Author: Anne P. DePrince, PhD

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:

1. At what rate do youth experiencing houselessness report victimization before and after leaving home?
2. Are youth who experience victimization before leaving home more likely to later experience victimization after leaving home?
3. 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.

by Adi Rosenthal, 3^rd Year Graduate Student, TSS Group

Each year in the United States, about 3.5 million children are the center of child abuse or neglect investigations. These children are arguably our country’s most vulnerable. Often, the well-being of these children can be supported by providing services to their caregivers based on families’ needs.

Unfortunately, caregivers involved in child welfare say they receive fewer services than they want and need, and they face barriers to accessing those services.

Many researchers have examined the mental health service needs of families involved in child welfare, but caregivers’ needs reach beyond psychological. Families also have physical health needs, such as medical care and access to healthy food; school-based needs such as tutoring, extra-curriculars, and testing for learning disorders; basic needs such as food, clothing, shelter; and needs related to social support from their friends and community.

Caregivers face numerous barriers in getting these needs met, including skepticism about services and fear of judgement as well as external barriers, such as lack of financial resources and services not being available.

Unfortunately, measures that get at families’ diverse needs and barriers haven’t been available, leaving researchers and service providers unable to formally assess the caregivers’ needs, and in turn, address them.

The TSS Group set out to create a measure of service needs and barriers across service areas, which we’re calling the Checklist of Service Needs and Barriers (C-SNAB). We drafted items for this measure based on previous research about families’ needs. The measure included several areas: basic needs (such as clothing, diapers, and other non-food items, paying bills, housing), physical health (such as medical care, access to healthy food, insurance), school-based services (such as tutoring, extra-curriculars, and testing for learning disorders), mental health (such as therapy for child or caregiver, substance use treatment, parenting support), and social support (such as mentorship, support from a religious or cultural community). The measure also includes a checklist of barriers for caregivers to indicate what makes access to services challenging. This checklist includes logistic barriers (such as not having a computer or transportation), structural barriers (such as services not being available or not being affordable), and barriers related to stigma or uncertainty about services.

Next, we asked 32 caregivers of children involved in abuse or neglect investigations to fill out C-SNAB in order to examine how well the measure, designed based on past research, picked up on the day-to-day barriers and needs facing caregivers.

Here’s what we learned.

The C-SNAB seemed to capture the breadth of needs and barriers families faced. Nearly all (94%) of the caregivers interviewed had at least one unmet service need. On average, caregivers reported experiencing 4 unmet service needs.

Caregivers commonly reported needs across more than just one service area. Basic needs showed up most frequently, followed by physical health, school-based needs, mental health needs, and social support.

Caregivers had the greatest unmet needs in the basic needs category, which included things like needing help paying bills or rent, getting diapers or clothing, and fixing things that are broken in their home or neighborhood. In fact, 50% of caregivers reported having unmet basic needs. This fits with past research that has shown families involved in child welfare investigations are disproportionality from low socioeconomic groups. This suggests that when families show up for child abuse investigations, they are likely to have high levels of economic needs.

Needs weren’t the whole story. Families faced many barriers – an average of seven, in fact! Most commonly, caregivers reported not being able to afford services, not being sure how to obtain them, not having enough time, and lack of availability of services in their community. 

Families described facing the greatest barriers in their efforts to get school-based, medical, and mental-health services. Accessing these kinds of services require navigating complex organizations, such as school boards and administrators, insurance companies, and often numerous different healthcare providers. This finding suggests that caregivers may benefit from warm hand-offs between providers and help navigating these complicated systems. Early and hands-on coordination of services could have a meaningful impact on the trajectories and wellbeing of families and children.

Take-Aways

Our work on this new measure indicates that caregivers involved in child abuse and neglect investigations have many unmet needs, which was not surprising given the sheer number of barriers they faced. Preliminary analyses suggest that the C-SNAP was an efficient and useful tool for gathering information about their needs and barriers.

This study has potentially important implications at this moment in time, when communities are grappling in new ways with how systems fail people of color. Families from Black Indigenous People of Color communities have long histories of being treated differently in child welfare and other systems. For example, twice as many black children in the child welfare system are placed in foster care compared to white children, even when the cases are similar. For black and minoritized caregivers, expressing their service needs could mean being blamed for those needs or invoke fear that their needs will be used against them or reinforce “disparaging stereotypes about Black family unfitness and need for white supervision”

We hope that the C-SNAB’s inclusion of service needs AND barriers conveys to families that difficulties aren’t reflective of something about them; rather, barriers to getting their family’s needs met are real and worthy of attention.  Supporting caregivers by reducing barriers and meeting their service needs is a critical path to improving child wellbeing and safety. Accurate assessment of these needs and barriers is a critical step.

