Dr. Aura Obando Describes How She Maximizes Love and Manages Stress in Boston Family Shelters

The Basics team is honored to interview Dr. Aura Obando, the Family Team Medical Director at the Boston Health Care For The Homeless Program. According to the Annual Homeless Census, Boston has been making great strides towards addressing family homelessness. Dr. Obando leads the team that provides high quality care to 1,600 families with children during their most vulnerable time. The mother of three small children, Dr. Obando graciously talked to us about how she uses the Basic practice Maximize Love, Manage Stress for the families she serves, as well as to address the secondary trauma that she experiences herself from hearing their stories.

Thank you Dr. Obando for being committed to one of Boston's most vulnerable populations. Before we hop into The Basics, would you mind describing what shelter life is like?

Shelter stays average a year for many families. The shelters look a lot like a [college] dorm and shelters and shelter staff try to make families feel comfortable. Big shelters are usually in institutional buildings that were former hospitals. Each family gets a room and then they share a cafeteria and common space. Small family shelters are often located in old Victorians in communities like Jamaica Plain or Roxbury. Families take one of the rooms and then they all share cooking and cleaning duties. They also share a common space and the kitchen. While they are not required to leave at 6 a.m., like in some of the adult shelters, they are required to be actively looking for work, studying, or demonstrating some kind of activity.

How do you integrate The Basics into the work you do with families?

I love that all of The Basics are low-cost, free, or low-tech solutions to positive parenting behaviors. And so, all of The Basics help our work in some capacity, because our patients are currently living in shelters and don't have access to things like age-appropriate books and toys.

Dr. Aura ObandoDr. Aura Obando in one of the 4th trimester groups she runs, helping a mom figure out how to get her baby in and out of a carrier. Photo Credit: Dr. Aura Obando.

The families really love the videos and they're very easy to show. Maximize Love, Manage Stress has had the greatest impact and is my favorite.

Sometimes we show the Basics’ videos individually or encourage parents to look them up on their own, but mostly we use them in group settings. We have a couple of groups that we run in shelters, including a postpartum group for new moms. They're all pretty young and it's a great opportunity to get The Basics going early.

We show two videos at a time, have some food, then break into discussion groups.

Why Maximize Love Manage Stress?

In groups, the participants share how they manage their own stress. And although there can be poor access to a lot of resources, hearing from their peers is really helpful to other parents who are struggling with a lot of stressors.

Opening up the discussion builds community amongst shelter residents, which is really important because homelessness is a very isolating experience, especially during early motherhood.

And then we, as a clinic, can also offer other interventions that are more clinical for managing stress, including meeting with a therapist, having a medical visit, and talking about medications to help with depression and anxiety.

You mentioned hearing from other parents is comforting to the families. What are some of the ways the families themselves manage their stress?

That’s a great question. One of the ways that comes up a lot is getting outside to leave the stressful environment of the shelter.

Shelters have a lot of rules, like curfews and mandatory check-ins. So getting away from that setting, where people feel like they're being watched very closely, can be liberating.

Getting outside also brings up a whole discussion on what’s nearby? Where to go? Where's the nearest park? Where are the nearest libraries and diaper banks, and other free and local ways to decrease stress?

Families also talk about how walking and getting exercise is really helpful. Depending on the site, there are gyms nearby that offer free or discounted memberships and sometimes they even have childcare available, which is really nice.

Gym discussions lead to how do you get a gym membership and what's the youngest age childcare will take care of? Through these conversations, families are generating a list of resources that will help them cope with all their stresses.

Sometimes we talk about listening to music and having dance parties on your own as a quick de-stressing mechanism.

It’s really nice witnessing the families build community and seeing friendships develop after these discussions so that they can rely on each other in a stressful moment.

Wow, it's powerful that the residents feel loved and supported enough to open up during these group discussions. Can you tell us a little bit about your role as the Family Team Medical Director and how you support Maximizing Love and Managing Stress?

Our entire program is based on the idea that we bring medical care to where people are. Knowing there are a lot of barriers when families experience homelessness, all of our clinics are based in family shelters. We've built clinics throughout the Boston area that provide primary care and urgent-care type services. Our team is comprised of medical providers: medical doctors, nurse practitioners, physician assistants, and nurses. We also have five therapists, a psychiatrist, and a psychiatric nurse practitioner on the team for behavioral health support.

Our case managers are absolutely essential to getting our work done. They help us address all the barriers to care by providing bus passes to medical appointments and putting in medical rides so that patients can get to their specialists. They also assist families in getting material needs like clothes, diapers, and wipes. And of course, a lot of our patients come in without health insurance and we get them connected immediately.

We pack a lot of supplies into our suitcase and, literally, set up a mini-clinic in a shelter living room or kitchen to see patients that way.

My role as medical director is making sure that all those clinics are functioning. Even though the setting is atypical in these shelters, our goal is for our clinic to provide the same gold standard of care that they would get at Boston Medical Center, Upham’s Corner Health Center or MGH Chelsea HealthCare Center.

It sounds like you and the team are able to help manage stress for families simply by going to them.

Yeah, that’s the key. Moms and dads that don’t have bus passes to get to the clinic and are on a limited income will often prioritize their children’s health, but let their own health lapse. So we do a lot of parental well-care on site to address that need.

I love the program's whole family approach. I'm curious, how do you Maximize Love and Manage Stress in your own home?

That’s another good question as I’m reentering the workforce and trying to strike that balance. I try to let go of mom guilt. I think it’s easy when you’re a working parent to feel inadequate in both the areas of work and parenting. I rely on really good child care support. My partner and I make sure to take time for each other and for our marriage. I listen to audiobooks and try to do a little bit of escape from the stresses of my daily life, so that I show up at home, or at work, with a clear mind. I make sure to spend some time with my kids, playing with them before getting into the chaos of our night time routine of dinner and bedtime. Even if it’s short, just some solid play time, which is one of The Basics, helps us connect every day.

Dr. Aura Obando Candid photo of Dr. Aura Obando during one a clinical session. Photo credit: Dr. Obando.

Can you elaborate more on how the stress of work impacts your home life?

The work itself is incredibly rewarding, but we all incur a little bit of secondary trauma by hearing about others’ trauma.

Generally, the feelings of fulfillment from the work outweigh any of that. But there are always some really sad cases that just weigh on you and it’s really hard to not bring that home. So I try to separate that. I don’t want to let myself get depressed thinking about residents’ circumstances and have my kids feel that stress or depression. I really try to set boundaries and make sure to take some time for self-care. We also do that proactively as a program, and as a Family Team. We take time to talk about challenging situations at work and how all of us have coped with it, to try to make sure that we are not letting the secondary trauma go unattended.

Thank you, Dr. Obando! It's great to hear that you have a supportive team around you while you serve families experiencing homelessness. We also appreciate your dedication to The Basics and especially to Maximizing Love and Managing Stress amongst your team, in your groups, and in your home.

The Basics have been a wonderful resource. I’m a big fan of them in general.

This interview was conducted by Dominique, blogger behind DommiesBlessed.

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