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YOUTH in Chronically Homeless Families By Courtney Smith CURRENT ISSUES Providing Mental Health Services May 2009.

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Presentation on theme: "YOUTH in Chronically Homeless Families By Courtney Smith CURRENT ISSUES Providing Mental Health Services May 2009."— Presentation transcript:

1 YOUTH in Chronically Homeless Families By Courtney Smith CURRENT ISSUES Providing Mental Health Services May 2009

2 Presentation Background This presentation was created by Courtney Smith with major contributions from the Pediatrics Work Group of the Health Care for the Homeless Clinicians’ Network. Pediatric clinical topics were identified during a national meeting of homeless health care clinicians in 2008 –Coordination of mental health and substance abuse services for homeless youth –Provision of mental health services tailored to youth from chronically homeless families In 2009, the Pediatrics Work Group surveyed homeless health care providers in collaboration with Courtney Smith regarding the two topics listed above. This presentation is a result of those surveys. May 2009

3 YOUTH in Chronically Homeless Families Homeless Youth McKinney Vento Act Definition Individuals between birth & 18 years old who are accompanied by one or more homeless parent(s) or caregiver(s) US Department of Education. No Child Left Behind: The McKinney Vento Homeless Assistance Act (2004). Retrieved April 7, 2009 from d.gov/progra ms/homeless/ guidance.pdf d.gov/progra ms/homeless/ guidance.pdf May 2009

4 Homeless McKinney Vento Act Definition Individuals or families that lack a fixed, regular, and adequate nighttime residence US Department of Housing and Urban Development. Homeless Emergency Assistance and Rapid Transition to Housing Act of Retrieved November 9, 2009 from vtrack.us/congr ess/bill.xpd?bill =s vtrack.us/congr ess/bill.xpd?bill =s YOUTH in Chronically Homeless Families May 2009

5 Chronically Homeless McKinney Vento Act Definition Continuously homeless for a year or more or at least four homeless episodes during the last three years UD Department of Housing and Urban Development. Homeless Emergency Assistance and Rapid Transition to Housing Act of Retrieved November 9, 2009 from vtrack.us/congr ess/bill.xpd?bill =s vtrack.us/congr ess/bill.xpd?bill =s YOUTH in Chronically Homeless Families May 2009

6 WHY is this issue important? 1 in 50 American Children are Homeless Each Year National Center of Family Homelessness 2008 May 2009

7 WHY is this issue important? FAMILIES The largest subgroup of the homeless population is located in rural areas Vissing 1996 May 2009

8 Unstable living conditions Poor sleeping quarters Bug infestations Communicable diseases WHY is this issue important? Mental Health is significantly affected by… May 2009

9 Extreme poverty Food insecurity Nutrient deficiencies Inadequate clothing WHY is this Issue Important? Mental Health is significantly affected by… May 2009

10 Physical health Prevention Acute care Chronic disease WHY is this issue important? Mental Health is significantly affected by… May 2009

11 Abuse Sexual Physical Emotional WHY is this issue important? Mental Health is significantly affected by… May 2009

12 High-risk behaviors Substance use Sexual risk-taking Illegal activities Mental Health is significantly affected by… WHY is this issue important? May 2009

13 Many aspects of homelessness initiate, compound, or perpetuate the symptom frequency and severity of a wide variety of mental health issues WHY is this issue important? May 2009

14 Some Common Mental Health Diagnoses in Homeless Children Acute reaction to stress Attention Deficit Disorder Anxiety disorder Depression Insomnia Isolation Mood disorder, NOS Nightmares Post-Traumatic Stress Disorder WHY is this issue important? May 2009

15 Seven Risk Factors For Mental Illness In Children The parent… 1.Does not have a high school degree 2.Has died Masten, A., Miliotis, D., Graham- Bermann, S., Ramirez, M., & Neeman, J. (1993). Children in Homeless Families: Risks to Mental Health and Development. Journal of Consulting and Clinical Psychology. 61(2); WHY is this issue important? May 2009

16 The child has… 3.One parent 4.Experienced divorce or separation of parents 5.Been in foster care Masten, A., Miliotis, D., Graham- Bermann, S., Ramirez, M., & Neeman, J. (1993). Children in Homeless Families: Risks to Mental Health and Development. Journal of Consulting and Clinical Psychology. 61(2); WHY is this issue important? Seven Risk Factors For Mental Illness In Children May 2009

