National Association For The Education of Homeless Children and

YouthAlbuquerque,

NM

October 28, 2012

Peter DonlonProject CATCH

CoordinatorRaleigh, NC

Overview of PresentationGenesis of Project CATCHResearch / JustificationCore componentsOutcomes: First 18 monthsUnderstanding and Applying Trauma Informed Care

Project CATCH partnership with the Wake County School System - NC

Genesis of the ProjectSalvation Army identified a community need to serve young children experiencing homelessness. 474 Children were screened between fiscal years 2006 and 2010 (approx. 118 per year).

News of this need was brought to the local Young Child Mental Health Collaborative. YCMHC convened a collaborative group of shelter and mental health professionals.

The collaborative group conducted a needs assessment and then led the development and submission of a grant to fund the project.

Needs Assessment Process

For 2 years, shelter staff & mental health experts met monthly to discuss status of services to homeless families.

Intensive study of 4 shelters (Marmaud, 2008) included staff & parent focus groups as well as observation in shelters.

Review of professional literature and the work of national organizations.

Justification: What We Discovered… 1. Rate of family homelessness is

high and rising rapidly

In Wake Co, approx. 330 parents & children reside in a shelter each night. Family homelessness in Wake is rising by about 11% yearly, and 25% of homeless individuals are children and youth (Wake Point in Time Count, Jan, 2008).

Local trends reflect national trends (U.S. Conference of Mayors, 2010; U.S. Department of Housing and Urban Development, 2011 )

Justification

2. Homeless children are more likely to have social-emotional concerns and mental health problems than children housed in poverty.

There is significant risk for toxic levels of stress, a precursor to the disruption of developing nervous and immune systems that can lead to mental and physical health problems (American Journal of Public Health, August 2009; National Child Traumatic Stress Network, 2005).

Justification 3. Homeless children in NC may be at

particular risk for these outcomes.

29th in the nation in America’s Youngest Outcasts: State Report Card on Child Homelessness (2010), indicating a need for improvement in services, planning, and policies concerning children who are homeless.

34th in the nation on the 2012 Kids Count rating conducted by the Annie E. Casey Foundation.

Justification4. Social-emotional and developmental

challenges of homeless children are rarely addressed

Children are often “invisible” in shelters because……staff members focus on housing goals. …mental health needs are not routinely

assessed…parents often don’t recognize stress in

their own children.

Therefore, increased attention to children’s needs is essential.

Justification 5. Parents experiencing homelessness face

parenting challenges, and are unable to provide quality parenting

Shelter climate does not support positive parenting and healthy family interactions.

Policies and practices are not conducive to nurturing parenting practices and positive family relationships.

Justification 6. Staff and volunteers often miss opportunities

to support residents in their roles as parents. 7. Staff and volunteers are not equipped to

respond productively to disruptive child behavior that may be symptomatic of deeper trauma/stress or mental health issues.

Therefore, staff need education and training

Justification

8. Despite rich resources and expertise, coordination & integration of services is lacking.

Many families move from shelter to shelter without consistent provision or coordination of services among shelters.

Shelter staff access community resources sporadically and inefficiently.

Therefore, coordination & collaboration are needed.

Justification Summary:

Reviewed research on homelessness and health and how these two are intertwined

Witnessed aspects of service delivery that jeopardized progress of clients

Realized what we were not doing:Addressing social-emotional &

developmental needsProviding a shelter environment that

supports healthy family interactionsCoordinating services across shelters

Grant effortsReceived private and state funding to support 3-year project to establish a sustainable system of care to:

Address social-emotional & developmental needs of children

Provide a shelter environment that supports healthy family interactions

Coordinate services across sheltersEvaluate the system for possible

dissemination

Goals and Core Components

1. Address developmental & social emotional needs of children

Develop common intake protocol upon admission to any family shelter program in the county.

CATCH staff (2) conduct assessment of every child (birth – 18), and make appropriate referrals.

Build a data base to track the health and well-being services children receive as they transition from homelessness to stable housing in the community.

Goals and Core Components2. Provide a shelter environment that supports healthy family interactions

On-site services for families within programs to support healthy parent/child relationshipsPhysical and Emotional Awareness for Children who

are Homeless (PEACH) programRaising a Thinking Child (Spivack & Shure)

TheraplayOrganized tutoring programs

for kids in the shelters

Goals and Core Components 3. Coordinate services across sheltersDevelop database of family information. Case Manager meets with each family to review

family goals and discuss and resolve potential barriers to continuity of care.

