Voices from the Field Blog: Holding Spaces for Care – Trauma-Informed Approaches

by Darby Penney
June 20, 2014

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Homeless and Housing Resource Network contributing writer Darby Penney reflects on the moving testimony of a formerly homeless mother who received trauma-informed services through a SAMHSA treatment for the homeless grant in Albany, the Addiction and Recovery Center for Hope (ARCH) program.

More than 60 local health and human service providers, researchers, government officials, and community members came together in Albany, NY, on June 10, 2014, for a roundtable discussion exploring how findings of the SHIFT study (Service and Housing Interventions for Families in Transition) can be used to change policies and practices to help reduce family homelessness.

The study found that homeless mothers are a highly traumatized and under-served group; 93 percent of participants had a history of trauma, with 81 percent having experienced multiple traumatic events. About half the women met diagnostic criteria for post-traumatic stress disorder (PTSD) at the beginning of the study. The majority met criteria for major depression, and most were survivors of interpersonal violence by family, intimate partners, or other known perpetrators. Their children were also negatively impacted by their mothers’ trauma histories, with 41 percent having physical and/or emotional difficulties at baseline (Hayes et al., 2013).

The SHIFT study, funded by the Wilson Foundation, was conducted in the upstate New York cities of Albany, Syracuse, Rochester, and Buffalo by the National Center on Family Homelessness (NCFH). It identified mothers in emergency shelter, transitional housing, and permanent supportive housing programs and interviewed them three times over a 30-month period. 

The results of this study are consistent with those of an earlier study of factors involved in family homelessness (Bassuk et al., 1997), according to Carmela DeCandia of NCFH. What is new, she said, is the study’s conclusion that unresolved trauma issues—as indicated by severity of symptoms of PTSD—and low self-esteem were the only predictors of continuing residential instability at 30 months into the study.
 
These findings illustrate the critical need for agencies that serve homeless families to learn about trauma and its impact, along with implementing trauma-informed approaches to service provision. This conclusion was emphasized by the moving testimony of a formerly homeless mother who received trauma-informed services through the ARCH program. After multiple episodes of homelessness, which resulted from struggles with her own emotional distress and her daughter’s suicide attempts, Maria, a single mother, entered the ARCH program. Talking with ARCH staff, she realized for the first time that what she experienced as a child was abuse and that she is a survivor of trauma. Maria and her children moved into a supported apartment program, and with ARCH’s trauma-informed supportive services, she has been able to return to the workforce.

While some in the audience were familiar with the idea of trauma-informed approaches (formerly referred to as trauma-informed care), it was apparently a new concept for most of those who participated in the roundtable. A recent review of the literature found that while trauma-informed care offers a coherent framework for providing homelessness services, the concept remains unclear for many providers and the mechanisms for creating trauma-informed organizational and systems change is not well understood in this field (Hopper et al., 2010).

SAMHSA defines trauma-informed approaches as follows: A program, organization, or system that is trauma-informed realizes the widespread impact of trauma and understands potential paths for recovery; recognizes the signs and symptoms of trauma in clients, families, staff, and others involved with the system; it responds by fully integrating knowledge about trauma into policies, procedures, practices, and settings; and it seeks to actively resist re-traumatization.

Homeless service providers—as well as other human services agencies—can request training and technical assistance on trauma-informed approaches to become a trauma-informed organization and to provide trauma-informed peer support, as well as related issues, through SAMHSA’s National Center for Trauma-Informed Care (NCTIC).

For more information on technical assistance from NCTIC, contact Pam Rainer at prainer@ahpnet.com. To access the SHIFT study, please navigate to this link: http://www.air.org/sites/default/files/SHIFT_Service_and_Housing_Interventions_for_Families_in_Transition_
final_report.pdf

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

Hayes, M., Zonneville, M., & Bassuk, E.  (2013). The SHIFT Study: Final Report. Needham MA:  The National Center on Family Homelessness.

Hopper, E. K., Bassuk, E. L., & Olivet, J. (2010). Shelter from the storm: Trauma-informed care in homelessness services settings. The Open Health Services and Policy Journal, 3(2), 80-100.

Interested in being an HRC Guest Blogger? E-mail us at HomelessPrograms@samhsa.hhs.gov.

