National Association For The Education of Homeless Children and Youth Albuquerque, NM October 28, 2012 Peter Donlon Pr

1. National Association For The Education of Homeless Children and Youth Albuquerque, NM October 28, 2012 Peter Donlon Project CATCH Coordinator Raleigh, NC

2. Overview of Presentation • Genesis of Project CATCH • Research / Justification • Core components • Outcomes: First 18 months • Understanding and Applying Trauma Informed Care • Project CATCH partnership with the Wake County School System - NC

3. Genesis of the Project Salvation Army identified a community need to serve young children experiencing homelessness. 474 Children were screened between fiscal years 2006 and 2010 (approx. 118 per year). News of this need was brought to the local Young Child Mental Health Collaborative. YCMHC convened a collaborative group of shelter and mental health professionals. The collaborative group conducted a needs assessment and then led the development and submission of a grant to fund the project.

4. Needs Assessment Process • For 2 years, shelter staff & mental health experts met monthly to discuss status of services to homeless families. • Intensive study of 4 shelters (Marmaud, 2008) included staff & parent focus groups as well as observation in shelters. • Review of professional literature and the work of national organizations.

5. Justification: What We Discovered… 1. Rate of family homelessness is high and rising rapidly In Wake Co, approx. 330 parents & children reside in a shelter each night. Family homelessness in Wake is rising by about 11% yearly, and 25% of homeless individuals are children and youth (Wake Point in Time Count, Jan, 2008). Local trends reflect national trends (U.S. Conference of Mayors, 2010; U.S. Department of Housing and Urban Development, 2011 )

6. Justification 2. Homeless children are more likely to have social-emotional concerns and mental health problems than children housed in poverty. There is significant risk for toxic levels of stress, a precursor to the disruption of developing nervous and immune systems that can lead to mental and physical health problems (American Journal of Public Health, August 2009; National Child Traumatic Stress Network, 2005).

7. Justification 3. Homeless children in NC may be at particular risk for these outcomes. 29th in the nation in America’s Youngest Outcasts: State Report Card on Child Homelessness (2010), indicating a need for improvement in services, planning, and policies concerning children who are homeless. 34th in the nation on the 2012 Kids Count rating conducted by the Annie E. Casey Foundation.

8. Justification 4. Social-emotional and developmental challenges of homeless children are rarely addressed Children are often “invisible” in shelters because… …staff members focus on housing goals. …mental health needs are not routinely assessed …parents often don’t recognize stress in their own children. Therefore, increased attention to children’s needs is essential.

9. Justification 5. Parents experiencing homelessness face parenting challenges, and are unable to provide quality parenting • Shelter climate does not support positive parenting and healthy family interactions. • Policies and practices are not conducive to nurturing parenting practices and positive family relationships.

10. Justification 6. Staff and volunteers often miss opportunities to support residents in their roles as parents. 7. Staff and volunteers are not equipped to respond productively to disruptive child behavior that may be symptomatic of deeper trauma/stress or mental health issues. Therefore, staff need educationand training

11. Justification 8. Despite rich resources and expertise, coordination & integration of services is lacking. • Many families move from shelter to shelter without consistent provision or coordination of services among shelters. • Shelter staff access community resources sporadically and inefficiently. Therefore, coordination & collaboration are needed.

12. Justification Summary: • Reviewed research on homelessness and health and how these two are intertwined • Witnessed aspects of service delivery that jeopardized progress of clients • Realized what we were not doing: • Addressing social-emotional & developmental needs • Providing a shelter environment that supports healthy family interactions • Coordinating services across shelters

13. Grant efforts Received private and state funding to support 3-year project to establish a sustainable system of care to: • Address social-emotional & developmental needs of children • Provide a shelter environment that supports healthy family interactions • Coordinate services across shelters • Evaluate the system for possible dissemination

14. Goals and Core Components 1. Address developmental & social emotional needs of children • Develop common intake protocol upon admission to any family shelter program in the county. • CATCH staff (2) conduct assessment of every child (birth – 18), and make appropriate referrals. • Build a data base to track the health and well-being services children receive as they transition from homelessness to stable housing in the community.

