they can lose weight. Unrealistic expectations can undermine clients’ weight-loss efforts. Lasting changes take time to become well established. Many clients want to see quick results and that just isn’t realistic.

Perhaps the only time when losing is synonymous with success is in weight loss. While many of us are trying or wishing we could lose weight, some are actually doing it. What can we learn from these successful “losers”?

Registered Dietitian Susan Quimby, of Nutrition Works LLC in Portland, has been helping people lose weight for almost 20 years, as well as maintaining a twenty-five pound weight loss of her own. From day one, Susan tells her clients, “Don’t do anything to lose weight that you are not willing to do for the rest of your life. What you do to lose the weight, you need to do to maintain the loss.”

Attitude and Expectations

A positive attitude is fundamental to the rest of Susan’s recommendations. Successful losers believe they can lose weight. Unrealistic expectations can undermine clients’ weight-loss efforts. Susan says, “Lasting changes take time to become well established. Many clients want to see quick results and that just isn’t realistic. If a client loses 30 pounds in a year, I think that is terrific success, provided that she did it in a healthy manner.”

Small Changes

According to Susan, her successful clients don’t take everything on all at once. She recommends identifying one or two changes. For example, establish a good breakfast and start walking. Other areas to target for change are:

• Fats—Focus on monounsaturated fats and Omega 3 fatty acids; avoid trans- and saturated fats.
• Vegetables—There is no such thing as too many vegetables.
• Carbohydrates—All carbohydrates are not bad; look for whole grains and limit or avoid refined

It should not be about deprivation. She urges clients to eat good food—not to waste their calories on tasteless or unsatisfying foods. “Eat real food. Take your time. Enjoy what you eat. I have found that when clients consume foods that are satisfying, they have a tendency to eat less.” Susan adds, “Clients who are frequently snacking when not hungry or overeating at meal times may need to develop effective strategies to change those behaviors in order to achieve their goals.”

Planning

Planning ahead is another key to long-term success. To simplify the planning process, Susan suggests finding two or three breakfast options that work and choose from them. The same goes for lunch. Susan recommends an afternoon snack with protein and a carbohydrate, since six hours is too long to go without eating. Successful losers don’t arrive home at 6 p.m. with no idea what is for dinner. They have a plan and the ingredients on hand so that it is easy for them to make wise choices.

Portion Control

Portions are one of the chief ways Susan sees her clients unintentionally undercut their own efforts. “People tend to underestimate the amount of food they consume. A client will tell me they have a serving of orange juice (4 ounces) but are actually consuming 8 or 12 ounces, or 1/2 cups of ice cream, when in reality it is closer to 2 cups. If you do that throughout the day, those calories add up, and you can be facing a weight gain even when you are being careful about your food choices.” A site like the free www.Fitday.com, where you can track consumption and calculate calories, can point to areas where excess calories are interfering with weight loss.

Get Moving

Successful losers find ways to be active that they can enjoy and stay with all year long. Susan delivers the news straight. “Like it or not, you need to exercise—ideally 5 times per week,” she said. “I tell my clients to start with 15 minutes per day. I don’t care if you bowl, belly dance, or walk with a friend. You need to find what works best for you—and not wait for motivation to find you.”

When the focus is on making changes that will last and contribute to good health, successful losers become successful maintainers. And, in the end, that is the ultimate goal for those of us who struggle with weight issues.

Here is what Successful “Losers” have to Say

“If I thought I was going to be on a diet for the rest of my life, I would not do it. What I have learned is that by exercising regularly, avoiding sugary foods, and controlling my portions, I can lose weight. By taking those steps, I have not only lost 50 pounds but have cut out and reduced the medications I am on for diabetes.”—Kay L., Portland

“With a young family and busy consulting business, my biggest challenges were to find the time to exercise and to plan and prepare meals I needed in order to reach my goals. The temptation to find a ‘quick’ answer was finally outdone by the experience that it never works. I just had to admit that this was the priority: put myself higher on the list for a while, even when the time for exercise or healthy eating reduced my time for work and family. But it paid off.  With 25 pounds gone, I have more energy for all aspects of my life.”— Naomi M., Portland

“I reached a point in my life when I realized I couldn’t live like this anymore. I have lost 75 pounds through wise food choices, and I’m becoming a much more active person. It was not easy, but it was so worth it. I feel wonderful!”—Suzanne H., Brunswick

Elizabeth P. Quinlan lives and writes in Portland. When not trying to figure how to work more vegetables into family meals, she can be found at the gym or on the Boulevard, usually with a friend

