The Needs of Women: Here’s Why the Lotus House Programs are Gender Specific.
Women young and old, who are homeless and alone survive by being invisible. Staying awake through the night out of fear, they sleep on buses and in airports, hospitals, abandoned buildings, backyards and alleyways in a desperate attempt to find shelter each night without being detected. Finding food in garbage cans and behind restaurants, women avoid panhandling because doing so makes them a highly visible targets for crime. They bathe in public restrooms, desperate to go unnoticed. But of course, they cannot hide forever, especially from predators.
Physically vulnerable, homeless women and female youth are at heightened risk of sexual assault, human trafficking and violence in its many forms. On the streets, homeless men, drug dealers and pimps prey on women by offering protection. Gender neutral shelters may be just as risky for women who are alone, especially those who have high special needs and are medically fragile, suffering from mental health issues, pregnant or victims of trauma. The “protectors” quickly becomes their abusers. The story of one woman at Lotus House is the story of many. When she refused to “trick” for her so-called protector to pay for a hotel night, she was beaten to within an inch of her life, permanently losing the sight in one eye as a result of the head injuries she sustained. Sadly, her story is all too familiar for those who seek refuge at Lotus House.
Not only is the experience of homelessness by women gender specific, so too are many of the reasons they experience homelessness. The overwhelming majority of the women we serve at Lotus House are victims of physical or sexual abuse, domestic violence, trafficking or other severe traumas, usually starting in childhood. Childhood trauma unaddressed can impair the cognitive and social/emotional development of a child, her educational and work success, and lead to life long struggles with depression, anxiety, PTSD and other mental health conditions, including substance abuse as a form of self medication, putting her at risk of further violence. Women fleeing domestic violence and other forms of abuse are forced to give up homes, jobs, support systems and more to escape, too often only to find themselves at equal or greater risk of danger in homeless shelters and on the street. Violence leads to homelessness and women who are homeless remain at risk for further violence and victimization. Childhood abuse, domestic violence and homelessness can become an endless cycle without access to the support and resources needed to heal broken bodies, minds and spirits.
For some women and youth, simply being pregnant means a loss of schooling, employment and apartment, at a time when they are most vulnerable and in need of resource for themselves and their infants. For women diagnosed with breast cancer, the inability to work, mounting medical bills and prolonged treatment make homelessness yet another harsh consequence of their illness, compounding a woman’s fears, hopelessness and depression. To be sure, women who are medically fragile, developmentally delayed, or suffering from serious mental health issues are at the greatest risk of harm on the street or in crowded emergency shelters too strained to answer their calls for help with the time. More than shelter, they need a comprehensive support system and access to multi-faceted resources to truly break the cycle of homelessness.
What the Research Shows About Homeless Women and Children
We know that:
- “Women and children are the new faces of homelessness.”1 In 2007, 65% of the sheltered homeless population was women, and families with children comprised 23% of the overall shelter users.2
- Violence puts women, youth and children at risk of homelessness, and homelessness puts women and children at risk for violence.3
- Violence is a critical factor in homelessness.4 Studies show that violence is normative in the lives of homeless women and children with at least half experiencing homelessness after fleeing from a violent relationship.5 The majority (92%) of homeless mothers have experienced severe physical and/or sexual assault at some point in their lives; 66% experienced severe physical abuse and 43% were molested as children.6
- “Sexual and physical violence is intergenerational: In a national survey of more than 2,000 American families, 50% of men who frequently assaulted their wives also abused their children.”7 Sixty-nine percent (69%) of sexual assault victims are girls under the age of six and 73% are under the age of 12 years old. (Snyder, 2000)
- Homelessness itself is traumatic, puts women and children at risk of further victimization, and makes families sick.8 Women and children experience dislocation from home and community, loss of important roles, social isolation and feelings of helplessness. Poor nutrition and lack of nutrition also put them at risk for vitamin deficiencies, anemia, diabetes, high blood pressure and other illnesses.9 Without a home and proper support system, such as nourishing meals, health care, access to medications, day care and transportation assistance, the barriers to maintaining employment become insurmountable, and can lead to an endless cycle of homelessness.
- All too often, “[h]omeless services are not designed to respond to the women and children who show symptoms of distress: Homeless women who present symptoms of post traumatic stress (psychic numbing, rage reactions, re-experiencing painful past episodes, depression, anxiety, endless watchfulness, sleeplessness) may use substances to help them medicate the painful trauma-related sequelae. They may have difficulty accessing essential housing, economic, health care, educational, childcare and peer support services.”10
The statistics listed above reflect the experiences of those we serve all too well. Over 90% of the women at Lotus House report histories of childhood abuse, domestic violence or other trauma. The impact of domestic violence, untreated mental health issues, and other traumas, including homelessness, can be devastating, pervasive, lifelong and intergenerational if left untreated.