Monthly reviews of family goals and services in meetings of representatives from each shelter and CATCH staff.

Raleigh area Coordinated Intake process is underway. All children entering the homeless shelter system are being referred to Project CATCH.

Goals and Core Components Coordinate services across shelters (Cont’d)

Monthly meetings of CATCH members to identify gaps in community services.

Agencies that could assist in closing gaps are invited to the table.

Procedures are put in place to maximize available resources.

Yahoo Group“Our Mission is to be a professional community that

connects the Wake County shelter staff in order to share information, resources, and ideas that help us serve families experiencing homelessness.”

Be a place for shelter staff to connect and collaborate.

Create a common location for brainstorming to take place.

Bring focus to the mental health needs of children and their families experiencing homelessness.

Make professionals from community readily accessible to shelter staff.

Goals and Core Components 4. Evaluate Program for possible dissemination to other communitiesDatabase for first 21 months is completedWorking with NCFH to establish enhanced data

collection modelCurrently studying results of social / emotional/

developmental screenings of all childrenProcess is underway to locate funders to keep the

program going, and to develop model for other communities to use.

Feedback from Agency Partners and Community is very favorable

CATCH staff activities

1.Referrals are made from shelters2.Screening is conducted.

1.Parent Interview2.Brigance; Ages and Stages3.Parenting Stress Index4.Eyberg Child Behavior

Inventory3.Needs are identified (e.g., further

evaluation, treatment)4.Results and decisions are

entered in data base.5.Cases are followed closely.

Resources are ineffective if families don’t have access to them. Project CATCH staff members provide transportation for families as needed to attend appointments.

Raleigh, NC area partners/programs

Carying Place (located in Cary, NC)Haven House Healing Place Interact - RaleighPassage Home PLM Families TogetherRaleigh Rescue MissionSalvation ArmySouthlight (located in Fuquay-Varina, NC)Support Circles of Catholic CharitiesWake County Public SchoolsWake Interfaith Hospitality NetworkWomen’s Center of Wake County

Training Activities:National Center on Family Homelessness and Project CATCH staff

Pre-training involved shelter self-assessments of policies and practices and a web-based overview of trauma-informed practices.

On-site training in trauma-informed best practices to promote strong families and children’s well-being.

Follow-up on-site training conducted to discuss progress and problem-solve challenges.

The First 18 months!

Foundation funder expects…• Do shelters change policies?• Do staff, administrators, and

volunteers at shelters change their practices?

• Are they more trauma-informed?• Is there better communication

and collaboration across shelters?

• Do families benefit from the changes?

• Is CATCH sustainable?

State funder expects…

• Shelter staff / programs to participate in interagency information sharing

• Shelter programs have needs assessments and training plans developed

• Children referred to and screened by Project CATCH staff

• Case management follow-up / individual intervention contacts with children and families

How is Project CATCH changingshelter service delivery?

• Shelters are looking at self-care, Intake procedures, self-awareness of vicarious trauma, and involving consumers in advisory groups

• 9 of 10 shelters have identified preliminary goals toward becoming more Trauma-Informed - full agency assessments are underway, program adjustments have been made

• Average of 20 agency reps attend monthly CATCH meetings to share resources, struggles, etc

How is Project CATCH changing shelter service delivery?

• Strong agency child referrals facilitate rapid connections to services

• Trauma-Informed care has been incorporated into the NC Schools statewide training protocol for personnel working with children

• Time is being dedicated to Trauma-Informed care in agency staff meetings.

Major barriers to change

• Staff turnover – Shelter jobs are stressful with high potential for burnout - Trauma-Informed training needs to be constant for evening monitor staff

• Former clients become staff members in some agencies, bringing need for self-awareness, managing boundaries, and understanding vicarious trauma

• Some shelter agencies are funded based on rapid housing outcomes - trauma awareness is a slow change process, and lower priority for some agencies

Year End Results:• AS of June 30, 2012:• 90% of agencies participating reported

utilizing new resources/protocols for children as a result of information sharing (Currently at 88.9%)

• 75% of shelter programs assessed successfully achieved one identified goal related to serving children and families more effectively (Currently at 70%)

Year End Results:

• AS of June 30, 2012:• 60% of children B-5 assessed will receive

a needed service identified on their assessment as a result of activity referral/case management. (Currently at 67.5%)

• 20% of children B-5 assessed will receive a needed evidenced-based /informed service as a result of activity referral/case management (Currently at 20.4%)

CATCH B-5 Accomplishments • 187 children referred to Project CATCH (94%

of goal)

• 157 children screened/assessed (105% of goal) • 478 referrals made to community partners

(MH, Early Ed, Head start, Medical, Day Care, etc) (67% of goal)

• 125 received case management from Project CATCH (100% of goal)

• 32 received evidenced-based services

• 568 Substantive contacts (food, clothing, follow-ups, etc.)

