the emergence of the inner-city self-help center

Journal of Community Psychology Valume 16, July 1988

The Emergence of the Inner-City Self-Help Center Leonard A. Jason, Danikl Tabon, Elizabeth Tait, Georgeann Iacono,

Daniel Goodman, Peggy Watkins, and Gregory Huggins De Paul University

This article chronicles the effort of a group of self-helpers and professionals to collaborate with and to develop self-help groups in an impoverished area of an inner-city neighborhood in Chicago. Several self-help groups were started in the target area of the project. In a control area, no increases in self-help activity were found by the end of the study. Unique issues that were encountered in working on this project are highlighted.

It is now commonly acknowledged that most people seek support for personal problems from their natural support systems. The first and major source of support is sought among family, friends, and relatives, with other sources including neighborhood-based support systems (e.g., block association leaders), community gatekeepers (e.g., physi- cians, clergy), and self-help groups. The supportive social ties from these networks can help people build a sense of community, combat loneliness, and speed up recovery from illnesses (Pilisuk & Minkler, 1985).

Riessman (1985) has estimated that there are currently about 500,000 self-help groups and that 15 million Americans have become members. The extraordinary recent growth of self-help groups might be explained by the erosion of traditional sources of support, which has increased feelings of alienation and powerlessness. Self-help groups offer people understandable rationales for their problems, new norms from which to base their self- esteem, effective methods for coping, and useful strategies for changing their en- vironments. Ordinary citizens become empowered by the self-help process, for by helping others they obtain help for themselves. Self-help provides a viable preventive buffer for individuals exposed to stressful life events.

Mental health professionals are increasingly recognizing the value of these types of natural support systems and are developing ways of collaborating with them (Froland, Pancoast, Chapman, & Kimboko, 1981; Gesten & Jason, 1987). In addition to helping establish self-help groups (Harris, 198 l), professionals have been active in evaluating their impact (Jason, 1985); developing linkages between them and other informal helping networks (Jason et al., 1988); publicizing the groups through press releases, brochures, newsletters, etc.; training members in a variety of skills (e.g., interpersonal communication, active listening, group process, decision making, and problem solving) (Chutis, 1983); and linking interested members together through computerized statewide clear- inghouses (Madara, 1986).

We wish to thank Mary Buntin, Jim Davies, Elio de Arrudah, Steven Everett, Myrna Hammerman, Linda Harris, Francine Lewis, Milton Lewis, Catherine Murphy, Mary Nelson, Charlotte Ratcliff, Jackie Reed, Josephine Robinson, and Beatrice Young for extending to us an invitation to work with the Inner-City Self- Help Center and for graciously helping us learn about the process of establishing self-help groups in the inner city. In addition, the continual support of Daryl Isenberg, the director of the Self-Help Clearinghouse, is gratefully acknowledged. Our thanks also to the Fry Foundation for the financial support to launch the in- itiative described in this article. Leonard Borman, who originally conceived of the idea of the Inner-City Self- Help Center, died in the Fall of 1985. His passing was mourned by all the participants in the project.

Requests for reprints should be sent to Leonard Jason, Department of Psychology, De Paul University, 2219 N. Kenmore Ave., Chicago, IL 60614.

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Others have written about various roles professionals might take in their interac- tions with self-help groups. Gartner and Riessman (1984), for example, suggest that professionals can bring to self-help groups the values of a systematic approach, particular skills, and access to resources. In a similar vein to Chutis (1983), they suggest assistance in areas such as group development, process skills, public relations skills, and direct occasional consultation as needed. Hedrick (1 985) also recommends that professionals can provide guidance in conducting meetings and workshops, publishing direc- tories and newsletters, raising funds, coordinating activities, and making referrals. She makes the critically important distinction between a professional’s performing such activities for a group and a professional’s helping with such activities. The first would be an inappropriate role, whereas the second would be an appropriate collaborative role. It seems to be crucial for professionals constantly to be aware of the tendency to take over an activity instead of staying within the true spirit of a collaborative model. Final- ly, Hedrick discusses the potential for building coalitions of members and supporters of self-help groups who are interested in working together to attain self-help goals and provide mutual support in the process.

