By Naomi Wright (TSS Group), Tara Milligan (Graduate School of Social Work, DU), Kim Bender (Graduate School of Social Work, DU), Anne P. DePrince (TSS Group)
COVID-19 has renewed public attention to the U.S.’s “pre-existing condition” of houselessness, which has only worsened with recent COVID-19-related layoffs and job loss. Emerging evidence suggests those without housing may be at greater risk for infection with COVID-19. As researchers of interpersonal violence and abuse, we have had longstanding concerns about another health risk of housing instability: interpersonal victimization and revictimization.
Unfortunately, little research is available on youth experiences of violence and factors that might affect risk of revictimization after leaving home. Thus, we wanted to answer three questions:
- At what rate do youth experiencing houselessness report victimization before and after leaving home?
- Are youth who experience victimization before leaving home more likely to later experience victimization after leaving home?
- Could the connection between victimization before and after leaving home be explained by symptoms of psychological distress?
To answer these questions, we conducted preliminary analyses of data collected as part of a five-year collaborative study led by Dr. Kimberly Bender. The larger study tested a mindfulness training to reduce risky substance use and victimization among young people (age 18-20) residing at a Denver-area shelter. As part of that larger study, 245 young people living at a shelter participated in research interviews that asked about experiences of violence and abuse before and after leaving home as well as symptoms of posttraumatic stress disorder (PTSD) and depression. Finally, we asked some questions about their personal characteristics—such as time away from home, gender, and number of moves between cities after leaving home— that have been linked in previous research to increased risk for victimization.
Here are a few things we learned.
At what rate do youth experiencing houselessness report victimization before and after leaving home?
Nearly all young people (218 out of 236 youth; 92%) interviewed were victimized before leaving home. Three-quarters (183 out of 243 youth; 75%) were victimized after leaving home. The majority of young people reported violence in both settings (176 out of 237 youth; 72%). The figure below represents the distribution of violence experiences.
For comparison, in a 2018 research study with college students, who are approximately the same age as the young people in this sample, only 16% of the students reported experiencing violence or abuse in their lifetime.
Of the 218 young people victimized before leaving home, 198 (91%) experienced physical abuse, 99 (45%) sexual abuse, and 211 (97%) emotional abuse. We counted up the number of types of victimization young people reported: Before leaving home, youth experienced an average of 2.14 out of 3 of these types of victimization (SD = .88, range = 0-3).
Among the 183 young people victimized after leaving home, youth were most likely to experience conventional crime (155 youth; 85%) followed by peer victimization (111 youth; 61%), electronic victimization (108 youth; 59%) and sexual victimization (90 youth; 49%). Youth reported an average of 1.9 out of 4 types of victimization (SD = 1.47, range = 0-4).
Several factors were linked to victimization that warrant attention. Youth who had been away from home longer or moved more times between cities were more likely to be victimized while unstably housed than other youth in the sample. Young people who identified as cisgender women were significantly more likely to experience victimization than young people who identified as cisgender men. Young people who identified as transgender or gender non-binary had wide variation in experiences of victimization.
Are youth who experience victimization before leaving home more likely to later experience victimization after leaving home?
In short: yes. As has been found in many other populations, young people in this study who reported experiencing more victimization before leaving home also reported significantly more victimization after leaving home. The upward-trending dotted line in the figure below provides a visual representation of the relationship between victimization before and after leaving home.
Could the connection between victimization before and after leaving home be explained by symptoms of psychological distress?
Yes, at least partially. Young people’s levels of psychological distress seemed to play a role connecting victimization before and after leaving home. Specifically, young people who experienced more types of victimization before leaving home reported more symptoms of posttraumatic stress disorder (PTSD) and depression; in turn, youth with more symptoms of psychological distress reported more victimization after leaving home.
The path to revictimization through PTSD symptoms was significant.
The path to revictimization through depression symptoms was also significant.
Limitations to consider
These findings provide preliminary evidence that childhood victimization may increase psychological distress, and in turn, revictimization among young people experiencing houselessness. However, an important limitation has to be considered. We measured victimization and psychological distress at the same time; therefore, it’s possible that revictimization increased symptoms rather than symptoms increasing revictimization.
So what? We can better support youth experiencing houselessness by addressing the effects of childhood victimization and supporting trauma-informed care
The best supports for young people experiencing houselessness try to address the many facets of their complex social, material, physical, and psychological needs. These findings point to the importance of determining whether young people have a history of childhood victimization in order to support interventions for psychological distress and to ensure safety – but waiting until young people are living in shelters makes this more difficult. Early-life preventative programs as part of schools, child welfare, and foster care systems could serve as universal points of screening and intervention.
Research also shows that it is common for people who have been victimized to cope with their experiences by using substances or have difficulty regulating their emotions and attention. All of these issues can make accessing and using services more challenging. One way to help young people get services despite these challenges is to focus on trauma-informed models of care. Such trauma-informed programs go beyond providing for basic needs, or building skills to be productive citizens, to also support the emotional, physical, and relationship wellbeing of unstably housed young people. Trauma-informed practices also use universal design in day-to-day practices to account for the cognitive or social effects of trauma. For example, visual aids could accompany verbal explanations to help with attention and remembering the information later. Another approach is the use of harm-reduction models that are most helpful to youth whose strategies for coping may be mistaken as deliberate misconduct.
Our hope is that the current study’s findings can be one brick in the pathway to understanding and reducing revictimization among young people experiencing houselessness. We do not doubt that building a route to reduce the risk to unhoused youth will require significant advocacy, collaboration within communities, and efforts toward larger social change.
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Acknowledgements: The research described here was supported by the National Institute On Drug Abuse of the National Institutes of Health under Award Number NIH 1 R15 DA039355-01. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Trauma Research Notes 