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Voices From the Field Blog: Removing Barriers to Education

by Mary Poor
April 23, 2014

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Homeless and Housing Resource contributing writer Mary Poor highlights the Boston Public Schools (BPS) Homeless Education Resource Network and its commitment to making a difference for the children and families within the community who are experiencing homelessness.
 
Families represent an increasing segment of the homeless population in the United States, with more than 77,000 households and nearly 165,000 children experiencing homelessness in 2012. The heavy toll of homelessness on children’s health and well-being is well documented – they have higher rates of acute and chronic illnesses, experience emotional and behavioral problems that interfere with learning at almost three times the rate of other children, and go hungry twice as often as other children. The challenges confronting children and families experiencing homelessness can seem insurmountable – except for those individuals who have made a long-term commitment to work creatively to address their complex issues, build relationships, and advocate for a more just system.

Mary William is a Boston social worker that made such a commitment. She is the Director of the Homeless Education Resource Network (HERN), a program that she helped start more than 25 years ago in the Boston Public Schools (BPS). HERN - originally called the Homeless Student Initiative – was established in response to the McKinney-Vento Act, the federal law that removes barriers to education and ensures immediate enrollment and educational stability for children and youth experiencing homelessness. When the HERN program began, it provided basic services, such as transportation, school supplies, clothing, and referrals, for approximately 100 students experiencing homelessness in the school district.

Over the years, HERN has grown to meet the needs of over 3,000 BPS students who are currently experiencing homelessness in the school district. These students attend 142 Boston Public Schools. On a recent spring day, I had the opportunity to talk with Ms. William about some of the challenges facing HERN and the children and families that it serves. Ms. William immediately said that providing transportation to approximately 500 students who reside outside of the school district is one of HERN’s most pressing concerns. She explained that sometimes families who are experiencing homelessness could find temporary housing only outside of Boston. Some children live as far away as Chicopee or Greenfield, Massachusetts, which results in the children commuting up to four or five hours each school day. Since these families do not choose to move to another school district or city, the McKinney-Vento Act ensures that students who are experiencing homelessness can opt to remain in their original school. Since changing schools can negatively affect how a student performs academically and how they form relationships with other students, every effort is made to provide children with educational stability.

Although families have the option of registering their children in the school in their temporary communities, Ms. William said that 99 percent of the families choose not to enroll them. Ms. William explained, “They have lost everything. The only thing stable is their schools. Nothing is familiar in their temporary communities. They don’t know the teachers. The whole culture is a shock for them. Sometimes it’s hard for them to establish new relationships. Sometimes there’s a language barrier, too.” She also noted that some communities do not have the resources to support the families. The bottom line is that every time a child has to change schools, his or her education is disrupted. According to some estimates, three to six months of education are lost with every move. At the same time, commuting long distance to attend school is far from optimal for students.

Ms. William also talked about the challenges that children who are experiencing homelessness face in the classroom. In addition to the distance that some of the children travel to and from school, many of the children that HERN serves are tired and have difficulty focusing on their work. Oftentimes, homework is not completed and attendance can be inconsistent. And sometimes the children aren’t privileged to share the fact that they are experiencing homelessness with their friends or teachers because their parents do not want others to know about their situation. This inadvertently puts an emotional toll on the children. As Ms. William reminded me, “Homelessness is the end result of a long struggle.” And the long-term consequences of homelessness can be daunting. Students who experience homelessness are 50 percent less likely to graduate, four times more likely to drop out of school, and three times more likely to need special programs. These are tough odds to be up against.

Despite these challenges, Ms. William and her staff at HERN are committed to making a difference in helping BPS children and families who are experiencing homelessness to succeed. In addition to providing transportation and other basic services, HERN has established an evening program aimed at closing the achievement gap. Some BPS teachers are trained to work specifically with children and families temporarily living in shelters. Each of these teachers is assigned to one shelter, which s/he visits on a regular basis throughout the school year, providing two hours of mentoring per visit on topics such as math and literacy, relationship building, parental rights, and managing and coping with stress. The teacher also serves as a liaison between BPS and the shelter, which allows BPS to address issues in a timely way and provide support for the families who live there.