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Advice on Screening for Down Syndrome

A negative screen does not rule out the possibility of having a child with Down Syndrome.  However, it does indicate that the fetus is unlikely to be affected.  Likewise, a positive screening test does not indicate that the fetus has Down Syndrome, but rather that fetus is at an increased risk for trisomy 21.  In fact, most screen-positive pregnancies for Down Syndrome will result in a normal fetus

Down Syndrome, first described in 1866 - oddly enough by Dr. Down - affects approximately 1 in 800 pregnancies.  Individuals with Down Syndrome have the additional 21 chromosome. The debilitating nature of this disease has resulted in a variety of antenatal testing strategies to detect affected fetuses.  Major structural birth defects and marked developmental delays have led to a desire to try to detect this condition in utero.  Certain diagnosis can be made one of two ways: by a chorionic villous sampling (biopsy of the placenta) at 10 to 13 weeks, or by amniocentesis  which samples amniotic fluid after 14 weeks.  Both techniques result in obtaining fetal cells for chromosomal analysis, and both procedures carry a 1% risk of pregnancy loss.  Since it is not practical or desirable to perform invasive procedures on all pregnant women, a variety of screening techniques has been used to select those pregnant mothers at higher risk (of carrying a child with Down Syndrome) for possible invasive testing.

Historically, age was used as the primary risk factor to base whether or not a woman would be offered testing for Down Syndrome.  While it is true that the risk of trisomy 21 does increase with age (a woman age twenty has a 1 in 2000 risk, while a woman age forty five has a 1 in 15 risk), it is also true that most woman having children are younger (less than the age of 35).  Therefore most infants born with trisomy 21 are going to be born to younger mothers.  Offering amniocentesis to women age greater than or equal to age 35 or older, only detected approximately 35% of all fetuses with trisomy 21.  It also subjected 6 - 8 % of women to having an amniocentesis.  Fetal biochemical markers for Down Syndrome -measured in maternal serum at around 16 weeks of pregnancy - were added in the 1980s and 1990s.  Maternal age and analysis of  these fetal-derived proteins (which are made in different amounts by fetuses that have Down Syndrome)  resulted in 55 - 60% of Down Syndrome fetuses being diagnosed; with only 5 - 6% of all pregnant women being positive and undergoing invasive testing.

Most recently, the American College of Obstetricians and Gynecologists has stated clearly that all women should be offered chromosomal testing regardless of age. They should be encouraged to be tested on a risk-based approach.  The latest version of the risk-based approach involves obtaining biochemical markers and an ultrasound measurement of the thickness of skin behind the neck of the fetus between 11 and 13 weeks of gestation.  If the first screen is positive (at a risk of 1 in 220), the patient can elect to undergo invasive testing or a later, more detailed, genetic ultrasound.  The newest version of this early testing combines more traditional biochemical screening at 16 weeks, with the first screen at 10 - 13 weeks.  Patients who are at a very high risk for Down Syndrome at the initial screen are offered chorionic villous sampling. Otherwise, a second maternal blood sample is obtained at 16 weeks, and the risk for trisomy 21 is then calculated using both results.  Once again, approximately 5 - 6% of the pregnant population will screen positive using this sequential approach, with detection rates for trisomy 21 reaching the 90 - 95% range.

Several words of caution are in order.  First, in order to be reliable, the very early ultrasound needs to be performed using meticulous technique.  Measuring the fold of skin behind the neck of a 10 to13-week fetus is not an easy task.  Special credentialing of the technician is required, along with a rigorous quality assurance program.  Secondly, patients need to understand exactly what the tests can and cannot predict.  A negative screen does not rule out the possibility of having a child with Down Syndrome.  However, it does indicate that the fetus is unlikely to be affected.  Likewise, a positive screening test does not indicate that the fetus has Down Syndrome, but rather that fetus is at an increased risk for trisomy 21.  In fact, most screen-positive pregnancies for Down Syndrome will result in a normal fetus.  Medically speaking, it makes sense to perform 20 or so procedures in order to find the one fetus that has Down syndrome.  The alternative is to not test for Down Syndrome, or to test every one - only to find the one fetus with Down Syndrome out of 800 tested.