CATCH K-12 Accomplishments Children ages 5-18

*Data collected from 7/1/11 to Present• 166 children referred to Project CATCH

• 143 children screened and assessed• 119 received case management from

Project CATCH• 154 referrals made to community

partners (MH, Early Ed, Headstart, Medical, Day Care, etc.) (food, clothing, etc.)

Total for all Project CATCH Kids• 353 Children referred to Project CATCH• 35 Referred from school social workers (April to June

2012)

• 318 Referred from shelter partners

• 300 Received developmental and psychosocial screenings and assessments

• 244 Received case management support from Project CATCH

• 722 Referrals made to community partners (MH, Early Ed, Headstart, Medical, Day Care, etc.)

• Diapers, formula, and clothing vouchers also distributed

Q1 2012-2013 149 children have been referred to CATCH -

On track to serve approximately 595 children this fiscal year

A brief overview…

Homeless Children and

TraumaMost

homeless parents don’t recognize the

effects on their kids

Homeless Children and traumaBy the age of 12, 83% of homeless children are

exposed to at least 1 violent event, including:

Hearing gunshotsSeeing an adult being shot Seeing a dead bodySeeing someone stabbedWitnessing physical or sexual abuse

Homeless Children and Trauma

1 in 50 children in America experience homelessness. Current number is 1.5 million

53% are under the age of 6Homeless children experience overwhelming loss:

a sense of place, friends, pets, important possessions, and self

Homeless children experience disrupted relationships; parental health problems cause lack of normal development

Violence, hunger, and lack of access to school and healthcare

NCFH

Single Mothers who are Homeless92% Experience severe physical and/or sexual

abuse. For 63%, assault was by an intimate partner

Have 3 times the rate of PTSD (Post Traumatic Stress Disorder) (36%) and twice the rate of drug and alcohol dependence (41%)

Mothers often are in poor physical healthOver 1/3 have a chronic physical

health condition.They have ulcers at 4 times the rate

of other women. (The National Center on Family Homelessness, 2012)

As children, nearly one quarter of single adults who are homeless lived in foster care, a group home , or other institutional setting; most were physically or sexually abused.

Among Homeless Youth… Conflict and violence is the

primary cause of homelessness. 46% have been physically abused1 in 5 youth who arrived at shelters

came directly from foster care 25% had been in foster care in the

previous year. Kathleen Guarino - NCFH

Links Between Trauma & Brain Size (Putnam, 2006)

In studies of children who have experienced trauma:

Corpus callosum (links right & left hemisphere) shows decreased size.

Areas of the frontal lobe (linked to planning & judgment) showed a decreased size.

The anterior cingulate gyrus (rapid decision making) showed decreased levels of a chemical crucial to neuron health (N-acetyl-asparte). The level is similar to what is found in adult PTSD patients and experiences of persons struggling with late stage alcoholism.

Trauma’s Impact on Psychosocial Development (Putnam, 2006)

Children who have experienced trauma are represented disproportionally in Type D attachments (disorganized/disoriented).

Type D can result from frightening/frightened parental behavior, parental negativity, criticism, or mothers who rank high as dissociative.

This attachment disruption is linked to numerous negative outcomes including: poor school performance, difficulties with peers, low self-esteem, cognitive immaturity, and bizarre behavioral patterns.

What Researchers Say About This Populaton:

“[These] children are particularly vulnerable and are thus at greater risk for developmental delays.” (Chiu,2010, p. 73)

“Research has demonstrated that homeless children have disproportionate negative academic experiences, including absenteeism…high rates of mobility…grade repetition…and the need for special education services, which may all contribute to poor academic performance.”

( Hong, 2012, p. 1440)

Trauma Informed Care Defined

“Trauma-Informed care is a strengths-based framework that is grounded in an

understanding of and responsiveness to the impact of trauma, that emphasizes physical, psychological, and emotional safety for both survivors and providers, and that

creates opportunities for survivors to rebuild a sense of control and empowerment.”

