Providing Mental Health Services for Families Impacted by Psychological and Physical Homelessness

1. Providing Mental Health Services for Families Impacted by Psychological and Physical Homelessness Kimberly Bradley, PsyD Center for the Vulnerable Child Children’s Hospital & Research Center Oakland National Conference on Ending Family Homelessness: Building Healthy Families Oakland, CA February 9, 2007

2. Acknowledgements Collaborators: Children’s Hospital & Research Center Oakland Cheryl Zlotnick, RN DrPH Tammy Tam, PhD

3. Physical Homelessness is associated with: • housing instability • food insecurity • lack of adequate clothing • lack of adequate health care Psychological Homelessness is associated with: • the impact of generational homelessness • social isolation: lack of connection, lack of stable attachments/ relationships • a history of chaotic, haphazard, and sporadic experiences • trauma, victimization and multiple losses

4. Public Entitlements Social Services Health care Legal Education Systemic Circles of Influence on the Family Child Welfare

5. C.O.R.E. Program Framework Program Approach: • social justice • cultural responsiveness • family preservation • public health Services Provided: • therapeutic, direct-care services at 3 • different levels: child, mother and family • collaboration with other agencies • helping families navigate systems • psychoeducation • referral to community resources

6. Mental Health Practices • family assessment on the roots of homelessness for the family: situational or generational homelessness; psychological or physical; emotional or economic • meet family where they are • provide emotional support through individual, family and/ or group therapy • provide parent education, counseling and support • educating systems on the needs of homeless families • advocacy for homeless children and families • creative treatment plans that meet the individual needs of the family • crisis intervention and management • working with whoever is considered family

7. Barriers to Ending Family Homelessness • Chronic homelessness, instability and poverty • Lack of employment skills necessary to earn a living wage • inadequate affordable housing • Substance abuse problems & history of inadequate drug tx for homeless mothers • History of trauma and victimization • CPS involvement - child placement in foster care system • Loss of public entitlements • Lack of external supports

8. Gaps in Service - Service Needs • culturally accountable and responsive services • affordable housing with supportive services • family preservation & child abuse prevention services • rent subsidies for times of family crisis • federal dollars funding homeless families • mental health services specifically for caregivers • mother-child residential substance abuse treatment • systems collaboration • services for youth transitioning out of foster care

9. References Bassuk, E.L., Buckner, J.C., Perloff, J.N., & Bassuk, S. (2003, November). Prevalence of mental health and substance use disorders among homeless and low-income mothers. Am J Psychiatry, 155: 11 Brissett-Chapman, S. (1998) Homeless african-american women and their families: Coping with depression, drugs and trauma. In book, Drug Addiction Research and the health of women. Eds.: C.L. Wetherington & A.B. Roman. National Institute on Drug Abuse. Kushel, M.B., Evans, J.L., Perry, S., & others (2003, November). Victimization among homeless and marginally housed persons. Archives of Internal Medicine 163, pp. 2492-249 Zima, B.T., Wells, K.B., Benjamin, B. & Duan, N. (1996, April). Mental health problems among homeless mother: relationship to service use and child mental health problems. 53(4) pp. 332-338. Zlotnick,C., Robertson, M.J., & Tam, T. Substance use and separation of homeless mothers from their children. (2003). Addictive Behaviors. (28) pp1373-1383.