Trauma-Disclosure, Meaning-Making, and Help-Seeking in Mothers Experiencing Homelessness: Results From a Trauma-Focused, Clinical Ethnographic Narrative Intervention.

Mothers experiencing homelessness are seldom asked about past trauma that may be causal to housing instability and poor health. There are also few validated trauma-focused interventions in family shelters. To address this gap, we tested the feasibility and acceptability of the trauma-focused clinical ethnographic narrative intervention (CENI-TF) in increasing mothers' trauma disclosure, appraisal of its meaning in their lives, and help-seeking behaviors. We also present the qualitative findings to contextualize the intervention. Findings are organized under three major domains and nine subthemes that capture participants' voices and experiences. The CENI-TF has the potential to promote help-seeking behaviors and interrupt recurring cycles of trauma and housing instability in this at-risk population.

A Community-Academic Approach to Preventing Substance Use Disorders.

BACKGROUND: The coronavirus disease 2019 pandemic and activism against structural racism heightened awareness of racial-ethnic disparities and disproportionate burden among the underserved. The opioid crisis further compounds these phenomena, increasing vulnerability for substance use disorders (SUD). Community-based participatory research can facilitate multidisciplinary collaboration, yet literature on these approaches to prevent and reduce SUD and associated stigma remains limited. OBJECTIVE: Discrimination, stigma, and multiple crises with health care and systemic barriers increasingly marginalize the underserved, specifically around SUD. The Detroit Area Mental Health Leadership Team (DAMHLT, since 2015), aims to optimize SUD prevention, enhance resiliency and advocacy to advance knowledge on SUD research and influence community-level research and practice. LESSONS LEARNED: DAMHLT's approach on bidirectionality, community level access to real-time epidemiological data, advocacy (i.e., institutional responsiveness) and dissemination may be translational to other partnerships. CONCLUSIONS: As we move through an ever-changing pandemic, DAMHLT's lessons learned can inform partnership dynamics and public health strategies such as hesitancy on public health response.

Health Risks and Outcomes of Homelessness in School-Age Children and Youth: A Scoping Review of the Literature.

Despite reports that over 1.3 million school-age children (ages 5-18) were homeless in 2019, little is known about the effects of homelessness on their overall health and well-being. To better understand where gaps exist, a scoping review of the literature was conducted to identify studies of the physical, mental, and behavioral health risks and outcomes of school-age children experiencing homelessness or housing instability. Following the Joanna Briggs Institute framework and Preferred Reporting Items (PRISMA) guidelines, seven electronic databases were searched using key words: homelessness, children, health, and well-being. Of the 4,372 records, 23 articles met inclusion criteria. Most examined mental health and high-risk activities or behavioral risks related to school achievement. Few studies tracked the long-term health outcomes of homeless school-age children. Findings have implications for school nurses who have contact with children experiencing homelessness and are in position to intervene to prevent negative health sequelae in this vulnerable population.

The Eco-Social Trauma Intervention Model.

OBJECTIVES: We describe a transdisciplinary theory of change for interventions to promote trauma recovery that utilizes an eco-social approach to enhance health status and well-being following trauma exposures. This four-level theory of change could be applied to other population health problems, as well. METHODS: This theory-development process included reviewing existing literature, identifying assumptions, defining core concepts, stating propositions, depicting concepts and propositions for clarity, and illustrating with case examples grounded in our focus on trauma. RESULTS: The resulting Eco-Social Trauma Intervention Model offers a framework for interventions that address the impact of trauma on the individual level through self-regulation, interpersonal level through relationships, community/organizational level through safety, and societal level through identities. Application of this model to intervention development for those affected by trauma is intended to promote resilience, recovery, posttraumatic growth, and positive adaptations to traumatic stress for populations, going beyond the current Western paradigm of treating individuals for psychopathology. CONCLUSIONS: The Eco-Social Trauma Intervention Model offers an adaptable transdisciplinary framework for developing and researching scalable trauma interventions for individuals, communities, and populations.

Understanding Trauma Normativeness, Normalization, and Help Seeking in Homeless Mothers.

Although trauma-informed approaches guide services to families experiencing homelessness, more emphasis is placed on securing housing than addressing underlying trauma contributing to housing instability. Examining the stories of 29 homeless and/or unstably housed mothers within the broader literature on family trauma and violence, chronic illness, and cultural aspects of family functioning, we define the process of trauma normativeness and normalization that may occur with repeated trauma experiences and argue that rehousing efforts must include concomitant attention to trauma and to understanding how individual, family, community, and cultural factors influence help-seeking behaviors in this vulnerable and growing population.