Kathleen Guarino, NCFH

What we are teaching about Trauma-Informed Services

Training of shelter and school staff includes:

• The effects of trauma on neurological / psychosocial development of parents and children

• Behavioral “problems” vs adaptive responses to trauma

• Understanding acute, chronic, and complex trauma • Understanding potential retraumatization via the

service system• Recognizing traumatic stress • Potential mislabeling or misdiagnosing of MH

symptoms without considering past experiences of trauma

• How schools can increase trauma informed responses.

Trauma-Informed Intake Assessments

• Intake is conducted within the first 24-72 hours of families arriving at the shelter; flexibility is possible based on level of stress observed

• Completed and updated by trained staff members who have on-going contact with clients, and responsibility for carrying out plans

• Conducted and stored in a private area to ensure confidentiality - the limits of confidentiality are also explained; who has access, how information is used, etc.

• Includes questions about clients’ current needs, resources, strengths, mental and physical health, history of substance use, cultural backgrounds, and related cultural strengths

Programming for Trauma Informed Shelter Services

• Offering a calming presence and a safe refuge

• Clients are introduced to staff and others

• Clients are given a physical tour of the facility when they arrive

• Immediate needs such as food and clothing are addressed

• Creating free and friendly spaces

• Photographs and responsibilities of staff and others are posted in the facility.

• Relaxed length of stay

Developing goals and plans using trauma-informed practices

The following are basic components of goal development that are routinely implemented:

Consumer goals are recorded in written, individualized plans

Consumer goals are reviewed and updated regularly

A system of follow-up is applied consistently across the program

Goal development is led by the client, then supported and resourced by the Case Manager

Developing goals and plans using trauma-informed practices, cont.

• Each client needs a written, individualized self-care or crisis prevention plan. These should include the following:

A list of situations that the person finds stressful or overwhelming and remind him/her of past traumatic events (i.e. triggers) Ways that the client shows that he/she is stressed or overwhelmed Staff responses that are helpful and not helpful when the client is feeling upset or overwhelmed A list of people to go to for support

** Helpful criteria for evaluating shelter policies & rules

• Is the policy necessary?• What is the purpose?• Does it serve that

purpose?• Who does it help or

hurt?• Does it facilitate or

hinder client inclusion?• Were clients included?• What is the tone and

language?

Understanding Signs When There is No Self Disclosure

“I stay with”Frequent address changesChildren making reference to unusual

sleeping arrangements“Doubling up”Observe large amount of possessions in car,

i.e. sleeping in car

Due to stigma, families who experience homelessness may not disclose the situation.

Communication & Connection“Although the McKinney-Vento Homeless

Assistance Act provided children experiencing homelessness more opportunity for educational stability, they continue to face disruptions in their education…” (Kilmer, 2012, p. 339)

Of elementary students experiencing homelessness, only 21.5% are proficient in math and 24.4% inreading. It is worse among high school students, where 11.4% are proficient in math and 14.6% in reading. (NCFH)

Language: Person CenteredThe emphasis is on the person, defining them

as who they are and not a current experience:

Homeless person -> Person experiencing homelessness

This language shift allows room for the child and the entire family to be recognized not as the “sum of their situation”, but as people who are growing, changing, and shifting. It also serves to remove some of the stigma these families are frequently experiencing.

Suggested ResponsesPrioritize communication among teaching teams,

social workers, school psychologist to ensure all players have the same and updated information.

Recognize the school can be one of the few places of stability and create events that are inclusive of families (Kilmer, 2012) such as the model seen during Hurricane Katrina at Mayfair Elementary

Try to eliminate barriers such as transportation, language, and social stigma. (Kilmer, 2012)

Responses Cont’d

A Shift to InclusivenessThe shift in language, communication and

connection will help contribute to much of this, however it is important for school staff to understand that the severe social stigma attached to the experience of homelessness means families are coming in already feeling ostracized from peers, teachers, and staff.

Emphasis must be on clear effort to include in a manner which allows families opportunities to interact as equals.

Equal InteractionsTry to avoid activities which ask parents to

bring food.Enable parents to work as chaperones on field

trips (i.e. cover cost, transportation).Minimize the appearance of these outreach

efforts by normalizing language, sensitive communication for arranging pick-ups, and letting parents take the lead on how they choose to interact with the staff.

These efforts will add additional emotional and physical toll on staff, so the final two pieces of trauma informed care are crucial.

**Vicarious Trauma & Self CareIn order to provide good trauma informed care, it is

VITAL to recognize the vicarious trauma experienced and respond with appropriate self care. Tired, emotionally drained workers will not be able to recognize the signs of trauma within children or parents and will likely label them as “difficult” or “problematic”.