Those most in need of preventive programming are the poor and minorities (Gibbs, 1984), groups that have been most adversely affected by recent cutbacks in social service programs (Pilisuk & Minkler, 1985). Mental health professionals have struggled with devising ways to encourage people of low income to take advantage of self-help groups (Jason, La Pointe, & Billingham, 1986). Maton (1984) states that those who live in poor urban areas infrequently become involved with self-help groups due to a lack of awareness of existing groups, lack of availability of diverse types of self-help groups, perception that existing groups do not address immediate economic concerns, ethnic group norms that discourage the sharing of personal problems with strangers, preference of action-oriented solutions to problems over talk-oriented strategies, and high crime levels, which promote suspicion of strangers and fear of traveling at night. In addition, professionals, family members, clergy, and other influential people might not encourage their clients and constituencies to utilize such groups.

Although the number and kinds of self-help groups have more than doubled in the Chicago area during the last decade (Borman & Pasquale, 1983), the number of such groups found in the inner city, among indigent and minority populations, is sur- prisingly low. Few public or private agencies operating in the inner city encourage the development of such groups; most agencies provide direct service to their clients and little help in organizing or facilitating voluntary support groups. At the same time, existing self-help groups have some difficulty in making connections with inner-city populations. Difficulties with recruitment and the problem of finding places to meet and auspices for conducting meetings present barriers to the development of groups in this area.

The present article describes a project whose overall objectives were to increase the number and utilization of self-help groups for specific populations in the inner city of Chicago. New self-help groups were formed for problems and conditions germane to inner-city populations. The process of organizing this effort is described in considerable detail so that others might better understand the obstacles that were encountered as well as the possible solutions that were discovered.

Establishing the Inner-City Self-Help Center (ICSHC) During the summer of 1984, the executive director of the Self-Help Center in

Evanston received a seed grant to increase the number of self-help groups in the inner

INNER-CITY SELF-HELP 289

city. The Inner-City Project was formed in February of 1985, with a self-help member from Men Overcoming Violence and a nurse educator at the University of Illinois as co-leaders. Their mission was to mobilize support among self-helpers and professionals in order to develop self-help groups in the inner city.

An open meeting for discussion of the Inner-City Project was held on March 21, 1985, with 7 monthly meetings held subsequently. An average of 14 people from 12 different self-help and professional organizations attended 2-hour sessions and par- ticipated in lively discussions concerning reasons for the paucity of self-help groups in the inner city, the possible need for an inner-city self-help center, and the reality that inner cities might need groups developed on a different model from those used successfully in the suburbs. Throughout these conversations, a value repeatedly expressed was that no organization should dictate to the community what its needs are, but that community members need to be involved in the setting of agendas as to their self-help needs. Altogether, about 40 people attended at least one of these planning meetings during the spring and summer of 1985.

Three subcommittees (Directory of Inner-City Groups, Education and Public Rela- tions, and Project Coordination and Development) were formed in order to facilitate progress on key issues between monthly meetings. The first committee, with the help of a research assistant from DePaul University, attempted to identify current self-help groups in Chicago, primarily from the listings in The Self-Help Directory (Borman & Pasquale, 1983). As expected, most of the groups were based in the suburbs. The Educa- tion and Public Relations subcommittee sponsored a free health fair, where a variety of self-help groups were present to discuss their ideas and philosophy with the public; of the 54 participants indicating their interest in a list of health topics, 44% were interested in smoking and disease, 40070 in alcohol abuse, and 33% in overweight/nutrition.

The most active subcommittee was Project Coordination and Development. This group began meeting weekly in June. At the outset, subcommittee members decided that decisions would be based on a majority vote and that at least 51% of the subcommittee's membership would be self-help participants. Committee members were to promote the self-help concept by providing resources for self-help groups and organizations within the project community; promoting and developing the general concept of self-help groups in the community through flyers, posters, and other sources of communication; and aiding in the organization of self-help groups in the project area by identifying and supporting natural leaders who wanted to start self-help groups.

