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Trauma-Informed Care for Families Experiencing Homelessness

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Supporting Families Experiencing Homelessness

Abstract

Homelessness is a devastating experience that can significantly impact the health and well-being of adults and children. Often these families have experienced ongoing trauma in the form of childhood abuse and neglect, domestic violence, and community violence, in addition to the trauma associated with the loss of home. Traumatic experiences impact how children and adults think, feel, behave, and relate to others, and trauma that goes unrecognized and unaddressed can have potentially devastating implications for development across the life span. Within social service settings, a lack of awareness of trauma increases the risk of causing additional harm. In recognition of this significant public health issue, there is a call to adopt trauma-informed care as a best practice for meeting the needs of trauma survivors across service systems. Trauma-informed care is an organization-wide approach that is grounded in an awareness, understanding, and responsiveness to the impact of trauma, and emphasizes the need to create environments that ensure safety, choice, control, and empowerment for survivors. Often this means changing the policies, practices, and culture of an organization. Key components of trauma-informed care for families experiencing homelessness include: Supporting Staff Development; Creating a Safe and Supportive Environment; Assessing and Planning Services; Providing Services and Trauma-Specific Interventions; Involving Families; and Adapting Policies. This chapter explores the need for a trauma-informed approach to serving families who are homeless, how trauma-informed care is operationalized in homeless service settings, and steps to sustain trauma-informed practice.

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References

  • American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author.

    Google Scholar 

  • Annoshian, J. L. (2005). Violence and aggression in the lives of homeless children. Journal of Family Violence, 20, 373–387.

    Article  Google Scholar 

  • Bassuk, E. L., Buckner, J. C., Perloff, J. N., & Bassuk, S. S. (1998). Prevalence of mental health and substance abuse disorders among homeless and low-income housed mothers. The American Journal of Psychiatry, 155(1), 1561–1564.

    PubMed  Google Scholar 

  • Bassuk, E. L., Buckner, J. C., Weinreb, L. F., Browne, A., Bassuk, S. S., Dawson, R., et al. (1997). Homelessness in female-headed families: Childhood and adult risk and protective factors. American Journal of Public Health, 87(2), 241–248.

    Article  PubMed Central  PubMed  Google Scholar 

  • Bassuk, E. L., Dawson, R., Perloff, J., & Weinreb, L. (2001). Post-traumatic stress disorder in extremely poor women: Implications for health care clinicians. Journal of the American Medical Women's Association, 56(2), 79–85.

    PubMed  Google Scholar 

  • Bassuk, E., & Friedman, S. (2005) Facts on trauma and homeless children. National Child Traumatic Stress Network Homelessness and Extreme Poverty Working Group. Retrieved from http://nctsn.org/nctsn_assets/pdfs/promising_practices/Facts_on_Trauma_and_Homeless.

  • Bassuk, E., Konnath, K., & Volk, K. (2006). Understanding traumatic stress in children. Newton, MA: National Center on Family Homelessness. Retrieved from www.familyhomelessness.org.

    Google Scholar 

  • Bassuk, E. L., Melnick, S., & Browne, A. (1998). Responding to the needs of low-income and homeless women who are survivors of family violence. Journal of the American Medical Women's Association, 53(2), 57–64.

    PubMed  Google Scholar 

  • Bassuk, E. L., & Rosenberg, L. (1990). Psychosocial characteristics of homeless children and children with homes. Pediatrics, 85(3), 257–261.

    PubMed  Google Scholar 

  • Bassuk, E. L., Weinreb, L. F., Buckner, J. C., Browne, A., Salomon, A., & Bassuk, S. S. (1996). The characteristics and needs of sheltered homeless and low-income housed mothers. The Journal of the American Medical Association, 276(8), 640–646.

    Article  Google Scholar 

  • Bloom, S. (2000). Creating sanctuary: Healing from systemic abuses of power. Therapeutic Communities: The International Journal for Therapeutic and Supportive Organizations, 21(2), 67–91.