15. Goals and Core Components 2. Provide a shelter environment that supports healthy family interactions • On-site services for families within programs to support healthy parent/child relationships • Physical and Emotional Awareness for Children who are Homeless (PEACH) program • Raising a Thinking Child (Spivack & Shure) • Theraplay • Organized tutoring programs for kids in the shelters

16. Goals and Core Components 3. Coordinate services across shelters • Develop database of family information. • Case Manager meets with each family to review family goals and discuss and resolve potential barriers to continuity of care. • Monthly reviews of family goals and services in meetings of representatives from each shelter and CATCH staff. • Raleigh area Coordinated Intake process is underway. All children entering the homeless shelter system are being referred to Project CATCH.

17. Goals and Core Components Coordinate services across shelters (Cont’d) • Monthly meetings of CATCH members to identify gaps in community services. • Agencies that could assist in closing gaps are invited to the table. • Procedures are put in place to maximize available resources.

18. Yahoo Group “Our Mission is to be a professional community that connects the Wake County shelter staff in order to share information, resources, and ideas that help us serve families experiencing homelessness.” • Be a place for shelter staff to connect and collaborate. • Create a common location for brainstorming to take place. • Bring focus to the mental health needs of children and their families experiencing homelessness. • Make professionals from community readily accessible to shelter staff.

19. Goals and Core Components 4. Evaluate Program for possible dissemination to other communities • Database for first 21 months is completed • Working with NCFH to establish enhanced data collection model • Currently studying results of social / emotional/ developmental screenings of all children • Process is underway to locate funders to keep the program going, and to develop model for other communities to use. • Feedback from Agency Partners and Community is very favorable

20. CATCH staff activities • Referrals are made from shelters • Screening is conducted. • Parent Interview • Brigance; Ages and Stages • Parenting Stress Index • Eyberg Child Behavior Inventory • Needs are identified (e.g., further evaluation, treatment) • Results and decisions are entered in data base. • Cases are followed closely.

21. Resources are ineffective if families don’t have access to them. Project CATCH staff members provide transportation for families as needed to attend appointments.

22. Raleigh, NC area partners/programs • Carying Place (located in Cary, NC) • Haven House • Healing Place • Interact - Raleigh • Passage Home • PLM Families Together • Raleigh Rescue Mission • Salvation Army • Southlight (located in Fuquay-Varina, NC) • Support Circles of Catholic Charities • Wake County Public Schools • Wake Interfaith Hospitality Network • Women’s Center of Wake County

23. Training Activities:National Center on Family Homelessness and Project CATCH staff • Pre-training involved shelter self-assessments of policies and practices and a web-based overview of trauma-informed practices. • On-site training in trauma-informed best practices to promote strong families and children’s well-being. • Follow-up on-site training conducted to discuss progress and problem-solve challenges.

24. Project CATCH The First 18 months!

25. Foundation funder expects… • Do shelters change policies? • Do staff, administrators, and volunteers at shelters change their practices? • Are they more trauma-informed? • Is there better communication and collaboration across shelters? • Do families benefit from the changes? • Is CATCH sustainable?

26. State funder expects… • Shelter staff / programs to participate in interagency information sharing • Shelter programs have needs assessments and training plans developed • Children referred to and screened by Project CATCH staff • Case management follow-up / individual intervention contacts with children and families

27. How is Project CATCH changingshelter service delivery? • Shelters are looking at self-care, Intake procedures, self-awareness of vicarious trauma, and involving consumers in advisory groups • 9 of 10 shelters have identified preliminary goals toward becoming more Trauma-Informed - full agency assessments are underway, program adjustments have been made • Average of 20 agency reps attend monthly CATCH meetings to share resources, struggles, etc

28. How is Project CATCH changing shelter service delivery? • Strong agency child referrals facilitate rapid connections to services • Trauma-Informed care has been incorporated into the NC Schools statewide training protocol for personnel working with children • Time is being dedicated to Trauma-Informed carein agency staff meetings.

