Depression in Homeless Families
Over the last few years, agencies such as the National Coalition for Homelessness, the Department of Housing and Urban Development and the United Way CAP report show that after a period of decline, the problem of homelessness is again on the rise. With a detrimental economic situation and the knowledge that our culture places a high significance on materialistic means to indicate a person’s value and worth, it’s not a stretch to see how people in a position of homelessness could find themselves depressed or how children who show up to school unwashed and hungry might be ridiculed by their peers and lead to feel depression themselves during one of the most important times in their lives for developing a sense of self-worth and ego.
It is this population of homeless families that my services will be aimed at in order to help prevent or alleviate depression. According to the CAP report homeless families report having at least 1 child under the age of 18 living with them and only 77% of these reported children are in school (a drop from 88% reported in previous years). A study done by the National Coalition for the Homeless shows that instead of drug abuse being listed as one of the most common reason for being homeless, recent studies have shown that unemployment is now the most common reason given for homelessness.
I want to serve this particular population because I went through shelter programs as a child and I saw how depressed some of the aspects of the various programs made my mother. The National Coalition for Homelessness also shows that this population needs our help with their study showing that hate crimes against the homeless have increased in every city following an act of criminalizing the homeless which is also on the rise.
There are two agencies in Santa Cruz which focus solely on homeless families. The first of these agencies is the Rowland and Pat Rebele Family Shelter. This shelter provides 1 bedroom and studio like accommodations for no rent but they do random drug testing which may make parents who don’t use drugs feel victimized. They also don’t allow for people to cook in their residences which is a basic parenting skill. This may lead some people to feeling hopeless and more like failures, which can cause or reinforce feelings of depression.
The other agency is the homeless service center which only offers beds, has a 30 day limit and has a 4-6 week waitlist. Residents are also only allowed on the premise during certain hours. This last shelter program really only solves the problem off getting them off the street and doesn’t look at their mental well being at all. For my program I feel that expanding upon the Rebele Family shelter in a way to allow more freedoms and self-sufficiency will be best. I also feel that by sharing services and helping with over-flow, I can do so without getting in the way of the other shelters.
In my agency help and support will come mostly from volunteers and outside agencies. Outside agencies include Ed Frey who is a Santa Cruz attorney who does pro-bono work for the homeless community, the Dinettes Community dental health clinic, the women’s health center and the Safety Net Clinic Coalition who provides medical, dental, mental health and pre-natal services. My volunteers will come from the community, a lot of them from local schools like UCSC, and they’ll do things like baby-sitting, tutoring, cooking and art classes, ride sharing (similar to wheels for seniors), provide skills training workshops and other activities. Paid positions will be temporary to start out with and will include a site manager, handyman, mechanic, accountant, intake staff, volunteer coordinator and PR person. Gradually as people come into the program who have experience and training in these job fields, these positions will be taken over by them so that even the money spent for running the program will be going into the pockets of those people that we are trying to help.
The professional staff will be the first hired and they will be screened by their experience and training in working with psychological disorders as well as for non-profit organizations. All will attend a 6 week training along with the volunteers. The training session will be set up into two, one hour a week training sessions for six weeks (Appendix A).
Although it will be easy to get the word out about the shelter, the hard part will be getting the families that need help to come because they may be too embarrassed to admit that they need help or they may be put off because it is a new place. In order to get the word out, fliers will be distributed at schools to help target the children of homeless families who are sending their children to school. There will also be a spot on the flier letting parents know that even if they do not need the services, they are welcome to donate money to help out the families of children that go to school with their child. Fliers will also be left with local soup kitchens and churches since families that are too embarrassed to seek lodging may still seek food for their children or spiritual support. I’ll also make connections with the other family shelters in town so that if they have to turn someone away due to a lack of room, they can refer them over to my services.
Money for my program will come mostly from grants. The Energy Shelter Grants program gives out an average grant of $7,969,489 a year with a two year contract. DHCD also gives out a homeless shelter grant in an average one time award of $500,000. The LDS church also gives out homeless shelter grants in the average amount of $341,000 along with providing supplies and food. Fundraising will also be done through programs like the Human Race, book drives and community BBQs (Appendix B).