Rather than focus on the entire city of Chicago, a decision was made to focus efforts on one particularly impoverished section, Austin/West Garfield Park. For comparison purposes, a bordering area, North and South Lawndale, was chosen as the nonproject, control area. According to census data, in the Austin/West Garfield Park area, 29.5% of the 171,891 residents live below the poverty level (the median family income is $13,744), and 86% of the residents are Black, 11% White, and 3% other (mostly Hispanic). For the control area, 29.7% of the 136,727 residents are below the poverty level (median family income, $13,156); 53% of the residents are Black, 23% White, and 24% other (mostly Hispanic). For one month, an effort was made to find all current self-help groups in these areas (listings in The Self-Help Directory were examined, social service agencies were contacted, and community leaders were interviewed). Only two groups (Alcoholics Anonymous and Tough Love) were identified in the Austin/West Garfield Park area and three groups in the control area (AA, Cocaine Anonymous, and Nar- cotics Anonymous). One of the self-help groups already existing in the AustinIWest

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Garfield Park area had been operating for about 2 years (AA) and the other (Tough Love) for about one year. Contact with the leaders of both groups was initiated, and both agreed to work closely with the ICSHC (e.g., our brochure listing local groups would include their self-help groups, and they were invited to our weekly meetings).

The project was housed at Bethel New Life, Inc., an appropriate site because of its progressive programming for the community, which included a recycling center, an employment services office, an energy saver center that offers energy audits and low- interest loans, a holistic health center, an adult day care center, and a substantial housing redevelopment program. Bethel is located in the West Garfield Park area, which has one of the highest infant mortality rates in the city (23 per 1,OOO) and a 19% unemployment rate (probably an underestimate because many Blacks have completely dropped out of the labor force).

On August 24, 1985, a mini-fair was scheduled at Bethel in conjunction with a food- sharing program. About 150 people came to the food-sharing program and in the process passed several tables where there were representatives from a variety of self-help groups. People could sign forms if they were interested in joining a particular group. The most popular group was TOPS (Take Off Pounds Sensibly); 10 people indicated that they would like to join such a group.

During our weekly meetings, a number of key community leaders talked to our group, including a social worker with considerable experience in starting self-help groups, the chairman of the board of an area bank, the founder of a sexual assault self-help group, and the founder of the AA group that met in the West Garfield Park area. In addition, we made efforts to meet with other influential residents (e.g., the founder of the Tough Love group, the police superintendent, social service personnel in the area) to let them know about our newly named Inner-City Self-Help Center (ICSHC), which continued to be housed at Bethel.

A research assistant at DePaul University interviewed seven clergy people during the spring of 1986 in order to assess their beliefs about the needs of the community and to inform them of ICSHC’s existence and purpose. The interviews were informal but included several standard questions. When asked to list the types of problems they dealt with when counseling congregation members, six of the clergy named lack of jobs/employment, and six mentioned communication problems within the family; three mentioned gangs and substance abuse; two cited child abuse, lack of educational skills, teenage pregnancy, and inadequate housing; other problems that were identified by only one minister included addiction to gambling, children of divorcing parents, mental illness, problems in schools, and lack of involvement in getting to know neighbors. The ministers mentioned a total of 31 problems (several of which were named by more than one person) and thought that self-help groups would be helpful for 9 of them (jobs, n = 3; lack of educational skills, n = 2; gangs; substance abuse; inadequate housing; and lack of involvement in getting to know the neighbors). Altogether, the ministers were familiar with 14 self-help groups; when asked if they knew of any self-help groups in the area, they did not mention any presently in existence.

Development of Self-Help Groups Because the most frequently identified self-help interest during the August 1985 mini-

fair was TOPS, a TOPS group was launched at our Bethel site the following month. A representative from the TOPS organization met with us to discuss the pragmatics

INNER-CITY SELF-HELP 29 1

of starting a group and then attended the first few meetings. The 10 people who had expressed an interest in TOPS were invited to the first meeting. Since the inception of this group, other people with weight problems have been referred to the group by the Bethel Holistic Health Center. About 10 members have been regularly attending this self-help group. TOPS requires a $12 one-time fee, which has posed a problem for some members. On perceiving this barrier, the ICSHC decided to subsidize half of each membership fee with grant money, and members were asked to donate $1 at each of the first 6 meetings.

The next area we worked on was smoking, which was identified as a high priority during the free health fair. For 3 weeks during November, a local television station broad- cast a smoking cessation program on the 12:OO and 9:00 news. To capitalize on this media event, we scheduled self-help group meetings to accompany the 3-week program. Residents listed in the West Garfield Park telephone directory were called and asked if they were smokers, and if so, they were invited to attend a weekly support group at Bethel to accompany the television series. One hundred people signed up for the groups. Due to inclement weather, attendance was lower than expected. Each registrant was sent a self-help manual describing a step-by-step process €or quitting smoking. In addition, each person received at least two phone calls from us each week to assess their progress in the project. When the participants were interviewed 4 months following the program’s end, 20Yo had actually quit smoking. When asked what they liked most about the program, participants mentioned the support phone calls, the free helpful manual, and being able to follow a program within their homes by watching television; i.e., the non-group portion of our program was perceived as most helpful. Reasons given for not attending the group meetings included bad weather, transportation problems, fear of going out at night, and lack of need, because the program could be watched in their own homes and they had been given a self-help manual to use in reducing their smoking levels.

