Embed Size (px)
Citation preview
Success Stories that Inform Effective
Counseling Approaches with People in Homelessness
Rebecca R.S. Bertram, Psy.D.University of Saint Thomas
Mental Health Systems, PC
Introduction to the Study
• Doctoral project
• University of Saint Thomas
• Results will be interweaved with current research literature to inform practice implications
Learning Objectives
• Recognize experiential aspects of homelessness
• Identify possible strengths or resilience factors for people experiencing homelessness
• Apply research and practice implications for clients in homelessness
https://www.youtube.com/watch?v=THxtcWNw3QA
[Taken from Rethink Homelessness organization through Orlando, Florida]
Introduction
• Homelessness as a significant community issue• Nationally: 610, 042 people were homeless in January 2013 (The
National Alliance to End Homelessness, 2014)
• In Minnesota: At least 10,214 people were homeless in 2012 on any given night (Amherst Wilder Foundation, 2013)
Image taken from http://queenslibrary.force.com/HOC__cmscontent?
CMSId=a0Uo00000002TyLEAU
Introduction
• Significance to psychology• Experience of homelessness has clear psychological impacts
(American Psychological Association, 2010; Bentley, 1997; Davis, 1996; Eynan, Langley, Tolomiczenko, Rhodes, Links, Wasylenki, & Goering, 2002; Kuhlman, 1994; Liu, 2008; Lott & Bullock, 2007; Markos & Lima, 2003)
• Many factors can contribute to homelessness, however:
• Correlation between mental health issues and homelessness
• In Minnesota, 60% of homeless individuals reported serious mental illness in 2012 (Amherst Wilder Foundation, 2013)
Literature Review
• What is included• Adults
• Intervention-focused
• What is not included• Homeless youth
• Assessment literature
Literature Review
• Risk factors to homelessness• Combining data from the Bureau of Justice Statistics & the National
Alliance for Homelessness (2012)
• Odds of experiencing homelessness after being discharged from prison= 1 in 13.
• Combining data from the Department of Health and Human Services & National Alliance for Homelessness (2012)
• Odds of a youth person experiencing homelessness after aging out of the foster care system= 1 in 11.
• Who is homeless today• Acknowledging heterogeneity and common demographics
Literature Review
• Systemic factors that intersect with homelessness• Lack of affordable housing, inequities related to the education system, foster care
system, social alienation of homeless people, insurance system, disparities in the judicial system, changes in the job market
• Role of psychologists
• Larger economic shifts
• Mass incarceration of people of color, as it relates to housing (Alexander, 2010)
• Disproportionate sentencing of people of color as compared to Caucasians
• Felony charges and housing
Literature Review
• Culture of poverty• Cultural values (Payne, 1996)
• Level of discrimination and experiences of oppression (Sue and Sue, 2013)
• Working with people in poverty• Guidelines for interventions (Foss, Generali, and Kress, 2011; Sue and Sue, 2013)
Literature Review
• Preliminary guidelines for working with clients in homelessness• Action-oriented and collaborative processes (APA Presidential Task Force, 2005;
Foss, Generali, & Kress, 2011; Sue & Sue, 2013)
• Flexibility in the counseling role (American Psychological Association, 2010; Sue & Sue, 2013; Toporek et. al., 2006; Koegal (as cited in Bentley, 1997)
• Relationships, support, and safety (American Psychological Association, 2010, Bentley, 1997; Combs, 2012; Speirs, Johnson, & Jirojwong, 2013; Tischler, Rademeyer, & Vostanis, 2007)
• Collaboration with other resources (American Psychological Association, 2010, Miller, 2011; Sue & Sue, 2013)
Issues in the Literature
• Not enough data specific to counseling people in homelessness
• Focus on pathology over strengths
• Risk of reflecting societal stereotypes in the research
• Homelessness occurs disproportionately to people of color
• Need for strengths-based, multi-culturally aware, and client-focused data to appropriately implement multi-culturally competent research.
• Risk of bias in the literature itself, and in misinforming psychologists about effective interventions with multicultural populations.
