Homelessness as psychological trauma: Broadening perspectives

2019

The health and behavioral health consequences of childhood trauma FACT SHEET February 2019 Purpose This fact sheet was developed by the National Health Care for the Homeless Council and the National Network to End Family Homelessness, an initiative of The Bassuk Center on Homelessness and Vulnerable Children and Youth. The purpose is to ensure clinicians working with people experiencing homelessness understand the role of Adverse Childhood Experiences (ACEs) in health outcomes as well as the options for responding. ACEs and Health Risks Childhood trauma compromises neurological development and increases risk for immediate and long-term adverse health outcomes. The term ACEs originated in a 1998 Centers for Disease Control and Prevention and Kaiser Permanente study that documented significant associations between ACEs and negative health outcomes. In that study, 10 family-level ACEs were explored, and findings showed a graded relationship between the number of ACEs with health and behavioral health outcomes in adulthood.

Child abuse & neglect, 2018

Previous studies that have explored the association between childhood trauma and homelessness indicate that traumatic events can lead to survivor distrust of interpersonal relationships and institutions, prolonged homelessness and poor health and social outcomes. The majority of this literature relies on quantitative data and fails to investigate the personal experiences of childhood trauma that are found to impact housing status later in life. Semi-structured, qualitative interviews were conducted with 25 men living in an urban area in Ontario who had spent more than 30 consecutive nights in an emergency shelter over the course of their housing histories. During data analysis, it was observed that all of the men had experienced some form of trauma or neglect in childhood which contributed to their entries into homelessness. Using a case study approach, three entry pathways into long term homelessness are described: 1) youth; 2) emerging or early adulthood; and 3) middle adulthood. ...

2015

Journal of Counseling Psychology, 1996

Stressful experiences and their effects on the psychological well-being of 113 homeless women and 116 low-income housed women were investigated. Measures of victimization assessed multiple dimensions of this construct, including criminal victimization, sexual harassment, and sexual abuse. Measures of current daily environmental hassles and quality of family environment while growing up also were included. Additional measures assessed positive and negative interpersonal exchanges, sense of coherence, and overall psychological distress. Regression analyses indicated that victimization experiences were significant predictors of psychological well-being for both samples. Results also highlighted the importance of investigating both the positive and negative dimensions of interpersonal influences as well as internal resources, and suggested that these resources for coping with stress may be differentially perceived and utilized by these groups. These findings also suggest the need for specific preventive and remedial interventions to empower homeless and low-income housed women. Homelessness has been viewed as a problem to which the resources available to psychologists are particularly applicable. The APA Council of Representatives (1991) stated that the problem of homelessness is in need of attention from psychologists for a number of reasons, including the

The Open Health Services and Policy Journal, 2010

It is reasonable to assume that individuals and families who are homeless have been exposed to trauma. Research has shown that individuals who are homeless are likely to have experienced some form of previous trauma; homelessness itself can be viewed as a traumatic experience; and being homeless increases the risk of further victimization and retraumatization. Historically, homeless service settings have provided care to traumatized people without directly acknowledging or addressing the impact of trauma. As the field advances, providers in homeless service settings are beginning to realize the opportunity that they have to not only respond to the immediate crisis of homelessness, but to also contribute to the longer-term healing of these individuals. Trauma-Informed Care (TIC) offers a framework for providing services to traumatized individuals within a variety of service settings, including homelessness service settings. Although many providers have an emerging awareness of the potential importance of TIC in homeless services, the meaning of TIC remains murky, and the mechanisms for systems change using this framework are poorly defined. This paper explores the evidence base for TIC within homelessness service settings, including a review of quantitative and qualitative studies and other supporting literature. The authors clarify the definition of Trauma-Informed Care, discuss what is known about TIC based on an extensive literature review, review case examples of programs implementing TIC, and discuss implications for practice, programming, policy, and research. (Marra). Many of these programs sent unpublished program evaluation reports, manuals, or self-assessment tools, for inclusion in this review.

Physical and Emotional Abuse: Triggers, Short and Long-Term Consequences and Prevention Methods, 2013

Childhood abuse has multiple negative impacts on lifetime development. Increased levels of psychiatric problems are well documented, in particular personality disorder and substance abuse. Furthermore, effects can be long lasting and heavily influence the life course of the abused individuals. It is therefore perhaps not surprising that homeless adult populations in industrialised countries tend to report high levels of childhood physical and sexual abuse. Studies of homeless individuals can shed light on the socioeconomic consequences of severe childhood abuse. Furthermore, they provide insights into the impact of such abuse on mental health in a population in which levels of abuse and mental illness are both high. From a systematic analysis of case notes and clinical interviews, we have collected data on 217 homeless adults in the city of Sheffield, England. More than one in four homeless individuals reported levels of physical abuse or sexual abuse during their childhoods, and levels of psychiatric illness were high, particularly schizophrenia and personality disorder. Furthermore, histories of abuse were found to be associated with being female and with having been raised in local authority care. In adulthood, sexual abuse was associated with personality disorder; whereas, physical abuse was more linked with self-harm. The results reveal a complex picture of psychosocial problems linked to childhood trauma among many homeless adults.

