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Running head: DAY COUNSELING PROGRAM

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Day Counseling Program Proposal Targeting Homeless Women Residing in Community Shelters Myia Bennett Texas Woman’s University


PROPOSAL TARGETING HOMELESS POPULATION Table of Contents Introduction and Background ..................................................................................................... 3 Review of Literature ..................................................................................................................... 5   Objectives and Aims ..................................................................................................................... 7   Program Design............................................................................................................................. 7   Group Activity I....................................................................................................................... 9   Group Activity II ..................................................................................................................... 9   Group Activity III .................................................................................................................. 11   Group Activity IV.................................................................................................................. 11   Quarterly Outing.................................................................................................................... 12   Conclusion ................................................................................................................................... 12   References .................................................................................................................................... 14   Appendix ...................................................................................................................................... 16   Figure 1 Direct and Indirect Services Provided by Clinical Mental Health Counselors (Program Leaders) ..................................................................................................................... 16  

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PROPOSAL TARGETING HOMELESS POPULATION Introduction and Background There are different official definitions to describe homelessness used by various organizations and the government but despite slight differences in definition, there is universal recognition of homelessness as a problem that plagues a significant portion of the U.S. residents. A homeless individual is someone who lacks permanent, stable housing; the term also encompasses individuals who “doubles up”—a term used to describe a person who must stay with others because they are unable to maintain a residence themselves. This definition is more encompassing and generally used by the U.S. Department of Health and Human Services. An alternative, more restrictive definition defines homelessness by listing criteria such as an individual who lacks a regular, fixed, and adequate nighttime residence, an individual(s) who will lose there permanent residence within 14 days due to eviction, and families with youth or unaccompanied youth who have moved frequently and experienced residential instability over a long period of time for reasons like substance addiction, domestic violence and even chronic disability. The consistent thread across these definitions is the lack of stable, long-term independent housing free of “doubling up” (“What Is The Official,” 2014). Homelessness affects a significant portion of the population; the U.S. Department of Housing and Urban Development Office of Community Planning and Development (2013) provided a report to congress. The department’s 2013 report took a snapshot of any given night in January 2013 and calculated the number of individuals experiencing homelessness on this random night. The total number of individuals was 610,042. They were further subcategorized into various groups which include: 67% were aged 25 years and old, 23% were youth aged 18 years and younger, 35% of the 610,042 lived in unsheltered conditions, and 65% lived in sheltered conditions. The department also reported a 4% decline in the number of people living

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PROPOSAL TARGETING HOMELESS POPULATION with homelessness since 2012, driven primarily by a decrease in the number of unsheltered individuals. The department simultaneously reported a 1% increase over the same period in the number of sheltered individuals, which should consequently lower the total decline to 3%. 5 states accounted for more than half of the 610,042 individuals: California (22%), New York (13%), Florida ( 8%), Texas (5%), and Massachusetts (3%). Of the 610,042, 64% were individuals not in a family and 36% were living with homelessness as part of a family. The National Center on Family Homelessness (2011) released a report that reflected subcategorized percentages of the total number of people living with homelessness as reported by the U.S. Department of Housing and Urban Development Office of Community Planning and Development in a 2010 report. The center reported that the typical homeless family is comprised of a mother in her late twenties with two children. The report showed that 80% of women are in a family, 43% of the total homeless population is made up of African-Americans, 38% is made up of Caucasians, 15% are made up of Hispanics and 3% are Native American. 53% of the total numbers of mothers living with homelessness do not have a high school diploma, and over 92% of these mothers have experienced severe physical and/or sexual abuse at some point. In addition, 50% of these mothers have experienced a major depressive episode since being presented with the problem of homelessness and are more vulnerable to suffering with mental and physical health problems. The impact of homelessness on the family is reflected in the high percentages of stress and anxiety. The National Center on Family Homelessness (2011) cites combinations of unemployment, health and mental challenges, single parenting, lack of affordable housing, poverty and income disparity, and exposure to physical/sexual violence as potential drivers of what causes homelessness. Other researchers corroborate the center’s report citing women who experience