HERN also tries to nurture and develop children’s interests and talents through its small but growing mentoring program, Mpcat. BPS students from grades 5 through 12 who are living in transitional housing are paired with volunteer mentors who provide them with enrichment and cultural activities, such as trips to museums, shows and performances, sports games, and other outings. Ms. William noted that mentoring programs make a difference, both in the feedback that she receives from the students and families who participate in the Mpcat program and in studies that have shown that children who have a mentor have improved relationships with their parents and peers, perform better academically, and are 46 percent less likely to develop substance use disorders.

HERN also has a well-established summer program, which is held throughout the month of July. Ms. William says that the program is “loaded with enrichment activities and art projects.” Participants go to the zoo, bowling, movies, playgrounds, and local museums, including a sleepover at the Boston Museum of Science. They also create poetry, practice writing, act in short plays, and participate in art activities. Ms. William said the summer program allows “kids to be kids,” while helping them to become better readers and writers, strengthening their leadership skills, developing their talents and creativity, and helping them form positive friendships.

In keeping with BPS’s integrated and holistic approach to education, HERN works closely with the BPS Office of Family and Community Engagement, Boston area family shelters and housing service providers, the faith-based community, Interagency Council City of Boston, Boston area hospitals, Citizen Banks, and City Missions Society. HERN also relies on volunteers to provide support for its mentoring program and special events. To volunteer or learn more about HERN’s commitment to action and advocacy for the educational needs of children and families, please visit the HERN website.

Sources:
The National Alliance to End Homelessness: State of Homelessness in America 2013: http://www.endhomelessness.org/library/entry/the-state-of-homelessness-2013

The Homeless Education Research Network: http://www.bostonhern.org.

Interested in being a HRC Guest Blogger? E-mail us at homelessprograms@samhsa.hhs.gov

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Voices From the Field Blog: Will You Still Be Mine?

by Rachael Kenney
January 27, 2014

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Homeless and Housing Resource Network contributing writer Rachael Kenney illuminates the challenges that couples experiencing homelessness face in forming connections with others as well as redefining intimacy in their daily lives.

Mark: “Well, if you had three wishes, what would they be?”
Paul: “House. Job. Baby.”

Watch a few of Mark Horvath’s videos about couples and it immediately becomes clear: Couples that are homeless have a similar desire for intimacy as couples who aren’t homeless. Not just physical intimacy, but emotional intimacy; a sense of closeness and emotional warmth. But so many of the ways that we build intimacy aren’t accessible while homeless. There is no kitchen in which to cook for one another, no TV to cuddle in front of, and no place to come home to together.

Paul, and his girlfriend Katie met when they were both already living on the street in London. Like many young folks on the street, they were not in school and could not secure employment, so they built intimacy by spending all of their time together, searching for resources, panhandling, and just waiting for tomorrow. One might suggest that these relationships are dangerous, that the young people glamorize homelessness and getting into relationships will just perpetuate the situation. There is some truth to this claim, as couples have more difficulty getting off the street because they often disregard housing options that won’t allow them to stay together. But dating while living on the street can also have a positive impact. For Katie, homelessness and her relationship with Paul contributed to her sobriety.

Others, like Edward and Anita, were married for twenty-two years before they became homeless. It appears that their strong foundation is what carries them through episodes of homelessness. And then there are Maria and Neville:

Maria: “[I’d wish for] a cheap little car so I can get around, and a wheelchair. Actually, a wheelchair is my priority.”
Neville: “And each other.”
Maria: “And each other. We’ve been married for four months, been together for five years. And I’ve never been happier in the sense of a relationship.”

Even with the stressors of being homeless together, these people value their relationships and work hard to maintain them. Their relationships remind them that they are valuable and worthy. They are important in at least one other person’s life.

When night falls, these three couples can be found “sleeping rough,” or on the street. Some of the reasons they do this are the same reasons that single people avoid shelters: theft, violence, and strict rules. But couples also sleep outside because most shelters can’t accommodate couples, even same-sex couples, in the same sleeping quarters. Sleeping rough may be a way to hang on to a sense of normalcy. Regardless of whether or not they are physically intimate during this time together, it gives them the opportunity to build emotional intimacy. And as they close their eyes and drift off into sleep, they can almost believe that they are holding one another in bed in their own home. And that the light from the stars and the streetlights is filtering in through the windows, rather than directly down on them from above.