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Acknowledgments: This research was supported by a grant from the Colorado Evaluation and Action Lab to Anne DePrince and Julia Dmitrieva. Thank you to the project’s government partners as well as the Traumatic Stress Studies Group for making this work possible.

by Anne P. DePrince & Naomi Wright

Would more money help?

More precisely: Would increases in funding for victim services across Colorado change service provision, improve organizational capacity to service victims, and improve collaboration across service agencies?

That kind of change is a tall order. But that’s what our colleagues at the Office for Victims Programs (OVP) wanted to know years ago as Colorado prepared for an increase in Victims of Crime Act (VOCA) Program funds from the federal government. The increases started in May 2016, when programs across the state received one-time infrastructure awards. In January 2017, overall funding for victim services increased through regular cycle grants.

With the timeline for funding changes in mind, our team looked back to 2015 to get a snapshot of crime victim services before any funding changes. In particular, we drew on grant reports, submitted quarterly by VOCA-funded agencies. Then, we followed the victim service story that unfolded in the quarterly grant reports until the end of 2019.

As great as grant reports may be for counting things, they don’t necessarily tell the story of day-to-day impact. That’s why we also interviewed 30 program or executive directors who were randomly selected from agencies with VOCA funding. Directors spoke with us multiple times between 2018 and 2020 to share their perspectives on the impact of VOCA funding on their agencies and crime victims.

Key Findings

The subtitle for this section should be something like, “Feeling Tired? We Have Some Graphs to Explain Why.”

From 2015 (before funding increases) to 2019, the average number of clients served by VOCA-funded programs significantly increased across the state. The change was what researchers call a large effect size — the kind of effect one dreams of finding in their own research, but rarely sees. Just look at yours, though, Colorado:

Unpacking the graph above, the blue lines represent the average number of clients served each quarter by agencies who had VOCA funding from 2015 to 2019. The red lines are new clients. We focused on the 88 agencies who had funding across the whole five-year evaluation period in order to include a baseline before funding increased. This was a rigorous, though conservative, test of impact because we set aside data from more than seventy organizations who had VOCA funding for a subset of the evaluation period.

If you’re a long-time Trauma Research Notes reader who has grown fond of thinking skeptically about data, you might find yourself wondering, “Sure, services went up, but maybe that would have happened anyway as Colorado’s population grew or agencies built on their 2015 momentum.” We hear you and applaud your skepticism. We wondered about that too, so we ran some analyses to see if there was evidence that Colorado victims services were simply on an upward service trajectory that would have happened with or without VOCA funding increases. We don’t think that’s the case. Here’s why: Below is a graph that shows the average number of clients served per quarter across years. When we compared the years, there was no significant difference between 2015 and 2016. However, a significant change in services occurred in 2017, after agencies had time to put their one-time grants to use and regular cycle funding increased.

Significant changes in the average total clients served per quarter are indicated with ** (p<.01) and *** (p<.001).

While those data provide evidence that agencies had improved organizational capacity to serve more clients, other data showed changes in services themselves.  Below is a figure that illustrates the significant increase over time in the average number of clients who 1.) received information and referrals; 2.) criminal/civil justice system assistance, and 3.) personal advocacy or accompaniment. Agencies maintained shelter/housing and emotional support/safety service levels over the five years.

There was also evidence that agencies expanded services to minoritized and marginalized communities. For example, the number of clients who identified as Black, Hispanic/Latinx, Lesbian/Gay/Bisexual/Transgendered, and Deaf/Hard of Hearing increased over time. This was echoed in interviews with Directors, who described the ways that VOCA funding increased agency capacity to serve diverse crime victims — from freeing up funds that could then be used for interpretation services to hiring bilingual staff.

Directors also offered evidence of improved collaboration. For example, the vast majority of Directors said in 2018 that VOCA funding had increased their capacity to collaborate with other agencies. By Fall 2019, Directors were significantly more likely to describe their agencies as maximizing their overall funding and resources through collaboration with other agencies. Here’s how they described things:

“We wouldn’t have even been there [in a collaborative workgroup] if not for the VOCA funds in most respects.

“We have some long-term very solid collaborative relationships in the community, but I think the, VOCA’s focus on civil legal services in the past couple of years has had enormous significance in the ability to think creatively, to, as a collaborative kind of leadership, to think creatively of how could we serve more people, how could we serve folks better, how do we get at a different type of need that we haven’t been able to do before.”

“We’ve been able to collaborate more with other offices to learn more and to figure out how to do some of the seemingly simple things, like updating our intake form so that it’s the most inclusive intake form possible. We’re able to collaborate with other entities to make sure that we’re representing folks in the correct way or at least providing them with a space to represent themselves in a comfortable way.”

