Addressing Trauma in Homeless
Children & Youth
Presented by:
Shelley Johnson, Executive Director, Partners to End Homelessness
Eric Wood, LPC, MS State Hospital, Rise Above for Youth
PARTNERS TO END HOMELESSNESS
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Collaboration of 40+ homeless service agencies, advocates, and for-profit entities
with a mission of preventing and ending homelessness in central Mississippi.
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Monthly membership meetings
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Annual Point-In-Time Count (homeless census)
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Service Gap Analysis and Best Practice Implementations
One of 3 Continuums of Care recognized in Mississippi serving Hinds, Madison,
Rankin, Warren & Copiah Counties
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Oversees $1.7 million in HUD funding to area shelters for supportive housing services
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Provides access and administration of the Homeless Management Information System (HMIS) for
the community
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Evaluates the integrity and efficacy of funded programs
Operates a 15 bed women & children’s shelter in Jackson
• Rental & Utility Assistance to Prevent Homelessness and Re-house homeless
individuals
• Hotel Vouchers, Transportation and Mental Health Service support
• Transportation for Homeless individuals – beginning in January 2015 through
Wellsfest funding
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CONTRIBUTING 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/neglect
 Homeless episodes only serve to exacerbate existing issues that
preceded them.
HEALTH AND FAMILY LIVING
• Teen birth rate per 1,000: 55
• Children living in single parent
families: 46%
• Children in foster care: 3,582
• Percent of children in immigrant
families: 3%
• Number of grandparents raising
grandchildren: 87,717
KIDS COUNT DATA HINDS COUNTY
POVERTY 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%
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 Economic well-being
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Poverty 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/A
Percent of jobs that are low-wage: 35.5%
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Percent of individuals who are uninsured: 19%
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EDUCATION
 Education
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Individuals 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%
FAMILIES ACCESSING FEDERAL PROGRAMS
 Adults and children receiving welfare (TANF): 23,290
 Children receiving food stamps (SNAP): 284,000
 Households receiving federal rental assistance: 62,074
 Families receiving child care subsidies: 10,400
 Participants in all Head Start programs: 30,329
 Number of children enrolled in Medicaid and CHIP: 550,703
 Number of women and children receiving WIC (Women, Infants and
Children supplemental nutrition program): 91,652
 Households receiving LIHEAP (Low Income Home Energy Assistance
Program): 65,526
MENTAL HEALTH
SUBSTANCE ABUSE
HOUSING
 Housing
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Total households: 1,085,062
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Renters: 29%
Households paying more than 30% of income on housing:
142,518
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Homeless people: 2,413
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Home foreclosure rate: 2.33%
 Justice System
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Number of youth residing in juvenile justice and correctional
facilities: 413
Total incarcerated (prison and jail): 22,319
“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-Nimmer
Parenting and Public, 2000
HOMELESS FAMILIES
 Families 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.2
 Less 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.
EFFECTS OF HOMELESSNESS
 FOR THE FAMILY
 Loss of community, routines possessions, privacy and security
 Feeling 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 CHILDREN
 Are sick at twice the rate of other children
 Go hungry twice as often as non-homeless children
 More than 1/5 of preschoolers have emotional problems serious enough to require
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professional care, but less than 1/3 receive any treatment
Are twice as likely to repeat a grade
Twice the rate of learning disabilities and three times the rate of emotional and behavioral
problems
Half experience anxiety, depression, or withdrawal compared to 18% for their peers
By the time they are 8 years old, 1 in 3 has a major mental disorder
HOMELESS YOUTH IN AMERICA – THE
DATA
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Between 6% and 22% of homeless girls are estimated
to be pregnant [Health Resources and Services Administration, 2001]
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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].
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75% of homeless or runaway youth have dropped out
or will drop out of school
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Between 20% and 40% of homeless youth identify as
LGBT.
HOMELESS YOUTH IN AMERICA – THE
DATA
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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].
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5% to 7% of American youths become homeless in any given year [NAEH,
2007].
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Unaccompanied youth account for 1% of the urban homeless population
[U.S. Conference of Mayors, 2007].
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Youth age 12-17 are more at risk of homelessness than adults [The Prevalence
of Homelessness Among Adolescents in the United States, 1998]
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Homeless youth are evenly male-female, although females are more likely
to seek help through shelters and hotlines.
LGBT YOUTH
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There are only 4,000 youth shelter beds in the United States, yet as
many as 500,000 unaccompanied youths experience homelessness
each year.
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Many homeless young people have fled abusive situations, left the
foster care system with no resources, or been rejected by their
families because of sexual orientation or gender identity.
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LGBT youth are disproportionately over-represented in the homeless
youth population, with as many as 40% of the nation’s homeless
youth being LGBT, while only 5% of the overall youth population is
LGBT.