Addressing the Need for Gender Specific Programming
Research indicates that different strategies need to be employed in providing services and treatment because the male and female experience of homelessness is very different.11 This is especially true in terms of engagement of the most disaffiliated women (Watkins et. al., 1999). Traumatic events in the lives of women and children feed into a sense of economic and emotional powerlessness and economic dependence. A matrix of poverty, victimization, early physical and sexual abuse, substance abuse and mental illness experienced by homeless women is mirrored in the literature by evidence of depression, low-self esteem, mal-adaptation, health problems and social disaffiliation (Beeber, 1999; Reasoner, 1998; Boes, 1997; Jackson-Wilson, 1993; Baldwin, 1998).
Since the 1980’s, studies have indicated that gender-specific programming is critical to effective outcomes for women. Rather than designing programs on a ‘one size fits all basis’ with research based on studies of the male homeless population, a more gender specific focus is now being recognized as appropriate to address the special needs of women.
Programs that adopt a non-institutional approach to homeless services have been found to be the most successful in reaching, engaging and changing the lives of homeless women. They focus on the importance of a warm, causal, non-institutional environment to engage the homeless into services (Brown & Cohen, 1990). They rely on self-help and self-empowerment (Breton, 1984). They often use a strengths approach with an emphasis on engaging and mobilizing women’s strengths while empowering them (Boes, 1997). They aim to ameliorate the pervasive social isolation of homelessness, to promote the learning of social skills, and to build self-efficacy and self-esteem. A supportive environment, caring staff, and flexible structure is crucial to engaging women who have a more complex history with victimization, fear and distrust of others and mental health problems into social service programs (D’Erole & Struening, 1990). This type of environment encourages community and involvement and fosters respect in showing that the staff and volunteers value the client’s opinions, feelings, and desires.
Comprehensive services and treatment must be based on understanding the context and needs of women’s daily lives. Such services:
- Identify and build on women’s strengths;
- Avoid confrontational approaches;
- Teach coping strategies, based on women’s experiences, with a willingness to explore women’s individual appraisals of stressful situations;
- Arrange for the daily needs of women, such as childcare;
- Have a strong female presence on staff;
- Promote bonding among women.
Gender Specific Issues in Working With Women: A Holistic Approach. Colleen Clark, Ph.D Florida Mental Health Institute Tampa, Florida http://mhlp.fmhi.usf.edu/facultyStaff/pfocus.cfm?focusid=183
The Report on Women and Homelessness, March 1, 2011, Crossroads, Rhode Island, found:
The female homeless population is growing, and we need to pay more attention to their unique needs. Trauma-informed care is essential to meeting the needs of the large percentage of women who have suffered trauma from family separation, violence and abuse. Increased focus on intensive female-centered case management, counseling, and support services is necessary to help homeless women develop work skills. Additionally, today’s economy mandates that we provide ample opportunities including affordable housing, job-training, and comprehensive services for women seeking a better future. Research shows it is possible to break the cycle of childhood abuse, domestic violence, and homelessness with life changing support, tools, education, and resources that heal broken bodies, minds and spirits,12 and Lotus House is committed to helping homeless women achieve those outcomes for a better way of life. Our approach emphasizes trauma-informed, evidence based and informed therapies, psychosocial education, and comprehensive support services in a nurturing environment that addresses the special needs of women with understanding, wisdom and compassion. Learn More About the Evidence Based Design of our Programs.
Evidence Informed Design of Lotus House Programs
Learning from the homeless women and female youth we serve, Lotus House has adopted enriched programming incorporating evidence-based and informed mental health services focused on trauma resolution, individual and group therapy, and psychosocial education to address the impact of past experiences of violence and trauma during the window of opportunity presented while women and youth are with us. The mental health goals of the For Women Only Program are to:
- Increase trauma resolution and the development of resiliency, and
- Reduce chronic and revolving-door homelessness of the women we serve.
Committed to achieving these goals and outcomes to fostering the resilience of homeless women, Lotus House is utilizing a prevention and intervention framework which works to resolve trauma and mental health issues in mothers, avoid traumatic experiences in the lives of homeless women, and promote healthy healing via trauma resolution, intensive individual and group therapy and facilitation of the development of resilience in women and youth. This level of mental health treatment, prevention and promotion is typically not available to low income/homeless women on a timely basis or at all. Lotus House affords women a unique window of opportunity to heal, resolve trauma, create nurturing, healthy attachments so critical to their healing, resilience and building the foundation for long term stability.
Lotus House has selected evidenced-based and informed focused therapy modalities, assessment tools and supportive services that have been shown to be effective interventions with and appropriate for homeless women and youth. We have used national homeless organizations and the U.S. HHS SAMHSA Homeless Resource Center as sources for researching appropriate evidence-based programs and measurement tools for trauma-based program development. (see “HRC Expert Panel on Evidence-Based Practices in Homeless Services, February 11, 2008”, atwww.homeless.samhsa.gov). Utilizing evidence-based programs is the most effective way of using their time with us.