The main approach taken when designing my program is towards the stress and coping model. Studies have shown that homelessness usually contains a series of stressors both before becoming homeless and while being homeless. These stressors include: sickness, depression, eviction, unemployment and victimization. Stress Theory research and documentation has shown that there are links between feelings of high stress and mental health issues such as depression (Monroe & McQuaid, 1994). Interaction between the demands that stressors place on an individual and the coping resources of that individual play a key role in mental health and stability. A study of homeless families and their coping mechanisms showed that most individuals in the study used escape avoidance which is one of the least effective coping strategies and can lead to mental health issues such as depression (Banyard, 1998). According to the Dohrenwend Model, when met with a stressor, people go through a process of primary appraisal, secondary appraisal and then employ a coping strategy. In primary appraisal a person decides how bad the event is, in the secondary appraisal stage they determine if they can handle it and then they try to cope. Since the research listed above shows that my target population often uses non-beneficial coping mechanisms, I have designed my program to help teach clients to use more beneficial coping mechanisms as well as to help reshape their thinking using cognitive applications so that their responses to the stressors during the primary and secondary appraisal stages will be more positive and less threatening.
I will also be using behavioral, cognitive and self-help applications. According to the cognitive theory of depression, depressed people think the way that they do because their thinking is biased towards negative interpretations of the world around them (Beck, 1964). I will employ cognitive-behavioral therapies to help individuals reframe there thinking and see things more positively. Specific uses of the cognitive and behavioral applications will be shown later with the outline of the shelter program. Self-help applications will also be seen below with the outline of the program.
The shelter itself will consist of an 88 building apartment complex with 2 community houses that both have a kitchen, a front room and two-game rooms attached. For one building, one of the game rooms will be used to house clothing that will be collected in various clothes drives. The other room will be used to house canned goods, toys and other necessities (pet food, blankets, towels, etc) that will also be collected in drives. The kitchen and front room will be open to the homeless population. For the second guest house, the front room as well as the two game rooms will be used for group meetings, skills training, baby-sitting and other services which will be outlined later. The kitchen in this second guest room will only be used by staff and volunteers to help prepare meals for drop-ins or for sick residents.
Anyone will be welcome to come for programs and services but in order to receive placement into one of the apartment buildings, clients will need to have at least 1 child under the age of 18 living with them. All clients entering the program will need to fill out paperwork consisting of a health record form, a COPE Questionnaire (to help establish coping skills and stress habits), a mental health survey, a behavioral contract agreeing to be supportive and cooperative within the community, a skills assessment sheet and employment history to help with skills training and possible job placement and a brief written statement from them saying what they want from the program and anything that they feel they may need help with.
The tertiary prevention will come from the program itself which is designed to alleviate homelessness and the depression that accompanies it. The program will consist of placement in one of the 88 apartment buildings, 18 of which will be set up for temporary housing (a 3 month stay or less), 40 will be set up for transitional housing (6 months or less) and 30 will be set up for semi-permanent housing (1 year or less). Families who have never before been homeless and shown signs of steady residence and employment who may only need help before they are able to line up another job, find another place or save up for another deposit are most likely to be placed into temporary housing. Families who may have some of the previous requirements but who may not have a long employment history or who have other considerations like divorce, loss, etc. will likely be placed into transitional housing. Families entering the program who have histories of homelessness will likely be placed into semi-permanent housing. All families will be consulted about where they feel that they should be placed. Studies have shown that people who feel like they have more control over their lives and what is happening to them are less likely to feel symptoms of depression and hopelessness (Burt, Pearson & Montgomery, 2005).
All of the apartments will be furnished through donations from the LDS church. Toiletries and disposable goods such as milk, lettuce and sandwich meats will be provided to clients through a form filled out and then processed by Desert Industries. Participants will also have access to the donated clothes, toys, canned goods and pet food. The shelter will be a pet friendly environment since studies have shown that homeless families that have had to give up pets for shelter living have suffered from higher amounts of depression and anxiety since they feel as if they’ve lost a part of their family (Gress, 2003).
Housing will be rent free so that families can save up for a deposit. Programs will be available to all on-site residence but are not mandatory since studies have shown that homeless families that are forced to participate in shelter activities have increased feelings of hopelessness and suffer from higher rates of depression due to feeling like they have no control. One particular study showed that homeless families that participated in camp type programs where they got to make their own decisions and rules and have a time out from shelter programs were more mentally resilient and less likely to express symptoms of depression (Kissman, 1999). The semi-permanent housing option will be set up the same way as the transitional and temporary housing program only for the second 6th month period residents will pay a reduced rent rate and bills based on their income. This will act as a form of behavioral therapy so that these families can get used to deadlines with paying bills again and needing to budget with the reward being feelings of accomplishment and self-efficacy.
The housing portion of the program is all set up in a way to make participating families feel like they have an optimized amount of control over a circumstance that they had no control over being forced into. It is set up based on the coping and stress model by helping to alleviate the stressors of homelessness by providing a residence of their own where they get to say when they come and go, how they want their space organized, the types of food they want their families eating, how and when they cook and even to some degree the length of their stays. This amount of control will not only help to limit their stressors but will also help in the cognitive aspect of reframing their ideas on being homeless by limiting the amount of victimization that they feel. This positive reframing will help to lesson symptoms of depression according to the cognitive model of psychology and can also help to prevent feelings of depression in families that join the program shortly after losing their housing.
