Barriers and facilitators for access to mental health services by traumatized youth

Polytrauma is a highly prevalent public health problem in the U.S. with even higher rates in urban areas. Children with polytrauma often end up in multiple child-serving systems (e.g., mental health, child welfare, education, juvenile justice) with needs that are both complex and severe. Providers within these child-serving systems have potential to serve as gatekeepers to trauma services by linking youth with trauma-informed treatments and supports that promote recovery. The purpose of our study was to assess the perspective of providers who participated in a nine-month, trauma-informed care (TIC) training intervention on 1) their capacity to make referrals to trauma-specific services following the training, and 2) factors external to the training intervention that supported or hindered their ability to link traumatized youth with services. A subset of sixteen participants from the TIC training completed individual interviews. These participants were predominantly female, African American, and based in the social services sector. The constant comparative method was used to derive three thematic domains related to participant perceptions regarding youth referrals: 1) Organizational and provider capacity to provide trauma treatment or to make referrals to trauma-specific services, 2) Barriers to youth accessing trauma services, and 3) Suggestions for improving coordination of care and referrals. Our study highlights the influence of contextual factors on whether a TIC training can improve the capacity of agencies and individual providers to support traumatized youth in accessing appropriate services. The development of a structure that formally connects youth-serving agencies and providers with specialists trained in addressing traumatized youth is recommended.     

Lessons learned while building a trauma-informed public behavioral health system in the City of Philadelphia

Exposure to traumatic experiences among youth is a serious public health concern. A trauma-informed public behavioral health system that emphasizes core principles such as understanding trauma, promoting safety, supporting consumer autonomy, sharing power, and ensuring cultural competence, is needed to support traumatized youth and the providers who work with them. This article describes a case study of the creation and evaluation of a trauma-informed publicly funded behavioral health system for children and adolescents in the City of Philadelphia (the Philadelphia Alliance for Child Trauma Services; PACTS) using the Exploration, Preparation, Implementation, and Sustainment (EPIS) as a guiding framework. We describe our evaluation of this effort with an emphasis on implementation determinants and outcomes. Implementation determinants include inner context factors, specifically therapist knowledge and attitudes (N = 114) towards evidence-based practices. Implementation outcomes include rate of PTSD diagnoses in agencies over time, number of youth receiving TF-CBT over time, and penetration (i.e., number of youth receiving TF-CBT divided by the number of youth screening positive on trauma screening). We describe lessons learned from our experiences building a trauma-informed public behavioral health system in the hopes that this case study can guide other similar efforts.     

Strengthening youth citizenship and social inclusion practice — The Australian case: Towards rights based and inclusive practice in services for marginalized young people

This article provides a framework for understanding disadvantaged young people from a youth citizenship perspective that includes social inclusion principles and a rights based approach to service delivery. This paper will argue that a rights based and inclusive practice approach can help to enable the self-confidence, resilience and capacities of marginal youth in efforts to counter social exclusion. A social inclusion strategy that is derived from the European Union helps frame inclusive practice and is explicitly linked to an emerging national human rights and inclusive agenda for marginalized youth in Australia. Elements of inclusive service practice include youth participation in services, issues of access and equity, service responsiveness, joined-up services and user-led accountability. These elements provide a basis for bringing a citizenship framework into services, and for professional learning and education in work with marginal youth. A framework is suggested that seeks to recognise and respond to highly disadvantaged youth that includes the marginalizing ‘intersections’ of gender, racial and disability identities. Brief excerpts of secondary qualitative data on two highly vulnerable youth populations-homeless youth and Aboriginal youth-are used to highlight the need for a citizenship approach that listens and responds to these vulnerable young people in both research and practice.     

Promoting Evidence-Based,Trauma-Informed Social Work Practice

ABSTRACT

Given the human costs of psychological trauma, social workers should be well versed in trauma-informed care (TIC). This framework helps guide the efforts of systems, organizations, and practitioners toward reducing trauma or mitigating its effects. The field has created TIC principles, although they have yet to be fully realized as practical applications. This article makes the case that theoretically and empirically grounded content on trauma should be foundational to social work education. We also argue that social work practice will be advanced by clearly defining trauma and by distinguishing TIC from trauma-focused and trauma-sensitive approaches. Finally, a TIC certificate program illustrates how graduate student training and social work practice are enhanced by integrating trauma content into classroom and field settings.     