MENTAL HEALTH AND HOMELESSNESS
• 20 to 25% of the homeless population in the United States suffers from
some form of severe mental illness
• Whereas only 6% of all Americans suffer from a severe mental illness
• Men tend to be at a greater risk for homelessness than women
• African American’s are at greater risk for homelessness than other ethnic
groups
BARRIERS TO TREATMENT
 Poverty. Basic needs such a food, clothing, shelter, or transportation
supersede the need for treatment
 May lack proper documents to obtain government assistance (address, ID,
birth cert. etc. )
 Face double stigma of being Homeless and having a Psychological Disorder
 Their disorder may impede their ability to ask for help or connect with
local resources
MENTAL HEALTH ISSUES FOR HOMELESS
CHILDREN/YOUTH
A 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 districts
 Splitting families
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Women & Children or Men’s Shelters (no options for in-tact families)
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Men with Children
 Shelter policies
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Focus on Mom/Parent – not attending to issues facing children affected by homelessness
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Requirement to vacate shelter during daytime hours (emergency/transitional)
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Inability to obtain employment beyond 5pm
 Lack of mental health resources for children/youth
 Lack of childcare resources
 Few safe places for homeless youth
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Mandated Reporting/Child Welfare involvement
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Returning youth to abusive households
 Lack of substance abuse treatment options for homeless individuals
SYSTEM BASED SOLUTIONS
 Transportation to maintain school district – offering stability for students who experience
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homelessness
The use of Rapid Re-housing for families experiencing homelessness
Modified 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 youth
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Emergency Shelter
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Long-term transition
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Improve access to transitional programs out of foster care
 Focus 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.
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BECOMING 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-traumatization
What Happened to you? vs What’s Wrong With You?
COMPLEX 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
COMMON TRAUMA EXPERIENCED BY
HOMELESS CHILDREN AND YOUTH
 Child physical and sexual abuse and neglect
 Witnessing violence at home between parents or caregivers
 Removal from home by child protective services
 Incapacitation of parents due to mental illness, substance abuse,
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or incarceration
Witnessing community violence
Experiencing violence in their own relationships
Harassment or violence due to homelessness, sexual orientation,
and/or gender identity
Physical and sexual assault on the street
Incarceration
Engaging in survival sex or prostitution.
COMMON RESPONSES TO TRAUMA
 Difficulties sleeping and/or eating
 Inability to concentrate or complete everyday tasks
 Feelings of inadequacy and guilt
 Preoccupation with their bodies
 Stomach aches, headaches, and other multiple health
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complaints
Acting out or impulsive behaviors, including unsafe sex,
multiple sexual partners, substance abuse, or illegal activities
Bullying or intimidation of peers or staff
Behaving as if they were younger than they actually are
Impulsive and aggressive behaviors
Heightened moodiness and irritability
Pushing away caregivers
INFANT 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
THE EFFECTS OF TRAUMA ON THE BRAIN
THE 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
THE EFFECTS OF TRAUMA ON THE BRAIN
LONG TERM EFFECTS OF ABUSE AND
NEGLECT
 Diminished growth in the left hemisphere, which may increase the risk
for depression
 Irritability in the limbic system, setting the state for the emergence of
panic disorder and posttraumatic stress disorder
 Smaller growth in the hippocampus and limbic abnormalities, which can
increase the risk for dissociative disorders and memory impairments
 Impairment in the connection between the two brain hemispheres,
which has been linked to symptoms of attention-deficit/hyperactivity
disorder.
Teicher M.D., 2000
THE EFFECTS OF TRAUMA ON THE BRAIN
CHARACTERISTICS OF INDIVIDUALS THAT
THRIVE AFTER HOMELESSNESS AND TRAUMA
Resiliency
Determination
Having meaning and purpose to life
Self - Care
Accepting help from others
CHARACTERISTICS OF RESILIENCY
 Ability to adopt new behaviors
 Developing a sense of self esteem and self efficacy
 Using painful experiences as a learning platform for transformation
 Attitudinal and Behavioral Shifts from negative to positive life trajectory
 Less engagement in high risk behaviors
 Learning to recognize ones own needs and how to meet them constructively
DETERMINATION
 Determination – Building Self Confidence and Self Sufficiency
 Tenacity and Persistence in attaining goals
 Inner Strength
 Pride in making it through adversity
 Service 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.
HAVING A MEANING AND PURPOSE TO LIFE
 Seeing how an individual fits into the bigger picture
 Commitment to serve the community vs. what one can get or what is “owed” to
them.
 Hope coupled with gratitude as indication of resilience
 Gratitude 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
SELF CARE
 Learning specific behaviors and adopting attitudes that enhance self care
 Taking care of oneself physically, emotionally, mentally and spiritually
 Finding constructive ways to get ones needs met
 Assertively protecting oneself when needs are being blocked
 Decision making becomes a source of pride
 Acknowledging ones own needs can lead to a deeper sense of self acceptance
 Realizing Self Care can be a gradual process
 Keeping a journal
 Learning to speak up for oneself
 Self protection including
 Setting personal boundaries
 Distancing self from unhealthy relationships
 Developing effective problem solving skills greatly contributes to development of resiliency
 Weighing pros and cons
 Looking at things in more than one way
 Listing options out
ACCEPTING HELP FROM OTHERS
Readiness for help
 Openness to allowing helping individuals into their life
 Reaching a point of receptivity
 Actively seeking help
 Beginning to trust safe people over time
 How professionals can foster readiness
 Acknowledge the need to transition from street homelessness into housing
 Seeking 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
PROGRAM 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
PERSON CENTERED PROGRAMS
 Autonomy vs. Dependence
 Meeting basic needs before
therapeutic needs (Housing First)
 Crisis Remediation
 Safe Shelter
 Food
 Clothing
 Medical Care (*Kidd 2003)
OUTCOMES FROM HIGHLIGHTED
PRACTICES
 Being able to model healthy relationships with peers
 Addresses isolation
 Can contrast from previous negative experiences and
destructive patterns.