Along with housing, participating clients will also have access to services and programs. The services clients will have access to include medical, mental health, dental, ride programs, baby-sitting, tutoring, NA, AA and other rehab services. Medical, dental and rehab services will primarily be offered off site but the ride sharing program will give residents without a car easy access to and from appointments for themselves or their children. All other services will be offered on site because studies have shown that homeless families in programs with more on-site options experienced a greater decrease in mental health symptoms (Burt, Pearson &Montgomery, 2005). NA and AA meetings will be easily accessible on site in one of the game rooms of the community house. Tutoring services will be offered on site from volunteers to help students and to give parents a chance to attend programs, look for a job or have some alone time. Baby-sitting will also be offered by the volunteers or by other parents on site who want to help which will add to feelings of self-worth.
Programs will be in place by volunteers and guest speakers to help clients learn new job skills. After contracting with local companies, internships will also be in place so that clients can receive hands-on training with the potential for being hired on after the internship period. Fliers will be sent out to residents for specific workshops that fit their needs based on their original skills assessment and previous job history paperwork. Workshops will also be given on people skills, problem solving, computer and phone skills as well as on how to give a proper interview. The mental health programs offered will focus mainly on cognitive-behavioral therapies as well as stress and coping therapies. Programs will also be offered that are geared towards the individual as well as the family unit since studies have been done that show that services that are allowed to be individualized and focus on the needs of the individual family members as well as the family unit as a whole are the ones that are most likely to be beneficial in alleviating symptoms of mental health conditions and allow for helping to develop a positive focused schema (Koblinksy, Morgan & Anderson, 1997).
The stress and coping based programs will offer classes for effective goal planning, help with identifying stress triggers and response and one that will go over the 8 classes of coping and which ones are most effective and least effective. There will also be a support group for depression, a class to help with cultivating social support networks, a class for meditation and relaxation techniques and another class that explains what emotional intelligence is and explains ways of raising emotional intelligence. The cognitive-behavioral therapies programs will include a class for relaxation, mindfulness and distraction techniques, a guided discoveries class, a logical fallacies class to help in identifying cognitive errors, an art class that helps with imagery and stress release and a class that helps to reframe thinking using journaling and the 3 column method (Clark, Beck & Alford, 1999). To help with stress release, volunteers will also run programs that deal with cooking classes, art classes, gardening classes, dance classes, etc. Another program specifically set up for the children will be behavioral contracting. Children will be asked to sign behavioral contracts with the staff as well as their own parents. For the contract with the parents, the parents will be able to decide how to deal with the positive reinforcements with their children. This specific contract with the parents will help the parents to feel like they have more control and will also help to ensure that these good behaviors will continue even after they leave the program. For the contract with the staff, children will earn points if seen showing good behavior, for good grades, by participating in programs on site (including dances, movie nights, etc) and for volunteering within the program. These points can then be redeemed for trips (boardwalk, bowling, museum, UCSC event, etc) or for donated items such as skateboards, bicycles, video games, books, etc. A study showed that children who participated in positive behavioral condition as well as cognitive-behavioral programs showed high results of response and decreased feels of depression (Keller, 2000).
The program will also help clients with the transition between the shelter community and life on their own again. Through contracts with local housing groups, the shelter will help to locate affordable living places for people that are ready to branch out on their own again. Should they need it, the program will also assist with a housing deposit which can be paid back by the client on their own time schedule. This aspect of the program is in place because of a study showing that 80% of families that receive continued support after transitioning out of a shelter program where in stable residences and situations for at least 1 year after leaving the shelter program (Shinn et al, 1998). This will also help to act as a secondary prevention measure since because being homeless, these families are more likely to become homeless and suffer from depression again. This secondary prevention measure will also be in place by being there monetarily for families who have not been through the program but who are at risk of losing their homes and suffering the stressors that accompany homelessness and lead to depression. Programs will remain available to clients that have left the program. This way clients will feel that they have a stable social network and during secondary appraisal in the Dohrenwend model will feel like they can deal with any issues that arise for them in the future rather than resulting in depression.
Lastly, I will judge the effectiveness of my program in two ways. The first is by requiring all clients leaving the program to fill out client feedback forms so I can generate feedback on how to tweak the program. Secondly, I will conduct a longitudinal study where I will check in with families that have left the program at the 6 month mark and then again on a yearly basis for 5 years. I will check in on their living arrangement and stability and I will also check in with them on their mental status by asking them how often they have felt symptoms of depression on a weekly basis which I will compare with the surveys they took when they entered the program. I will also ask them if they have noticed any changes in behavior that they feel may be attributed to the program. With the comparison results I’ll also find out which services and programs each person in my survey participated in so I can cross reference them.
