Presentation on theme: "Addressing Trauma in Homeless Children & Youth"— Presentation transcript:
1Addressing Trauma in Homeless Children & Youth Presented by:Shelley Johnson, Executive Director, Partners to End HomelessnessEric Wood, LPC, MS State Hospital, Rise Above for Youth
2Partners to end homelessness Collaboration of 40+ homeless service agencies, advocates, and for-profit entities with a mission of preventing and ending homelessness in central Mississippi.Monthly membership meetingsAnnual Point-In-Time Count (homeless census)Service Gap Analysis and Best Practice ImplementationsOne of 3 Continuums of Care recognized in Mississippi serving Hinds, Madison, Rankin, Warren & Copiah CountiesOversees $1.7 million in HUD funding to area shelters for supportive housing servicesProvides access and administration of the Homeless Management Information System (HMIS) for the communityEvaluates the integrity and efficacy of funded programsOperates a 15 bed women & children’s shelter in JacksonRental & Utility Assistance to Prevent Homelessness and Re-house homeless individualsHotel Vouchers, Transportation and Mental Health Service supportTransportation for Homeless individuals – beginning in January 2015 through Wellsfest funding
3Contributing factors to homelessness Evaluating the economic factors contributing to homelessness and supports in place for those who need them helps us to better understand issues facing those we serve.Traumatic events occur within our community members prior to homelessness including food insecurity, housing instability, community and domestic violence, developmental disabilities, substance abuse and child abuse/neglectHomeless episodes only serve to exacerbate existing issues that preceded them.
4Health and family living Teen birth rate per 1,000: 55Children living in single parent families: 46%Children in foster care: 3,582Percent of children in immigrant families: 3%Number of grandparents raising grandchildren: 87,717
6Poverty in Mississippi Child poverty rate: 35%Senior poverty rate: 18%Women in poverty: 23.9%Percent of single-parent families with related children that are below poverty: 47%Economic well-beingPoverty rate: 24.2%Extreme poverty rate: 10.2%Unemployment rate: 9%Food insecurity: 20.9%Low-income families that work: 43.6%Minimum Wage: N/APercent of jobs that are low-wage: 35.5%Percent of individuals who are uninsured: 19%
7EDUCATIONEducationIndividuals with a high school diploma/equivalent: 81%Individuals with a four year college degree: 20.7%Teens ages 16 to 19 not attending school and not working: 13%Percent of college students with debt: 57%High school graduation rate: 63.8%
8Families accessing federal programs Adults and children receiving welfare (TANF): 23,290Children receiving food stamps (SNAP): 284,000Households receiving federal rental assistance: 62,074Families receiving child care subsidies: 10,400Participants in all Head Start programs: 30,329Number of children enrolled in Medicaid and CHIP: 550,703Number of women and children receiving WIC (Women, Infants and Children supplemental nutrition program): 91,652Households receiving LIHEAP (Low Income Home Energy Assistance Program): 65,526
11housing Housing Total households: 1,085,062 Justice System Renters: 29%Households paying more than 30% of income on housing: 142,518Homeless people: 2,413Home foreclosure rate: 2.33%Justice SystemNumber of youth residing in juvenile justice and correctional facilities: 413Total incarcerated (prison and jail): 22,319
12-Zenobia Embry-Nimmer “Homelessness is severe trauma. It stays with you the rest of your life. In the two years I was homeless, the main thing that was reinforced within me was that I was not worthwhile, that I did not belong, not only to the community, but maybe even to humankind.”-Zenobia Embry-NimmerParenting and Public, 2000
13Homeless familiesFamilies are the fastest growing segment of the homeless population, now accounting for almost 40 percent of the nation’s homeless.Typical Homeless Family: Single mother in her late 20s with two-three young children – usually preschoolers.More than 90% of sheltered and low-income mothers have experienced physical and sexual assault over their lifespan.At least 1.35 million children are homeless during a year’s time.42 percent of children living with homeless parents are under the age of 6.Homeless babies show significantly slower development than other children do.More than one-fourth of children under age 5 suffer from depression, anxiety, or aggression after becoming homeless.2Less than one-third of homeless children who need help for their emotional problems are receiving it.Unless otherwise specified, statistics were derived from the National Center on Family Homelessness.