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PROPOSAL TARGETING HOMELESS POPULATION family trauma as an alarmingly prevalent concern for community mental health professionals, and the representation of single mothers range from 85-94% in homeless families—tying single parent families to the dilemma. Evidence linking substance abuse in women living with homeless was another common thread amongst research studies (McWhirter, 2006; Milburn, & D’Ercole, 1991; Slesnick, Glassman, Katafiasz, & Collins, 2012). Review of Literature Review of different research reports showed that women experienced states of homelessness more than men, and that these women were often single parents and faced multiple problems. The first and most obvious one is a lack of affordable, safe and permanent housing. Poverty levels, unemployment, underemployment, lack of education, lack of a primary support system, health problems, mental health problems, disability, lack of adequate/safe child care, lack of access to transportation, traumatic events, and catastrophic events are all potential contributors to a combination of factors that minimize access to affordable and permanent housing. Some women manage to access assistance from social programs but often not without challenges, even after obtaining access. Stress and anxiety levels are high amongst these women. They are often plagued with with patterns of acute stressful life events. Housing instability and poverty compound traumatic experiences and the ability to successfully and independently manage the demands of single parenting, which many of the women are charged with. Depression and hopelessness is not uncommon; it can be accompanied by substance abuse and other maladaptive coping strategies. Anger and frustration with slow or no progress is also often observable. These are some of the challenges that women living with homelessness face (Fraenkel, Hameline, & Shannon, 2009; Milburn & D’Ercole, 1991; Slesnick, Glassman, Katafiasz, & Collins, 2012).

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PROPOSAL TARGETING HOMELESS POPULATION The use of cognitive behavioral therapy in group format is a research supported treatment for use with depression and can be used in the case of comorbidity with multiple diagnoses. This supports the idea that implementation of a group therapy with a narrative theme that allows for the exploration of thoughts, feelings, rules, assumptions and beliefs amongst women living with homelessness and experiencing symptoms of distress, depression, potentially abusing substances or who may have multiple Axis I diagnoses, will be an effective treatment producing symptom relief (Bieling, McCabe, Antony, 2006). Fraenkel, Hameline, & Shannon (2009) examined the use of narrative based interventions and programs with individuals living with homelessness in a shelter environment. Program implementation provided a platform for participants to rebuild personal pride, self advocate, redefine their personal identity, develop a positive and hopeful vision for their futures, provide support to one another, witness the modeling of empathy and offerings of support from others, externalize problems and articulately identify the effects homelessness has on their lives, and allowed participants to share their stories freely, without judgment or fear of negative consequences. Other literature acknowledges the power of narrative therapy programs used with youth who initially present problem filled narratives. The approach was collaborative, less structured, and challenged the problem filled stories youth have when starting the program. Program leaders focused on having externalizing conversations with the youth to separate the problem from the individual and consequently grant control over the problem to the individual; leaders worked with youth to identify the effects the problem stories have had over time in their lives and work with youth to co-author new stories. Though this program targeted youth in a

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PROPOSAL TARGETING HOMELESS POPULATION community service agency setting, it can be adapted to work with an adult population (Little, Hartman, & Ungar, 2008). Objectives and Aims After a review of the literature, the implementation of a half-day workshop with roots in cognitive behavior therapy principles and influences of narrative therapy was designed. The program was designed considering the uniqueness of its background setting in a homeless shelter that serves women. The program was structured with the goal of minimizing distress, fostering relaxation and self-advocacy, providing psycho-education and group therapy to encourage schematic reframing/writing new stories, increasing coping strategies, and strengthening support systems. The program’s goal is also to remain collaborative in its efforts to serve the population. Efficacy can be measured with anonymous feedback questionnaires assessing usefulness and reports of decreased distress. Program Design The program is offered in a group modality at the homeless shelter. Women who reside at the shelter as well as those who utilize the shelter’s services and facilities but reside in transitional housing elsewhere will be encouraged to participate. The group will be closed to the general public, and participants will be verified as current shelter residents or residents of transitional housing elsewhere for safety purposes. The program will be administered in the shelter with a quarterly pre-planned and scheduled outing in lieu of the normal group schedule. Participants are expected to not only be women, but predominantly single parents, may be under or unemployed, women with little or no college education—many of whom will not have earned a high school diploma, women who lack a support system and have likely been exposed to or experienced some sort of physical violence or sexual assault, range in age from early

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PROPOSAL TARGETING HOMELESS POPULATION adulthood to late adulthood, and come from various cultural backgrounds; these assumptions are based on population data (The National Center on Family Homelessness, 2011). Participant exclusion will be limited to individuals who are reported by shelter staff to be a potential threat to the safety and autonomous functioning of the group due to various reasons such as repeated disruptive behavior or displays of disrespect and violence within the living quarters of residents, and/or low social functioning or severe disability that would undoubtedly limit the effectiveness of the program despite participation; discretion will be left to the shelter staff regarding the limiting of group participants. Two licensed counselors and/or social workers and/or psychology professionals will lead the program and assist in securing funding; the use of counselor interns will be permitted, provided there is at least one licensed professional present. Additional professionals may be employed to provide volunteer or discounted services; professionals could include massage therapists, nurse practitioners, and financial advisors. The licensed counselors will provide quarterly program cost projections and a true up of costs in a cost analysis report to be provided consistently in accordance with shelter guidelines. Potential resource costs could include narrative art supplies, public transportation during outings, and discounted payment of external professional services. The shelter will budget for the program and program leaders will actively seek funding through grant writing, community partnerships, and donations. The program will begin at 8am and end at 1pm; each hour will contain a group activity that will be rooted in the principles of cognitive therapy with narrative therapy and psychoeducational components. Mindfulness and relaxation techniques will minimize stress, raise awareness and offer individual assessment of current emotional state and thoughts. Narrative therapy activities will promote the externalization of participant problems, an emotional release

