Adverse childhood experiences (ACEs) can have profound effects on the mental and physical health outcomes of those who are impacted, and ACEs are prevalent among those in the United States who are unhoused. Alachua County has extremely high rates of unhoused persons, including many mothers and their children. For these mothers who are unhoused, accessing healthcare is an additional burden that can seem insurmountable. This project wants to provide access to quality women’s health and mental health care for mothers who are unhoused by offering these services at a local homeless shelter medical clinic. In addition to healthcare, the project will provide family therapy, education on ACEs and parenting skills, and outreach to the schools attended by the children of the mothers who are unhoused. The project aims to increase healthcare access to mothers who are unhoused, increase knowledge about ACEs and address the impacts on the mothers, and prevent further exposure to ACEs among the mothers and their children.
Public Health Framework
To target primary prevention, this program will educate mothers who are unhoused on the impact of ACEs and provide trauma-informed parenting strategies. Staff at schools attended by children of the mothers who are unhoused will also receive training on ACEs, providing tools to prevent and reduce the impact of ACEs in the school system and increasing awareness of the benefits of screening for ACES. For secondary prevention, the program will incorporate ACEs screening in the healthcare visits of the mothers who are unhoused. Program staff will also work with the schools attended by the children of the mothers who are unhoused to develop a protocol for future screening for ACEs in the school system. Finally, a tertiary level of prevention will incorporate treatment for the comorbidities associated with ACEs, including both medical and mental health care.
Level(s) of Social-Ecological Model
Three levels of the McLeroy Social-Ecological Model (SEM)- individual, interpersonal, and institutional- were utilized in the development of this program (McLeroy et al., 1988). The individual level is addressed through education of mothers who are unhoused on the impact of ACEs as well as the provision of parenting strategies to reduce the incidence and impact of ACEs. These mothers will also receive health education from the clinic providers in hopes of altering attitudes regarding the importance of preventative health care for women. Additionally, mental health care and therapy will be provided to mothers who are unhoused that will give them tools to engage in healthier self-care and parenting behaviors.
The interpersonal level of the SEM is addressed through the family therapy provided to mothers who are unhoused and their children. These family therapy sessions will aim to break the multi-generational parenting patterns that are detrimental to the mental and physical development of children. Family therapy may also provide the mothers who are unhoused with the opportunity to work through issues that have plagued relationships within their own families of origin and allow the mothers to strengthen familial support.
The institutional level of the SEM is addressed through the program’s work with the local schools. The school staff will receive education on ACEs, with the goal of implementing an ACEs screening program in the schools. The collaboration between the family therapist and the school staff will also provide additional support for the children of mothers who are unhoused and hopefully reduce the impact of ACEs on the children’s emotional health and academic success.
Trauma-Informed Principles Your Grant Will Utilize
The SAMHSA Trauma and Justice Strategic Initiative (2014) outlines six principals that are integral to providing trauma-informed care. Safety will be incorporated into the physical environment of the women’s health clinic, as well as within the clinic’s programming. The clinic will be well-lit and held in a space that has its own entrance and is separate from the general medicine clinic. The clinic staff, from intake to providers will be all female, and no male staff or providers will enter during the women’s clinic, as many women who are unhoused are victims of intimate and partner violence enacted most often by males. Intake and clinical interviews will be conducted privately, away from other clients attending the clinic.
The principal of empowerment, voice, and choice builds on the strengths and experiences of the individual clients and staff within an organization and aims to foster resiliency and facilitate healing and recovery (SAMHSA, 2014). By providing knowledge about ACEs, parenting tools, and therapy to address the impact of ACEs on the mothers who are unhoused and their children, this program hopes to develop resiliency in the mothers who are unhoused and their children and promote healing and recovery from ACEs and trauma. A shared decision-making process is also integral to the principal of empowerment, voice, and choice (SAMHSA’s Trauma and Justice Strategic Initiative, 2014). The women’s clinic will focus on patient-centered care, empowering mothers who are unhoused with the knowledge and support needed to make a choice for the preventative care or treatment that is best for the individual woman and her current life circumstances.
Finally, the principal of cultural, historical, and gender issues will be incorporated into the program through mandatory annual staff training and the inclusion of culturally and gender sensitive medical and mental health care provided in the clinic and during therapy sessions.
McLeroy, K. R., Bibeau, D., Steckler, A., & Glanz, K. (1988). An ecological perspective on health promotion programs. Health Education Quarterly, 15(4), 351–377. https://doi.org/10.1177/109019818801500401
Substance Abuse and Mental Health Services Administration (2014). SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed Approach. HHS Publication No. (SMA) 14-4884.
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