HOMELESS CHILDRENS LIFE CYCLE Clayton Chau

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HOMELESS CHILDRENS LIFE CYCLE Clayton Chau
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Eric HandlerPaul De LeonKaren MuñozJeffrey
HernándezAlan AlbrightMark RefowitzLeia
Dwight Smith
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WHAT WE KNOW
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FACTS

• Homeless children were also more residentially
  unstable having moved 3.4 times on average in
  the past year
• 34 of homeless children had been placed in
  foster care or gone to live with a relative at
  some point in the past

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FACTS

• 11.6 between age 3 months to 17 years had been
  physically or sexually abused
• Lifetime rates of sexual abuse were much higher
  for homeless youth age 5-17 (21)
• Weinreb et al. Determinants of health and
  service use patterns in homeless and low-income
  housed children. Pediatrics. 1998

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HEALTH EFFECTS

• Poor health for homeless children begin at birth
• Poor nutrition and poverty exacerbate illness and
  disability
• Higher rates of ear infections, intestinal
  infections and respiratory infections
• More likely to suffer from chronic illnesses such
  as cardiac disease, neurological disorders and
  asthma
• Less likely to utilize preventive care
• Americas Homeless Children New Outcasts,
  Better Homes Fund, 1999

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ACADEMIC EFFECTS

• Approximately two-third performed below grade
  level in reading and mathematics achievement
• Homeless children often suffer from delayed
  speech, language, cognition, social, and motor
  development, the results of a lack of
  age-appropriate stimulating exercises
• Approximately 70 were at moderate or greater
  risk academically or behaviorally. About 10 of
  those were at severe risk ? about 30 of homeless
  students are functioning within the normal range
  or have only mild risk factors
• Ziesemer and Marcoux. Homeless children Are they
  different from other low-income children? Social
  Work, 1994
• Reganick. Prognosis for homeless children and
  adolescents. Childhood Education, 1997

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PSYCHOLOGICAL EFFECTS

• 11 of homeless children reported depressive
  symptoms
• Older children reported to have more aggressive
  and acting out behavior than younger children do
• Mother's distress as strongly associated with
  reporting greater behavior problems in the child
• Homeless children are 30 more likely to suffer
  from drug addiction during adulthood
• Child behavior problems were above normal levels
  for homeless children, particularly for
  antisocial behavior
• Homeless adolescents did report lower self-worth
  and more negative perceived academic competence
• Among homeless children, younger girls appeared
  to have the most overall behavioral and emotional
  problems
• Bassuk et al. Homelessness and Its Relation to
  the Mental Health and Behavior of Low-Income
  School-Age Children. Developmental Psychology,
  1999
• Graham-Bermann et al. Children in Homeless
  Families Risks to Mental Health and Development.
  Journal of Consulting and Clinical Psychology,
  1993

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HOMELESSNESS TRAUMA
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DEFINITION

• The experience of multiple, chronic and
  prolonged, developmentally adverse traumatic
  events, most often of an interpersonal nature
  (e.g., sexual or physical abuse, war, community
  violence) and early-life onset.
• These exposures often occur within the childs
  caregiving system and include physical,
  emotional, and educational neglect and child
  maltreatment beginning in early childhood. Other
  forms of trauma include chronic exposure to
  community violence, loss of a primary caregiver
  in early childhood, loss of home, loss of
  consistency, etc.
• Cook et al., Psychiatric Annals, 2005
• Spinazzola et al., Psychiatric Annals, 2005

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CHILDHOOD DEVELOPMENT (AGE 1-12)

• Capacity to communicate
• Presence of self-concepts and self-awareness
• Ability for reasoning (developed capacity to
  solve new and relatively complex problems)
• Morally responsible

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SEVEN DOMAINS OF IMPAIRMENT IN COMPLEX TRAUMA

• Van der Kolk et al. Disorders of extreme stress
  the empirical foundation of complex adaptation to
  trauma. J Trauma Stress. 2007

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• Attachment
• Biology
• Affect regulation
• Dissociation
• Behavioral control
• Cognition
• Self-concept

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1. ATTACHMENT

• Problem with boundaries
• Distrust and suspiciousness
• Social isolation
• Interpersonal difficulties
• Difficulty attuning to other peoples emotional
  states
• Difficulty with perspective taking