29. Major barriers to change • Staff turnover – Shelter jobs are stressful with high potential for burnout - Trauma-Informed training needs to be constant for evening monitor staff • Former clients become staff members in some agencies, bringing need for self-awareness, managing boundaries, and understanding vicarious trauma • Some shelter agencies are funded based on rapid housing outcomes - trauma awareness is a slow change process, and lower priority for some agencies

30. Year End Results: • AS of June 30, 2012: • 90% of agencies participating reported utilizing new resources/protocols for children as a result of information sharing (Currently at 88.9%) • 75% of shelter programs assessed successfully achieved one identified goal related to serving children and families more effectively (Currently at 70%)

31. Year End Results: • AS of June 30, 2012: • 60% of children B-5 assessed will receive a needed service identified on their assessment as a result of activity referral/case management. (Currently at 67.5%) • 20% of children B-5 assessed will receive a needed evidenced-based /informed service as a result of activity referral/case management (Currently at 20.4%)

32. CATCH B-5 Accomplishments • 187 children referred to Project CATCH (94% of goal) • 157 children screened/assessed (105% of goal) • 478 referrals made to community partners (MH, Early Ed, Head start, Medical, Day Care, etc) (67% of goal) • 125 received case management from Project CATCH (100% of goal) • 32 received evidenced-based services • 568 Substantive contacts (food, clothing, follow-ups, etc.)

33. CATCH K-12 Accomplishments Children ages 5-18 *Data collected from 7/1/11 to Present • 166 children referred to Project CATCH • 143 children screened and assessed • 119 received case management from Project CATCH • 154 referrals made to community partners (MH, Early Ed, Headstart, Medical, Day Care, etc.) (food, clothing, etc.)

34. Total for all Project CATCH Kids • 353 Children referred to Project CATCH • 35Referred from school social workers (April to June 2012) • 318 Referred from shelter partners • 300 Received developmental and psychosocial screenings and assessments • 244 Received case management support from Project CATCH • 722 Referrals made to community partners (MH, Early Ed, Headstart, Medical, Day Care, etc.) • Diapers, formula, and clothing vouchers also distributed • Q1 2012-2013 149 children have been referred to CATCH - • On track to serve approximately 595 children this fiscal year

35. A Trauma-Informed approach serves as the foundation for CATCH components A brief overview…

36. Homeless Children and Trauma Most homeless parents don’t recognize the effects on their kids

37. Homeless Children and trauma • By the age of 12, 83% of homeless children are exposed to at least 1 violent event, including: • Hearing gunshots • Seeing an adult being shot • Seeing a dead body • Seeing someone stabbed • Witnessing physical or sexual abuse

38. Homeless Children and Trauma • 1 in 50 children in America experience homelessness. Current number is 1.5 million • 53% are under the age of 6 • Homeless children experience overwhelming loss: a sense of place, friends, pets, important possessions, and self • Homeless children experience disrupted relationships; parental health problems cause lack of normal development • Violence, hunger, and lack of access to school and healthcare NCFH

39. Single Mothers who are Homeless • 92% Experience severe physical and/or sexual abuse. For 63%, assault was by an intimate partner • Have 3 times the rate of PTSD (Post Traumatic Stress Disorder) (36%) and twice the rate of drug and alcohol dependence (41%) • Mothers often are in poor physical health • Over 1/3 have a chronic physical health condition. • They have ulcers at 4 times the rate of other women. • (The National Center on Family Homelessness, 2012)

40. As children, nearly one quarter of single adults who are homeless lived in foster care, a group home , or other institutional setting; most were physically or sexually abused. Among Homeless Youth… • Conflict and violence is the primary cause of homelessness. • 46% have been physically abused • 1 in 5 youth who arrived at shelters came directly from foster care • 25% had been in foster care in the previous year. Kathleen Guarino - NCFH

41. Links Between Trauma & Brain Size (Putnam, 2006) • In studies of children who have experienced trauma: • Corpus callosum (links right & left hemisphere) shows decreased size. • Areas of the frontal lobe (linked to planning & judgment) showed a decreased size. • The anterior cingulate gyrus (rapid decision making) showed decreased levels of a chemical crucial to neuron health (N-acetyl-asparte). The level is similar to what is found in adult PTSD patients and experiences of persons struggling with late stage alcoholism.

