Trauma-informed interactions within a trauma-informed homeless service provider: Staff and client perspectives.

This study aims to provide practical insights for developing trauma-informed interaction strategies between service providers and participants in homeless service organizations (HSOs). Twelve providers and 17 participants were interviewed for a qualitative study on trauma-informed care (TIC) within an HSO. Thematic analysis revealed six themes regarding provider approaches to TIC interactions with participants: provide a sounding board, promote safety, foster understanding and respect, build relationships and trust, facilitate connection to services, and ensure flexibility in service provision. Participants noted three themes regarding their views of TIC interactions with providers: possess education and experience, build relationships and trust, and demonstrate supportive interpersonal styles. This study describes the application of TIC within an HSO, emphasizing the importance of supportive, positive interactions that promote understanding, respect, and trust. It highlights key factors in service provision. The findings expand our understanding of TIC implementation in HSOs and suggest areas for improvement.

A Qualitative Examination of Collaborative Infrastructure within Sexual Assault Response Teams.

Sexual assault response teams (SARTs) are multidisciplinary interventions that seek to improve the response to sexual assault in their community. SARTs bring together relevant stakeholders (e.g., sexual assault advocates, medical/forensic examiners, police, prosecutors) to coordinate the response to sexual assault and improve survivors' help-seeking experiences. SARTs may adopt various infrastructures to guide their team (e.g., case review, subcommittees), but little is known about how infrastructure influences SART effectiveness. Therefore, this qualitative study examined the helpful versus challenging aspects of SART infrastructure. Interviews from a national random sample of 169 SART leaders revealed helpful versus challenging aspects of mission statements, formal protocols, subcommittees, team roles, trainings, meetings, and case review. Participants believed infrastructures have positive influences on interdisciplinary relationships, team efficiency, and creating improvements in responding to sexual assault. However, certain infrastructures were difficult to implement for some teams. Additionally, some infrastructures can have unintended consequences, such as exacerbating team conflict. Findings suggest that SARTs may benefit from first focusing on infrastructures that build trusting interdisciplinary relationships and widespread buy-in prior to implementing accountability-focused measures (e.g., protocols, case review).

Stressors of Rape Crisis Work From the Perspectives of Advocates With and Without Sexual Assault Victimization History.

Rape crisis centers largely rely on volunteers for delivering emergency room advocacy to survivors of sexual assault. Volunteer advocates bear witness to trauma as part of their role, such as when listening to details of sexual assault. This exposure may negatively affect advocates long term, which may lead to secondary traumatic stress and vicarious traumatization, and possibly reduce their ability to provide quality services and remain in their role. In addition, some advocates may be survivors of sexual assault themselves. Survivors may differentially experience the toll of advocacy work. The present qualitative study sought to identify stressors that advocates face within their role, aspects of stressors unique to survivors who advocate, and the effects of stressors on advocates. Semistructured interviews were conducted with 18 current volunteer advocates, 11 of whom identified as survivors, from three rape crisis centers. Findings demonstrated stressors associated with self-evaluation; rules or expectations of the role (including the crisis nature of the role); witnessing lack of client support; helplessness around sexual assault as a systems issue; identifying with the client; witnessing the physical and emotional impact on clients; and being reminded of their own assault. Results also revealed how these stressors and advocacy overall influenced advocates. Unique aspects of stressors to survivors arose in the way advocates experienced the stressors. In addition, survivors exclusively described being reminded of past trauma within advocacy work. Findings have implications for supporting advocate well-being by better understanding the stressors that may lead to negative outcomes and informing individual coping, training, and overall organizational support of advocates. Such measures may ensure retention of volunteers and maintain quality advocacy services.

Predictors of employment outcomes in a comprehensive service program for individuals experiencing chronic homelessness.

This study examined predictors of employment service referral and employment outcomes among individuals experiencing chronic homelessness participating in a comprehensive service program emphasizing housing placement and economic independence. The sample included all participants enrolled in the program. Participants self-determined whether to be referred for employment services. Outcomes included (a) whether participants were referred for employment services offered by the program (N = 275); and (b) whether employment was attained among the subsample of participants referred for employment services (N = 135). Logistic regression analyses for the 2 outcomes were conducted. Predictors included demographics and health indicators collected via self-report during program intake. Participants who were younger and racial/ethnic minorities were more likely to seek referrals than those who were older and White/European American. Individuals who were unemployed due to disability were less likely to seek referrals than those who were unemployed but seeking employment. Participants with better reported health and who were unemployed but seeking employment were more likely to attain employment than those with poor health or were unemployed for another reason (e.g., retired, disabled). Findings from this study have implications for employment services implemented in the context of homeless service programs. Future developments in employment services for people who are chronically homeless should include an array of employment services varying in intensity based on need. Other issues to be addressed to facilitate employment and its impact include addressing stigma and increasing earning potential. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Trauma-Informed Care for Individuals with Serious Mental Illness: An Avenue for Community Psychology's Involvement in Community Mental Health.

Individuals with serious mental illness are at particularly high risk for trauma; however, service environments with which they interact may not always be trauma-informed. While community mental health and other human services settings are moving toward trauma-informed care (TIC) service delivery, a variety of TIC frameworks exist without consensus regarding operationalization, thereby leading to challenges in implementation. TIC is principle-driven and presents substantial overlap with community psychology values and competencies, including ecological frameworks, second-order change, empowerment, and citizen participation. One way to address barriers to TIC implementation is to draw on the strengths of the field of community psychology. With a particular emphasis on the applicability of TIC to individuals with serious mental illness, this paper identifies key implementation issues and recommends future directions for community psychologists in clarifying the service framework, its adaptation to specific service contexts, and improving delivery through consultation and evaluation. Community psychologists may work with various disciplines involved in the TIC field to together promote a more conscious, actionable shift in service delivery.

Applying a Time-Patterned Typology of Homelessness Among Individuals with Mental Illness.

Identification of subgroups of the homeless populations, or typologies, has been an important research priority to guide homelessness services and policies. This study builds on previous typological research conducted in the general homeless population by focusing on individuals with mental illness to further delineate typologies within a more homogenous subset of the homeless population. A time-patterned typology based on episodes of street and shelter homelessness over a four-year period was applied to a sample of 246 individuals identified through mental health administrative records. Four groups were created based upon patterns of homelessness: 26.8% experienced homelessness for 4 years, 13.4% had one episode of homelessness but were no longer homeless at the end of the follow-up, 48.4% had at least two episodes of homelessness, and 11.4% had a single episode of homelessness lasting 3 months or less. Findings from a multinomial logistic regression indicated that gender, presence of a psychotic disorder, substance abuse, and year of study enrollment significantly predicted group membership. Residential trajectories upon exit from homelessness and at the end of the four-year follow-up were examined. Implications for current policy and future research are discussed.

Caring for people with severe myalgic encephalomyelitis: An interpretative phenomenological analysis of parents' experiences.

Experiences of parents who care for sons or daughters with severe myalgic encephalomyelitis are rarely discussed within the literature. Narratives of parent-carers in Lost Voices from a Hidden Illness were analyzed using interpretative phenomenological analysis. This study aimed to give voices to those who care for individuals with myalgic encephalomyelitis and are often stigmatized and inform future research supporting parent-carers. Results included themes of identity change, guilt, feeling like outsiders, uncertainty, changing perceptions of time, coping mechanisms, and improvement/symptom management. Findings could inform the development of carer-focused interventions and provide vital information to health professionals about parent-carers' lived experience.