Banyard, V.L. & Graham-Bermann, S.A. (1998). Surviving Poverty: Stress and Coping in the Lives of Housed and homeless mothers. American Journal of Orthopsychiatry, 68, 479-489.
Beck AT: Thinking and depression, II: theory and therapy. Arch Gen Psychiatry 1964; 10:561-571
Burt, M. R., Pearson, C. L., & Montgomery, A. E. (2005). Strategies for preventing homelessness. Washington, DC: U.S. Department of housing and Urban Development.
Clark DA, Beck AT, Alford BA: Scientific Foundations of Cognitive Theory and Therapy of Depression. New York, Wiley, 1999
Gress K. 2003. “Animals helping people. People helping animals. Interview by Shirley A. Smoyak” J Psychosoc Nurs Ment Health Serv. 2003 Aug;41(8):18-25
Keller MB, McCullough JP, Klein DN, Arnow B, Dunner DL, Gelenberg AJ, Markowitz JC, Nemeroff CB, Russell JM, Thase ME, Trivedi MH, Zajecka J: A comparison of nefazodone, the cognitive behavioral-analysis system of psychotherapy, and their combination for the treatment of chronic depression. New England Journal of Med 2000; 342:1462-1470
Kissman K. 1999. “Respite From Stress and Other Service Needs of Homeless Families.” Community Mental Health Journal, 35,3, 241-259
Koblinsky, S.A., Morgan, K.M., & Anderson, E.A. (1997). African-American homeless and low income housed mothers: Comparison of parenting practices. American Journal of Orthopsychiatry, 67, 37-47.
Monroe, S.M., & McQuaid, J.R. (1994). Measuring life stress and assessing its impact on mental health. In W.R. Avison & I.H. Gotlib (Eds.), Stress and mental health: Contemporary issues and prospects for the future (pp. 43-73). New York: Plenum Press.
Shinn, M., Weitzman, B. C., Stojanovic, D., Knickman, J. R., Jiminez, L., Duchon, L., et al. (1998). Predictors of homelessness from shelter request to housing stability among families in New York City. American Journal of Public Health, 88, 1651-1657.
6 Week Training Program
Session 1 (1 hour)
-Mental Health: common mental health disorders and common interventional models.
Session 2 (1 hour)
-Mental Health Cont’d: depression, coping strategies and ego building.
Session 1 (1 hour)
-Ethical and Legal Mandates: Confidentiality, duty to warn, involuntary holds, child abuse and elder and dependant abuse.
Session 2 (1 hour)
-Principles and Standards
Session 1 (1 hour)
-People Skills and Problem Solving
Session 2 (1 hour)
– Critical Thinking and Logical Fallacies
Session 1: (3 hours)
– CPR Training
Appendix A (continued)
Session 2: (1 hour)
-Overview of Volunteer Positions: duties, tasks, hours and skills.
Weeks 5 & 6
– Break out sessions where volunteers will learn about the particular rules of the positions that they are interested in and will receive training in those areas.
Two Year Budget
Energy Shelter Grant: $7,969,489
DHCD Grant: $500,000
LDS Grant: $341,000
Human Race Fundraising: $15,000
Total Starting Budget: $8,827,489
Start Up Costs:
Apartment Complex: $3,200,200
Total Remaining: $5,588,289
Garbage & Water: $1,800
Vehicle Insurance: $280
PR Person: $900 stipend
Site Manager: $1,500
Property Insurance: $917
Appendix B (Continued)
Volunteer Coordinator: $900 stipend
Total Monthly Costs: $12,597
$12,597 x 6 months = $75,582
Total remaining after first 6 months: $5,512,707
Months 7-12: Reduced rent starts coming in.
-30 apartments between $400-$600 each = $15,000/month
Monthly Costs: Monthly Income:
$12,597 x 6 = $75,582 $15,000 x 6 = $90,000
*Assume about 80 families are helped with rent, deposit and/or utilities with the average amount being $2,500 per family with a pay back rate of 50%. = -$100,000
Total remaining after 1st year: $5,490,110
Second installation of Energy Shelter Grant: $7,969,489
Funds at beginning of year 2: $8,548,599
Monthly Costs: Monthly Income:
$12,597 x 12 = $151,164 $15,000 x 12 = $180,000
*Assume about 200 families are helped with rent, deposit and/or utilities with the average amount being $3,000 per family with a pay back rate of 80%. = -$120,000
*Assume $100,000 worth of repairs needed to be done through out the course of year 2.
Total Funds After Year 2 Available: $8,357,435