42. Trauma’s Impact on Psychosocial Development (Putnam, 2006) • Children who have experienced trauma are represented disproportionally in Type D attachments (disorganized/disoriented). • Type D can result from frightening/frightened parental behavior, parental negativity, criticism, or mothers who rank high as dissociative. • This attachment disruption is linked to numerous negative outcomes including: poor school performance, difficulties with peers, low self-esteem, cognitive immaturity, and bizarre behavioral patterns.

43. What Researchers Say About This Populaton: • “[These] children are particularly vulnerable and are thus at greater risk for developmental delays.” (Chiu,2010, p. 73) • “Research has demonstrated that homeless children have disproportionate negative academic experiences, includingabsenteeism…high rates of mobility…grade repetition…and the need for special education services, which may all contribute to poor academic performance.” ( Hong, 2012, p. 1440)

44. Trauma Informed Care Defined “Trauma-Informed care is a strengths-based framework that is grounded in an understanding of and responsiveness to the impact of trauma, that emphasizes physical, psychological, and emotional safety for both survivors and providers, and that creates opportunities for survivors to rebuild a sense of control and empowerment.” • Kathleen Guarino, NCFH

45. What we are teaching about Trauma-Informed Services • Training of shelter and school staff includes: • The effects of trauma on neurological / psychosocial development of parents and children • Behavioral “problems”vsadaptive responses to trauma • Understanding acute, chronic, and complex trauma • Understanding potential retraumatization via the service system • Recognizing traumatic stress • Potential mislabeling or misdiagnosing of MH symptoms without considering past experiences of trauma • How schools can increase trauma informed responses.

46. Trauma-Informed Intake Assessments • Intake is conducted within the first 24-72 hours of families arriving at the shelter; flexibility is possiblebased on level of stress observed • Completed and updated by trained staff members who have on-going contact with clients, and responsibility for carrying out plans • Conducted and stored in a private area to ensure confidentiality - the limits of confidentiality are also explained; who has access, how information is used, etc. • Includes questions about clients’ current needs, resources, strengths, mental and physical health, history of substance use, cultural backgrounds, and related cultural strengths

47. Programming for Trauma Informed Shelter Services Offering a calming presence and a safe refuge Clients are introduced to staff and others Clients are given a physical tour of the facility when they arrive • Immediate needs such as food and clothing are addressed • Creating free and friendly spaces • Photographs and responsibilities of staff and others are posted in the facility. • Relaxed length of stay

48. Developing goals and plans using trauma-informed practices • The following are basic components of goal development that are routinely implemented: • Consumer goals are recorded in written, individualized plans • Consumer goals are reviewed and updated regularly • A system of follow-up is applied consistently across the program • Goal development is led by the client, then supported and resourced by the Case Manager

49. Developing goals and plans using trauma-informed practices, cont. • Each client needs a written, individualized self-care or crisis prevention plan. These should include the following: • A list of situations that the person finds stressful or overwhelming and remind him/her of past traumatic events (i.e. triggers) • Ways that the client shows that he/she is stressed or overwhelmed • Staff responses that are helpfuland not helpful when the client is feeling upset or overwhelmed • A list of people to go to for support

50. ** Helpful criteria for evaluating shelter policies & rules • Is the policy necessary? • What is the purpose? • Does it serve that purpose? • Who does it help or hurt? • Does it facilitate or hinder client inclusion? • Were clients included? • What is the tone and language?