University of Denver Professor, Kimberly Bender, Writes about her Research on Preventing Victimization among Homeless Youth
Homeless youth often leave home as a last resort to escape abusive home environments. In collaboration with Drs. Kristin Ferguson (Arizona State University) and Sanna Thompson (University of Texas, Austin – retired), my multi-site study of 601 homeless youth in Denver, Los Angeles, and Austin, found approximately 80% of youth experienced physical abuse and 36% sexual abuse prior to leaving home.
Unfortunately, once on the streets, youth face new victimization risks, such as robbery, assault, and sexual assault. Across the sites in our study, more than 83% experienced direct victimization while 78% witnessed victimization of others or were threatened with violence. Much of the violence experienced while homeless is severe and leads to significant physical and emotional injury. Unfortunately, those youth with the most significant trauma histories are most at risk for new experiences of victimization on the streets.
One explanation for the link between significant childhood trauma and later victimization is that early chronic abuse normalizes violent behavior and makes it difficult to detect new risks when they are encountered. For example, a youth who ran away from a violent home where they witnessed domestic violence may later miss red flags that a new acquaintance is being controlling, jealous, or emotionally abusive.
Our 145 qualitative interviews across the three cities helped us to identify the situations that place youth at risk for victimization and to better understand youths’ methods for detecting risk. Youth described the following risk cues:
- Internal risk cues, consisting of physiological and physical sensations that indicated something was not right, such as tightness in their stomachs, racing hearts, chills;
- Interpersonal cues, consisting of reading other people’s body language, mannerisms, and invasive questioning; and
- Environmental cues, consisting of situations such as dark, isolated, and unfamiliar locations associated with danger.
Many youth stated that, although they used these cues to detect risk, danger could occur anytime and anywhere, suggesting that they often did not identify cues before victimization was unavoidable.
Safety Awareness for Empowerment (SAFE)
Safety Awareness for Empowerment (SAFE) is a mindfulness-based cognitive skill-building intervention aimed at training homeless youth to better detect danger cues and then problem solve and act assertively to avoid such dangers. The intervention uses mindfulness techniques to augment youths’ abilities to attend to internal, interpersonal, and environmental risk cues associated with victimization. The model was adapted from Dr. Anne DePrince’s Healthy Adolescent Relationship Project to reduce intimate partner violence among teen girls in child welfare. We modified the intervention to address risk cues identified through our previous qualitative and quantitative findings. Through a small randomized control trial with a total of 74 youth, SAFE was pilot tested and shown to increase risk detection abilities and improve some aspects of mindfulness.
A key factor associated with victimization is substance use. Youth who use substances are less able to detect danger cues and to defend themselves. At the same time, youth who have experienced trauma and victimization report more often using substances to self-medicate. SAFE, adapted to address these two interrelated problems, is now being tested with a grant from the National Institute on Drug Abuse. This larger 3-year trial will determine whether youth randomly assigned to participate in SAFE are less likely, compared to youth who receive usual shelter services, to experience victimization and use substances over a 6-month period.
Although victimization is quite elevated among homeless youth, it is not inevitable. We hope to empower youth to develop skills to keep themselves safe and healthy.
Blog Post Author: Kimberly Bender, PhD, Associate Professor at the Graduate School of Social Work at the University of Denver
Kimberly’s area of expertise is psychosocial intervention for homeless youth. In addition to leading the research projects described in this blog post, she has published extensively in the areas of substance use, trauma, posttraumatic stress disorder, and broader mental health concerns experienced by homeless youth. Additionally, Dr. Bender prioritizes training students as research team members on her community-engaged research projects and has been recognized with several student-nominated awards.
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Last September, we attended a webinar hosted by the Center for Social Innovation’s training center, t3. The webinar, led by Dr. Rachel Latta, introduced a new tool (the TICOMETER) for assessing the degree to which an organization is trauma informed. Since this topic has significant relevance to agencies working with individuals and families experiencing homelessness, we asked Rachel to write a blog post on the TICOMETER. This is what she wrote.
Trauma is pervasive among adults and children in the U.S. A national study reported that almost 90% of respondents reported at least one traumatic event in their lifetime, with multiple exposures being the norm (1). Approximately 60% of children experience at least one trauma annually (2). Within systems serving low-income populations (e.g. child welfare and homelessness), traumatic stress may be nearly universal (3 4).
Given the high rates of trauma exposure in the general population, health and human service providers are increasingly recognizing the need to use a trauma-informed approach to service provision. Trauma-informed care has emerged as a . . .
“ . . . strengths-based framework grounded in an understanding of and responsiveness to the impact of trauma. It emphasizes physical, psychological, and emotional safety for both practitioners and survivors, and creates opportunities for survivors to rebuild a sense of control and empowerment” (5).
