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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Category: General

Voices from the Field Blog: Peer Support for Veterans Involved in the Justice System

by Darby Penney
May 29, 2014

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Homeless and Housing Resource Network contributing writer Darby Penney highlights the work of MISSION DIRECT VET (Maintaining Independence and Sobriety through Systems Integration, Outreach and Networking-Diversion and Recovery for Traumatized Veterans), which is a treatment program that serves veterans with co-occurring mental health and substance abuse issues.

“Shortly after the opening of the pilot site for our Jail Diversion-Trauma Recovery program, we quickly realized that one of the veterans involved in our program was homeless,” said David Goldstein, a team member of MISSION DIRECT VET in Massachusetts. “So the two of us got in the car and drove over to the local veterans’ shelter. We were introduced to the staff, and after the veteran told his story of how PTSD (post-traumatic stress disorder) contributed to his homelessness and his involvement with the courts, he was welcomed with open arms. The warmth present in the room brought me to tears. This was my first, and certainly not my last, experience with a homeless veteran and a welcoming shelter.”

The MISSION DIRECT VET program began with a single pilot site in Worcester, MA in 2009 that has expanded to two other sites in the state. Its goal is to serve veterans with mental health, substance abuse, and other trauma-related issues who are involved with the criminal justice system in order to divert them from jail into trauma-informed services. Originally funded through a five-year SAMHSA grant, the program continues now with state funding.

MISSION-DIRECT VET is a manualized treatment program for people with co-occurring mental health and substance abuse issues. It is the primary treatment service that is offered, and it is supplemented by 12 months of peer support services and case management. Referrals and linkages to vital community-based services such as veterans’ services, vocational and independent living skills programs, family support, and transitional residence programs are also central to the program.

Veterans are over-represented among people experiencing homelessness (e.g., in 2010, veterans accounted for about 10 percent of the total U.S. adult population and 16 percent of the homeless adult population). The good news is that homelessness among veterans has declined by an estimated 25 percent since 2007, according to the U.S. Department of Housing and Urban Development’s 2013 Annual Homeless Assessment Report. 

The National Alliance to End Homelessness reports that homeless veterans include service members from every era since World War II. While Vietnam-era veterans are at greater risk of homelessness than those from other eras, veterans of recent conflicts are more likely to be more gravely disabled. One recent study found two-thirds of homeless Iraq and Afghanistan veterans were diagnosed with PTSD, a rate far higher than earlier generations of veterans (Tsai et al., 2013).

This is where programs that offer a strong peer support component can be especially helpful. MISSION-DIRECT VET team member David Goldstein is a Vietnam veteran, a trauma survivor, and person in recovery. He provides the veterans who participate in the program with one-on-one peer mentoring, facilitates veterans support groups, and connects veterans to resources in the community. Perhaps most importantly, he listens, sits with people who are in trouble, and offers a non-judgmental perspective of someone who has been through many of the same experiences as the people he serves.

While Goldstein has seen the success stories of many of the veterans who have been through the program, he cautions that there are still areas for improvement. “Veterans who go into homeless shelters are often there, directly or indirectly, because of substance abuse issues with drugs and/or alcohol that are often related to PTSD. Because of the rules of the shelters subsidized by the VA (Veterans Administration), they may be asked to leave due to abusing the very substances that got them there to begin with. To keep these veterans from falling back into homelessness, the protocols for these shelters must change,” he said.

References
Henry, M., Cortes, A., & Morris, S. (2013). The 2013 Annual Homeless Assessment Report (AHAR) to Congress. Washington, DC: The U.S. Department of Housing and Urban Development, Office of Community Planning and Development.

National Alliance to End Homelessness. (n.d.). Veterans. Washington, DC: National Alliance to End Homelessness. [Website article]. Retrieved from http://www.endhomelessness.org/pages/veterans

National Center for Veterans Analysis and Statistics. (2012). Profile of Sheltered Homeless Veterans for Fiscal Years 2009 and 2010.  Washington, DC: The U.S. Department of Veterans Affairs.Retrieved from http://www.va.gov/vetdata/docs/SpecialReports/Homeless_Veterans_2009-2010.pdf

Tsai, J., Pietrzak, R. H., & Rosenheck, R. A. (2013). Homeless veterans who served in Iraq and Afghanistan: Gender differences, combat exposure, and comparisons with previous cohorts of homeless veterans. Administration and Policy in Mental Health and Mental Health Services Research, 40(5), 400-405.

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

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Category: General | Guest Entry

Voices from the Field: Responding to Holiday Triggers

by Katie Volk
October 22, 2013

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Year-round, we encourage providers to adopt a trauma-informed lens – to use knowledge of trauma and its impact to make decisions about all aspects of their relationships with clients and how they run their program.

During the holiday season, the need for a trauma-informed approach is critical. Everywhere we turn, we’re reminded that it is supposed to be “the most wonderful time of the year.” While for some that may be true, for others, the holiday season is wrought with triggers – songs, scents, rituals, pressure to conform to particular social and familial expectations, increased presence of alcohol, more interactions with family/friends. For those experiencing homelessness, the holidays may also serve as a reminder of what does not exist – a home in which to celebrate, cook, decorate, and rejoice. Loss, loneliness, and shame are powerful triggers.

So what can we do?

1. Think about how the holiday season impacts you, the service provider. Are you in a frenzy, hopping from turkey donations to a sudden influx of volunteers to clients in crisis? What are your own holiday triggers? Take time to notice your own responses.

2. Ask yourself “what helps and what hurts?” As you work with clients and your team, be aware in every instance, you have an opportunity to interact in a trauma-informed way. Asking “what helps and what hurts” can be a good “gut-check.” Sure, local honor society students may want to sponsor a gift-giving drive for the kids in your program, but ask yourself: Is that what the kids (and their parents) need right now? How could we set it up so that it doesn’t feel shaming? What could we do instead?

3. Plan now. Talk with your team and clients now about what the holidays may bring up for them. By being proactive, you are being trauma-informed. Even if clients have nothing to say, you have opened the door for conversation. And by talking to your team, you can be prepared as a staff to support one another and those you serve.

4. Pay attention to nutrition and exercise. Cookies, pies, and cake – oh my! Taking care of one’s body is good self-care advice no matter the season, but with additional stress and temptation everywhere, be more mindful about eating and exercise habits. Be sure to drink plenty of water. Indulge in sweets, caffeine, and alcohol in moderation. Go for a walk. Talk with clients about these habits too, as part of routine conversations on good self-care.

5. Create meaningful rituals. This is a great opportunity to involve clients. Let them be your guide. Ask yourself how to celebrate, with your team and your program, in ways that relieve stress rather than add to it.

6. Remember the principles of trauma-informed care. Healing happens in relationships. Recovery is possible. Support client control, choice, and autonomy. Learn more here.

From all of us at the Homelessness Resource Center, we wish you a healthy, safe, and joyful holiday season.

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

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