This resource provides valuable information about the traumatic responses that individuals experience homelessness may exhibit.

The lives of people who are homeless are defined by uncertainty, isolation, threats, and danger.  Compounding this picture are shockingly high rates of lifelong exposure to physical violence and sexual abuse.  Given the frequency of exposure to overwhelmingly stressful events, it is not surprising that many people who are homeless develop complex post-trauma responses.

Researchers have documented how many people who have been exposed to traumatic stress develop bodily pain and chronic health conditions, and have difficulty forming supportive relationships with providers or accessing health care.  As van der Kolk described (1996), the body expresses what it cannot verbalize.  In his words, “the body keeps the score” of traumatic experiences.     

Bodily complaints and symptoms may not be readily recognized as mirrors of trauma and abuse.  Therefore, it is imperative that providers serving people who are homeless systematically screen their clients for histories of traumatic exposure and violent victimization.  This process can occur over time as providers develop increasing rapport with their clients, but should include:

• Screening for immediate safety and making a Safety Plan.
• Asking about histories of sexual and physical abuse, domestic violence as adults, random violence, and other types of traumatic exposure.  
• Assessing your program/agency to determine if you are providing services within an environment that considers and respects the complex ways in which people respond to trauma (“trauma-informed” services).

The reference list below offers some helpful resources.  Please browse through our knowledge base to learn more about post-trauma responses.

Helpful References

Bassuk E.L., Dawson R., Perloff J., Weinreb L. (2001).  Post-traumatic stress disorder in extremely poor women: Implications for health care clinicians. JAMWA, 56: 79-85. (http://www.jamwa.org/index.cfm?objectid=C2EBA536-D567-0B25-531FB3A437CE3BA9)

Foa, E.B. (1992). Posttraumatic Stress Diagnostic Scale. Minneapolis: MN: National Computer Systems, Inc. (http://www.pearsonassessments.com/tests/pds.htm)

Green B., Epstein S., Krupnick J., Rowland J. (1997). Trauma and medical illness: Assessing trauma-related disorders in medical settings. In Wilson J & Keane T (Eds) Assessing Psychological Trauma and PTSD. New York: Guilford Press, pp 160-191.
(http://www.guilford.com/cgi-bin/cartscript.cgi?page=pr/wilson5.htm&dir=pp/paci&cart_id=886962.7948)

Melnick S. & Bassuk E.L. (1999). Identifying and Responding to Violence among Poor and Homeless Women. Health Care Provider’s Guide. Newton, MA: NCFH. (http://www.nhchc.org/Publications/domesticviolence.html)

MacMillan H.L., Wathen C.N., Jamieson E, et al. (2006). "Approaches to screening for intimate partner violence in health care settings: A randomized trial." JAMA. 296(5):530-536. (http://jama.ama-assn.org/cgi/content/abstract/296/5/530)

National Center on Family Homelessness (in press). Trauma-Informed Organizational Self-Assessment for Programs Serving Homeless Families.  Newton, MA: NCFH.
In press, contact Kathleen Guarino for more information (kathleen.guarino@familyhomelessness.org)

National Child Traumatic Stress Network (http://www.nctsnet.org/nccts/nav.do?pid=hom_main)

van der Kolk, B.A. (1996). The body keeps the score. Approaches to the psychobiology of posttraumatic stress disorder. In van der Kolk  B., McFarlane A.C. and Weisaeth L. (Eds). Traumatic Stress: The Effects of Overwhelming Experience on Mind, Body and Society. New York: Guilford Press, pp 214-241.  
(http://www.guilford.com/cgi-bin/cartscript.cgi?page=pr/vanderkolk.htm&dir=pp/taptsd&cart_id=886962.7948)

Warshaw C. & Ganley A. (1998). Improving the Health Care Response to Domestic Violence: A Resource Manual for Health Care Providers. (2nd Ed). Produced by the Family Violence Prevention Fund in Collaboration with the Pennsylvania Coalition Against Domestic Violence. (http://www.endabuse.org/programs/display.php3?DocID=238)