• Where is the client’s voice?
• Focus on the author’s perspective
• Likely different SES background and perspective
Statement of the Problem
• Local psychologists have limited research on working with this population• Risk of utilizing ineffective interventions, and/or re-enacting
experiences of oppression with clients
• Need more data
Research Question
What can clients tell us about the experience of homelessness, the transition out of homelessness, and counseling during homelessness that can help guide
future counseling interventions?
Investigative Methods for the Current Study
• Success stories
• Qualitative methods: Interpretive Phenomenological Analysis (IPA)• Goodness of fit for purpose of the study
• Sampling and data collection
• Criteria to be eligible
• Semi-structured interviews
Interview Number Gender Participant
Pseudonym
Ethnicity
1 M Terrell African American
2 M Shelton Caucasian
3 F Sue Native American
4 M Keaton African American
5 M Larry African American &
Native American
6 M Carson “American”
7 M Bob African American
8 F Victoria African American
9 M Charlton African American &
Cherokee
Participant demographics
Interview Question Follow Up Questions
What do you wish counselors understood about
what it’s like to be homeless?
What are other people missing about what it’s
like to be homeless?
Tell me about your success story. What were the most important parts of your
success?
What was most helpful to you during this
transition out of homelessness?
What was counseling like for you? What were you impressions of counseling and of
your counselor?
What role did counseling play in your success
story?
What worked in counseling and what was
difficult in counseling?
What was most helpful that your counselor did?
What was least helpful?
Immersing oneself in the script: Reading and re-reading• In text: Intonation of
speech• Right margin:
Exploratory comments
• Left margin: Emergent themes
Coding script • Cutting the script
into chunks
Connecting and abstracting themes within each script• Sorting into within
script themes• Color-coded
notecards
Analysis Process
Connecting and abstracting themes within each script• (Continued)
Connecting and abstracting themes across scripts• Grouping into
super-ordinate themes and sub-themes
Finalizing super-ordinate themes and sub-themes• Results of the
study
Analysis Process
Types and levels of within-interview methodological measures to increase trustworthiness
Interview Number Within-interview methods utilized to increase trustworthiness
Level of within-interview analysis for these methods
1 Auditing Coding, emergent themes, themes within transcript
2 Validity check with participant Themes within transcript
3 Auditing Coding, emergent themes, themes within transcript
4 Validity check with participant Themes within transcript
5 Validity check with participant Themes within transcript
6 Validity check with participant Themes within transcript
7 Auditing Emergent themes, themes within transcript
8 Auditing andValidity check with participant
Emergent themes, themes within transcript
9 Validity check with participant Themes within transcript
Additional Measures of Trustworthiness
• Auditing also occurred across scripts, at the level of super-ordinate themes and sub-themes
• Reflection journal for the researcher
Ethical and Diversity Issues
• Approved by IRB within UST
• Stirring up old emotions and experiences• Informed consent and resources provided
• Structural and systemic barriers
• Avoiding the assumption that counseling played significant role
• Lack of researcher personal experience with homelessness & risk of replicating biases • Reflection journal, validity checks, auditing
• Qualitative methods to capture the participant’s voice rather than the researcher’s voice
Results: What the Participants Said
• 9 super-ordinate themes
• 27 sub-themes
Understanding the complexity and diverse face of the homeless condition.
Wide variety of factors leading to homelessness. Recognition that anyone could experience
homelessness as a part of the human condition. Homelessness as a lifestyle for some people in long-term homelessness.
“I would wish that they understood that we are not cut from the same cloth...Not everybody is homeless for the same reason.”
“You can’t just judge us all on the same thing. We only got one thing in common, we’re homeless, and that’s the only thing we got in common. That’s it and
nothing else.”
“You ain’t be but one step from being homeless too.”
“You can be highly educated, you can be highly intelligent and you could be highly successful and still end up homeless due to a variety of weird reasons
coming together at the same time.”