Interested in being a HRC Guest Blogger? Email us at generalinquiry@center4si.com.

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Category: General | Guest Entry

Limitless Potential

by Valerie Gold
December 20, 2013

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Homeless and Housing Resource Network contributing writer Valerie Gold recounts the experience joining a team of runners from Back On My Feet, an organization that uses running to help people experiencing homelessness change the way they see themselves and to achieve real change. 

So much of the work to address homelessness involves waiting: waiting for people’s names to rise to the top of various lists, waiting for apartments to pass inspection, waiting for replacement documents, approvals, or funds. Waiting, and its accompanying frustrations, contribute to the sense of powerlessness and hopelessness endured by many people experiencing homelessness.

As 2014 begins, Back On My Feet (BOMF) is not waiting, but instead is racing forward with its mission to use running to help people experiencing homelessness to realize their own power and to achieve real change. With the addition of two new chapters in the last twelve months, BOMF now operates running teams based in homeless shelters in eleven cities across the country. Nearly 400 individuals experiencing homelessness are running with these teams each month. Eighty-two percent report that their health is good or excellent, and 94 percent describe themselves as hopeful about their futures. And so far, 46 percent of BOMF runners have obtained employment, housing, or both.

The Monday before Thanksgiving, I joined the team of BOMF runners who live at the New England Shelter for Homeless Veterans for a pre-dawn run. The team assembled at 5:20 a.m. in the lobby of the shelter. The runners were easy to spot, bundled up in BOMF tracksuits and shod in bright new running shoes. As we waited for a few volunteers (referred to as "nonresident team members") to arrive, Eric,* a tall and friendly vet with an easy laugh, described the 5K race in South Boston that he had run the day before through a fierce wind and temperatures well below freezing. This was his first race, he said, and he almost stopped several times, but was urged on by Kathleen, BOMF’s Program Coordinator, who ran with him the entire way to set his pace and make sure that he achieved his goal of completing the event.

Once everyone arrived, we moved outside, formed a circle, did some jumping jacks to warm up, and then put our arms around one another and recited the Serenity Prayer. And then we were off. I settled in to run next to Joe, an elegantly-coiffed runner with a white goatee whose pace accelerated as the stars faded and the moon slowly set, until I nearly collapsed from trying to keep up with him. The physical suffering was worth it, as Joe was a great conversationalist, expounding upon the concepts of self-efficacy and mental toughness as I gasped and groaned and otherwise generally displayed my lack of any toughness – mental or otherwise. When I finally gave up and waved Joe on, I was immediately joined by a group of women from the Common Ground Team. One of them had her arm in a sling, and all of them shivered cheerfully as they introduced themselves and told me how long they had been on the team. I had no idea which of them were people experiencing homelessness and which of them were nonresident team members. This is part of what works about BOMF– by building teams of runners instead of groups of givers and recipients of support, of assistance, of anything but fellowship and mutual encouragement and accountability, BOMF makes it possible for people who have experienced terrible things, including great isolation, to resocialize and reconnect with others, while building or rebuilding key aspects of their identities: as athletes, teammates, morning people, or just plain survivors. At the same time, nonresident runners have the opportunity to connect in a meaningful and immediately rewarding way with people with whom they might otherwise never be engaged.

After my run, I followed the Boston BOMF staff back to the offices that they occupy, courtesy of Comcast. Victor, Kathleen, and Allison, all fearsomely fit, energetic, and passionate about their work, described their goals for doubling the number of BOMF runners in Boston, and for maximizing the positive impact of their program through strategic partnerships with homeless service providers and individualized supports for runners. They shared challenges, ranging from the easily addressed (advising a new team member that he should relieve himself before leaving the shelter as opposed to doing so mid-run in front of his teammates) to the more complex, like the heightened risk of substance abuse relapse, arrest, or other crisis occurring during the weeks between Thanksgiving and New Year’s Day. Running alone won’t eliminate this risk, of course, but it can help, and the accountability and sense of belonging that comes from being on a team provides further protection. As Victor, the Boston Executive Director, shared his plans for "over programming" with movie nights, dinners, and races during this period, his investment in the safety and success of each team member was clear.

