Understanding Homelessness in L.A. County: Evidence-Based Practices for Serving the Homeless

Understanding Homelessness in L.A. County: Evidence-Based Practices for Serving the Homeless

Evidence-based care means translating the findings of scientific research to our daily care practices and clinical decision-making. Evidence-based practices (EBPs) integrate the best available evidence with clinical knowledge and expertise, while considering patients’ unique needs and personal preferences. If used consistently, EBPs are more likely to achieve optimal patient outcomes, such as sustained housing, sobriety, and mental health.

As a behavioral healthcare provider, L.A. CADA uses EBPs in treatment delivery. For example, the use of Motivational Interviewing (MI) helps people resolve ambivalence to treatment participation. As opposed to intense, confrontational techniques designed to break denial and resistance, MI builds participant trust and confidence, meeting them anywhere they are in regards to readiness for change. Our therapists and counselors also use Cognitive-Behavioral Therapy CBT) to help patients change the thoughts and behaviors that are contributing to distressing emotions, substance use, and a criminal lifestyle. CBT helps the treatment participant build a set of skills that enables an individual to be aware of thoughts and emotions. They learn to identify how situations, thoughts, and behaviors influence emotions, and improve feelings by changing dysfunctional thoughts and behaviors. These are only two of many EBPs used to promote and support behavioral health recovery.

There are also evidence-based practices specific to homelessness. Recovery is virtually impossible while a person is living on the streets. Treatment programs use the Housing First EBP  to end homelessness faster by serving as a platform from which homeless persons and those at risk can pursue personal goals and improve their quality of life. The Housing First model is guided by the belief that people need basic necessities like food and a place to live before attending to other needs.

This EBP is based on the theory that:

1) client choice is valuable during housing selection and

2) exercising a choice for selection of supportive services is likely to make a client more successful in retaining housing and improving their life.

Another successful practice to help end homelessness is Trauma-Informed Care. Trauma and homelessness are connected in at least three ways.

First, research has shown that people who are homeless are likely to have experienced some form of trauma, often beginning in childhood. Of people involved in the criminal justice, substance use treatment, and homelessness service systems, 85% experienced trauma as children.

Secondly, trauma often happens during homelessness, for example by being a victim or witness of an attack, sexual assault or any other violent event. People can also be re-traumatized by services that leave them feeling powerless and controlled.

Thirdly, homelessness itself can be considered a trauma in multiple ways. Just the loss of a home together with loss of family connections and social roles can be traumatic. Social exclusion activates the same neurological systems as physical trauma, with a similar impact. Added to this, homelessness can be such an additional stress in the life of a person that it can erode a person’s coping mechanisms.

Trauma-Informed Care means that every person on every level of the system is trained to understand the role that trauma and violence play in the lives of our program participants.

As a system, we ensure that services:

1) accommodate the vulnerabilities of trauma survivors,

2) ensure that services avoid inadvertent re-traumatization, and

3) facilitate consumer participation in treatment.

These are just some of the many practices proven to help unhoused people with behavioral health disorders. There are many more. The best thing is that we don’t have to re-invent the wheel or use “what we’ve always used”. There are treatment practices scientifically demonstrated as effective.

 

Photo credit:<a href=’https://www.freepik.com/photos/group-therapy’>Group therapy photo created by DCStudio – www.freepik.com</a>

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