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PROPOSAL TARGETING HOMELESS POPULATION of distress through story telling, identification of personal strengths and learning new coping skills from others, strengthening of the social support system, identification of cognitive distortions through story telling, and the re-writing of personal stories (similar to the cognitive approach of schema re-interpretation or modification). Psycho-education will serve as a way to teach each participant to be her own therapist, foster autonomy, self-efficacy, empowerment, and prevent relapse (Beck, 2011; Fraenkel, Hameline & Shannon, 2009). Group Activity I The first hour will begin with an informal check in and sign up for massage times within the hour; breakfast will be provided via a cart from the shelter cafeteria and could be provided by the program leaders, in accordance with the shelter food safety guidelines. Each participant will be given the option to receive a 12-minute chair massage by a volunteer massage therapist during the first hour. The program aims to enlist the services of 2 massage therapists during the first hour, every week; participants will be encouraged to arrive at 8 and sign up for a 12 minute slot within the hour. This would allow for each participant to receive a massage and still have 40-45 minutes to partake in breakfast, drop children off at daycare, or even return to their living quarters before/after breakfast/their assigned massage time. Meditation tapes will play during the massage therapy sessions. The purpose of this activity is to promote mindfulness and relaxation, encouraging the relief of stress symptoms. The goal is also to foster a sense of identity and self worth through the receipt of services from another person. Group Activity II The design allows for variation during the second hour of the program; should program leaders observe that the majority of participants are repeat attendees, this activity can be changed, or it can be routinely changed to allow for leader increased leader engagement. This hour of activity

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PROPOSAL TARGETING HOMELESS POPULATION will be rooted in narrative therapy. A sample activity could be the use of story telling, one sentence and participant at a time: a participant would be asked to provide one sentence of “story telling.” The next participant would be asked to add to the story with a new sentence. Each participant would be given the opportunity to contribute to the story. For example, one participant, Jane Doe, begins the story by making the statement, “I feel like a walking stigma.” The next participant, Sally Doe, might add to the story with the sentence, “And now my kid feels the same way.” The next participant, Lisa Doe might add, “My daughter is being picked on at school because of me,” so on, and so forth. This activity allows participants to identify with each other, and strengthen social support systems. The activity leaders can note any internalizing of problems, cognitive distortions, etc. through observation of the activity. The story can go for as long as participants would like, and/or as time runs out, the activity gears could be switched with the “re-writing” of the story, where a group participant is asked to envision their very best self and life, three years from now, thinking of characteristics, qualities, and activities that would fill their day to day life—then start a new story. Jane Doe might start, “I have a house.” Sally Doe might follow with, “I decorated my living room in blue and white;” Lisa Doe might add, “I invite over you all for a BBQ.” Other story telling/narrative themed activities could be used during this hour. The goal is to deeply engage participants emotionally and cognitively; the leaders will want to explore beliefs/life stories, externalize the problems participants are currently facing and see those problems as temporary states/separate from the individuals, explore how the problem of homelessness is affecting their lives, share coping skills that have worked for some participants, explore future obstacles to ending the problem of homelessness, etc.

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PROPOSAL TARGETING HOMELESS POPULATION Group Activity III After an hour of personal exploration, this third hour of the program will allow for participants to take a break from self-disclosure and engage in active learning and problem solving. This component of the program was also designed for variation depending on the current prevalence of concerns experienced within the shelter. Activities during this hour could be: a workshop on couponing and finding deals for basic necessities or fun family activities (researched and presented by a volunteer expert or one of the program leaders, a brief video that shows several free and simple strategies for creating and sticking to a personal budget followed by completing leader provided sample budget forms/worksheets, a legal resource hour where a volunteer defense attorney, prosecutor, or legal aide could be available for Q&A and address some of the common legal concerns that homeless women might face. This portion of the program is meant to be practical and directly address challenges associated with homelessness. Active participation and input from the women regarding the challenges they are currently facing in the area is encouraged; leaders can utilize feedback for crafting future activities. Group Activity IV The final portion of the half-day program mirrors the first hour; lunch will be served via an outside caterer during this hour, and women will be encouraged to participate in the last narrative themed activity of the day. This activity will give participants the option of drafting a letter, or creating a poster board with a message to their state representatives sharing some part or a brief version of their story. Participants will be encouraged to advocate for themselves in their message—challenging their legislators to devise and implement legislation to improve the state of homelessness locally and nationally through adopting a living wage, increasing state amd federal funding to promote access to mental and medical health care and social services, etc.