A trauma-informed social work framework for the abortion seeking experience

ABSTRACT

This purpose of this article is to discuss the abortion seeking experience in relation to stress, trauma, and trauma-informed care. Definitions of stress and trauma are provided, and potential points of stress during the abortion seeking experience will be discussed in the areas of unintended pregnancy, policy barriers, provider access, and the external clinic environment. Abortion stigma will also be discussed in relation to individual stigma, mass media stigma, community stigma, social work practitioner stigma, and the impact of stigma on the abortion seeking experience. Next, we discuss a trauma-informed lens for considering the abortion seeking experience in the United States, and a trauma-informed social work framework for interacting with clients during the abortion experience is presented as a practice approach for reducing and eliminating trauma and trauma triggers. We then present the potential benefits of this approach. The article concludes with some additional recommendations for a trauma-informed approach to aspects of social work advocacy.     

The policy context of leaving care services: A case study of Northern Ireland

The transition of foster youth from state care to independent living has received increased research, practice, and policy attention in the United States and in many other countries. Most contributions to this literature have focused on documenting poor outcomes across various dimensions of need in the young people's lives whereas little attention has been given to the policy context in which the responses to those needs are being developed. In this article, we argue that there is a pressing need for better understanding of how the policy context can both promote and impede the development of appropriate services. To illustrate our argument, we use Northern Ireland as a policy case study both because of recent initiatives underway there in regard to youth transitions from state care and because of the heightened political sensibilities associated with it as a society. We draw attention to the socio-political historical context, a number of intersecting social policies, and the place of social work as a key occupation involved in delivering service improvements. We conclude by suggesting that this case study not only highlights the need to address similar aspects of the policy on youth transition from state care in the United States but also demonstrates the benefits of reflecting on policy development and implementation elsewhere in the world.     

Women and homelessness,a complex multidimensional issue: findings from a scoping review

Homelessness is an increasingly prevalent issue worldwide. Women represent the fastest growing segment of the homeless population and have differing needs to men. These differences need to be considered by service providers and other stakeholders working with homeless women. A scoping review was conducted to address the question “What is known about issues relating to homeless women in the existing literature?” PubMed, PsycInfo, Embase, CINAHL, Scopus and Web of Science were searched up until March 2018 with no date limits. The final sample of articles included in this scoping study was 232 from which six themes were extracted: (1) pathways into homelessness, (2) trauma, victimization and adverse childhood experiences, (3) mental and physical health issues, (4) barriers to accessing treatment and experiences with service providers, (5) social support and life satisfaction and (6) strengths, hopes and leaving homelessness. This review suggests a strengths-based approach to addressing women’s homelessness. This approach emphasizes people’s self-determination and strengths and views clients as resilient to problems they encounter in their lives. Future research and service provision should take into account the complexities in the lives of homeless women and recognize the autonomy of women to move out of homelessness.     

The invisibility of disability for homeless youth

A largely unexplored complexity in the lives of youth who have experienced homeless is the presence of intellectual, developmental and/or learning disabilities. Although emerging research shows that youth with cognitive disabilities are more likely to become homeless and that rates of cognitive disabilities are higher among the homeless population than the population in general, exploring the intersection of disability and homelessness for youth has not been a priority. In this study, a critical disability and systems failure lens is brought to bear on the vulnerability of youth who experience this intersection. Based on interviews with key informants in the disability, homelessness, education, employment and child welfare sectors in three sites in Ontario, Canada, the invisibility of disability among homeless youth is brought to light. We explore the ways youth with a disability in the homelessness sector are made vulnerable, the insurmountable barriers to getting access to the requisite assessment for disability services and the siloed nature of the homelessness and disability service sectors. An argument is made that “working outside the box” to assist youth to navigate significant system disjunctures is insufficient.     

A Framework for Healing from Loss

ABSTRACT

Many behavioral problems of youth may be viewed as complications with their grieving. This study investigates defenses which emerge in the face of repeated losses and trauma early in life and proposes a framework for understanding what is happening intra-psychically with youth who have such defenses. Inter-subjective and relational theory, early trauma theory, and social constructionist theory each inform this integrated framework for social work practice. Included is an extended cross-cultural case study of therapeutic work with a Latino youth in a community-based setting. Also included are clinical considerations for working with protective defenses emanating from early loss and trauma.     