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2. BIOLOGY

• Sensorimotor developmental problems
• Analgesia
• Problems with coordination, balance, body tone
• Somatization
• Increased medical problems across a wide span
  (e.g., pelvic pain, asthma, skin problems,
  autoimmune disorders, pseudoseizures)
• Schore A. Affect Regulation and the Origin of
  the Self The Neurobiology of Emotional
  Development. Hillsdale, NJ Lawrence Erlbaum
  Associates 1994

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3. AFFECT REGULATION

• Difficulty with emotional self-regulation
• Difficulty labeling and expressing feelings
• Problems knowing and describing internal states
• Difficulty communicating wishes and needs

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4. DISSOCIATION

• Distinct alterations in states of consciousness
• Amnesia
• Depersonalization and derealization
• Two or more distinct states of consciousness
• Impaired memory for state-based events
• Demitrack et al, Psychiatry Res., 1993
• Van der Kolk BA, Child Adolesc Psychiatr Clin N
  Am, 2003

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5. BEHAVIORAL CONTROL

• Poor modulation of impulses
• Self-destructive behavior
• Aggression toward others
• Pathological self-soothing behaviors
• Sleep disturbances
• Eating disorders
• Substance abuse
• Excessive compliance
• Oppositional behavior
• Difficulty understanding and complying with rules
• Reenactment of trauma in behavior or play (e.g.,
  sexual, aggressive)

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6. COGNITION

• Difficulties in attention regulations and
  executive functioning
• Lack of sustained curiosity
• Problems with processing novel information
• Problems focusing on and completing tasks
• Problems with object constancy
• Difficulty planning and anticipating
• Problems understanding responsibility
• Learning difficulties
• Problems with language development
• Problems with orientation in time and space
• Shonk and Cicchetti, Dev. Psychopathol., 2001
• Trickett et al, Dev. Psychopathol., 1994

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7. SELF-CONCEPT

• Lack of a continuous, predictable sense of self
• Poor sense of separateness
• Disturbances of body images
• Low self-esteem
• Shame and guilt

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PREVENTIONS/INTERVENTIONS

• Psychosocial treatment modalities targeted six
  core components safety, self-regulation,
  self-reflective information processing, traumatic
  experiences integration, relational engagement,
  and positive affect enhancement
• Parenting skills and educational supports for
  parents
• Community centers with programs focused on the
  above mentioned six components
• Complex Trauma Workgroup, National Child
  Traumatic Stress Network

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SAFETY

• Facilitate and ensure internal and environmental
  safety

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SELF-REGULATION

• Enhance the capacity to modulate arousal
• Restore equilibrium following dysregulation
  across domains of affect, behavior, physiology
  and cognition
• Expand interpersonal relatedness and
  self-attribution

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SELF-REFLECTIVE INFORMATION PROCESSING

• Develop the ability to effectively engage
  attentional processes and executive functioning
• Construct self-narratives
• Increase the ability to reflect on past and
  present experience
• Ability to anticipate and plan as well as make
  appropriate decision

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TRAUMATIC EXPERIENCE INTEGRATION

• Meaning making
• Traumatic memory containment or processing
• Remembrance and mourning of the traumatic loss
• Symptom management
• Healthy coping skills
• Cultivate present-oriented thinking and behavior

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RELATIONAL ENGAGEMENT

• Create therapeutic alliances
• Develop critical interpersonal skills such as
  assertiveness, cooperation, perspective-taking,
  boundaries and limit-setting, social empathy, and
  the capacity for physical and emotional intimacy

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POSITIVE AFFECT ENHANCEMENT

• Enhance self-worth, esteem and positive
  self-appraisal through the cultivation of
  personal creativity, imagination, future
  orientation, achievement, competence,
  mastery-seeking, community-building and the
  capacity to experience pleasure

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HOMELESSNESS, A LIFE CYCLE?
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FACTS

• Children subjected to various adverse experiences
  are far more likely to become homeless adults
• Foster care placement as one of the highest risk
  factors for later homelessness
• 35-43 of homeless mothers were sexually or
  physically abused as children
• Homeless children are at a far higher risk of
  becoming the homeless or even the chronically
  homeless of the next generation
• Herman et al. Adverse childhood experiences
  Are they Risk Factors for Adult Homelessness?
  American J of Public Health, 1997
• Bassuk et al. Characteristics of Homeless
  Sheltered Mothers. American J of Public Health,
  1986

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