Transcript Use of the SITCAP Model with the Homeless

SITCAP as an
Intervention with the
Homeless
Jean West MSW LCSW CTC-S CT
What is Trauma?
 Trauma is an overwhelming sense of terror,
powerlessness and the absence of a sense of safety.
Exposure
 Following exposure to a potentially trauma inducing
incident, survivors may become frozen in an activated
state of arousal.
 Arousal refers to a heightened state of alert and fear for
one’s safety.
 Experiences
Experiences which can cause
trauma
 Physical and/or sexual abuse
 Domestic violence
 Living with substance abusing parents
 Witnessing parental homicide
 Homelessness
 Burns/other serious accidents
 Car fatalities
 Divorce
 Natural disasters
Perception
Perception
 “When it comes to trauma, the critical factor is the
perception of threat and the incapacity to deal with it.”
Levine 2005
Three Types of Trauma
 Type I Single exposure/posttraumatic growth
likely/positive psychological outcome likely/survivor
versus victim
 Type II Single incident like abuse repeated over
chronic period / multiple exposures/PTG
accessible/can separate one incident from
another/impaired functioning but manages
 Type III Complex cumulative trauma/ can’t separate
out memories/trait and state anxiety/generational
transmission/psychiatric disorders/low functioning
Posttraumatic Stress Disorder
 According to the DSM-IVTR, in order for a child to be
diagnosed with PTSD, two characteristics must exist:
 The person experienced, witnessed, was related to, or
was confronted with an event or events that involved
actual or threatened death or serious injury or threat to
the physical integrity of self or others.
 The person(s) response involved intense fear,
helplessness or horror…
The Role of the Brain and the
Nervous System
So what does trauma do to the
developing brain?
 Sympathetic nervous system takes over.
 Cortisol and adrenaline goes up and stays up and acts
like an acid rain on the rest of the nervous system.
 Suppressed serotonin levels
 Affect dysregulation
 Depressed executive function organization, planning,
Traumas Effect on Learning
 In the arousal (anxious) state it becomes difficult to process
information, follow directions, recall information, and focus
 Physician’s office
 Poor problem solving, attention, disorganized
 Often only hear half of the words spoken by their teachers
 Cognitively will generally be far behind their peers, children
can often learn at three times the rate compared to when
engulfed in trying to survive
Traumas Effect on Behavior
 Hypervigilance
 Depression
 Difficulty sleeping
 Attention problems
 Easily startled
 Impulsivity
 Clinging
 Aggression
 Nightmares
 Fearful
 Disobedience
 Risk taking
 Impaired social skills
 Panic attacks
 Anger /rage
 Hypersensitive to touch,
 Can’t self sooth or modulate
emotions
movement, some sounds and
smells
Secondary Victimization or
Wounding
 Secondary victimization or wounding occurs when the
people and organizations you turn to for help respond
in subtle ways that cause you additional pain.
 Denial and disbelief
 Discounting and minimizing
 Blaming you
 Treating you as defective
Trauma and Homelessness
 “Trauma- physical, sexual, and emotional –is both a
cause and a consequence of homelessness.” HCH 1999
Trauma and Homelessness
cont…
“The experience of homelessness can be best understood
as highly stressful, and, in some instances, traumatic. While
homelessness is enormously stressful to individuals of any
age, children’s experiences are unique in that it involves
multiple losses during critical developmental periods.
Children who are homeless are likely to be forced to leave
behind valued possessions, experience disruptions in
friendships and other significant relationships, and both
change and infrequently attend school. Additional emotional
strains are tied to enduring the social stigma of
homelessness .” Cowan 2007
Impact of Homelessness on
Children
 Every day, homeless children are confronted with
stressful, often traumatic events.
 74% of homeless children worry they will have no place
to live.
 58% worry they will have no place to sleep.
 87% worry that something bad will happen to their
family. (Impact on education, trauma)
Impact cont…
 Within a single year:
 97% of homeless children move, many up to three
times.
 More than 30% are evicted from their housing.
 22% are separated from their family to be put in foster
care or sent to live with a relative.
 Almost 25% have witnessed acts of violence within
their family.
Mental Health
 The constant barrage of stressful and traumatic
experiences has profound effects on the cognitive and
emotional development of homeless children.
 Homeless babies show significantly slower
development than other children do.
 Homeless children between 6 and 17 years struggle
with very high rates of mental health problems.
The Emotional Impact
 More then one-fifth of homeless preschoolers have
emotional problems serious enough to require professional
care, but less then one-third receive any treatment.