    Google Scholar 

  • Bloom, S. L. (2006). Organizational stress as a barrier to trauma-sensitive change and system transformation. White Paper for the National Technical Assistance Center for State Mental Health Planning (NTAC), National Association of State Mental Health Program Directors. Retrieved from http://www.nasmhpd.org/publications.cfm.

  • Brewin, C. T., Andrews, B., & Valentine, J. D. (2000). Meta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adults. Journal of Consulting Clinical Psychology, 68(5), 748–766.

    Article  PubMed  Google Scholar 

  • Brewin, C. R., & Holmes, E. A. (2003). Psychological theories of posttraumatic stress disorder. Clinical Psychology Review, 23, 339–376.

    Article  PubMed  Google Scholar 

  • Browne, A. (1993). Family violence and homelessness: The relevance of trauma histories in the lives of homeless women. American Journal of Orthopsychiatry, 63(3), 370–383.

    Article  PubMed  Google Scholar 

  • Browne, A., & Bassuk, S. S. (1997). Intimate violence in the lives of homeless and poor housed women: Prevalence and patterns in an ethnically diverse sample. American Journal of Orthopsychiatry, 72, 261–277.

    Article  Google Scholar 

  • Buckner, J. C., Beardslee, W. R., & Bassuk, E. L. (2004). Exposure to violence and low-income children’s mental health: Direct, moderated, and medicated relations. American Journal of Orthopsychiatry, 74, 413–423.

    Article  PubMed  Google Scholar 

  • Caton, C., Boarnerges, D., Schaner, B., Hasin, D., Schrout, P., Fexlix, A., et al. (2005). Risk factors for long term homelessness: Findings from a longitudinal study of first time homeless single adults. American Journal of Public Health, 95(10), 1753–1759.

    Article  PubMed Central  PubMed  Google Scholar 

  • Cocozza, J. J., Jackson, E. W., & Hennigan, K. (2005). Outcomes for women with co-occurring disorders and trauma: Program-level effects. Journal of Substance Abuse Treatment, 28, 109–119.

    Article  PubMed  Google Scholar 

  • Cohen, J., Perel, J., DeBellis, M., Friedman, M., & Putnam, F. (2002). Treating traumatized children: Clinical implications of the psychobiology of posttraumatic stress disorder. Trauma, Violence & Abuse, 3(2), 91–108.

    Article  Google Scholar 

  • Community Connections (2002). Trauma and abuse in the loves of homeless men and women. Online PowerPoint presentation. Washington, DC. Retrieved from www.pathprogram.samhsa.gov/ppt/Trauma_and_Homelessness.ppt.

  • Cook, A., Spinazzola, J., Ford, J., Lanktree, C., Blaustein, M., Cloitre, M., et al. (2005). Complex trauma in children and adolescents. Psychiatric Annals, 35, 390–398.

    Google Scholar 

  • Cowan, B. A. (2007). Trauma exposure and behavioral outcomes in sheltered homeless children: The moderating role of perceived social support. Psychology Dissertations. Paper 39. Retrieved from http://digitalarchive.gsu.edu/psych_diss/39.

  • D’Andrea, W., Ford, J., Stolbach, B., Spinazzola, J., & van der Kolk, B. (2012). Understanding interpersonal trauma in children: Why we need a developmentally appropriate trauma diagnosis. American Journal of Orthopsychiatry, 82(2), 187–200.

    Article  PubMed  Google Scholar 

  • D’Ercole, A., & Struening, E. (1990). Victimization among homeless women: Implications for service delivery. Journal of Community Psychology, 18, 141–151.

    Article  Google Scholar 

  • Elliott, D. E., Bjelajc, P., Fallot, R. D., Markoff, L. S., & Reed, B. G. (2005). Trauma-informed or trauma-denied: Principles and implementation of trauma-informed services for women. Journal of Community Psychology, 33(4), 461–477.

    Article  Google Scholar 

  • Fantuzzo, J. W., & Lindquist, C. U. (1989). The effects of observing conjugal violence on children: A review and analysis of research methodology. Journal of Family Violence, 4, 77–94.

    Article  Google Scholar 

  • Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., et al. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine, 14(4), 245–258.

