Shift Study - Line Between Trauma and Homelessness
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Transcript of Shift Study - Line Between Trauma and Homelessness
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8/12/2019 Shift Study - Line Between Trauma and Homelessness
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8/12/2019 Shift Study - Line Between Trauma and Homelessness
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A partnership between the Marie C. and Joseph C. Wilson Foundation
and the National Center on Family Homelessness
SHIFT STUDY
Examined residential stability of families over time.
Compared emergency shelter, transitional housing,
permanent supportive housing.
Longitudinal study: Baseline; 15 Months; 30 Months.
Looked at housing and services provided as is in
the community (not a demonstration project).
Conducted in Rochester, Buffalo, Syracuse andAlbany, NY from 2007 to 2010.
Representative of mid-sized cities nationwide.
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8/12/2019 Shift Study - Line Between Trauma and Homelessness
3/26
A partnership between the Marie C. and Joseph C. Wilson Foundation
and the National Center on Family Homelessness
SHIFT STUDY
SHIFT Study N = 292 families at Baseline; 192 at 15Months; 184 at 30 months.
Emergency Shelter (ES): Temporary or transitional short-term shelter for families1 night to 3 months (45% ofsample).
Transitional Housing (TH): Housing and services to helpfamilies move to independent living within 24 months(41% of sample).
Permanent Supportive Housing (PS): Long-term,community-based housing with supportive services forpeople with intense needs. Supportive services may bedirectly provided or by other agencies (14% of sample).
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8/12/2019 Shift Study - Line Between Trauma and Homelessness
4/26
A partnership between the Marie C. and Joseph C. Wilson Foundation
and the National Center on Family Homelessness
SHIFT STUDY
Assessment Domains
Demographics.
History of homelessness.
Income, benefits, employment, education.
Mothers physical health, trauma history, mental health,
substance use, parenting.
Childs physical health, behavioral problems, mental
health, education.
Services received (for mother and for children).
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8/12/2019 Shift Study - Line Between Trauma and Homelessness
5/26
A partnership between the Marie C. and Joseph C. Wilson Foundation
and the National Center on Family Homelessness
Most mothers in their 20s; never married, with two or
three children.
Majority were African-American; one-quarter
Caucasian; 14% Latina or other.
More than one-third with no high school degree or
GED.
One-third graduated high school or obtained GED. Slightly less than one-third with some college or two-
year degree.
MOTHERS CHARACTERISTICS
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A partnership between the Marie C. and Joseph C. Wilson Foundation
and the National Center on Family Homelessness
TANF: BASELINE, 15 MONTHSAND
30 MONTHS
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8/12/2019 Shift Study - Line Between Trauma and Homelessness
7/26
A partnership between the Marie C. and Joseph C. Wilson Foundation
and the National Center on Family Homelessness
UNEMPLOYMENTOVERSTUDYPERIODIN
ALLTYPESOFHOUSINGPROGRAMS
83%
79%
84%
70%
63% 64%
60% 59%
68%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
EMERGENCYSHELTER TRANSITIONALHOUSING PERMANENTSUPPORTIVEHOUSING
BASELINE
15 MONTH
30 MONTH
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8/12/2019 Shift Study - Line Between Trauma and Homelessness
8/26
A partnership between the Marie C. and Joseph C. Wilson Foundation
and the National Center on Family Homelessness
RESIDENTIALINSTABILITYFamilies who moved once and had a rental subsidy
were not considered residentially unstable because
such a move may indicate a step towards stable
housing. Using this conservative definition:
At Baseline, 87% of families had moved multipletimes in the previous 18 months.
At 15 months, 63% of families were residentially
unstable.
At 30 months, half of families (49%) were stillresidentially unstable.