“They’ve been camping outside for the last 20 years. You can’t put them in a house because, like they once said, ‘I can’t live inside. I’ve been out here so long
this is the only way I can live now.’”
Devastating aspects of the experience of homelessness.
Negative psychological effects of experiencing homelessness. Vulnerability to theft, violence, and damage to physical health.
Experiences of isolation, stigma, and discrimination. “…depression, pain, sadness, unhappiness, and kind of just going off your survival
instincts.”
“I had blisters all over my feet, blood blisters on top of my toes, top of my toenails where I got blood, because I couldn’t afford to buy shoes that fit me, I was just so
poor.”
“If a person is homeless when they go out into the general population and the general population sees a homeless person, they stigmatize that person and they stigmatize them by the way they are reacting. If you have ever been homeless and you are on a
bus or train and that person sees you with a bunch of bags, they move away from you. They feel like you are going to hurt them because they think, I mean they make you feel inferior to them because you are going through this difficult situation. And they
do it by their actions and they do it by how they look at you.”
Homelessness in context: understanding systemic factors involved.Barriers to qualifying for housing. Gaps in necessary resources to transition out of
homelessness. Use and misuse of resources pertaining to homelessness. Experiences of homelessness specific to the state of Minnesota.
“Everyone is not there by choice, you know. It is really hard, like I say for some people. It is really hard, such as myself. I use myself as an example, it was very hard for a long time because I have a criminal background and they got my credit, which it was good I don’t have
bad credit. But that criminal background, other than that, that’s the thing that was just knocking me down. I can’t go to any regular
apartment building and get an apartment because it is the only thing they see that I have a felony on my record. That takes me out right
off the bat. They don’t need to go no further.”
https://www.youtube.com/watch?v=DcD1d9Ek2s4
[Taken from Rethink Homelessness organization through Orlando, Florida]
Resilience and strength factors in people who transition out of homelessness.
Reframing experiences with a perspective that is preparation-focused, positive, strengths-based, or focused on gratitude. Persistence through difficult
situations, repeated rejections, and isolation. The helpful role of spirituality, prayer (to God or ancestors), and connection to a church in transitioning out of
homelessness.“It's like you can complain about not having a house but it’s like at least I'm
living, everyday God has given me….I can still walk, I can still talk, I'm still alive, I'm still talking here.”
“I’m searching, I’m fishing. I might have to search late and keep the fish on the water, I might have to fish all the worms, I might have to fish with a hook with
no bait on it and might get a bite.”
God might “let somebody be watching what you just went through, because when they go through it they’ll be able to say, ‘well I seen sister so and so,’ or ‘I remember he lost his job and everything all in the same week, but look at him now. He didn’t give up, he didn’t kill himself, he didn’t go through, he
didn’t kill nobody, he didn’t rob no bank.’”
Importance of creating an effective support system to transition out of homelessness.
Creating a positive support system with a wide variety of professional and personal supports. Importance of avoiding contact with past
substance-using acquaintances.
“So if you got somebody motivating you, like they say don’t work out by yourself. Work out with somebody that’ll be going that extra mile. So
that’s what I basically did. I just kept surrounding myself with a network of people, just building on that until it came together. That’s
what it did, it came together.”
“I don’t hang with that negative crap no more because if I was hanging with you, I’m going to end up what I’ve been doing for these three
years over here. I’m going to lose it because what you want to do is trying to get high on something. It ain’t happening today, I’m not
doing that today.”
Factors involved in taking an active, personal role in transitioning out of homelessness.
Importance of being personally accountable to transition out of homelessness in response to the necessary supportive programming and resources. Role of identifying personally
meaningful goals and motivation to transition away from substance use and/or homelessness. Role of maintaining sobriety to obtain stability and transition out of
homelessness. Importance of stabilizing mental health by taking psychiatric medications. Importance of proactively networking (personally and professionally) to seek out
employment and housing opportunities. “I mean how can I put it? It had to be me. I had to look for the job, find
the job, send out the resume, make the phone call, fax the resumes. I had to do the work but they were supportive of me.”