    Article  PubMed  Google Scholar 

  • Figley, C. H. (2002). Treating compassion fatigue. New York: Routledge.

    Google Scholar 

  • Finkelstein, N., Rechberger, E., & Russell, L. A. (2005). Building resilience in children of mothers who have co-occurring disorders and histories of violence: Intervention model and implementation issues. Journal of Behavioral Health Services and Research, 32, 141–154.

    Article  PubMed  Google Scholar 

  • Goodman, L. A. (1991). The prevalence of abuse among homeless and housed poor mothers: A comparison study. American Orthopsychiatric Association, 61(4), 489–500.

    Article  Google Scholar 

  • Goodman, L., Saxe, L., & Harvey, M. (1991). Homelessness as psychological trauma. American Psychologist, 46(11), 1219–1225.

    Article  PubMed  Google Scholar 

  • Guarino, K., & Bassuk, E. (2010). Working with families experiencing homelessness: Understanding trauma and its impact. Zero to Three, 30(3), 11–20.

    Google Scholar 

  • Guarino, K., Rubin, L., & Bassuk, E. (2007). Trauma in the lives of homeless families. In E. Carll (Ed.), Trauma psychology: Issues in violence, disaster, health, and illness (pp. 231–258). Westport: Praeger.

    Google Scholar 

  • Guarino, K., Soares, P., Konnath, K., Clervil, R., & Bassuk, E. (2009). Trauma-informed organizational toolkit. Rockville, MD: Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, and the Daniels Fund, the National Child Traumatic Stress Network, and the W.K. Kellogg Foundation. Retrieved from www.homeless.samhsa.gov and www.familyhomelessness.org.

    Google Scholar 

  • Harris, M., & Fallot, R. (Eds.). (2001). New directions for mental health services: Using trauma theory to design service systems. San Francisco: Jossey-Bass.

    Google Scholar 

  • Herman, J. (1992). Trauma and recovery. New York: Basic Books.

    Google Scholar 

  • Hodas, G. R. (2006). Responding to childhood trauma: The promise and practice of trauma informed care. Pennsylvania Office of Mental Health and Substance Abuse Services. Retrieved from http://www.nasmhpd.org/docs/publications/docs/2006/Responding%20to%20Childhood%20Trauma%20-%20Hodas.pdf.

  • Hopper, E., Bassuk, E., & Olivet, J. (2010). Shelter from the storm: Trauma-informed care in homelessness service settings. The Open Health Services and Policy Journal, 3, 80–100.

    Article  Google Scholar 

  • Jennings, A. (2008). Models for developing trauma-informed behavioral health systems and trauma-specific services. Alexandria, VA: National Association of State Mental Health Program Directors, National Technical Assistance Center for State Mental Health Planning. Retrieved from http://www.annafoundation.org/MDT.pdf.

  • Kinniburgh, K., & Blaustein, M. (2010). Treating traumatic stress in children and adolescents: How to foster resilience through attachment, self-regulation, and competency. New York: The Guilford Press.

    Google Scholar 

  • Koegel, P., Melamide, E., & Burnam, A. (1995). Childhood risk factors for homelessness among homeless adults. American Journal of Public Health, 85, 1642–1649.

    Article  PubMed Central  PubMed  Google Scholar 

  • Luxenberg, T., Spinazzola, J., & van der Kolk, B. (2001). Complex trauma and disorders of extreme stress (DESNOS) diagnosis, Part one: assessment. Directions in Psychiatry, 21(25), 373–392.

    Google Scholar 

  • Macy, R. D., Behar, L. B., Paulson, R., Delman, J., & Schmid, L. (2004). Community based acute post-traumatic stress management: A description and evaluation of a psychosocial intervention continuum. Harvard Rev Psychiatry, 12(4), 217–228.

    Article  Google Scholar 

  • Morrissey, J. P., Ellis, A. R., & Gatz, M. (2005). Outcomes for women with co-occurring disorders and trauma: Program and person-level effects. Journal of Substance Abuse Treatment, 28, 121–133.