14Effects of homelessness FOR THE FAMILYLoss of community, routines possessions, privacy and securityFeeling more vulnerable to other forms of trauma such as physical and sexual assault, witnessing violence, or abrupt separation.Exacerbates other trauma-related difficulties and interfere with recovery due to ongoing traumatic reminders and challenges.HOMELESS CHILDRENAre sick at twice the rate of other childrenGo hungry twice as often as non-homeless childrenMore than 1/5 of preschoolers have emotional problems serious enough to require professional care, but less than 1/3 receive any treatmentAre twice as likely to repeat a gradeTwice the rate of learning disabilities and three times the rate of emotional and behavioral problemsHalf experience anxiety, depression, or withdrawal compared to 18% for their peersBy the time they are 8 years old, 1 in 3 has a major mental disorder
15Homeless youth in America – the data Between 6% and 22% of homeless girls are estimated to be pregnant [Health Resources and Services Administration, 2001]46% of runaway and homeless youth reported being physically abused; 38% reported being emotionally abused; 17% reported being forced into unwanted sexual activity by a family or household member [Department of HHS, 1997].75% of homeless or runaway youth have dropped out or will drop out of schoolBetween 20% and 40% of homeless youth identify as LGBT.
16Homeless youth in America – the data Between 1.6 and 2.8 million youth runaway and/or are homeless in a year [Office of Juvenile Justice and Delinquency Prevention, 2002; Research Triangle Institute, 1995].5% to 7% of American youths become homeless in any given year [NAEH, 2007].Unaccompanied youth account for 1% of the urban homeless population [U.S. Conference of Mayors, 2007].Youth age are more at risk of homelessness than adults [The Prevalence of Homelessness Among Adolescents in the United States, 1998]Homeless youth are evenly male-female, although females are more likely to seek help through shelters and hotlines.
18Mental health and homelessness 20 to 25% of the homeless population in the United States suffers from some form of severe mental illnessWhereas only 6% of all Americans suffer from a severe mental illnessMen tend to be at a greater risk for homelessness than womenAfrican American’s are at greater risk for homelessness than other ethnic groupsThat’s 1 in 5 to 1 in 4 homeless people suffering from a mental illness. Some attribute the rise in the homeless population with mental illnesses to theChanges in mental health services provided here in the US. We experienced a large deinstitutionalization in our country and changes in the managed health care system have put caps on the # of sessions, amount of $$ spent, limits the ability for people to remain in long term care in hospitals.
19Barriers to treatmentPoverty. Basic needs such a food, clothing, shelter, or transportation supersede the need for treatmentMay lack proper documents to obtain government assistance (address, ID, birth cert. etc. )Face double stigma of being Homeless and having a Psychological DisorderTheir disorder may impede their ability to ask for help or connect with local resourcesHomeless individuals who are suffer from a serious mental illness face special barriers to treatment, as many of you know
20Mental health issues for homeless children/youth
21A service provider’s perspective of issues within our CURENT community system School district responsibilities to maintain school district designation regardless of shelter site.The role of homeless liaisons within school districtsSplitting familiesWomen & Children or Men’s Shelters (no options for in-tact families)Men with ChildrenShelter policiesFocus on Mom/Parent – not attending to issues facing children affected by homelessnessRequirement to vacate shelter during daytime hours (emergency/transitional)Inability to obtain employment beyond 5pmLack of mental health resources for children/youthLack of childcare resourcesFew safe places for homeless youthMandated Reporting/Child Welfare involvementReturning youth to abusive householdsLack of substance abuse treatment options for homeless individuals
22System based solutions Transportation to maintain school district – offering stability for students who experience homelessnessThe use of Rapid Re-housing for families experiencing homelessnessModified policies for shelters (flexibility for jobs outside standard business hours and options to stay on-site during the day)Prioritize child care vouchers/placements for homeless families – increase available resources.Develop additional resources for runaway/homeless youthEmergency ShelterLong-term transitionImprove access to transitional programs out of foster careFocus on both the parents and children and evaluating the needs for mental/physical health and wellbeing.Shelters partner with treatment centers for partial/outpatient programming – providing housing at shelter sites, but attending treatment based programming during the day.Long term planning and support to reduce/eliminate homelessness recidivism.Proactive homeless prevention through service providers, schools, and counselors.