Transcultural Psychiatry

Exposure to violence, vulnerability due to lack of shelter, alienation due to stigma, the experiences of severe mental illness (SMI) and subsequent institutionalization, make homeless persons with SMI uniquely susceptible to trauma exposure and subsequent mental health consequences. This study aims to contribute to the development of culturally sensitive interventions for identifying and treating trauma in a population of homeless persons with SMI in Tamil Nadu, India by understanding the manifestations of trauma and its associated consequences in this population. Free-listing exercises followed by in-depth interviews were conducted with a convenience sample of 26 user-survivors who have experienced homelessness or were at risk of homelessness, and suffered from SMI. Topics explored included events considered to be traumatic, pathways to trauma, associated emotional, physical and social complaints, and coping strategies. Results indicate discrepancies in classification of traumatic ...

Community Mental Health Journal, 2007

Using the National Survey of Homeless Assistance Providers and Clients (NSHAPC), we found that among homeless mothers (n = 588), those living without their children were more likely to: be older than 35 years, unmarried, have been incarcerated, have been homeless for at least 1 year, and to have used psychiatric medication. Many homeless mothers had histories of childhood trauma, but it was the accumulation of adulthood traumas that was associated with not living with oneÕs children. Without mental health treatment, younger homeless mothers living with their children today may become the homeless mothers living without their children in the future.

Health & Social Work, 2010

This study examined the impact of physical and sexual trauma on a sample of 239 homeless men. Study participants completed a self-administered survey that collected data on demographics, exposure to psychological trauma, physical health and mental health problems, and substance use or misuse. Binomial logistic regression analyses were used to examine the relative significance of demographic factors and the four types of trauma exposure associated with three outcomes: mental health, substance abuse, and physical health problems. The authors found that trauma history was significantly associated with more mental health problems but was not associated with substance abuse problems for homeless men. This study reinforces service providers' perceptions that because many homeless men experience the long-term, deleterious effects of not only current stressors, but also abuse and victimization that often begin in childhood, homeless men are a subpopulation in need of proactive prevention services that emphasize long-term continuity of care rather than sporadic crisis-based services. Study findings suggest that mentally ill, homeless men need proactive services that address the sequelae of abuse with care that is specialized and distinctly different from care for homeless adults with substance abuse or physical health care issues.

Open Journal of Psychiatry, 2014

BACKGROUND: Symptoms of Post-Traumatic Stress Disorder (PTSD) have often been found in studies on homeless people, due to high rates of traumatic experiences. Most research on homelessness has been conducted in North America and Western Europe. However there are many social and cultural factors which can impact the prevalence and number of PTSD symptoms. AIMS: This study sought to determine the prevalence and predictors of trauma and PTSD symptoms among homeless adults in an Eastern European nation (Poland). METHOD: Randomly chosen residents of shelters were interviewed (N = 200). The respondents were asked about symptoms of PTSD, alcohol abuse/dependence, depression symptoms and perceived social support. RESULTS: The data indicated that 30% of the homeless sample were victims of traumatic events, 22% showed at least one PTSD symptom, and 7% met criteria for a lifetime diagnosis of PTSD. Symptoms of PTSD were the most common among those who had symptoms of alcohol abuse/ dependence and depression. CONCLUSION: The study's findings support the need to attend to mental disorders such as PTSD when addressing the array of needs of homeless people.

Polymer Journal, 2018

The overall purpose of the present study is to contribute to a better understanding of the experiences of young homeless women residing at Covenant House New York, a youth shelter that provides crisis and long-term residential programs to young adults ages 18-21. The main objective was to identify past life events and their contributions to the development of positive traits and psychopathology among three groups. The participants were 162 homeless young women, including childfree women, young mothers enrolled at a transitional living Rights of Passage program (12-18 months), and young mothers in crisis enrolled in a 30-day Mother and Child Crisis program. Past life experiences were identified via the Effort to Outcome (ETO) online software database maintained by Covenant House New York. Rates of psychopathology were measured using the IIP (interpersonal problems), PHQ-9 (depression), GAD-7 (anxiety), PSS (parental stress) while rates of positive traits were measured using the SCS (selfcompassion), SCBCS (compassion toward others), and PGIS (motivation to change). The results indicated that all participants, regardless of group affiliation, had similar life experiences, though childfree women were more likely to have a history of abandonment, physical abuse, and previous incidents of homelessness. Additionally, presence of abuse history was positively associated with development of psychopathology. As expected, history of sexual abuse was negatively associated with self-compassion, but it was positively associated with compassion toward others. Mothers at the Mother and Child Crisis program had greater rates of selfcompassion than mothers at the Rights of Passage program, and childfree women were more likely than the mothers to be compassionate toward others. Mothers at the Mother and Child Crisis program were also more likely to be compassionate toward others than mothers at the Rights of Passage program. Childfree women, however, were more likely to be depressed than mothers at the Mother and Child Crisis program. i TABLE OF CONTENTS List of Tables iv Chapter I INTRODUCTION AND LITERATURE REVIEW Pathways to Homelessness The sheer number of homeless youth has increased within the last decade (Saulny, 2012). Adolescents and young adults become homeless for various reasons. Though research in this area has been limited some investigators have tried to pinpoint the major causes of homelessness in youth. This is especially pertinent for women under the age of 35 who seem to be at an increased risk for homelessness (Lehmann, Drake, Kass, & Nichols, 2007). According to Aratani (2009), around one and a half million youth end up being homeless each year. While this age group may be at the highest risk for homelessness, it has been studied the least among the homeless population at large (Toro, Lesperance, & Braciszewski, 2011). The above-referenced number includes those that have spent at least one night away from their home without parental permission, those that were asked to leave their home, and those that are unable to return home due to family conflict or lack of contact with their families (Aratani, 2009). There have been numerous attempts to categorize this population. The most common definition is comprised of four groups: "runaways"those who left their parental home by choice usually to escape abuse; "throwaways"those who were ejected from the home by their parents due to familial dysfunction or youth behavior; "street youth"those who are involved in drug dealing, prostitution, and other risky behaviors; and "systems youth"those who aged out of foster care and are now homeless (Toro et al., 2011).