    Article  PubMed  Google Scholar 

  • Moses D. J., Reed B. G., Mazelis R., & D’Ambrosio, B. (2003). Creating trauma services for women with co-occurring disorders: Experiences from the SAMHSA women with alcohol, drug abuse, and mental health disorders who have histories of violence study. Delmar, NY: Policy Research Associates. Retrieved from http://www.prainc.com/wcdvs/pdfs/CreatingTraumaServices.pdf.

  • Mullen, J., & Leginski, W. (2010). Building the capacity of the homeless service workforce. The Open Health Services and Policy Journal, 3, 101–110.

    Article  Google Scholar 

  • Nader, K. (2011). Trauma in children and adolescents: Issues related to age and complex trauma reactions. Journal of Child and Adolescent Trauma, 4, 161–180.

    Article  Google Scholar 

  • National Child Traumatic Stress Network. Symptoms and behaviors associated with exposure to trauma. Retrieved from http://www.nctsn.org/trauma-types/early-childhood-trauma/Symptoms-and-Behaviors-Associated-with-Exposure-to-Trauma.

  • National Scientific Council on the Developing Child (2004). Young children develop in an environment of relationships: Working Paper No. 1. Retrieved from www.developingchild.harvard.edu.

  • National Scientific Council on the Developing Child (2005). Excessive stress disrupts the architecture of the developing brain: Working Paper No. 3. Retrieved from www.developingchild.harvard.edu.

  • Noether, C. D., Brown, V., & Finkelstein, N. (2007). Promoting resiliency in children of mothers with co-occurring disorders and histories of trauma: Impact of a skills-based intervention program on child outcomes. Journal of Community Psychology, 35, 823–843.

    Article  Google Scholar 

  • North, C. S., & Smith, E. M. (1992). Posttraumatic stress disorder among homeless men and women. Hospital and Community Psychiatry, 43(10), 1010–1016.

    PubMed  Google Scholar 

  • Olivet, J., McGraw, S., Grandin, M., & Bassuk, E. (2009). Staffing challenges and strategies for organizations serving individuals who have experiences chronic homelessness. Rockville, MD: Center for Mental Health Services, Substance Abuse and Mental Health Services Administration.

    Google Scholar 

  • Osofsky, J. D. (1999). The impact of violence on children. The Future of Children, 9(3), 33–49.

    Article  PubMed  Google Scholar 

  • Pat-Horenczyk, R., Rabinowitz, R. G., Rice, A., & Tucker-Levin, A. (2009). The search for risk and protective factors in childhood PTSD. In D. Brom, R. Pat-Horenczyk, & J. D. Ford (Eds.), Treating traumatized children risk, resilience and recovery (pp. 51–71). New York: Routledge.

    Google Scholar 

  • Perry, B. D. (2001). The neurodevelopmental impact of violence in childhood. In D. Schetkey & E. Benedek (Eds.), Textbook of child and adolescent forensic psychiatry (pp. 221–238). Washington, DC: American Psychiatric Press, Inc.

    Google Scholar 

  • Perry, B. D., & Pollard, R. (1998). Homeostasis, stress, trauma, and adaptation: A neurodevelopmental view of childhood trauma. Child and Adolescent Psychiatric Clinics of North America, 7(1), 33–51.

    PubMed  Google Scholar 

  • Perry, B. D., Pollard, R., Blakeley, T., Baker, W., & Vigiliante, D. (1996). Childhood trauma, the neurobiology of adaptation and use-dependent development of the brain: How ‘states’ becomes ‘traits. Infant Mental Health Journal, 16(4), 271–291.

    Article  Google Scholar 

  • Prescott, L., Soares, P., Konnath, K., & Bassuk, E. (2008). A long journey home: A guide for creating trauma-informed services for mothers and children experiencing homelessness. Rockville, MD: Center for Mental Health Services, Substance Abuse and Mental Health Services Administration; and the Daniels Fund; National Child Traumatic Stress Network; and the W.K. Kellogg Foundation. Retrieved from www.homeless.samhsa.gov.

  • Putnam, F. W. (2006). The impact of trauma on child development. Juvenile and Family Court Journal, 1–11.