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PROPOSAL TARGETING HOMELESS POPULATION Participants will be allowed to freely express themselves and given the hour to finish their project. Those that create poster boards will be given the option to take a photo holding their poster board (they can cover their face with the board to maintain anonymity or opt out completely). Program leaders will compile the letters and photos into a presentation where they will seek out an opportunity to directly present (and at a minimum, simply mail) their demographic presentation to political leaders as an active initiative to lobby on behalf of the women experiencing homelessness. Quarterly Outing The quarterly outing will be a pre-planned event with a sign up sheet for participants and is designed to assist shelter administration leaders with overflow of demand for access to external services such as transporting women to an offsite location to obtain identification cards, or transporting children to a free shot clinic where they can obtain flu shots or other vaccinations, or this outing could address a demand for extracurricular activities outside of the shelter such as a family day at the local zoo. Program leaders will work with shelter administration to identify and prioritize needs and employ volunteers to assist in staffing the outing, overseeing organization, and securing donations/funding/budget funds/release forms/community partnerships/etc. to ensure a smooth activity. The outing will substitute one of the weekend halfday programs normally held at the shelter. Shelter administration will actively participate in the orchestration and final approval of all outings. Conclusion The program was designed with the population statistics and the challenges they face as the premise for intervention approaches. The program was structured based upon research supported techniques that have empirical reports of positive treatment outcomes when used with the

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PROPOSAL TARGETING HOMELESS POPULATION symptom presentation of this group of women and within the specific population of women currently residing in transitional housing and living in a current state of homelessness. The program was also designed with sensitivity to the limited funds available to community agencies. The program challenges leaders (counselors) to advocate for the population beyond the shelter and on a macro level (politics). Feasibility and conservative efficacy projections were also apart of the program design. It is feasible that the program would work with needs of this population.

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PROPOSAL TARGETING HOMELESS POPULATION References Beck, J. S. (2011). Cognitive behavior therapy basics and beyond (2nd ed.). New York, NY: The Guilford Press. Bieling, P. J., McCabe, R. E., & Antony, M. M. (2006). Cognitive behavioral therapy in groups. New York, NY: The Guilford Press. Fraenkel, P., Hameline, T., & Shannon, M. (2009). Narrative and Collaborative Practices in Work with Families that Are Homeless. Journal Of Marital And Family Therapy, 35(3), 325-342. Little, A., Hartman, L., & Ungar, M. (2008). Creating a Narrative-Based Practice Culture across a Youth Serving Agency: The Phoenix Youth Program's Story. Residential Treatment For Children & Youth, 25(4), 319-332. McWhirter, P. T. (2006). Community Therapeutic Intervention for Women Healing from Trauma. Journal For Specialists In Group Work, 31(4), 339-351. Milburn, N., & D'Ercole, A. (1991). Homeless Women: Moving toward a Comprehensive Model. American Psychologist, 46(11), 1161-69. National Center on Family Homelessness. (2011). The characteristics and needs of families experiencing homelessness. Retrieved from http://www.familyhomelessness.org/media/306.pdf Newsome, D. W., & Gladding, S. T. (2014). Clinical mental health counseling in community and agency settings (4th ed.). Upper Saddle River, NJ: Merrill/Prentice-Hall. Slesnick, N., Glassman, M., Katafiasz, H., & Collins, J. C. (2012). Experiences Associated with Intervening with Homeless, Substance-Abusing Mothers: The Importance of Success. Social Work, 57(4), 343-352.

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PROPOSAL TARGETING HOMELESS POPULATION U.S. Department of Housing and Urban Development Office of Community Planning and Development. (2013). The 2013 Annual Homeless Assessment Report to Congress. Washington, DC: U.S. Government Printing Office. Retrieved from https://www.onecpd.info/resources/documents/ahar-2013-part1.pdf What is the official term for homelessness. (2014). Retrieved from http://www.nhchc.org/faq/official-definition-homelessness/

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PROPOSAL TARGETING HOMELESS POPULATION

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Appendix Figure 1 Direct and Indirect Services Provided by Clinical Mental Health Counselors (Program Leaders) Problem/Concern

Direct

Indirect

Client/System Services

• Stress/Anxiety

• Massage Therapy

• No Support System/Maladaptive Coping Skills

• Group Counseling

• Healthy Functioning/General Wellness

• Psycho-education

• Political Underrepresentation

• Advocacy Initiatives

• Program Funding

• Grant Writing/Fundraising

• Access to Human Services

• Outings/Onsite Clinics

Homelessness: Community Program Proposal  

A day program proposal targeting women experiencing homelessness.