In searching for our next target area, we were convinced by a representative of Epilepsy Services of Chicago, who regularly attended our weekly ICSHC meetings, of the need for an epilepsy self-help group. To initiate such a group, we asked this member to visit the director of public relations at St. Anne’s Hospital, who was aware of the self-help concept and who provided space at the hospital and assisted with the advertis- ing of an educational meeting about epilepsy for the general public. Flyers were distributed to various hospitals, clinics, schools, and other inner-city areas to announce this meeting, and 500 notices were sent to people on the Epilepsy Services mailing list who lived on the west side of Chicago. About 25 people attended the meeting, where a neurologist gave a lecture on epilepsy; the presentation covered diagnosis of epilepsy symptoms, proper use of prescribed medications, and the general effects of different drugs on certain people. At the conclusion of the lecture, attendants were told when bi-weekly self-help support group meetings would begin. About 6 to 8 people have regularly been attending this group.

Although the ICSHC attempted to initiate several self-help groups, considerable time was also devoted to providing information about self-help to members of the target community, One year after our project began, the number of self-help groups in the control area had fallen from three to two, while the target area could count six self-help groups ongoing or in the early stage of development: epilepsy, Alcoholics Anonymous, Tough Love, Mothers Against Gangs, Unwed Mothers United, and Take Off Pounds Sensibly.

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Problems Encountered in Working on the Inner-City Self-Help Center Defining self-help was a continual issue for the ICSHC membership. One member

coming from a medical background defined self-help as self-care; taking care of oneself, which could be taught, was equated with self-help. Another member believed that self- help in the inner city should focus on social problems; self-help was conceived here as neighbors working together on a community problem. There was also considerable dialogue about affliction versus economic orientation; several members were strong supporters of affliction-oriented approaches (e.g., epilepsy, AA) for the inner city, whereas others believed money for food and rent to be necessary before people would participate in sharing feelings at self-help group meetings. Considerable time was spent discussing the pros and cons of these different approaches. Although we did not reach any firm conclusions, a working arrangement slowly evolved whereby each of the approaches was considered worthy of investigation, provided at least one member was willing to invest time and energy in piloting the model.

Given the degree of democracy in decision making that existed, the ICSHC never functioned like a well-tuned corporation. Our principal mission was learning what the community wanted and devising caring approaches for meeting these needs. If we were to be spokespeople for self-help, then the process that characterized our meetings needed to have a nonoppressive, humanistic, sharing, and open format. This format did not lead to efficiency; often we spent inordinate amounts of time talking about our ideas or the ideology that was manifested in our conversations. For example, when one member advocated teaching skills, another person said that a basic premise of our mission was to “work with, not for people.” Despite its inefficiency, we believed this format to be the best operating procedure for ICSHC. It was important that people interested and involved in self-help plan and design our organization and that “experts” not co-opt the process.

Racial tensions were also evident. About half of our members were White, and the neighborhood was predominately Black. The White committee members needed to develop a keener appreciation and understanding of the Black culture. It was understandable that there was some suspiciousness of Whites among the Black members of the ICSHC and residents of the community. Members of both races wanted to be respected for their competencies and not because of the color of their skin, but it was always ap- parent that race would be an issue, since decisions would affect a largely Black community. Some members believed Whites’ roles should gradually diminish in ICSHC and become consultative as more Black members assumed leadership positions.

Tensions frequently surfaced around the self-help versus professional dichotomy. Sometimes professionals used words or terms that were considered stigmatizing or con- descending. For example, when an ICSHC member used the term “epileptics,” he needed to be patiently reminded that they were people with epilepsy, not “epileptics” (i.e., people with cancer are not called “cancers”). Selection of members to represent the ICSHC at community forums also created occasional tensions. One ICSHC member felt strongly that only a self-helper should be the spokesperson for one of these meetings because only such a person could genuinely represent the interest of self-help. The ICSHC co- chair was insulted by this remark because she felt it indicated that she was not qualified to talk for a group she served as co-chair. This issue provoked a crisis, and many hours were spent on the telephone and at meetings clarifying our feelings on this point. After all had an opportunity to express their feelings, we agreed on sending two people to the board meeting, a self-helper and a professional.