 Homeless children have twice the rate of learning disabilities
and three times the rate of emotional and behavioral
problems as nonhomeless children.
 Half of school-age homeless children experience anxiety,
depression, or withdrawal compared to 18% of nonhomeless
children.
 By the time homeless children are eight years old, one in
three has a major mental disorder. NCTSN 2005
Homeless Children and
abuse
 8% have been physically abused, twice the rate of other
children.
 8% have been sexually abused; three times the rate of other
children.
 35% have been the subject of a child protection
investigation.
 24% have witnessed acts of violence within their family.
 15% have seen their father hit their mother.
 11% have seen their mother abused by a male partner.
National Center on Family Homelessness
Teens
 Homeless youth exhibit psychiatric disorders at a rate
six times greater than the general youth population,
with between 66 and 89 percent of homeless youth
having symptoms of one or more disorders. Whitbeck,
2009
Subgroups even more at risk
 Within the homeless youth population there are certain
sub-groups who are the most at risk for developing a
mental illness.
 Gay, lesbian, bi-sexual, and transgender youth appear
to have the most pervasive mental health problems.
 Youth who have been in state care
 Youth who have histories of abuse.
Profound Effects
 Taken individually or cumulatively, the experiences of
homelessness are likely to have profound effects on
children’s social, emotional and cognitive development.
(Anooshian, 2005; Bassuk, Buckner, et al, 1997
Homeless Fathers
 Although 70% of fathers of homeless children are in touch
with their children, most do not live with the family. The
downward spiral into homelessness for a child is often
accelerated if a father loses his job, becomes injured or ill,
has a bout with alcohol or drugs, or is involved with the
criminal justice system.
 50% of fathers are unemployed.
 43% have problems with drugs or alcohol.
 31% have physical or mental health problems.
 32% are in jail or on probation.
Homeless Mothers
Violence
 The frequency of violence in the lives of homeless mothers
is staggering.
 63% have been violently abused by an intimate male
partner.
 27% have required medical treatment because of violence
by an intimate male partner.
 25% have been physically or sexually assaulted during
adulthood by someone other than an intimate partner.
 66% were violently abused by a childhood caretaker or
other adult in the household before reaching 18.
 43% were sexually molested as children.
Connection
 Homelessness by itself can trigger significant mental
and emotional problems as trauma on the streets can
result in major depressive disorders, post traumatic
stress disorder, substance abuse, conduct disorder and
even suicide.
Trauma and Homelessness
Cont…
Homelessness results in a loss of community, routines,
possessions, privacy, and security.
 According to The National Traumatic Stress Network, more than
90% of sheltered and low-income mothers have experienced
physical and sexual assault over their lifespan.
 The experience of homelessness puts families in situations where
they are at greater risk of additional traumatic experiences such as
assault, witnessing violence, or abrupt separation.
 The stresses associated with homelessness can exacerbate other
trauma-related difficulties and interfere with recovery due to
ongoing traumatic reminders and challenges. NCTSN 2005
Trauma and Homelessness
Cont…
 Trauma is THE predominant mental health issue for
homeless mothers.
 Research confirms that the strongest predictor of
emotional and behavioral problems in poor and
homeless children is their mother’s level of emotional
distress. HCH 2003 (resiliency research with TLC)
 Emotional help is needed for both the parents and their
children in order to be most effective.
SITCAP: Primary Issues with
Trauma
 Fear / Terror
 Worry
 Hurt
 Anger
 Revenge
 Accountability
 Power
 Safety
 Survivor vs. Victim
Drawing
 Draw me a picture of what happened that you can tell me a
story about.
 Psychomotor activity that helps to trigger the sensory
memories when it is trauma focused
 Engages the child in active involvement in their healing
 Helps us to see what the child sees
 Helps the child externalize the experience and move it to a
safe place (the paper) outside himself which he has control
over
Drawing cont…
 Provides visual representation
 To communicate visually what we do not always have
words to describe
 Safe vehicle to communicate details
 Recreates a renewed sense of power and safety which
gives them hope for the future
Questions to Elicit Details
 After the child has drawn their experience, begin to ask
trauma-specific questions about the story
 What do you remember seeing or hearing?
 Do you sometimes think about what happened even when
you don’t want to?
 Do certain sounds, smells, etc… suddenly remind you of
what happened?
 What would you like to see happen to the person or thing
that caused this to happen?