But remember the subheading of this section because the counterweight to the many gains was evidence that agencies are straining under the ever-growing demand for their services as they try to also improve services to meet a broader range of client needs (e.g., mental health). For example, the majority of Directors indicated VOCA funding had improved their agencies’ capacity to serve crime victims initially, but their views changed by Fall 2019. In the Fall, 43% of Directors said their agencies were only able to maintain current capacities with VOCA funding, not further increase, as illustrated in the figure below.

Take-Aways

Since 2015, agencies across Colorado used VOCA funding to expand services to crime victims. This evaluation revealed evidence that increases in VOCA funding for victim services were associated with measurable change in line with many of the priorities identified by OVP back in 2015, such as (but not limited to):

• increases in number of clients served;
• increases in specific kinds of services, such as criminal-civil legal system assistance; and
• improved collaboration;

To sum things up, the last word goes to a Director who spoke with our team —

“VOCA funds are really integral to our ability to operate and function.”

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Acknowledgements: Thank you to members of the Traumatic Stress Studies Group for their contributions to this evaluation. The evaluation was funded by a contract from the Office for Victims Programs, State of Colorado.

by Anne P. DePrince, PhD and Leslie Hasche, PhD

From the Democratic presidential debate stage to op-ed pages, the affordable housing crisis hitting communities across the country has received much needed attention.

As a trauma psychologist and social worker, we applaud the national spotlight on housing affordability. Yet, that’s only part of the conversation we need to have to develop effective housing solutions. Now we need to talk about the role that abuse and exploitation play in housing instability, from adolescence to adulthood — and as our research team recently discovered, even into older adulthood.

The vast majority of youth experiencing homelessness say they left home to escape child abuse. This is especially true for LGBTQ youth who are more likely to be abused and kicked out of their homes than their peers. Once on the streets, sexual and physical victimization is common. Victimization on the streets then contributes to serious and costly health problems, such as depression, PTSD, and substance abuse.

In adulthood, domestic violence drives housing instability and homelessness among women and their children. Women fleeing their abusers may spend time in shelters or move multiple times. Women may also face tremendous economic instability when leaving abusers, making it difficult to get basic needs met, including finding and keeping housing.

Among older adults, our team’s new research points out risks that a lack of affordable housing is poised to create a perfect storm that leads to the exploitation of older adults. Nationally, concerns for affordability and accessibility of housing for older adults is only increasing. Plus, older adults who experience homelessness also face physical and sexual victimization that could be reduced by reentering housing. Housing insecurity is a pressing issue for older adults, and it becomes more complicated by the potential risk for victimization within one’s own home.

…we have to grapple with the ways that abuse and exploitation create housing instability.

Our team reviewed police reports of abuse and exploitation of more than 500 older adults. Nearly one in ten of the police reports described situations where another person – most often a family member – was exploiting an older adult’s residence in ways that put the older adult’s housing at risk.

What we read in police reports lined up with what practitioners working with older adults to prevent and respond to elder abuse also noticed. To get a sense of these cases, imagine an adult daughter living in her aging mother’s apartment in violation of the terms of the lease, which says only the mother can live there. By violating the lease, the older adult risks eviction. That housing instability can put their psychological and physical wellbeing at risk. Once evicted, the older adult will face housing shortages. She might find herself homeless, living out of a car or moving from shelter to shelter, making it difficult or impossible to access assistive medical devises. Or imagine an adult grandchild who sells drugs out of his grandfather’s living room. The grandchild stops people from coming over to the house, including the person the grandfather called to repair the roof. Unaddressed, that small leak grows into a chronic moisture problem that affects the older adult’s health.

Researchers have long recognized that people providing care for older adults may feel entitled to their resources, which can lead to exploitation. The current shortage of affordable housing in many communities may increase the likelihood that family members and other trusted adults exploit access to older adults’ residences.

From adolescence to the older adult years, abuse and exploitation are tangled up with housing issues. Solutions to the national housing crisis cannot focus on affordability alone. Instead, we have to grapple with the ways that abuse and exploitation create housing instability. Effective housing policies have to also work to decrease child abuse and domestic violence. At the same time, housing conditions can affect risk for victimization, as seen among youth living on the streets. There are hints that older adults maybe the next group to fall victim to exploitation because of the housing crisis. We need policies that address affordability and availability of housing for all Americans across the life span at the same time as abuse and exploitation if we are to end the housing crisis in America.

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Acknowledgements

Our research on older adults was supported by the National Institute of Justice [Grant #2013-MU-CX-0032]. The views expressed are those of the authors and do not necessarily represent the views or the official position of the National Institute of Justice or any other organization. Thank you to the Denver Forensic Collaborative for At-Risk Adults for their collaboration to make research with older adults possible, particularly Denver City Attorney’s Office (especially Linda Loflin Pettit), Denver District Attorney’s Office (especially Maro Casparian), Denver Human Services-Adult Protective Services, and Denver Police Department; and the Traumatic Stress Studies Group.