24Becoming Trauma Informed This means all staff are aware of the high incidence rate of traumatic exposure that patients have experienced, that we understand the impact of trauma, and that we understand the importance of avoiding re-traumatizationWhat Happened to you? vs What’s Wrong With You?We have to HAVE TO HAVE TO engage in self care and be willing to ask for helpWe are all human and others humans are going to evoke emotional responsesOur goal as health care providers needs to include managing those responses in a way that we can always keep in mind that we get to leave at the end of a shift, even if it’s a double shift. We need to avoid causing any harm to our patientsMOST IMPORTANT We can talk about all of this now but what happens when we get on a unit and our peers or supervisors don’t share our vision? We need to make the right choice for patient care that is in accordance with policy and patient preservation. ABOVE ALL IF WE MAKE CHOICES WITH A FRAME OF MIND THAT IS TRAUMA INFORMED WE ARE MAKING THE BEST CHOICESWhat is right is not always popular and what’s popular is not always right
25Complex Trauma“The term complex trauma describes both children’s exposure to multiple traumatic events, often of an invasive interpersonal nature, and the wide-ranging, long term impact of this exposure. These events are severe and pervasive, such as abuse or profound neglect. They usually begin early in life and can disrupt many aspects of the child’s development and the very formation of self. Since they often occur in the context of the child’s relationship with a caregiver, they interfere with the child’s ability to form a secure attachment bond.” - Complex Trauma: Facts for Service Providers working with Homeless Youth and Young Adults, June 2014
26Common trauma experienced by homeless children and youth Child physical and sexual abuse and neglectWitnessing violence at home between parents or caregiversRemoval from home by child protective servicesIncapacitation of parents due to mental illness, substance abuse, or incarcerationWitnessing community violenceExperiencing violence in their own relationshipsHarassment or violence due to homelessness, sexual orientation, and/or gender identityPhysical and sexual assault on the streetIncarcerationEngaging in survival sex or prostitution.
27Common Responses to trauma Difficulties sleeping and/or eatingInability to concentrate or complete everyday tasksFeelings of inadequacy and guiltPreoccupation with their bodiesStomach aches, headaches, and other multiple health complaintsActing out or impulsive behaviors, including unsafe sex, multiple sexual partners, substance abuse, or illegal activitiesBullying or intimidation of peers or staffBehaving as if they were younger than they actually areImpulsive and aggressive behaviorsHeightened moodiness and irritabilityPushing away caregivers
28Infant mental health“Infant mental health is the developing capacity of the child from birth to three to: experience, regulate, and express emotions; form close and secure interpersonal relationships; and explore the environment and learn—all in the context of family, community, and cultural expectations for young children. Infant mental health is synonymous with healthy social and emotional development.”Healing Hands, June 2005
30The effects of trauma on the brain “Brain development can literally be altered by toxic stress, resulting in negative impacts on the child’s physical, cognitive, emotional and social growth.” Child Welfare Information Gateway, November 2009 “[In] Babies who do not get responses to their cries, and babies whose cries are met with abuse…the neuronal pathways that are developed and strengthened under negative conditions prepare them to cope in the negative environment and impair their ability to respond to nurturing and kindness.” Shonkoff & Phillips, 2000 “Maltreatment may permanently alter the brains ability to use serotonin, which helps produce feelings of well-being and emotional stability.” Healy, 2004
32Long term effects of abuse and neglect Diminished growth in the left hemisphere, which may increase the risk for depressionIrritability in the limbic system, setting the state for the emergence of panic disorder and posttraumatic stress disorderSmaller growth in the hippocampus and limbic abnormalities, which can increase the risk for dissociative disorders and memory impairmentsImpairment in the connection between the two brain hemispheres, which has been linked to symptoms of attention-deficit/hyperactivity disorder.Teicher M.D., 2000
35Characteristics of individuals that thrive after homelessness and trauma ResiliencyDeterminationHaving meaning and purpose to lifeSelf - CareAccepting help from others
36Characteristics of resiliency Ability to adopt new behaviorsDeveloping a sense of self esteem and self efficacyUsing painful experiences as a learning platform for transformationAttitudinal and Behavioral Shifts from negative to positive life trajectoryLess engagement in high risk behaviorsLearning to recognize ones own needs and how to meet them constructively
37DeterminationDetermination – Building Self Confidence and Self SufficiencyTenacity and Persistence in attaining goalsInner StrengthPride in making it through adversityService providers can foster determination by providing opportunities for youth to demonstrate this characteristic. Exerting determination to turn their life around, an individual’s life experiences reinforce their own efforts. The process of becoming more resilient is self reinforcing.