17 The child has… 6.Experienced abuse 7.Witnessed violence Masten, A., Miliotis, D., Graham- Bermann, S., Ramirez, M., & Neeman, J. (1993). Children in Homeless Families: Risks to Mental Health and Development. Journal of Consulting and Clinical Psychology. 61(2); WHY is this issue important? Seven Risk Factors For Mental Illness In Children May 2009

18 National Survey Coordination of Mental Health Services for Youth in Chronically Homeless Families A CLINICAL PRIORITY FOR : 2008 Health Care for the Homeless Clinicians’ Network Pediatrics Work Group May 2009

19 What are the current best practices in mental health services for youth from chronically homeless families? National Survey May 2009

20 Child and Adolescent Psychiatrist Clinical Manager Family Physician Housing Coordinator Licensed Social Worker Physician Assistant Public Health Nurse Social Work Intern National Survey RESPONDERS 8 Responses received from a variety of service providers: May 2009

21 1 out of the 8 care providers stated that his/her agency provides: National Survey RESULTS Mental Health Services Tailored to Youth from Chronically Homeless Families May 2009

22 2 out of the 8 providers worked in agencies that: specialized in serving homeless youth National Survey RESULTS May 2009

23 provided general mental health services that were population nonspecific or made mental health referrals for homeless youth to other agencies National Survey RESULTS The remaining 5 providers worked at agencies that: May 2009

24 Only 1 provider reported that his/her agency had recommended best practices for providing mental health services to youth from chronically homeless families National Survey RESULTS May 2009

25 Best Practices as defined by one clinical manager Providing outreach Delivering home-based services including systems involvement (e.g. schools, community, family, and peers) Utilizing motivational interviewing, dialectical behavioral therapy and cognitive behavioral therapy Practicing care on a homeless family services team National Survey RESULTS May 2009

26 Reported barriers encountered when trying to provide best practice mental health services to youth: Limited treatment time Funding Difficulty coordinating with other agencies, e.g. child protection services or schools National Survey RESULTS May 2009

27 Barriers (continued): Limited clinical capacity and training Needs outweigh resources Extended referral wait time Lack of housing vouchers National Survey RESULTS May 2009

28 Barriers faced by care providers when trying to provide recommended best practiced services Lack of specialized staff Availability of services in area Limited resources specific to youth Several of these barriers are organization- based, or due to lack of government/ agency funding. However a few of these barriers can be addressed through improved practices National Survey RESULTS May 2009

29 Funding: How are Services for The Homeless Funded? Funding Sources include: HUD : Housing and Urban Development HHS : Health and Human Services VA: Veterans Affairs Labor: US Dept of Labor Justice: US Dept of Justice The National Alliance to End Homelessness, 2008 May 2009

30 Funding: How are Services for The Homeless Funded? Local, State, and Community funding differs greatly and these differences in funding streams greatly affect the services that can be provided President Obama recently signed the Omnibus Appropriations Act of 2009 which included $75 million for Substance Abuse and Mental Health Services Administration (SAMHSA) homeless programs The legislation also included $59.7 million for the Projects for Assistance in Transition from Homelessness (PATH) program. May 2009

31 National Survey Results Barriers faced by care providers when trying to provide recommended best practiced services –Limited treatment time –Lack of funding –Lack of collaborations with other agencies (e.g. child protection services and schools) –Capacity restrictions –Long referral wait time –Lack of housing –Lack of specialized staff –Limited services specific to youth May 2009

32 Importance of Community Integration & Agency Partnerships Community integration often occurs during the transition of mentally ill individuals into other services and/or housing options This transition often requires agency partnerships that allow for care providers to work together to assist individuals transition from one program to another In order to do this a care provider does not simply discharge a youth from services once the program is complete but instead assists them into their new surroundings/services until transition is complete May 2009