Journal of Adolescence, 2007

In the present report we describe patterns of traumatic events and Post-traumatic Stress Disorder (PTSD), both partial and full, among homeless youth and those at risk for homelessness, with an emphasis on gender differences. Participants were 85 homeless and at-risk youth (49% female) recruited from a dropin center in New York City in 2000. Youth completed a structured interview lasting 1.5 h. Rates of childhood maltreatment were substantial. Further, almost all youth experienced at least one traumatic event, with most experiencing multiple types of trauma. Gender differences were found in the types, but not prevalence or magnitude, of childhood maltreatment and traumatic events experienced. Partial symptomatology of PTSD was common for females but not males. Symptoms of depression and anxiety were found to co-occur with PTSD for females, which may complicate treatment efforts. Further investigation of the impact of trauma on homeless males is needed. r

1985

Homelessness is a significant social problem in the United States and it has been estimated that there may be as many as 2.5 million homeless people in this country today. For these people, pf-erty, substance abuse, and harsh living conditions may further contribute to the development of physical and mental health problems. A study was conducted to evaluate the mental and physical health needs of the homeless, with future goals of using the results in policy development by state agencies. Residents (N=75) of four temporary shelters in a large urban area were given a non-intrusive physical exam by a nurse. Nurses also gathered information on health-related behaviors, self-reported problems, and psychiatric hospitalization history. A social worker administered a self-report psychological symptom scale and gathered background and demographic information. The results indicated that the homeless, while a very heterogeneous population, suffered from signiEcant health problems which were compounded by a limited access to adequate and affordable health care. Many reported significant histories of psychiatric problems or current psychological distress. Mental and physical health problems may be exacerbated by alcohol or drug dependencies, environmental stresses, and victimization by criminals. These findings suggest the prevalence of a wide range of health problems among this homeless group. It is likely that the hard-core homeless, who live on the street and do not use shelters, experience even more extensive health problems. (NB)

American Journal of Community Psychology, 1992

Contrasts person-centered and structural explanations for homelessness. Methodological problems in studies of homeless people tend to exaggerate the role of individual deficits as causes of homelessness. A review of data on the distribution of poverty and of inadequate and unaffordable housing, with special emphasis on families, suggests the importance of structural causes. Data from 700 families requesting shelter and 524 families randomly drawn from the public assistance case load in New York City provide more support for a structural than for an individual deficit model Individual demographic factors are also important. Implications are drawn for research and action by psychologists. What are the causes of homelessness? This question begs several others.

Journal of Social Issues, 1990

Research on homelessness has tended to focus on problems of homeless individuals, sometimes diverting attention from underlying causes and reinforcing stereotypes about the population. A more comprehensive model of homelessness would include factors at the levels of individuals, social groups, and the socioeconomic context that contribute to homelessness. Papers in this issue investigate key factors at each of these levels. They consider the scope of homelessness and the history of society's responses, individual problems as both consequences and causes of homelessness, dynamics of entry to and exits from homelessness, and pertinent social policy at both micro-and macrolevels. When faced with social problems, concerned social scientists, particularly psychologists, tend to focus on the afflicted individuals. Research often aims at identifying the characteristics of the individuals in question or the consequences of the problem for them. Such research can call attention to social problems and mobilize public opinion to address them, but it also carries risks. Specifically, there is a risk of diverting attention from underlying causes and possible solutions to the problem, and a risk of reinforcing stereotypes about the population group in question. Research on homelessness has followed this pattern. It has paid extensive attention to the characteristics of people who are homeless, especially in regard to their health and mental health status (see citations in Table 1 and in Wright, this issue). This approach has successfully enumerated the problems prevalent among homeless persons and has stimulated development of services to address them. By focusing on what is wrong with "the homeless," however, we risk following the classic steps of blaming the victim: identifying a social problem, studying those afflicted to determine how they differ from the rest of us, defining Correspondence regarding this article should be addressed to Marybeth Shmn, Center for