Understanding service provision and utilization for vulnerable youth: Evidence from multiple informants

Research has demonstrated that the ability of children to cope well with risk exposure can be partly attributed to the social ecology that surrounds them, including their access to resources. Few studies however have explored the interaction of services that many vulnerable children receive in relation to surrounding risks and available resources. This study reviews data of a paired sample of 166 Canadian multiple service using youth (at least using two of five public service systems) and a youth-nominated person most knowledgeable (PMK) focused on the contextual risk factors, service use variables, and pscychosocial outcomes of youth participants. Despite low to moderate correlations between youth and PMK (the person who is most knowledgeable about youth's lives) reports, findings showed that both PMKs and youth perceive service provision as a mediator between risk and pscychosocial outcomes. For youth however, better quality of service provision is key to improved developmental outcomes. Furthermore, the more risk factors youth face at home and at school, the less likely they are to perceive their services as helpful or appropriate to their needs. Youth data also reflects far more complex interactions between risks, service provision and outcomes than PMK data. Greater sensitivity is needed to both an adult and youth's perceptions of risk and related service needs if service access is to be provided optimally.     

The need for safe spaces: Exploring the experiences of homeless LGBTQ youth in shelters

Studies indicate LGBTQ youth are at higher risk of homelessness (2–13 times) than their heterosexual cisgender counterparts and that they represent a substantial portion of youth utilizing housing and shelter services. Some authors have provided anecdotal (rather than empirical) examples of LGBTQ youth experiencing abuse or mistreatment in shelters; most studies focusing on LGBTQ homeless youth have been conducted in large cities and have rarely collected data from both youth and providers. Using an exploratory, grounded theory approach, this study utilized data from interviews with LGBTQ youth with a history of homelessness as well as service providers working with this population in a mid-sized Northeastern city. Findings suggest youth experience multiple challenges, barriers, and mistreatment in the shelters; further, data suggests several ideas about how to transform shelters to better meet the needs of LGBTQ youth.     

Working with Homeless Populations to Increase Access to Services: A Social Service Providers’ Perspective Through the Lens of Stereotyping and Stigma

Through the lens of stereotyping and stigma, this article examines discrimination and prejudice toward homeless families from the perspective of social service providers. Semi-structured qualitative interviews were conducted with practitioners. A critical social work practice perspective is used to provide a framework for understanding how social worker knowledge about discrimination and prejudice informs the ways in which the workers engage with clients, build capacities, and advocate for clients in an anti-oppressive manner. The themes found in this study include: a) providers’ awareness of bias, stereotyping, prejudice, and discrimination; b) providers’ use of a range of strategies to work with people experiencing homelessness; c) providers’ ideas about strategies that organizations can implement for service provision; and) providers’ belief that additional advocacy and policy are needed in relationship to people experiencing homelessness.     

Rural Social Service Disparities and Creative Social Work Solutions for Rural Families Across the Life Span

The provision of social services in rural areas has historically presented a challenge for social workers. Rural social service disparities are presented in relation to key challenges surrounding the provision of social work services in the rural United States. Barriers that define rurality and hinder the provision of social work to rural families, a multicultural examination of rural community strengths and resiliency, and creative solutions for rural social work delivery are discussed. A case study utilizing collaborative partnerships between rural churches, schools, and community leaders to combat rural homelessness and streamline service delivery for rural families across the life cycle is presented.     

Responses to Homelessness in Australian Cities: Social Worker Perspectives

Abstract

Responses to homelessness in Australia are provided by a range of government and nongovernment services. The present study examined the experiences of social workers within these diverse services. The article discusses how social workers make meaning of their professional identity and responses to homelessness in contemporary practice and policy settings. The findings of a qualitative study of 39 social workers employed in Adelaide, Melbourne, and Sydney are analysed from a social constructionist perspective. The practice dilemmas for social workers interviewed related to the dominating influence of the contemporary political and economic climate, the managerial requirement of organisations, and the personal and professional tensions these political and organisational contexts created.     