“Number one is to stay clean and off of drugs and number two, staying out of trouble, and number three, getting a job.”
“I got a dream. Like I just wanted to be going by, being straight, going to church, having a job, and my baby beside me. I just think of that
and that’s what makes me keep straight.”
Mixed experiences with counselors while homeless.Helpful counselors show they care and are invested in their relationship with you. Other qualities of helpful counselors. Varied barriers and drawbacks in
counseling.
“Her number one priority was me. And you know, when you work with good people, you want to also do good for them.”
“I think it’s all about knowing that there is someone that cares about you and they are out to help you. It’s about having a relationship with somebody who’s really trying to work with you to help you get out of
that situation. I think the relationship is number one.
“They don’t really do anything. They have all these people handing these cards, and they don’t provide any counseling or anything. You’re just there, you are just a number with these folks…they
probably don’t have the skill level to do it.”
Benefits of group and individual counseling to people experiencing homelessness.
Counseling provides a positive emotional outlet. Group counseling helps you know you are not alone, provides hope, and helps you find
resources.
Capacity metaphor
“Like a person strung out on drugs. You can be strung out for 10 years, 20 years, and I've been strung out for 2 years. And I'm thinking
there's no way to get away. But you’ve been strung out for 10 or 20 years and you got away and you been led a successful productive, name in society. Everything is ok, that’s the hope at the end of the
tunnel. That’s the light I can see, I can see it in you.”
The essential role of housing, employment, financial, and other basic needs resources in transitioning out of homelessness.
Helpfulness of counselor or mental health practitioners coordinating resources, providing referrals, and providing practical help to transition out of homelessness. Supportive or transitional housing as an important next step toward obtaining permanent housing.
Types of resources
People in homelessness “just need somebody that can guide them in the right direction, tell them what kind of
resources they could use that might help and get them out of there and get them someplace to stay.”
Implications• Research and Practice
• Strengths and limitations of findings• Qualitative data: rich stories and information, yet results need replication
• Participants
• Generalizability
• Please note: **two-starred implications align with current literature, *one-starred implications have some limited support in the literature, and un-starred implications have very limited support in the literature to date
Practice Implications
• *Balance knowledge of risk factors to homelessness with the understanding that homelessness occurs across many different types of people and contexts.
• **Engage in continual self-reflection about personal assumptions.
• *Incorporate awareness of physical, psychological, and social wellbeing effects of being homeless
• *Felony history may all for special attention
• *Ask practical questions to assess whether or how systemic barriers occur
Practice Implications
• *Utilize counseling skill sets to reframe perspectives to build on resilience, strengths, and gratitude.
• *Consider assessing clients’ spiritual or religious orientations at intake.
• **Assess support systems of clients and work to maximize positive sources of support.
• Balance providing resources with individual accountability.• *Showing clients how to use the resources, without doing the work for them.
• *Incorporate motivational interviewing and collaborative processes of counseling.
Practice Implications
• **Apply common factors research about caring relationships in counseling (may be particularly important, given isolation).
• *Embrace some flexibility in your role as psychologist in ethically appropriate ways.
• *Assess client’s cognitive needs, and adjust vocabulary and interventions as needed
• *Utilize counseling skill sets to explore skills and strategies for clients to find emotional outlets• Including additional non-counseling resources for emotional outlets
Practice Implications
• Consider opportunities for group counseling with clients in homelessness.
• *Learn about local resources, and actively refer clients to and coordinate resources.• Handbook of the Streets by St Stephen’s human resources
• *Be ready to work as part of a team of workers for clients
• *Utilize hands-on, practical approaches to assist clients with practical issues.
• *Understand the important role of supportive or transitional housing
Research Implications
• Role of repeated rejection with people in long-term homelessness.