High-ACE Low Wage Workers: Occupational Health Nursing Research and Praxis Through a Trauma-Informed Lens.

Individuals with a history of adverse childhood experiences (ACEs) disproportionately have poor mental and physical health outcomes. These experiences affect individuals across the life span extending beyond health with deleterious impact on work-related outcomes. Low-wage workers are particularly at risk. Social service and health organizations are becoming aware of the extent to which the populations they serve have been affected by these experiences. Employment support programs may serve high-ACE individuals but likely are unaware of their histories and the developmental or health deficits that result and can impinge on successful employment. Occupational health nurses may be well-positioned not only to implement trauma-informed care in workplaces but also to influence the ways in which employment services for this vulnerable group are delivered. The purpose of this article is to consider how ACEs could affect vulnerable workers. The need for trauma-informed research and praxis to advance occupational health nursing is discussed.

In Their Own Words: Exploring Family Pathways to Housing Instability.

Housing instability threatens the health and well-being of millions of families across the United States, yet little is known about the characteristics or housing trajectories of at-risk families. To address this gap in our understanding of family risk for housing instability and homelessness, we undertook a qualitative descriptive study utilizing a convenience sample of 16 mothers recruited from a housing service agency living in Detroit and receiving emergency services to avoid homelessness. Participants completed the Brief Patient Health Questionnaire (PHQ), then narrated their life events and reasons for housing instability and disclosed desired interventions for homelessness prevention. Data analysis reveals that women experienced high rates of previously undisclosed trauma, broken family relationships, early parenting responsibilities, social isolation, and system failures that contributed to recurrent episodes of housing instability. We argue that housing instability is a symptom of multiple chronic underlying issues that need more than a temporary financial patch.

The Data Dilemma in Family Homelessness.

Current estimates of homelessness in the U.S. are biased toward counts of sheltered or visibly unsheltered individuals. Those who remain out of sight during counts and/or live in places or circumstances that elude the United States Department of Housing and Urban Development's (HUD) definition of homelessness remain undercounted. Underreporting the unique characteristics associated with subgroups of people experiencing homelessness also limits access to the services that best meet their needs. As national counts drive policy and funding for housing-related services, front-line providers have too few resources to treat less visible and understood populations. We argue that homeless families are particularly vulnerable to these trends and explore how current data collection and reporting approaches thwart family homelessness interventions and prevention.

Using Sociograms to Enhance Power and Voice in Focus Groups.

OBJECTIVE: To discuss the use of sociograms in our focus groups with homeless sheltered mothers and to assess facilitator influence and the distribution of power influence. DESIGN AND SAMPLE: An exploratory, descriptive qualitative design that utilizes both focus groups and sociograms. Two focus groups were conducted in December 2009 (N = 7) and January 2010 (N = 4). Data analysis included a content analysis and a process analysis using sociograms to graphically represent group participant dynamics. RESULTS: Use of the sociogram provided a means to assess the influence of the facilitator as well as quantify the degree to which group participants' voices are included. CONCLUSION: Using sociograms provides a viable mechanism to complement content analysis and increase the methodological rigor of focus groups in health care research.

Voices from the street: exploring the realities of family homelessness.

Homelessness threatens the health and well-being of thousands of families in the United States, yet little is known about their specific needs and how current services address them. To fill this knowledge gap, we explored the experiences of homelessness families in Detroit, Michigan. We targeted homeless mothers and their caseworkers for study to see if the perceptions of needs and services were in alignment. Using focus groups and content analysis, we identified four overarching themes that illustrate homeless mothers' experience with homelessness. We then analyzed data from caseworkers to look specifically for similarities and differences in their perceptions. Key findings included reports of family histories of violence, poverty, social isolation, and a lack of informal support as contributing to homelessness. The differing perspectives of mothers and their caseworkers regarding how best to move forward highlight how current programs and services may not be meeting the needs of this growing and vulnerable cohort.

Overcoming: a concept analysis.

BACKGROUND: Nurses often work with individuals and populations striving to improve or maintain the quality of their lives. Many, struggling from complex health and social problems, are challenged to surmount barriers to achieve this goal. The growing number of homeless families in the United States represent one such cohort. AIMS: To develop an operational definition of overcoming and explicate its meaning, attributes, and characteristics as it relates to homeless families. METHODS: Using the concept analysis method described by Walker and Avant, along with an extensive literature review, and sample cases pertaining to family homelessness, we delineated the defining attributes, antecedents, consequences, and empirical referents of the concept, overcoming. CONCLUSION: The results of this concept analysis, particularly the relationship of overcoming to family homelessness, provide guidance for further conceptualization and empirical testing, as well as for clinical practice.