33 Importance of Community Integration & Agency Partnerships Waratah Area Homeless Outreach Psychiatric Services implemented intervention to serve homeless individuals 10 years later this intervention was assessed The 3 key factors of this intervention: –engage clients in a culturally competent manner –use assertive outreach techniques –Collaboration with other agencies Results of the use of assertive outreach, integration of treatment and housing programs, along with continuous care for community integration showed significant decreases in urban and rural homelessness Homles, A., Hodge. M., Newton, B., Bradley, G., Bluhm, A., Hodges, J., Didio, L., & Doidge, G. (2005). Development of inner urban homeless mental health service. Australian Psychiatry. 13(1); May 2009

34 Importance of Community Integration & Agency Partnerships In 2004 Yanos, Barrows & Temberis looked into how the integration of homeless individuals into stable and transitional housing coincides with their integration into a community, with the hypothesis that specifically believed housing type impacted community integration significantly Results of this study found that the degree in which individuals were integrated into their new community before ending services affected mental health symptoms and relapse incidences Yanos, P., Barrows, S., & Temberis, S. (2004) Community Integration in the Early Phase of Housing Among Homeless Persons Diagnosed with Severe Mental Illness: Successes and Challenges. Community Mental Health Journal. 40(2); May 2009

35 Barriers to Care Barriers faced by care providers when trying to provide recommended best practiced services –Limited treatment time –Lack of funding –Lack of collaborations with other agencies (e.g. child protection services and schools) –Capacity restrictions –Long referral wait time –Lack of housing –Lack of specialized staff –Limited services specific to youth May 2009

36 Lack of Housing 90,889 units of emergency shelter, transitional housing, and permanent supportive housing are available for families nationwide Most people on public housing and Section 8 waiting lists are families with extremely low incomes. It is likely that many of them have experienced or are currently experiencing homelessness 38 states have state housing trust funds National Center on Family Homelessness, 2008 May 2009

37 Lack of Housing Several studies have shown that housing is a key element in reducing mental health symptoms and stabilization among the homeless population Transitional services and continuous services while housed are associated with decreases in homeless relapse and mental health hospitalization Herman, Conover, Felix, Nakagawa & Mills, 2007; Johnson, Samberg, Calsyn, Blasinsky, Landow& Goldman,1999; Yanos, Barrows & Temberis, 2004) May 2009

38 Lack of Housing Recent studies have shown that providing permanent, supportive housing for people with serious mental illnesses is more cost-effective than services currently provided by the public hospital, prison, and shelter systems Herman, Conover, Felix, Nakagawa & Mills, 2007; Johnson, Samberg, Calsyn, Blasinsky, Landow& Goldman,1999; Yanos, Barrows & Temberis, 2004) May 2009

39 Barriers to Care Barriers faced by care providers when trying to provide recommended best practiced services –Limited treatment time –Lack of funding –Lack of collaborations with other agencies (e.g. child protection services and schools) –Capacity restrictions –Long referral wait time –Lack of housing –Lack of specialized staff –Limited services specific to youth May 2009

40 Lack of Specialized Staff To better serve the homeless population, health care providers should be aware of the unique issues and risk factors faced by this population Trainings are readily available through interactive videos, group sessions, or publications to help staff provide culturally competent and tailored care to this population May 2009

41 Lack of Specialized Staff Training specialized staff should include topics on: Understanding the impact of traumatic stress and creating trauma-informed services Addressing the needs of children living in shelters Understanding the mental health needs of people who are homeless Educating staff about burnout, secondary trauma, and self-care Motivational interviewing techniques Involving consumers in program s Evaluating programs (The National Center on Family Homelessness, 2008a) May 2009

42 Barriers to Care Barriers faced by care providers when trying to provide recommended best practiced services –Limited treatment time –Lack of funding –Lack of collaborations with other agencies (e.g. child protection services and schools) –Capacity restrictions –Long referral wait time –Lack of housing –Lack of specialized staff –Limited services specific to youth May 2009

43 Availability of Services & Limited Resources Regaining stability is key to treating mental illness of youth from chronically homeless families Services and resources can be limited due to staffing, funding, or grant restrictions. Collaborations with other agencies can ease these restrictions and pool resources to provide services such as: housing, physical and mental health care, and counseling May 2009