    Google Scholar 

  • Rog, D. J., Holupka, C. S., & McCombs-Thornton, K. L. (1995). Implementation of the homeless families program: Service models and preliminary outcomes. American Journal of Orthopsychiatry, 65, 502–513.

    Article  PubMed  Google Scholar 

  • Saakvitne, K. W., Gamble, S., Pearlman, L. A., & Lev, B. T. (2001). Risking connection: A training curriculum for working with survivors of childhood abuse. Baltimore: Sidran Institute.

    Google Scholar 

  • Saxe, G. N., Ellis, B. H., & Kaplow, J. B. (2006). Collaborative treatment of traumatized children and teens: The trauma systems therapy approach. New York: Guilford Press.

    Google Scholar 

  • Shinn, L. M., Rauch, S. L., & Pitman, R. K. (2006). Amygdala, medial prefrontal cortex, and hippocampal function in PTSD. Annals New York Academy of Sciences, 1071, 67–79.

    Article  Google Scholar 

  • The National Center on Family Homelessness. (1999). Homeless children: America’s new outcasts. Newton, MA: Better Homes Fund.

    Google Scholar 

  • Tischler, V., Rademeyer, A., & Vostanis, P. (2007). Mothers experiencing homelessness: Mental health, support and social care needs. Health & Social Care in the Community, 15(3), 253–256.

    Google Scholar 

  • United States Department of Veterans Affairs, National Center on PTSD (2012). PTSD in children and adolescents. Retrieved from http://www.ptsd.va.gov/professional/pages/ptsd_in_children_and_adolescents_overview_for_professionals.asp.

  • United States Interagency Council on Homelessness (2010). Opening doors: Federal strategic plan to prevent and end homelessness. Retrieved from http://www.usich.gov/PDF/OpeningDoors_2010_FSPPreventEndHomeless.pdf.

  • van der Kolk, B. (1994). The body keeps the score: Memory and the evolving psychobiology of post traumatic stress. Harvard Review of Psychiatry, 1(5), 253–265.

    Article  PubMed  Google Scholar 

  • van der Kolk, B. A. (2003). The neurobiology of childhood trauma and abuse. Child and Adolescent Psychiatric Clinics, 12, 293–317.

    Article  Google Scholar 

  • van der Kolk, B., McFarlane, A. C., & Weisaeth, L. (Eds.). (1996). Traumatic stress. New York: Guilford Press.

    Google Scholar 

  • van der Kolk, B. A., Roth, S., Pelcovitz, D., Sunday, S., & Spinazzola, J. (2005). Disorders of extreme stress: The empirical foundation of a complex adaptation to trauma. Journal of Traumatic Stress, 18(5), 389–399.

    Article  PubMed  Google Scholar 

  • Volk, K., Guarino, K., Grandin, M., & Clervil, R. (2008). What about you? A workbook for those who work with others. Needham, MA: The National Center on Family Homelessness. Retrieved from http://www.familyhomelessness.org/resources.php?p=sm.

  • Weinreb, L., Buckner, J. C., Williams, V., & Nicholson, J. (2006). A comparison of the health and mental health status of homeless mothers in Worcester, Mass: 1993 and 2003. American Journal of Public Health, 96, 1444–1448.

    Article  PubMed Central  PubMed  Google Scholar 

  • Wood, D., Valdez, R. B., Hayashi, T., & Shen, A. (1990). Homeless and housed families in Los Angeles: A study comparing demographic, economic, and family function characteristics. American Journal of Public Health, 80(9), 1049–1052.

    Article  PubMed Central  PubMed  Google Scholar 

  • Yehuda, R. (2002). Postraumatic stress disorder. New England Journal of Medicine, 346(2), 108–114.

    Article  PubMed  Google Scholar 

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Correspondence to Kathleen M. Guarino L.M.H.C. .

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Guarino, K.M. (2014). Trauma-Informed Care for Families Experiencing Homelessness. In: Haskett, M., Perlman, S., Cowan, B. (eds) Supporting Families Experiencing Homelessness. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-8718-0_7

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