38Having a meaning and purpose to life Seeing how an individual fits into the bigger pictureCommitment to serve the community vs. what one can get or what is “owed” to them.Hope coupled with gratitude as indication of resilienceGratitude for opportunities to learn and grow from adversity can foster a sense of optimism which is indicated by interest in further education and assisting those who have suffered from similar fates
39Self CareLearning specific behaviors and adopting attitudes that enhance self careTaking care of oneself physically, emotionally, mentally and spirituallyFinding constructive ways to get ones needs metAssertively protecting oneself when needs are being blockedDecision making becomes a source of prideAcknowledging ones own needs can lead to a deeper sense of self acceptanceRealizing Self Care can be a gradual processKeeping a journalLearning to speak up for oneselfSelf protection includingSetting personal boundariesDistancing self from unhealthy relationshipsDeveloping effective problem solving skills greatly contributes to development of resiliencyWeighing pros and consLooking at things in more than one wayListing options out
40Accepting help from others Readiness for helpOpenness to allowing helping individuals into their lifeReaching a point of receptivityActively seeking helpBeginning to trust safe people over timeHow professionals can foster readinessAcknowledge the need to transition from street homelessness into housingSeeking and utilizing shelter and other services is a CHOICE to be anticipated, rather than a immediate outcome.Acknowledge the strength, courage, skill and determination it takes to survive as a homeless youth.Offer tailored, less restrictive, minimally invasive and strength based services
41Program vs. person centered treatment Program Centered: used to be the norm – in this format patients were expected to conform to program expectations and patient failures were viewed as indications that the patient was not “ready” for treatment (i.e., car assembly line)Person-centered treatment: accepts the patient’s own goals as the basis for the treatment contract and builds on the patient’s strengths and preferences to advance treatment objectives (e.g., build a hot rod).(Sharp, Traunstein & Redditt, 2012) Van Dyke ATC Training
42Person centered programs Autonomy vs. DependenceMeeting basic needs before therapeutic needs (Housing First)Crisis RemediationSafe ShelterFoodClothingMedical Care (*Kidd 2003)
43Outcomes from highlighted practices Being able to model healthy relationships with peersAddresses isolationCan contrast from previous negative experiences and destructive patterns.Identifying, engaging and sustaining healthy personal boundariesTransformed self image
44Quality Professionals/Programs Nature of the Program – addressing comprehensive needs of the individualCaring Consistently over time and in a variety of waysDeveloping a level of trust in relationshipsSustained commitment to the individual and outcomesAccess to experiences that allow one to develop self esteem and self efficacyQuality ProfessionalsFidelity to the Nature of the Program (3 points above)A source for comfort as well as guidanceDeveloping a model for healthy relationships that can be employed with peersRespectful confrontationStrength based perspective and knowing progress is often not a linear patternBELIEVE in the promise of change and potential in the populationUNDERSTAND that life is a developmental processDEEPEN your understanding of the healing power of relationships
45Effective interventions for homeless youth Recognition of the unique culture of homeless youthMust be culturally competentRecognizing trust, power and control strugglesShame – diminished understanding of self-careEmpowering Treatment ModelGoalsRestoration of safety and control – first goal of treatmentAssist to develop trustExercise control of ones own lifeDecrease ShameIncrease self care self esteem“The greatest need of any traumatized individual is to feel safe, and this often requires attention to various practical dimensions” Wilson,Freeman, Lindy 2001 p. 247.