44 Availability of Services & Limited Resources Evaluation of a 5-year intervention, Access to Community Care and Effective Services and Supports (ACCESS) program utilized across 18 sites ACCESS program promoted Aggressive Community Treatment (ACT) for homeless individuals with mental illness Through community collaborations in each site, the ACCESS programs offered advocacy, outreach, medical evaluation, prescriptions, medication maintenance, housing assistance, entitlement, and budgeting services to this population Johnson, M., Samberg, L., Calsyn, R., Blasinsky, M, Landow, W., & Goldman, H. (1999). Case Management Models for Persons Who are Homeless and Mentally Ill: The ACCESS Demonstration Project. Community Mental Health Journal. 35(4); May 2009

45 Availability of Services & Limited Resources A similar study was done in 2008 on the use of resources collaboration across agencies to provide the homeless mentally ill population was more resources The results showed that integrated services were associated with an increased use of outpatient services for medical, mental, and substance abuse treatment Mares, A., Greenberg, G., & Rosenheck, R. (2008) Client- level Measures of Service Integration Among Chronically Homeless Adults. Journal of Community Mental Health. 44; May 2009

46 Recommendations & Further Research Due to the limited survey responses, further research is recommended on best practices used by agencies to provide mental health services to homeless youth from chronically homeless families Also more research is recommended regarding services provided in rural areas May 2009

47 Recommendations & Further Research After further investigation into the topic of mental health services provided and best practices for youth from chronically homeless families it is suggested that a resources guide book be published for national service providers to utilize as a training and references tool There is a lack of research on this particular population due to the transient nature of homeless families and the difficulty of standardizing research among different types of homelessness; further research on a national and local level is necessary in order to find the best way to serve this population May 2009

48 Resources The National Center on Family Homelessness –America’s Youngest Outcast: State Report Card on Child Homelessness The National Health Care for the Homeless Council Homeless Children’s Network Coalition on Human Need National Alliance to End Homeless Children’s Defense Funds National Network for Youth PolicyLink National Center for Healthy Housing Voices for America’s Children May 2009

49 References Erikson, E. H. (1956). The problem of ego identity. Journal of the American Psychoanalytic Association. 4, Haley, N., Roy, E., Leclerc, P., Boudreau, J.F., Boivin, J.F. (2004). Characteristics of adolescent street youth with a history of pregnancy. Journal of Pediatric and Adolescent Gynecology, 17, Health Care for the Homeless Clinicians’ Network. (2008). Adapting Your Practice: Treatment and Recommendations on Reproductive Health Care for Homeless Patients. Retrieved February 18, 2009, from Herman, D., Conover, S., Felix, A., Nakagawa, A., & Mills, A. (2007). Critical Time Intervention: Models for Preventing Homelessness in High Risk Groups. Journal of Primary Prevention. 2; Homles, A., Hodge. M., Newton, B., Bradley, G., Bluhm, A., Hodges, J., Didio, L., & Doidge, G. (2005). Development of inner urban homeless mental health service. Australian Psychiatry. 13(1); Johnson, M., Samberg, L., Calsyn, R., Blasinsky, M, Landow, W., & Goldman, H. (1999). Case Management Models for Persons Who are Homeless and Mentally Ill: The ACCESS Demonstration Project. Community Mental Health Journal. 35(4); Mares, A., Greenberg, G., & Rosenheck, R. (2008) Client-level Measures of Service Integration Among Chronically Homeless Adults. Journal of Community Mental Health. 44; May 2009

50 References (continued) The National Alliance to End Homelessness. (August 2008) Understanding How HUD and SAMHSA programs Work Together. Retrieved on April 9, 2009 from The National Center of Family Homelessness. America’s Youngest Outcasts: State Report Card on Child Homelessness. (2008). Retrieved on April 7, 2009 from The National Center of Family Homelessness. Training. (2008a). Retrieved on April 7, 2009 from United States Department of Education. No Child Left Behind: The McKinney Vento Homeless Assistance Act (2004). Retrieved April 7, 2009 from United States Department of Housing and Urban Development. Homeless Emergency Assistance and Rapid Transition to Housing Act of Retrieved November 9, 2009 from Vissing, Y. Out of Sight, Out of Mind: Homeless Children and Families in Small Town America, The University Press of Kentucky; Lexington. Yanos, P., Barrows, S., & Temberis, S. (2004) Community Integration in the Early Phase of Housing Among Homeless Persons Diagnosed with Severe Mental Illness: Successes and Challenges. Community Mental Health Journal. 40(2); May 2009


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