Lessons Learned from Integrating a Trauma-Informed Assessment and Group Therapy Intervention (SFCR) in Homeless Settings

Background: Violence plays a significant role in the lives of children experiencing homelessness. By age twelve, 83 percent of homeless children have been exposed to violent events, including abuse and witnessing acts of violence within their families and communities. For children experiencing homelessness, the adverse emotional consequences of violence are compounded by severe stress caused by housing instability and living in a chaotic shelter setting. Despite the adverse effects of violence, services in homeless shelters are fragmented, poorly-resourced, adult-focused, and ill-prepared to meet the complex needs of children. To address the gap in services for homeless children who have experienced violence and trauma, American Institutes for Research (AIR) and the Central Massachusetts Housing Alliance, implemented “START with Kids” (Shelter-based, Trauma-informed Assessment, Referral and Treatment), a comprehensive integrated care approach to providing trauma-informed, clinically-driven care for children ages 0 to 18 in homeless shelters in Worcester, MA. At the shelter level, START with Kids involved training on trauma and trauma-informed care for children, and ongoing clinical support and consultation for shelter staff. For families, START with Kids integrated child-specific assessments and service planning into shelter practice and offered the Strengthening Family Coping Resources (SFCR) group intervention.

Methods: Efforts to integrate child-focused services included joint (shelter staff with American Institutes for Research’s project team) implementation of all program components. System-wide trauma informed training sought to prepare shelter leadership and staff to adapt current programming and shelter case managers to co-facilitate the SFCR group sessions with AIR’s clinical child specialist. Professional development for shelter staff also included education on conducting child-focused assessments and service plans. The clinical child specialist was co-located with shelter staff to offer ongoing clinical support and consultation. The national SSPA evaluator monitored these start-up and implementation activities through monthly telephone calls and interviews with program staff during two site visits.

Results: While all shelter staff received ongoing training to integrate child-focused assessments and service plans, START with Kids was not fully integrated into routine practice at the treatment shelter due in part to limited shelter staff readiness and capacity (e.g., resources, time, and skills) to deliver the different program components. Also, both shelter residents and staff continued to focus primarily on housing stability and fulfilling shelter requirements, rather than expanding the focus to include child-focused planning. Issues around integrating trauma-informed practices into the shelter setting will be discussed.

Implications: This program was designed to enhance the capacity of homeless service providers to assess, refer and support the children in their programs, expand collaboration among the shelters and the community, adapt and implement a clinically-based intervention, and solidify best practices for serving children within the homeless service system in Worcester and beyond. Continued efforts to overcome systemic barriers to achieving these goals are necessary.