 Identifying, engaging and sustaining healthy personal boundaries
 Transformed self image
QUALITY PROFESSIONALS/PROGRAMS
 Nature of the Program – addressing comprehensive needs of the individual
 Caring Consistently over time and in a variety of ways
 Developing a level of trust in relationships
 Sustained commitment to the individual and outcomes
 Access to experiences that allow one to develop self esteem and self efficacy
 Quality Professionals
 Fidelity to the Nature of the Program (3 points above)
 A source for comfort as well as guidance
 Developing a model for healthy relationships that can be employed with peers
 Respectful confrontation
 Strength based perspective and knowing progress is often not a linear pattern
 BELIEVE in the promise of change and potential in the population
 UNDERSTAND that life is a developmental process
 DEEPEN your understanding of the healing power of relationships
EFFECTIVE INTERVENTIONS FOR
HOMELESS YOUTH
 Recognition of the unique culture of homeless youth
 Must be culturally competent
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Recognizing trust, power and control struggles
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Shame – diminished understanding of self-care
 Empowering Treatment Model
 Goals
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Restoration of safety and control – first goal of treatment
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Assist to develop trust
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Exercise control of ones own life
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Decrease Shame
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Increase 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.
STEPS FOR PRE-ENGAGEMENT WITH
HOMELESS YOUTH
 Pre-engagement (Outreach)
 Establishing communication and trust between youth and provider
 Make the first contact warm, respectful, and non-threatening
 Attending to the immediate needs of youth by offering basic items such as food, clothing
and hygiene
 Convey respect of boundaries, empathy and genuine desire to be of assistance
 Identify and introduce service options that convey an understanding of needs relevant to
the youth homeless population
 Building of rapport assists in the transition to full service engagement
ENGAGING 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 conversation
 Focusing on Strengths
 Not 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
TRAINING
 All providers should all receive training including:
 Homeless youth culture
 LGBTQ cultural competency
 Crisis intervention model
 Trauma informed care
 Motivational Interviewing
SELF CARE FOR PROVIDER – COMPASSION
FATIGUE
“There is a cost to caring” – Charles Figley
 Be Aware of the Signs:
 Increased irritability or impatience
 Decreased concentration
 Denying that traumatic events effect clients or feeling numb or detached
 Intense feelings and intrusive thoughts, that don’t lessen over time, about a client’s trauma
 Dreams about client trauma
 Guard against isolation
 Get support by working in teams
 Ask for support from administrators and colleagues
 Recognize compassion fatigue as an occupational hazard – not a weakness or
incompetence – it is the cost of caring
 Seek help with your own trauma
 Talk to a Professional
 Attend to self care
WHAT YOU CAN DO
 Advocate
 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 implement
 For 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.
 Participate
 Join your local Continuum of Care
 Get to know your Homeless Liaisons at your local school district
 Expand the community resource list by sharing your knowledge of mental health resources
available at little or no cost for homeless families/youth.
 Volunteer
 Without 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
NATIONAL ADVOCACY, RESEARCH, POLICY
AND BEST PRACTICE RESOURCES
 The National Child Traumatic Stress Network www.NCTSN.org
 National Coalition for the Homeless www.nationalhomeless.org
 Urban Institute www.urban.org
 National Resource Center on Homelessness and Mental Illness www.nrchmi.samhsa.gov
 National Law Center on Homelessness and Poverty www.nlchp.org
 Children’s Defense Fund www.childrensdefense.org
 Health Care for the Homeless Information Resource Center www.prainc.org/hch
 National Healthcare for the Homeless Council www.nhchc.org
 National Network for Youth www.nn4youth.org
 National Alliance to End Homelessness www.naeh.org
 True Colors Campaign
(LGBTQ homeless youth) www.truecolorsfund.org
 Forty To None Project
(LGBTQ homeless youth) www.fortytonone.org
 Center for the Study of Social Policy – Youth Thrive Project (improving outcomes for youth in care)
http://www.cssp.org/reform/child-welfare/youth-thrive
 The National Law Center on Poverty and Homelessness www.nlchp.org
SPEAKER CONTACT INFORMATION
 Shelley Johnson, Executive Director, Partners to End Homelessness
sjohnson@ptehms.org
601-213-5301
www.ptehms.org
 Eric Wood, LPC, MS State Hospital & Rise Above for Youth
ericdanielwood80@aol.com
601-613-0228
SAVE THE DATE – OCTOBER 18TH
Duling Hall, 7pm-11:30pm – Tickets $35 available at the door or via www.ptehms.org
**Dress in your 70s Best***