Organizations and practitioners directly integrate their knowledge and understanding of trauma into everyday practice and promote their capacity to recognize and respond to the needs of trauma survivors. Trauma-informed care implies that recovery is possible for everyone, regardless of how vulnerable they may appear. Organizations seeking to implement trauma-informed care must consider how well they have integrated its principles by focusing on ongoing training priorities, relationship building, physical environment, service delivery, and policies and procedures at all levels of the organization (6).
As organizations move toward becoming more trauma informed, they need ways to measure and track their progress in implementing trauma-informed principles within their organization. Although process-oriented assessments exist, these assessments are time and resource intensive and are often impractical for busy, under-resourced health and human service agencies. Additionally, researchers looking to measure the effectiveness of trauma-informed trainings and implementation tools have not had access to empirically validated measures.
To meet this growing need, the Center for Social Innovation and its training division, t3, developed the TICOMETER, a psychometrically validated measure for assessing the degree to which an organization is trauma informed and identifying gaps in implementation within an organization. The measure is 35 items, takes approximately 15 minutes to complete, and is administered online. The TICOMETER allows organizations to determine the nature and strength of trauma-informed care and practice across five domains:
- Building trauma-informed knowledge and skills
- Respecting service users
- Promoting trauma-informed policies and procedures
- Establishing trusting relationships
- Fostering trauma-informed services
The analysis can be used at a single point in time or at set points throughout an organization’s efforts to implement trauma-informed care, provided that sufficient time has passed for improvement to take hold. The TICOMETER offers organizations a tool to aid in moving toward ensuring trauma-informed service delivery. When organizations are able to integrate trauma-informed care, service users receive better care and have better health outcomes, staff burnout and turnover are reduced, and staff satisfaction is increased.
For more information about the TICOMETER and to purchase access, please visit: http://us.thinkt3.com/ticometer
View a free webinar on the TICOMETER at: http://info.thinkt3.com/webcast-ticometer-0
To contact t3 (think. teach. transform.) with questions, please email us at: email@example.com or call us at 617.467.6014
Blog Post Author: Rachel Latta, PhD has worked with low-income and homeless adults since 1999, with a focus on intimate partner violence (IPV). This experience guides her research, policy development, service development, clinical care, and training. Dr. Latta has served as a local and national trainer on trauma, trauma-informed care, and IPV. As an adjunct faculty, she has taught courses on gender, race, and counseling skills. She has worked in and directed grassroots organizations and mental health and substance abuse clinics, and she also founded and directed an outpatient clinic for veterans and their families dealing with IPV. Dr. Latta is a licensed psychologist in the state of Massachusetts. She had a previous career as an editor and still wields a red pen.
To contact Rachel directly, email her at firstname.lastname@example.org.
The National Center Supports the Dissemination of Findings from a Study of Homeless Families in Upstate New York
A recent study of families entering homeless shelters, transitional housing, and supportive housing programs highlighted that a history of trauma is nearly universal among homeless mothers, and presents a challenge for establishing long-term housing stability. The SHIFT Study, conducted in partnership by the Wilson Foundation and the National Center on Family Homelessness, followed 292 families from 48 housing programs in Rochester, Buffalo, Syracuse, and Albany, for a total of 30 months. Major findings include:
- 93% of the mothers had experienced at least one trauma and 81% had experienced more than one.
- Adverse childhood experiences (ACEs) among mothers were also common; 79% had experienced at least one ACE and 56% had experienced more than one.
- Post-traumatic stress disorder and symptoms of major depression were common.
- Poor child outcomes were predicted by maternal depression.
- Residential instability at 15-months was predicted by being unemployed, lower education, poor health, and low self-esteem.
- At 30 months, residential instability was only predicted by low self-esteem and high rates of post-traumatic stress symptoms.
While previous research has documented the high rate of trauma among homeless mothers, the SHIFT Study is the first to show that trauma symptom severity can contribute to long-term housing instability.
To disseminate the findings, the Wilson Foundation held roundtable meetings in each of the four New York communities included in the study. The meetings featured a review of the study’s major findings and a discussion of how to increase and strengthen trauma-informed care within the local service system, and how improve the system’s response to the housing and health needs of homeless mothers and their children.
The National Center for Excellence in Homeless Services co-hosted the Albany roundtable on June 10th, along with the study authors and CARES, Inc. The event was attended by roughly 50 people from the area’s social service agencies and a small number of local community members. Following the event, the Times Union Newspaper wrote an article on homeless children and families in the Capital Region.
To learn more about the SHIFT Study, you can read the final report here.
Blog Post Author: Amanda Aykanian, Research and Project Lead at the National Center