Finally, it is important to understand that pregnancy, like life, is full of uncertainties and potential risks.   Every time you drive a car, there is a risk of being involved in an accident  - even if you are the safest driver out there.  Likewise, when a pregnancy occurs, there are many potential risks to that unborn child.  Genetic conditions number into the thousands: preterm delivery is always a possibility, and 2 % of fetuses will have major birth defects. It is important to understand that we cannot control all potential risks in life or in pregnancy, yet we can try to undergo evaluations during pregnancy in a thoughtful and sensible manner.  Screening for chromosome abnormalities like Down Syndrome is not meant to terrorize the pregnant couple.  Rather it is to inform and identify couples at a higher risk, and offer them the potential of diagnosing a Down Syndrome fetus.  

THE FLAB REPORT:
Itsy Bitsy Teenie Weenie

by Danie Connolly

     You couldn’t buy a better day.  The sun was shining, there was a nice breeze and the clouds were white and fluffy- the kind that’s perfect for imaginations.    I had my grandsons; 2 and 4 years old, visiting for the weekend and we planned to spend the day at the beach exploring tidal pools and building sandcastles.   Boys need their bulldozers, dump trucks and cranes -we had enough equipment to start Big Dig #2.  With more toys than a moving van could tow, we trudged across the sand like three unwise men lost in the desert.   Finally spying a port-a-potty and a gigantic sand dune, I wiped the sweat from my brow and halted the little man caravan trailing behind.
     “This is the most excellent spot for us,” I announced, plopping down the blanket, a cooler loaded with food and a collection of suntan lotions that Rite Aid and CVS couldn’t rival. 
     “Grammy, I’m going to find pennywinkles and sandy dollars,” the oldest grandson proclaimed the moment he found his pail and shovel.
     “Why?” asked the littlest guy.  It’s amazing how many times in an hour a 2 year old can ask that same question.
     “So we can buy ice cream!” the 4 year old yelled ecstatically.
“Ice cream!  Ice cream!” the 2 year old repeated, somehow managing to repeat every answer and create a dance to go with it.        
It was hysterical to watch him dance as he spun around, occasionally leaping up and down as he repeated the words ‘ice cream’.  I could see people smiling as they watched this one man show.   So much for the carrot sticks and celery I packed.
     “The ice cream man doesn’t come to this beach.” I replied, trying to be the Grandmother setting the right example.
     “Then how can this be the most excellent spot?  My teacher says excellent means the best.”  The oldest wasn’t buying into any Grammy act.  Good question, I thought, but I wasn’t pulling up our stakes.
     “This is the most excellent spot,” I tried to reason, “but Grammy shouldn’t eat ice cream because she’s trying to be a good girl and stay on her diet. “  He paused a moment to consider what I’d just declared- you could almost see his little brain working overtime.
     “Grammy, I’m going to make you dinner for your diet with crabs and fishies.   It’s a good thing.” (He’d been watching Martha on TV just before we left).
     “I don’t think I want to eat those itsy bitsy teenie weenie crabs,” I told him while making a goofy face.
     “Why?” The 2 year old was fully engaged wanting to know why I’d pass on crabs and fishies; it sounded delicious to him.  A few muddy sand pies for dessert and what else could you want?
     “Ahhhh… because Grammy likes lobster better,” I offered as an excuse.
     “Lobster! Lobster!”  Again with the dance – only this time he was pretending his hands were claws. He was drawing a crowd with this comedy act of his. 
     I remember trying to convince my kids that lobsters were big sea bugs.  Nothing could deter them from ordering them at restaurants- they were way too smart for me and their champagne taste far outspent my beer budget.
Too many lobsters and too much butter was a dangerous combo for my waistline, but I was still smiling from the fact I shared a sentence with itsy bitsy teenie weenie – regardless if it had nothing to do with yellow polka dot bikinis.
     We sat on the blanket with this beautiful day all around us, and enjoyed our PBJ’s and cut fruit.  Afterwards, we made several sandcastles with first class moats and driftwood flag poles Donald Trump would have envied. 
     The day was getting hotter and it was time to get wet.
     “Let Grammy put more sun lotion on you before we go in the water,” I cautioned.   No one was getting sunburned on my watch.
     “Are you going to put on your bathing suit, Grammy?” the oldest queried.
     “No sweetheart,” I answered, picturing that I look like a beached whale in the swimsuits I owned. 
     “Grammy isn’t going to wear her bathing suit today,” I added.
     “Why?” the little voice inquired for the 200th time.
     “Because Grammy’s Fat!” the 4 year old shouted for the world to hear.
     “Grammy’s Fat! Grammy’s Fat!” the littlest one echoed loudly, jumping up and down and entertaining the beach with his latest dance.  Oh…excellent.

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