Solutions For Women
To promote trauma resolution, life skills building, and empowerment of homeless women, the For Women Only Program includes:
- Early Screenings of each woman’s mental health and well-being, arranging more comprehensive mental health assessments where issues are identified and assistance with medications
- Weekly Individual Counseling to address each woman’s needs and concerns, and resource coordination to connect each woman to needed support services, tools and resources at Lotus House and within the community
- Personalized Action Plan and individualized service planning with a full continuum of support services for each woman to address her needs, including: medical and mental health issues and treatment; social service advocacy and benefits; educational, vocational and employment steps and goals; life skills building; and long term housing objectives; as well as regular assessments of progress toward identified goals
- Seeking Safety, an evidence-based present-focused treatment for persons with a history of trauma and substance abuse. Seeking Safety focuses on coping skills and psychoeducation and incorporates four key principles: 1) safety as the overarching goal (helping women attain safety in their relationships, thinking, behavior and emotions); 2) integrated treatment (working on both PTSD and substance abuse); 3) a focus on ideals to counteract the loss of ideals in both PTSD and substance abuse; and 4) four content areas: cognitive, behavioral, interpersonal, and case management; This counseling framework helps women build protective factors to moderate the impact of past and future trauma experiences and increase coping skills.
- Say It Straight, an evidence based communication training program, designed to help youth and women develop empowering communication skills and behaviors and increase self-awareness, self-efficacy and personal and social responsibility – while reducing risky behaviors such as substance abuse, bullying violence, precocious sexual behavior and behaviors that can result in HIV infection. SIS emphasizes values such as resiliency, courage, compassion and integrity, and builds protective factors. It is designed to include high-risk youth and the homeless and youth ages 18-25.
- Pre- And Post-Testing to improve our services and outcomes. Pre- and post testing assessments include: PTSD Checklist – Civilian (PCL-C) developed by the Veterans Administration; Life Events Checklist (LEC); Global Assessment of Functioning (GAF); Functional Assessment Rating Scale (FARS)
The gender specific programming at Lotus House is carefully designed to assist women heal and reclaim their lives, build the foundation for a safe, secure and better way of life, and truly break the cycle of homelessness. Our approach emphasizes trauma-informed, evidence-based and informed therapies, education, and comprehensive support services in a nurturing environment that addresses the special needs of these courageous women. Your donations make all that we do possible and are truly life changing. Thank you!
- A Long Journey Home, A guide for Creating Trauma Informed Services for Mothers and Children Experiencing Homelessness (Draft), p. 6, citing US Conference of Mayors, 2007
- Id., p.7
- Id. p. 5, 7-8
- Id. p. 7, citing Browne and Bassuk, 1997; Goodman, 1991; Bassuk et al., 1996
- Id. p. 7, citing Bassuk et al., 1996, Browne and Bassuk, 1997, Bassuk, Melnick, and Browne, 1998
- Id. p. 7, citing (Straus and Gelles, 1990)
- A Long Journey Home, A guide for Creating Trauma Informed Services for Mothers and Children Experiencing Homelessness (Draft), p. 5, 7
- Id. pp. 7-8
- Id. p.7
- Baldwin, Dana M., “The Subsistence Adaptation of Homeless Mentally Ill Women”, Human Organization Summary 1998, Vol 57(2), p. 190-99.
Beeber, Linda S., “Testing an Explanatory Model of the Development of Depressive Symptoms in Young Women During a Life Transition,” Journal of American College Health, Vol 45(5), p.227-34.
Boes, M. (1997). “Social work with homeless women in emergency rooms: A strengths-feminist perspective”. Affilia Journal of Women and Social Work, 12 (4), 408- 437.
Breton, M. (1984). “A drop-in program for transient women: Promoting competence through the environment”. Social Work, 29, 542-546.
Brown, K. S. & Cohen, B. (1990). “A feminist approach to working with homeless women”. Affilia Journal of Women and Social Work, 5, 6-20.
D’Ercole, A., & Struening, E. (1990). “Victimization among homeless women: Implications for services delivery”. Journal of Community Psychology, 8, 141-152.
Jackson-Wilson, A. G. (1993). “Disaffiliation revisited: A comparison of homeless and non homeless women’s perception of family of origin and social supports”. Sex Roles: A Journal of Research. 28 (7-8), 361-378.
Watkins, Katherine E., Shaer, A. and Sullivan, G. “The Role of Gender in Engaging Dually Diagnosed in Treatment”, Community Mental Health Journal, Apr. 1999, Vol 35(2), p. 115-126.
Reasoner, Robert W., “Review of Self-Esteem Research,” Online Document. http://www.self-esteem-nase.org/research.html. National Association for Self-Esteem, 1998.
- Center on the Developing Child at Harvard University, The InBrief Series.http://www.developingchild.harvard.edu; The Science of Early Childhood Development (2007), National Scientific Council on the Developing Child; Center on the Developing Child at Harvard University (2007), A Science Based Framework for Early Childhood Policy, Using Evidence to Improve Outcomes in Learning, Behavior, and Health for Vulnerable Children, pp. 2; Nicholas D. Kristoff, “Cuddle Your Kid”, The New York Times, October 20, 2012”, citing Paul Tough in How Children Succeed. http://www.nytimes.com/2012/10/21/opinion/sunday/kristof-cuddle-your-kid.html.