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8/12/2019 Shift Study - Line Between Trauma and Homelessness
9/26
A partnership between the Marie C. and Joseph C. Wilson Foundation
and the National Center on Family Homelessness
RESIDENTIALMOBILITY: NUMBEROFMOVES18 MONTHSBEFOREENROLLMENT
14% 13%
7%
85%88%
93%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
EMERGENCYSHELTER TRANSITIONALHOUSING PERMANENTSUPPORTIVEHOUSING
0 Moves
1 Move
2+ Moves
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8/12/2019 Shift Study - Line Between Trauma and Homelessness
10/26
A partnership between the Marie C. and Joseph C. Wilson Foundation
and the National Center on Family Homelessness
RESIDENTIALMOBILITY: NUMBER
OFMOVESBASELINETO15 MONTHS
0%
24%
52%
25% 25% 24%
75%
51%
24%
0%
10%
20%
30%
40%
50%
60%
70%
80%
EMERGENCYSHELTER TRANSITIONALHOUSING PERMANENTSUPPORTIVEHOUSING
0 MOVES
1 MOVE
2+ MOVES
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8/12/2019 Shift Study - Line Between Trauma and Homelessness
11/26
A partnership between the Marie C. and Joseph C. Wilson Foundation
and the National Center on Family Homelessness
RESIDENTIALMOBILITY: NUMBER
OFMOVES15 MONTHSTO30 MONTHS
30%
33%
36%36%
24%
36%
34%
43%
29%
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
EMERGENCYSHELTER TRANSITIONALHOUSING PERMANENTSUPPORTIVEHOUSING
0 MOVES
1 MOVE
2+ MOVES
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8/12/2019 Shift Study - Line Between Trauma and Homelessness
12/26
A partnership between the Marie C. and Joseph C. Wilson Foundation
and the National Center on Family Homelessness
RESIDENTIALINSTABILITY: 15 MONTHS
TO30 MONTHS86%
57%
29%
63%
53%56%
36%
49%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
EMERGENCYSHELTER TRANSITIONALHOUSING PERMANENTSUPPORTIVE TOTALSAMPLE
15 MONTHS 30 MONTHS
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8/12/2019 Shift Study - Line Between Trauma and Homelessness
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A partnership between the Marie C. and Joseph C. Wilson Foundation
and the National Center on Family Homelessness
CHANGEOVERTIMEINPREDICTORS
OFRESIDENTIALINSTABILITYFour Significant Predictors At 15 Months:
Lower level of education.
Unemployment.
Poor health. Lower self-esteem.
Two Significant Predictors At 30 Months:
Lower self-esteem. Severity of Post Traumatic Stress Disorder (PTSD)
symptoms.
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A partnership between the Marie C. and Joseph C. Wilson Foundation
and the National Center on Family Homelessness
HIGHPREVALENCEOFLIFETIME
TRAUMAFORMOTHERS 93% of mothers with trauma history:
o81% experienced multiple traumas.
o
79% traumatized as children.
Interpersonal violence most common trauma:
oHalf of mothers sexually abused as
children.oMore than two-thirds of mothers
physically abused as adults.
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A partnership between the Marie C. and Joseph C. Wilson Foundation
and the National Center on Family Homelessness
PRESENTATIONOFPTSD AMONG
HOMELESSMOTHERS
PTSD presents complexly for survivors of interpersonal violence:o Impacts all aspects of functioning (i.e. cognitive, affective,
relational, functional impairments).
o Does no tmirror PTSD presentation after acute events or combat
(i.e. flashbacks as primary symptom).
Results in severe impairment and loss of resources:o Severely impacts ability to establish safety and stability.
o Depressive symptoms often most prevalent.
o Negatively effects mothers parenting skills and responsiveness
to childrens developmental needs.
o Trauma can be transmitted intergenerationally to children.
To achieve long term stability services must also target:o Safety, stabilization, mental health, parenting & childrens
development, and skills to build resiliency.
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16/26
A partnership between the Marie C. and Joseph C. Wilson Foundation
and the National Center on Family Homelessness
PREVALENCEOFPHYSICALASSAULT
FORMOTHERS
34%
50%
43% 42%
50% 51%
57%
51%
66%
77%
62%
70%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
Emergency Shelter Transitional Housing Permanent Supportive Total Sample
CHILDHOODPHYSICALABUSE
ADULTHOODPHYSICALABUSE
LIFETIMEPHYSICALABUSE
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8/12/2019 Shift Study - Line Between Trauma and Homelessness
17/26
A partnership between the Marie C. and Joseph C. Wilson Foundation
and the National Center on Family Homelessness
PREVALENCEOFSEXUALASSAULT
FORMOTHERS
34%
46%
60%
42%
12%10%
19%
12%
41%
51%
67%
49%
0%
10%
20%
30%
40%
50%
60%
70%
80%
EMERGENCY
SHELTER
TRANSITIONAL
HOUSING
PERMANENT
SUPPORTIVE
TOTALSAMPLE
CHILDHOODSEXUALASSAULT
ADULTHOODSEXUALASSAULT
LIFETIMESEXUALASSAULT
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8/12/2019 Shift Study - Line Between Trauma and Homelessness
18/26
A partnership between the Marie C. and Joseph C. Wilson Foundation
and the National Center on Family Homelessness
MOTHERS MENTALHEALTH Major depressive symptoms reported by majority of mothers.