Evaluation issues also arose during our meetings. It was critical to obtain permis- sion from self-helpers to conduct project evaluations and to maintain confidentiality. By being sensitive to the needs of the group, trust was developed between the academic and non-academic members. In addition, we believe that some of the tensions were re- duced by having a Black self-help member serve as a research assistant.

Finally, we faced problems with our collaboration with Bethel, a powerful institu- tion in the community. After only 6 years of existence, the agency had a $10 million budget and had programs in diverse fields. During our stay at the West Garfield Park community, we soon learned that some community residents had mixed feelings about some of Bethel’s projects, including feeling that the Bethel leadership rather than the community was being empowered. It needs to be recognized that in any community, an organization that is powerful and develops multiple social service programs will often be controversial and will have both advocates and detractors. We eventually adopted the position that the ICSHC was housed at Bethel, but was not a Bethel program. It took months of clarification to assure the independence of the ICSHC.

Discussion The most cohesive element in the project was our sense that the ICSHC was an

important and needed setting in the community. With this commitment, we were willing to devote the time and energy to work out the many differences that existed. Over the months of the project, a sense of group identity emerged among the ICSHC members. The members developed a relationship where differences were not only tolerated but appreciated and where ideas could be challenged without a member feeling criticized or depreciated. The caring that existed in the group provided a buffer, protecting the project from numerous stressors, any one of which might have destroyed the project. Participant ownership of the project helped develop a certain robustness and sturdiness, allowing participants to cope with unexpected interfering effects (Kelly, 1985).

In the truest sense, the researchers were participant observers, actively involved in the process of creating the new setting and lending research skills to accomplish a number of disparate tasks (needs assessments, interviews, etc.). The relationship between the evaluators and the project was an intervention, one which evolved and matured as the different parties became familiar with each other and developed trust in one another. Kelly, Muiioz, and Snowden (1979) have articulated some of the personal qualities that are needed for this type of community work: a time and energy commitment, flexibili- ty, a belief that people will use new ideas if given a chance, and a faith that science and social action can blend in a manner that benefits both.

Some of the research activities engaged in by the team of investigators are familiar, such as identifying a subset of inner-city groups within an overall directory of self-help groups, gathering demographic information in our target area, identifying self-help groups in the experimental and control areas, and interviewing influential gatekeepers. However, other roles are rather different from the typical activities mental health professionals engage in and are trained for. Community organizing, public relations, and fund raising are not part of the typical graduate school curriculum in most areas of mental health training. Additionally, these features suggest the need for a true collaboration in which professionals drop their expert role and enter into a relationship characterized by reciprocal learning. Although professionals have skills that could be beneficial to self-help groups, it seems that professionals could learn a great deal from self-help groups about natural helping and normal ways of coping with transitions and life crises.

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True collaboration implies that professionals will need to relinquish their positions of power and enter into situations that are somewhat unfamiliar with the aim of learning new ideas about helping and how it occurs (Toro et al., 1987).

We agree with Harris (1981) that successful establishment of a self-help group depends upon a process of assessing the need for the group, obtaining information on similar groups, soliciting cooperation from interested professionals, developing appropriate publicity to inform the community, and establishing ground rules at the first group meeting. Informal contact with prospective members throughout this process is critical. A professional can support group development through serving as a co-leader, helping to set goals, identifying potential leaders, and helping to publicize the group. Although a professional might act as a catalyst in helping to start the group, as it develops its own leadership, authority needs to be relinquished to the group itself (Chutis, 1983).

Maton (1984) has suggested that new ways need to be developed to support inner- city residents attending self-help meetings. This might take the form of helping with transportation and child care for the poor who want to attend. Our epilepsy self-help group developed car pools to help members get home after group meetings. ICSHC committee members decreased the $12 fee, which we thought to be a barrier to par- ticipation, for the TOPS group. The smoking cessation intervention was provided in the homes of our participants to accompany a televised program. These are just a few of the approaches that we are currently testing in order to assess how self-help groups might be tailored to the unique needs of inner-city neighborhoods. Such economic issues need to be faced if self-help groups are to flourish in the cities.

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