 Do you sometimes think it should have been you instead?
Symptoms Versus Behaviors
 Reduction of PTSD symptoms can be experienced
without focusing on symptoms. Begin to restore a
sense of safety and power in the child and symptoms
will diminish.
Use of SITCAP in a shelter
 Children individual assessments, groups
 Parents trainings, support group
 Staff trainings
10 year old female
8 year old female
8 year old female
8 year old female
19 year old female
13 year old male
SJSD McKinney Vento
Initiatives 2010-2011
 Priority Level 1 building
 Staff training
 Parent training
 Screening of students
 Groups of 6-8 students, highest need using SITCAP model
 School Counselor and Social Workers training
 Trauma questions on local mental health centers assessment
/intake forms
 Community training for clinicians which included key shelter staff
2011-2012
 Shelter trainings
 Parent support group
 Counselors, social workers and community
certifications
 In-school one-on-one sessions with students
What does it mean for your
agency to be trauma informed?
 Safety
 Structure
 Becoming a witness
 We must be aware of how our own experiences effect
our ability to help
The Importance of Safety
People are not successful in
environments where they do
not feel physically and
emotionally safe, heard, and
respected. For people who
have experienced trauma,
issues of safety become even
more prominent.
Safety continued
Creating Consumer Crisis Prevention Plans
A written, individualized consumer self-care or crisis-prevention plan should include the
following:
A list of situations that the consumer finds stressful or overwhelming and remind him/ her of
past traumatic experience (i.e., triggers).
Ways that the consumer shows that he/she is stressed or overwhelmed (e.g. types of
behaviors, ways of responding, etc.).
Staff responses that are helpful when the consumer is feeling upset or overwhelmed.
Staff responses that are not helpful when the consumer is feeling upset or
overwhelmed.
A list of people to go to for support.
A list of situations that the consumer finds stressful or overwhelming and remind him/ her of
past trauma.
Importance in Assessment
Process
 Programs serving families who are experiencing
homelessness have an opportunity to address
children’s needs and connect them to appropriate
services. To meet children’s needs, questions about
their exposure to trauma must be included in the intake
assessment.
Policies
Homeless children are often required to spend part of
their days alongside their parents negotiating the
hierarchical maze of social service agencies that might
provide them with a place to sleep.
Sense of Control?
 When children are sheltered, they must learn and then
conform to new rules which dictate what time and
under what conditions they eat, sleep, shower, leave
and/or return to a building Living in a shelter setting
challenges pre-existing family rituals and unbalances
the authority of parents creating disharmony for adults
and children alike.
Separation
 Entering shelters may also result in forced separations
from parents and siblings due to program restrictions
that exclude fathers and/or adolescent boys. Shelters
crowded with strangers of all ages, some of whom may
be emotionally unbalanced or aggressive, may create
destabilizing and unsafe environments for children.
Judith Herman
Quote
“Atrocities refuse to be
buried…..Remembering and telling
the truth about terrible events are
prerequisites both for restoration of
the social order and for the healing of
individual victims.”
Quote from Primo Levi, Nazi
Concentration Camp Survivor
 “When the broken window was repaired and the stove
began to spread it’s heat, something seemed to relax in
everyone, and at that moment one prisoner proposed to the
others that each of them offer a slice of bread to us three
who had been working. And so it was agreed. Only a day
before a similar event would have been inconceivable. The
law of the camp said “eat your own bread, and if you can,
that of your neighbor,” and left no room for gratitude. It was
the first human gesture among us. I believe that that
moment can be dated as the beginning of the change by we
who had not died slowly changed from prisoners to humans
again.”
Resources

Cowan, Beryl Ann, "Trauma exposure and behavioral outcomes in sheltered homeless children: The moderating role of perceived
social support" (2007). Psychology Dissertations. Paper 39. http://digitalarchive.gsu.edu/psych_diss/39

HCH Health Care for the homeless Clinician’s network. Trauma and Homelessness.(1999) Vol.3, No.3

HCH Health Care for the homeless clinician’s network. Homelessness and family trauma: The Case for early intervention. (2003) Vol.
7, No. 2

Hermin, J. (1992) “Trauma and recovery”.

Levine, P. (2005) “Healing Trauma A pioneering program for restoring the wisdom of your body.” Sounds true Inc., Boulder CO.

NCTSN The National Child Traumatic Stress Network. Facts on Trauma and homeless children. (2005)

www.starr.traing.org/tlc

[email protected]
www.NCTSNet.org