Toward Trauma-Informed Career Counseling

The Adverse Childhood Experiences study (Felitti et al., 1998) showed that early adversity can have a profound lifelong effect on personal development, social relationships, coping methods, and career trajectories. The authors review critical findings related to trauma-informed counseling practices, discuss literature linking trauma and career theories, and consider how career counseling could address the effects of adverse childhood experiences using trauma-informed practices. An integration of trauma-informed practices with career counseling using narrative and other approaches is proposed. The proposed integration holds implications for incorporating trauma-informed practice in career counselor preparation programs and in career counseling practice.     

A narrative inquiry into familial and school curriculum making: attending to multiple worlds of Aboriginal youth and families

In this paper we draw upon a narrative inquiry alongside urban Aboriginal youth and their families in western Canada; the overall goal of our inquiry was to understand their educational and schooling experiences. Shifting our focus from schools as the only place where curriculum is made, we draw on the conceptualization of children, youth, and families as also engaged as curriculum makers in homes and in communities and in the in-between places of homes and schools. In this paper we explore the multiple curriculum-making worlds of Lane and Donovan, two Aboriginal youth. As part of understanding the multiple worlds and relationships between, and intersections of, multiple worlds, we draw on Lugones' concept of world traveling. We contemplate the importance of understanding lives over time, in geographic places, and social contexts. We wonder how the worlds youth inhabit are shaped by institutional, social, political, and institutional stories, and how these larger narratives shape the ways in which we attend to the lives of youth.     

A Trauma-Informed Model for Empowerment Programs Targeting Vulnerable Youth

Youth-led program development, organizing, research, and health promotion have been identified as an important practices for community practitioners. Since such practices target vulnerable youth, it is critical that such empowerment programs are trauma-informed. This paper addresses trauma, its potential impacts, and cultural differences in understanding trauma as well as the assumptions of empowerment and youth-led programming. The relationship between health and empowerment is described as well as how youth empowerment programs can specifically target symptoms of powerlessness, low self-esteem and interpersonal difficulties, commonly experienced by youth living in socially toxic environments. Implications for program development, research, and policy are considered.     

Who Is Supporting Homeless Youth? Predictors of Support in Personal Networks

Homeless youth lack the traditional support networks of their housed peers, which increases their risk for poor health outcomes. Using a multilevel dyadic analytic approach, this study identified characteristics of social contacts, relationships, and social networks associated with the provision of tangible and emotional support to homeless youth (N = 419, M age = 20.09, SD = 2.80). Support providers were likely to be family members, sex partners, or non–street‐based contacts. The provision of support was also associated with contacts' employment and homelessness status, frequency of contact, shared risk behaviors, and the number of network members that were homeless and employed. The results provide insights into how homeless youth could be assisted to develop more supportive social networks.     

Place,power, and possibility: Remaking social work with children and youth

This article introduces the work of an interdisciplinary group of scholars and activists who critically examine the nature and boundaries of social work with children and youth. Their works explore the institutional and social spaces shaping young people's lives; deconstruct discourses, policies, and practices that shape meanings and experiences of childhood; and consider challenges for social work and possibilities for transformative action. In this essay the editors address the social construction of childhood; outline a framework for analysis informed by an understanding of the cultural politics of childhood; consider the relationship between neoliberal globalization and contemporary thought and practice regarding children and youth; and introduce cutting-edge scholarship addressing place, power, and possibility and the remaking of social work with children and youth.     

Youth,activism, and social movements

There has been considerable debate over the extent and role of young people's political participation. Whether considering popular hand‐wringing over concerns about declines in young people's institutional political participation or dismissals of young people's use of online activism, many frame youth engagement through a “youth deficit” model that assumes that adults need to politically socialize young people. However, others argue that young people are politically active and actively involved in their own political socialization, which is evident when examining youth participation in protest, participatory politics, and other forms of noninstitutionalized political participation. Moreover, social movement scholars have long documented the importance of youth to major social movements. In this article, we bring far flung literatures about youth activism together to review work on campus activism; young people's political socialization, their involvement in social movement organizations, their choice of tactics; and the context in which youth activism takes place. This context includes the growth of movement societies, the rise of fan activism, and pervasive Internet use. We argue that social movement scholars have already created important concepts (e.g., biographical availability) and questions (e.g., biographical consequences of activism) from studying young people and urge additional future research.