BOMF is more than a novel idea or a promising practice. It is a reminder that the people we work with in outreach programs and homeless shelters have limitless potential for healing and growth. Running is a great way to tap into this potential. It changes a person from the inside out, and provides a daily demonstration of the lesson so eloquently articulated within BOMF’s vision statement: If we keep moving forward, we arrive someplace different, we arrive stronger and often as better versions of ourselves.

Of course, running is not the only way to move forward or fulfill potential. As 2014 begins, I challenge myself and my colleagues to stop waiting and take inspiration from BOMF to search for new and better ways to be reminded of the tremendous power that each of us holds within.

*Permission was granted by all of the individuals identified in this piece to share first names.

Interested in being a HRC Guest Blogger? Email us at generalinquiry@center4si.com.

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Nashville Changes Strategy to End Homelessness

by Steven Samra
August 06, 2013

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In 2005 Nashville joined many other cities in the development and implementation of a 10-year plan to end homelessness. Unfortunately, despite the best intentions, Nashville has, like many American cities, struggled to accomplish the goal. A cadre of obstacles and barriers, including, but certainly not limited to scarce resources, reliance on “readiness” as a precursor to obtaining housing, a closed Homeless Management Information System, lack of affordable units and housing vouchers, all contributed to the challenge of procuring housing.  A lack of coordination among area behavioral health providers exacerbated these challenges, and frustration and hopelessness were increasing within the homeless community with each passing year.  

Thanks to the efforts of a new Executive Director at the Nashville Metropolitan Homelessness Commission and a committed team of Commissioners, partners, and volunteers, a partnership with the 100,000 Homes Campaign, and a collaboration of several local providers and faith-based organizations, the situation appears to be changing for the better.  

On May 29-31, 2013, twenty teams comprised of over 100 community volunteers canvassed the streets and campsites of Nashville, Tennessee, using the Vulnerability Index to survey and create a priority list of individuals experiencing street homelessness who are most at risk of premature death if they remain homeless. The Vulnerability Index, created by Dr. Jim O’Connell, President of the Boston Healthcare for the Homeless program, identifies those who have been homeless the longest and are the most vulnerable. In addition to gathering the names, pictures, and dates of birth of individuals sleeping on the streets, the teams also captured data on their health status, institutional history (jail, prison, hospital, and military), length of homelessness, patterns of shelter use, and their previous housing histories.

A heavily attended community meeting was held on June 4, 2013, to discuss the results of the survey and kick off the start of a new campaign, “How’s Nashville”. The immediate goal of the campaign is to house 200 of the most vulnerable and chronically homeless into housing within 100 days. Once this is completed, How’s Nashville will continue the effort to house the city’s most vulnerable members with the ultimate goal of ending homelessness within the city by 2015.  Although using a Housing First approach is often more cost effective than alternate methods, and certainly more so than managing homelessness on the street, there are still costs associated with providing housing to those experiencing homelessness.  

Community members rose to the financial challenge associated with the campaign, donating $36,000 during the June meeting to help defray move-in costs associated with the transition from street to home.  Outreach workers began immediately moving individuals identified as high priority into housing at the end of the meeting, and invited attendees to walk with them to a welcome home celebration. Through the city’s efforts, one individual was identified as “most vulnerable” and was moved into housing after more than 7 years of life on the street.

The campaign is off to a strong start with 43 people successfully housed and supported during the month of June.  Conversely, from January to May 2013, just 19 people experiencing homelessness were placed into housing.  uly is also off to a solid start and should meet or exceed the minimum number of placements needed to meet the final housing goal of 200 people housed within 100 days.  

Nashville’s homeless population may finally have reason for optimism instead of pessimism.  There will continue to be challenges associated with scarce resources and the city’s approach is far from perfect.  Clearly however, Nashville has turned a corner and embraced a new approach that is proven to dramatically reduce homelessness.  With the momentum of the How’s Nashville campaign firmly pushing the effort forward, for the first time in many years, Nashville is housing those experiencing homelessness in a systematic, logical, and coordinated manner. The future appears brighter for the city’s most vulnerable residents than it has been for a very long time.

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Category: General | Guest Entry