46Steps for Pre-engagement with homeless youth Pre-engagement (Outreach)Establishing communication and trust between youth and providerMake the first contact warm, respectful, and non-threateningAttending to the immediate needs of youth by offering basic items such as food, clothing and hygieneConvey respect of boundaries, empathy and genuine desire to be of assistanceIdentify and introduce service options that convey an understanding of needs relevant to the youth homeless populationBuilding of rapport assists in the transition to full service engagement
47Engaging homeless youth Engagement - The worker collaborates with the youth to identify strengths, goals, and solutions.Rapport can be established and maintained by:Allowing youth to choose the subject and direction of the conversationFocusing on StrengthsNot rushing the client to make change or long term plans.Emphasis should be on fostering a sense of control, autonomy, and self efficacy.Be prepared to repeat this introductory information to youth many times. As they feel safer, they may be able to hear more of what you have to offer.Be prepared for them to challenge you or the rules.May lead to implementing contract and goal setting
48training All providers should all receive training including: Homeless youth cultureLGBTQ cultural competencyCrisis intervention modelTrauma informed careMotivational Interviewing
49Self care for provider – compassion fatigue “There is a cost to caring” – Charles FigleyBe Aware of the Signs:Increased irritability or impatienceDecreased concentrationDenying that traumatic events effect clients or feeling numb or detachedIntense feelings and intrusive thoughts, that don’t lessen over time, about a client’s traumaDreams about client traumaGuard against isolationGet support by working in teamsAsk for support from administrators and colleaguesRecognize compassion fatigue as an occupational hazard – not a weakness or incompetence – it is the cost of caringSeek help with your own traumaTalk to a ProfessionalAttend to self care
50What you can do Advocate Participate Volunteer Medicaid Expansion – expands resources for underserved populations. Many states utilize Medicaid funding for supportive services for homeless families and youth.MS Interagency Council on Homelessness – Bringing all parties to the table addressing homelessness – Bill passed in 2012 – Awaiting Government action to implementFor LGBTQ inclusive policies in your facility/organization. Ensure policies are in place that include culturally competent approaches to care.For training for all law enforcement agencies. Help first responders to better understand the complex needs of homeless individuals and families.For expanded training opportunities within your organization.ParticipateJoin your local Continuum of CareGet to know your Homeless Liaisons at your local school districtExpand the community resource list by sharing your knowledge of mental health resources available at little or no cost for homeless families/youth.VolunteerWithout critical resources, many agencies don’t have the funding to attend to the needs of children and youth in their programs. Offer time to provide trauma informed care to children and youth in local shelters
51National Advocacy, Research, Policy and Best Practice Resources The National Child Traumatic Stress NetworkNational Coalition for the HomelessUrban InstituteNational Resource Center on Homelessness and Mental IllnessNational Law Center on Homelessness and PovertyChildren’s Defense FundHealth Care for the Homeless Information Resource CenterNational Healthcare for the Homeless CouncilNational Network for YouthNational Alliance to End HomelessnessTrue Colors Campaign (LGBTQ homeless youth)Forty To None Project (LGBTQ homeless youth)Center for the Study of Social Policy – Youth Thrive Project (improving outcomes for youth in care)The National Law Center on Poverty and Homelessness
52Speaker Contact InformationShelley Johnson, Executive Director, Partners to End HomelessnessEric Wood, LPC, MS State Hospital & Rise Above for Youth
53Save the date – October 18th Duling Hall, 7pm-11:30pm – Tickets $35 available at the door or via**Dress in your 70s Best***