• How people in long-term homelessness affect other people in homelessness
• Help-seeking behaviors for medical and psychiatric care
• Additional resilience studies
• Strategies for clients to use to build the effectiveness of these support systems, especially in a culturally appropriate manner that respects the person’s inter-cultural communication style
• Research needs to be intentional about balancing individualistic and systemic factors involved in homelessness
Research Implications
• Motivational interviewing in homelessness
• Effectiveness of flexible role of counselor, and how to balance this with ethical considerations
• How clients’ demographic factors (such as education, criminal history, or ethnicity) influence the perceived responses of staff interventions• Varied experiences with participants perceptions of staff help
• Effectiveness of group counseling for people in homelessness.
• How to balance resource coordination with client accountability across different types of clients and different experiences of homelessness.
Follow-up on Learning Objectives
• Recognize experiential aspects of homelessness
• Identify possible strengths or resilience factors for people experiencing homelessness
• Apply research and practice implications for clients in homelessness
• **If you would like a table summary of results and implications…• Refer to additional handout
References
Alexander, M. (2012). The New jim crow: Mass incarceration in the age of colorblindness. New York: The New Press.
Amherst Wilder Foundation. (2013). Homelessness in Minnesota: Findings from the 2012 statewide homeless study. In Wilder Research online. Retrieved from
http://www.wilder.org/WilderResearch/Publications/Studies/Homelessness%20in%20Minnesota%202012%20Study/Homelessness%20in%20Minnesota%20-%20Findings%20from%20the%202012%20Statewide%20Homeless%20Study.pdf
Amherst Wilder Foundation. (2009). Homelessness in Minnesota 2009. In Wilder Research online. Retrieved from http://www.wilder.org/download.0.html?report=2339
APA Presidential Task Force. (2005). Report of the presidential task force on evidence-based practice. American Psychological Association.
APA Presidential Task Force. (2010). Report of the APA Presidential Task Force on Psychology’s Contribution to End Homelessness. American Psychological Association.
Bentley, A. (1997). The psychological effects of homelessness and their impact on the development of a counselling relationship. Counselling Psychology Quarterly, 10(1), 195-211.
Berg-Cross, L., & Kurtz, D. (1994). The role of private practice psychologists in assessing homeless families. Psychotherapy in Private Practice, 13(1), 43-53.
Brown, S. A. (2004). Innovative niches for practicing psychologists. US: American Psychological Association.
Buki, L. (2007). Reducing health disparities: The perfect fit for counseling psychology. The Counseling Psychologist, 35(5), 706-715.
Coleman, J., & Laishley, J. (1977). Expanding the scope of educational psychology. Child Care, Health & Development, 3(2), 105-109.
Combs, B.R. (2012). A study of success factors and strategies that enabled womento overcome homelessness (Doctoral dissertation). Grand Canyon University, Arizona.
Costello, E.J., Compton, S.N., Keeler, G., & Angold, A. (2003). Relationships between poverty and psychopathology: A natural experiment.
Journal of the American Medical Association, 290(15), 2023-2029.
Danish, S. J., Forneris, T., & Schaaf, K. W. (2007). Counseling psychology and culturally competent health care: Limitations and challenges. The Counseling Psychologist, 35(5), 716-725.
Davis, R.E. (1996). Tapping into the culture of homelessness. Journal of Professional Nursing, 12 (3), 176-183.
Doutrelepont, F. (2006). A psychologist in CLCS working with young street people. Revue Québécoise De Psychologie, 27(2), 147-165.
Espel, E.S., Bandura, A., & Zimbardo, P.G. (1999). Escaping homelessness: The influences of self-efficacy and time perspective on coping with homelessness. Journal of Applied
Social Psychology, 29(3), 575-596.
Foss, L.L., Generali, M.M., & Kress, V.E. (2011). Counseling people living in poverty: the CARE Model. Journal of Humanistic Counseling, 50, 161-171.
Fox, D. R. (2003). Awareness is good, but action is better. The Counseling Psychologist, 31(3), 299-304.
Franca-Terceira, M. L. (1992). Fee setting for low-income clients: Decision-making processes of psychologists in private practice. Dissertation Abstracts International, 52 (10-B),
5531-5532.
Gray, S. W. (1963). Hope for the deprived. US: American Psychological Association.