Decreased slightly at 15 Months, then remained steady at 30
Months.
Maternal depression predicted educational and emotionalproblems for children.
Half of mothers met diagnostic criteria for PTSD at Baseline
(decreased to 40% at 30 months).
PTSD symptom severity (e.g., not just the diagnosis) in mothers
predicted major depression, unemployment, poor child
outcomes, and residential instability.
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8/12/2019 Shift Study - Line Between Trauma and Homelessness
19/26
A partnership between the Marie C. and Joseph C. Wilson Foundation
and the National Center on Family Homelessness
MOTHERS MENTALHEALTH 49% of mothers in PS (N = 42) reported an inpatient
mental health hospitalization, compared to 12% in ES
and 21% in TH.
o78% had been sexually abused as children.
o100% had been physically abused in lifetime
(71% as adults).
PS selects for those with greatest needs, but this rateis very high and warrants further research.
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8/12/2019 Shift Study - Line Between Trauma and Homelessness
20/26
A partnership between the Marie C. and Joseph C. Wilson Foundation
and the National Center on Family Homelessness
CHILDOUTCOMES:
ENTIRESAMPLE
One-quarter of mothers reported having a child with
medical or physical disability affecting childs
functioning.
Nearly one-third of mothers reported having a childwith learning or emotional problems.
55% of mothers reported having a child living apart
from them prior to the study.
40% of mothers reported having a child living apart
from them during the course of the study.
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8/12/2019 Shift Study - Line Between Trauma and Homelessness
21/26
A partnership between the Marie C. and Joseph C. Wilson Foundation
and the National Center on Family Homelessness
CHILDOUTCOMES:
TARGETCHILD
Study conducted in-depth interview with mothers
about one target childin family.
At baseline, 41% of target children had significant
difficulties:oDifficulties decreased over time for children in
TH and PS programs.
oDifficulties increased over time for children in
ES programs. Throughout study, more than 40% had peer
problems.
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8/12/2019 Shift Study - Line Between Trauma and Homelessness
22/26
A partnership between the Marie C. and Joseph C. Wilson Foundation
and the National Center on Family Homelessness
CHILDOUTCOMES:
TARGETCHILD 65% had conduct problems or hyperactivity at
Baseline:
oDecreased slightly over course of study.
14% had emotional problems at Baseline:
o Increased to 39% at 15 Months.
oDecreased at 30 Months to Baseline
levels.
oChildren in ES programs struggled mostwith emotional problems at all data points.
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8/12/2019 Shift Study - Line Between Trauma and Homelessness
23/26
A partnership between the Marie C. and Joseph C. Wilson Foundation
and the National Center on Family Homelessness
SHIFT ANALYSISOFPROGRAMCOSTS:
PERFAMILY, PERDAY
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A partnership between the Marie C. and Joseph C. Wilson Foundation
and the National Center on Family Homelessness
Mothers employment status improved but
unemployment remained high across all types of
housing programs.
High rates of PTSD diagnosis decreased by only 10%over the study period (50% to 40%).
oSymptom severity predicted poor outcomes.
Many children (30% to 60%) struggled with physical
and emotional problems throughout the study period.
ES programs showed highest costs and least
improvement in outcomes.
SHIFT STUDYFINDINGS:
AFTER30 MONTHS
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25/26
A partnership between the Marie C. and Joseph C. Wilson Foundation
and the National Center on Family Homelessness
Trauma and interpersonal violence were prevalent for
homeless families.
Homeless mothers had high rates of major depressive
symptoms and PTSD and severe PTSD symptoms thatimpacted their residential stability.
Residential instability remained high across all types of
housing programs after 30 months.
Mothers PTSD symptom severity and lower self
esteem were the only two predictors of residential
instability after 30 months.
SHIFT STUDYFINDINGS:
AFTER30 MONTHS
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A partnership between the Marie C. and Joseph C. Wilson Foundation
d th N ti l C t F il H l
Housing programs need to address:
Mothers trauma histories and mental health consequences to achieve
residential stability for the family over time.
Childrens health and emotional problems to ensure family stability.
An effective response to family homelessness should include:
Housing. Case management to address immediate needs includingincome,
education and employment.
Comprehensive Assessments of mothers and children that are tailored
to the characteristics and needs of this subgroup of the homeless
population; results used to target service delivery.
Trauma-informed care. Parenting supportsand skills training.
Mental health services for mothers depression and PTSD.
Child-centered services and programs that promote and support
healthy development for young children (e.g., play spaces).
SHIFT POLICYIMPLICATIONS