To create an environment where families experiencing homelessness feel safe, recognizing vicarious trauma and responding with self care must be seen as PART of trauma informed care, not a negotiable “bonus”.

A brief overview…

Students who are Homeless in Wake County, NC

During 2011-2012, 2,757 students met McKinney Vento eligibility. At the end of the year, 2345 were still actively enrolled in Wake County Schools.

Highest number of students were in High School, Kindergarten, and 3rd grade in 2011-2012.

Almost ½ of total were in Elementary SchoolsThus far in 2012-2013, the number is approx 1373.

Michelle Mozingo, MSW, Wake County McKinney Vento Liaison for Homeless Students

Challenges:How do we get these children connected to

needed services?How do we establish and maintain collaborative

relationships with the school social workers?Is dual case management possible for those

living in shelters and attending schools, and what if there are multiple children in the family?

How do we establish knowledge of trauma informed care with those working with homeless children?

How we closed the gap…Project CATCH Community Meetings McKinney Vento Liaison and Preschool Social

Worker attend monthly meetings with reps from homeless agencies Recent topics/activities:

Navigating school re-assignment Assistance with IEP’s for homeless students Solving transportation issues Assistance with Special Ed services Self – Care with CATCH Chaplain CATCH and Trauma Informed Care info is disseminated

throughout the school system.

Trauma Informed Care Training35 School Social Workers attended day-long training on 4/23/12, facilitated by the National Center on Family Homelessness. 85 School staff from the Office of Early Learning attended 2-hr training 10/11/12, facilitated by Project CATCH staff.

Shelter-based case studies were used in both trainings to illustrate challenges clients face in shelter life

Internal meetings with Wake County:Met with Child Find Sr. Administrator – 9/7/2012

Discussed Project CATCH and TI Care Departmental training followed

Met with Family and Community Connections Administrator / Preschool Services Director and team members – 10/23/2012Discussed IEP process for homeless students, and

initial discussions about on-site training for staff and parents in shelters

Collaborative ProjectsAfter School & Summer Tutoring Program in shelters

Organized by the Wake County McKinney Vento Liaison for the last three years

Coats for Kids – New coats for any child in need – approximately 6,000 coats and $40K in gift cards distributed last year

Back to School Supplies – Community Groups / othersChristmas Toy Store – New toys and gifts for

children aged 0-12 – 47,882 distributed last yearAll programs sponsored by The Salvation Army of Wake

County

Collaborative ProjectsTelamon Corporation – Raleigh, NC

Manages Head Start and Early Head Start Programs in North CarolinaPartners with Project CATCHParticipation on Telamon’s Policy CouncilCurrently in discussions/planning to

implement a Head Start program in the new Salvation Army building , opening 3/2013.

Recently awarded grant to serve 417 children in Sampson County, NC

Collaborative ObservationsParents and children are engaging with each

other and their teachers at higher levelsAttendance and performance are improved –

kids want to stay in schoolIncreased support for unaccompanied youth

Social workers and staff experience: Enhanced community relationships Understanding of what life is like for families in the

shelter Clearer understanding of child behaviors and

parent interactions

Next steps for CATCH• Continue efforts to meet our 3 primary goals and enrich the core components.

• Conduct full program evaluation, with NCFH as partner.

• Continue collaborative work with Agency partners

• Searching for funders to continue CATCH beyond 6/2014

Contact Information:

Peter Donlon, MDIVThe Salvation Army of Wake County,

NCPeter.Donlon@uss.salvationarmy.org

National Center on Family Homelessness

www.familyhomelessness.org

References Chiu, Sheau-Huey., DiMarco, Marguerite A.(2010). A pilot study comparing two

developmental screening tools for use with homeless children. Journal of pediatric health care 24 (2). pg. 72-80.

Hong, Saahoon., Piescher, Kristy. (2012) The role of supportive housing in homeless children’s well- being: An investigation of child welfare and educational outcomes. Children and youth services review 34. pg. 1440-1447.

Kilmer, Ryan P., Cook, James R., Crusto, Cindy., Strater, Katherine P., Haber, Mason G. (2012). Understanding the ecology and development of children and families experiencing homelessness: Implications for practice, supportive services, and policy. American Journal of Orthopsychiatry 82 (3). Pg. 389-401.

National Center on Family Homelessness- www.familyhomelessness.org

Putnam, Frank. (2006). The impact of trauma on child development. Juvenile and family court journal. Pg. 1-11.