Greenberg, G.A., & Rosenheck, R.A. Jail incarceration, homelessness, and mental health: A national study. (2008). Psychiatric Services, 59(2), 170-177.
Haddad, M.B., Wilson, T.W., Ijaz, K., Marks, S.M., Moore, M. (2005). Tuberculosis and homelessness in the United States, 1994-2003. JAMA, 293(22), 2762-2766.
Hamilton, A.B., Poza, I., & Washington, D.L. (2010). “Homelessness and trauma go hand-in-hand”: Pathways to homelessness among women veterans. Women’s Health Issues, 21,
S203-S209.
Helms, J. E. (2003). A pragmatic view of social justice. The Counseling Psychologist, 31(3), 305-313.
Hohenshil, T. H. (1979). Adulthood: New frontier for vocational school psychology. School Psychology Review, 8(2), 193-198.
Holleman, W. L., Bray, J. H., Davis, L., & Holleman, M. C. (2004). Innovative ways to address the mental health and medical needs of marginalized patients: Collaborations between
family physicians, family therapists, and family psychologists. American Journal of Orthopsychiatry, 74(3), 242-252.
Hunsaker, R.C. (2011). Counseling and social justice. Academic Questions, 24(3), 319-340.
Joesting, J. (1973). On Cole and Bruner. American Psychologist, 28(1), 90-90.
Kuhlman, T.L. (1994). Psychology on the streets: mental health practice with homeless persons. New York, NY: John Wiley & Sons, Inc.
Lewin, M. H. (. (1975). Toward a bolder model: Establishing an independent practice. Professional Psychology, 6(2), 234-236.
Liu, W. M., & Ali, S. R. (2008). Social class and classism: Understanding the psychological impact of poverty and inequality. Handbook of counseling psychology (4th ed.). S. D.
Brown, & R. W. Lent (Eds.). Hoboken, NJ: John Wiley & Sons Inc.
Loreto, G. (1984). Psychotherapy for the underprivileged: The need to develop a psychotherapy that will meet the needs of clients from lower socioeconomic classes.
Neurobiologia, 47(1), 21-32.
Lott, B., & Bullock, H. E. (2007). Growing up poor and middle class: Heather bullock's story. Washington, DC, US: American Psychological Association. doi:10.1037/11501- 002
Luchins, A. S. (1986). What should be done about the homeless mentally ill? Clinical Psychologist, 39(2), 54-54.
Lynch, P. (2002). Begging for change: Homelessness and the law. Melbourne University Law Review, 26, 690-706.
Lyons, E., & Coyle, A. [Eds.]. (2007). Analyzing Qualitative Data in Psychology. London: Sage Publications.
Mahoney, D. (2006). Addressing homelessness and substance abuse. Clinical Psychiatry News, 34(3), 56.
Markos, P.A., & Lima, N.R. (2003). Homelessness in the United States and its effect on children. Guidance & Counseling, 18(3), 118-124.
Marshall, C. & Rossman, G.B. (2011). Designing qualitative research (5th ed.). Thousand Oaks, CA: Sage Publications.
McCallum, R. S., & Bracken, B. A. (2009). Intelligent testing of underserved populations. In J. C. Kaufman (Ed.), (pp. 193-219). New York, NY: Cambridge University Press.
Miller, P.M. (2011). A Critical Analysis of the Research on Student Homelessness. Review of Educational Research, 81(3), 308–337.
Nation, M. (2008). Concentrated disadvantaged in urban neighborhoods: Psychopolitical validity as a framework for developing psychology-related solutions. Journal of
Community Psychology.Special Issue: The Assessment of Power through Psychopolitical Validity, 36(2), 187-198.
National Alliance to End Homelessness. (2012). A research report on homelessness. The Homelessness Research Institute.
National Alliance to End Homelessness. (2014). An examination of homelessness,economic, housing, and demographic trends at the national and state levels. The Homelessness
Research Institute.
