It is time for a fundamental shift in awareness and in practice, but how do we do this?
The holidays are a time for thanks, a time to be grateful for all we have. It is also time to remember why we do what we do year-round and to inform others about the problem of homelessness. On November 13, to commemorate National Homeless Awareness Month, NCFH/AIR hosted a briefing with the Congressional Caucus on Homelessness, co-chaired by Representatives Eddie Bernice Johnson and Alcee Hastings, and Senator Patty Murray. The commitment to end the tragedy of homelessness was shared by all.
During the briefing, I shared information about the needs of families experiencing homelessness. Data from 20 years of research tells a story not frequently addressed—that of the extremely high rates of trauma in the lives of homeless mothers. The data has consistently indicated that over 90% of homeless mothers report lifetime histories of trauma. However, to date, this data has not been included in the national response to family homelessness. Why? The need to rehouse families quickly guides the current response, and important strides are being made. But, the long-term success of these models remains unknown. What we do know is that services are needed along with housing to ensure long-term stability for families experiencing homelessness.
In a recent study (SHIFT—Service and Housing Interventions for Families in Transition) released by NCFH/AIR in 2013, we found that almost 50% of families were still residentially unstable 30 months following placement in a housing program. Trauma symptom severity and low self-esteem were theonly two predictors of long-term residential instability. The findings reveal how homelessness is imbedded in a pattern of residential instability- which is linked to trauma. Without an eye towards understanding this pattern we run the risk of enacting solutions that may seem good in the short-run, but could leave families vulnerable over time.
We can do better. Trauma-informed care provides a cost effective solution to address this issue.
So, what is trauma and trauma-informed care?
Trauma, in contrast to the usual stresses of daily life, occurs outside the realm of expected daily experiences. Trauma overwhelms our physiological and psychological coping resources, often resulting in health, mental health, and functional difficulties. In families, caregivers with unaddressed trauma are often unable to meet their children’s needs. This makes the children vulnerable to impaired development. For the 40% of homeless children under the age of six, the period of early childhood period most critical for brain development, the potential impact is profound.
Trauma-informed care is a systemic strategy for changing the culture of organizations so policies and practices emanate from a shared understanding of trauma and its impact. Providing trauma-informed care requires an organizational commitment to building the workforce’s knowledge, awareness, and skills to create environments that support resiliency, recovery, and empowerment. Given the near universal rates of trauma among homeless families, a “universal design” approach to this public health problem is needed. This approach does not preclude re-housing families quickly or making use of community based services for specialized mental health treatment. It supports these goals, but views them as one part of a larger systemic approach. The framework of trauma-informed care supports the tenet of do no harm and guides providers to actively reduce risk factors and promote protective factors—including stable home environments. From the front door to the back door, families entering a trauma-informed homeless and re-housing system can be assured that no matter what door they walk through, they will receive appropriate care. For some, this may be all that is needed. For others, trauma-informed care uses assessment to target more specialized, trauma-specific, and mental health community-based services to those most at risk.
It is time for a fundamental shift in awareness and in practice, but how do we do this?
Philanthropy’s Role
First, it requires leadership at all levels to include an understanding and awareness of trauma and its impact in our strategy to end family homelessness. Second, funders can invest in training of its grantees to understand trauma and become trauma-informed. Finally, philanthropy can support longitudinal research to evaluate the effectiveness of trauma-informed programs and housing models on both short and long-term stability for families. Preliminary results suggest that these investments produce worthy returns for programs and systems, and more importantly, for families.
For more information, contact Carmela J. DeCandia, Psy.D. at [email protected], or the author of the SHIFT study, Maureen Hayes, Ph.D., at [email protected], or visit www.familyhomelessness.org and http://www.air.org/focus-area/human-social-development/.
Carmela J. DeCandia, Psy.D., is Director of The National Center on Family Homelessness at AIR. She is a licensed clinical psychologist with specialties in program development, family homelessness, trauma, child development, and assessment. She spent more than 20 years in direct service delivery working with families experiencing homelessness and trauma, dedicated to creating environments that support resiliency, recovery, and empowerment. Dr. DeCandia received a Master of Psychology from Boston University, a Doctorate in Clinical Psychology from Antioch University New England, and a mastery certificate in Global Mental Health from the Harvard Program in Refugee Trauma.