Trauma and Homelessness Initiative CHP Conference September 2015
Background The Trauma and Homelessness Initiative- Research project aimed to investigate the relationship between traumatic events and homelessness Four partnering agencies SHM, Mind Australia, VincentCare Vic. and ISCH involved in collaborative project Phoenix Australia (formerly ACPMH) undertook the research on behalf of agencies
Major Outputs Final Report outlining the research findings Service Framework with 27 recommended Principles of Action Worker Guidebook underpinned by recovery principles and mindfulness theory
Key Research Questions What is the link between Trauma and Homelessness? What are the types of traumatic events experienced by people who have also experienced homelessness? Does the experience of trauma contribute to homelessness? What are the accompanying mental health issues? e.g. PTSD, depression, substance use disorders What are the levels of social support and community connectedness? What are the barriers to seeking help for issues related to trauma and mental health?
Research Methodology Research comprised four stages Stage One Literature review Stage Two Service User qualitative interviews Stage Three Staff Focus groups Stage Four Service User Quantitative study
Target Group The key focus of the research was on people at risk of or experiencing long-term homelessness
Trauma Definition People's experiences of trauma in the study involved two types of trauma Type I traumatic, single events Type II events that are interpersonal, enduring and prolonged e.g. child abuse
Levels of Traumatic Experiences All 115 participants reported at least one traumatic event in their lifetime Type I Trauma was experienced by 98% of participants Type II Trauma was directly experienced by 60% of participants High levels of exposure to interpersonal violence (including sexual and physical assault)
Trauma Event Frequency Most participants were exposed to multiple traumatic events with over 97% having experienced more than four events in their lifetime This compares with a 4 per cent rate in the general community The average total number of traumatic experiences reported by participants was 21
Trauma Type The majority of participants (91%) were exposed to trauma during childhood (either Type I and/or Type II) 70% of participants experienced at least one traumatic event before experiencing homelessness
Trauma & Homelessness Trauma was often identified as a precipitant to becoming homeless, however, trauma exposure also occurred after becoming homeless Trauma exposure escalated after becoming homeless & majority of trauma exposure occurred after becoming homeless
Mental Health issues 88% of participants in the study met diagnostic criteria for at least one mental health diagnosis including: PTSD (73%), current depression (54%), alcohol abuse disorder (49%), alcohol dependence disorder ( 43%), substance abuse disorder (51%), substance dependence disorder ( 44%) and current psychotic disorder (33%)
Complex Psychiatric Profile The psychiatric profile of the participants was highly complex, demonstrated by multiple psychiatric disorders e.g. PTSD presented with major depressive disorder or a substance/alcohol use disorder
Mental Health People who reported exposure to Type II trauma were at increased risk of developing PTSD and having a highly complex mental health presentation However, those who had not experienced Type II trauma also presented with a highly complex presentation
Mental Health Symptoms associated with exposure to prolonged traumatic events identified: Emotional regulation difficulties (62%) Difficulty maintaining social relationships (93%) Risk taking and putting selves in danger (41%) Suicidal ideation (19%) and Dissociative experiences (72%)
Social Support and Seeking Help Participants experienced: High levels of social difficulties and social exclusion Low levels of social support and social connectedness High levels of difficulties maintaining social relationships
Social Support and Seeking Help Social disadvantage was identified as a fundamental component of the relationship between trauma and homelessness Many participants sought help, but half reported a time when they did not get professional help for a mental health problem
Overall Key Findings Trauma drives homelessness: Traumatic events often occur as a precursor to becoming homeless. Many people left home to avoid ongoing trauma in the form of assault, child abuse and other forms of interpersonal violence. Homelessness drives trauma exposure: Being homeless is a risk for experiencing further trauma. The frequency of trauma exposure escalated when people lost their housing.
Key Findings cont d Trauma drives social difficulties: Trauma impacts on an individual s sense of safety and connection with other people, especially when caused by a primary care giver. Trauma drives mental health problems: Exposure to traumatic events in both childhood and adulthood are associated with mental health problems.
Cyclical interrelationship A cyclical interrelationship exists between trauma exposure, long term homelessness, mental health difficulties and social disadvantage
Cyclical Interrelationship Trauma Exposure Mental Health Difficulties Long-Term Homelessness Social Disadvantage
Trauma Informed Service Framework A model of recovery for people experiencing long-term homelessness requires an integrated approach, across multiple service sectors This includes: homelessness services, drug and alcohol, clinical mental health, community mental health and specialist treatment and support services
Trauma Informed Service Framework A service framework is proposed that: Provides Trauma Informed Care Is based on Recovery Principles Is Strengths based and assists people to identify and develop coping skills
Trauma Informed Model of Recovery
Principles of Action 1. Promote understanding of trauma Some important principles include: Organisation-wide shared understanding of trauma and how this translates into trauma informed care All service users should have access to trauma informed care without the need to disclose trauma experiences Service users should be given control over assessments of trauma experiences
Principles of Action 2. Manage barriers to recovery and accessing support services Services need to manage the barriers to care through awareness of services, realizing the capacity for help seeking and engagement A person s readiness or capacity to engage with services is dynamic and varies over time Expectations of recovery need to be individually determined and communicated across different service sectors Facilitate communication between services by sharing trauma-informed understandings & adopting collaborative approaches
Principles of Action 3. Establish strong relationships by managing engagement safely, providing clear boundaries and clear worker role expectations Safe, consistent and effective therapeutic relationships with services are core elements of trauma informed care Clear information on the parameters of what can and can t be done needs to be communicated Correct and reliable information on how to access services should be provided Boundary management is critical to establishing safe, sustainable and productive therapeutic relationships
Principles of Action 4. Provide choice, control and predictability Service guidelines, clients rights, responsibilities and expectations on attendance, participation and behaviours need to be clearly communicated Services should enhance service user control 5. Engage in ongoing service improvement and evaluation by services service providers have an ethical responsibility to strive to understand the needs and experiences of service users evaluation targets against long term homelessness, but also recovery from trauma and mental health outcomes, should be a focus
Worker Guidebook A worker guidebook has been developed to assist staff to provide a trauma informed response It includes activities and supports to lessen the impact of trauma They are not therapy and can be administered by staff at different professional levels It includes the Decision Making Guide for Managing Trauma Disclosure
Concluding Key Messages Trauma & Homelessness strong relationship identified by research Addressing homelessness is not just about providing a roof over one s head Recovery is possible and the homelessness sector has a mandate to lead this work Resources available at: www.sacredheartmission.org