Patton, M.Q. (2002). Qualitative research and evaluation methods (3rd ed.). Newbury Park, CA: Sage Publications.
Payne, R. K. (1996). A framework for understanding poverty (4th ed.). Highlands, TX: aha! Process, Inc.
Phelps, L. F. (2007). Development of an instrument to assess coping among low-income African American mothers. ProQuest Information & Learning). Dissertation Abstracts
International: Section B: The Sciences and Engineering, 67 (9-B), 5418-5418.
Rhine, W. R. (1983). The role of psychologists in the national follow through project. American Psychologist, 38(3), 288-297.
Rich, A.R., & Clark, C. (2005). Gender differences in response to homelessness services. Evaluation and Program Planning, 28, 69–81.
Russell, P. (1992). Boundary issues: Multidisciplinary working in new contexts: Implications for educational psychology practice. The profession and practice of educational
psychology: Future directions. S. Wolfendale, T. Bryans, M. Fox, A. Labram & A. Sigston (Eds.). New York, NY: Cassell Educational.
Sapir, S. G., & Smith, K. M. (1992). The role of the international council of psychologists at the united nations. In U. P. Gielen, L. L. Adler & N. (. A. Milgram (Eds.), Psychology in
international perspective: 50 years of the international council of psychologists. (p. 19-29). Lisse, Netherlands: Swets & Zeitlinger Publishers.
Sears, P. S. (1971). What happened to the angel inside? US: American Psychological Association.
Smith, J.A., Flowers, P., & Larkin, M. Interpretative phenomenological analysis: Theory, method, and research. Los Angeles: Sage Publications.
Speirs, V., Johnson, M., & Jirojwong, S. (2013). A systematic review of interventions for homeless women. Journal of Clinical Nursing, 22, 1080–1093.
Sue, D. W., and Sue, D. (2003). Counseling the culturally diverse: Theory and practice (4th ed.). New York: John Wiley & Sons, Inc.
Sue, D. W., and Sue, D. (2013). Counseling the culturally diverse: Theory and practice (5th ed.). New York: John Wiley & Sons, Inc.
Suarez-Balcazar, Y., & Kinney, L. (2006). Realities and myths of safety issues for community researchers working in a marginalized African American
community. American Journal of Community Psychology, 37(3-4), 303-309.
Taylor, L. (2006). Review of Face to face with children: The life and work of Clare Winnicott. Journal of the American Academy of Child & Adolescent
Psychiatry, 45(7), 885-887.
Tischler, V., Rademeyer, A., & Vostanis, P. (2007). Mothers experiencing homelessness: mental health, support and social care needs. Health and
Social Care in the Community, 15(3), 246–253.
Toporek, R.L. Gerstein, L.H., Fouad, N.A., Roysircar, G., & Israel, T. (Eds.). (2006). Handbook for social justice in counseling psychology:
Leadership, vision, and action. London: Sage Publications.
Tucker, C. M., Ferdinand, L. A., Mirsu-Paun, A., Herman, K. C., Delgado-Romero, E., van den Berg, J. J., et al. (2007). The roles of counseling
psychologists in reducing health disparities. The Counseling Psychologist, 35(5), 650-678.
U.S. Department of Housing and Urban Development. (2010). The 2009 annual homelessness assessment report to congress.
Venanzi, A. (2008). The institutional dynamics of homelessness. International Journal of Sociology and Social Policy, 28(3/4), 129-145.
Vera, E. M., & Speight, S. L. (2003). Multicultural competence, social justice, and counseling psychology: Expanding our roles. The Counseling
Psychologist, 31(3), 253-272.
Wampold, B.E. (2010). The basics of psychotherapy: An introduction to theory and practice. Washington D.C.: American Psychological Association.
Thank you to…
• The participants who shared their stories
• People and agencies sharing information about the study, especially Tim Balke, Margaret Miles, Cathy ten Broeke, and Catholic Charities
• Doctoral project committee: Dr. Renninger, Dr. Frank, and consultant Dr. Stankovitch
• Auditor: Dr. Naomi Scott
