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Leading in times of trauma.

An employee is diagnosed with cancer or loses a family member unexpectedly. An earthquake destroys an entire section of a city, leaving hundreds dead, injured, or homeless. At time like these, managerial handbooks fail us. After all, leaders can't eliminate personal suffering, nor can they ask employees who are dealing with these crises to check their emotions at the door. But compassionate leadership can facilitate personal as well as organizational healing. Based on research the authors have conducted at the University of Michigan and the University of British Columbia's CompassionLab, this article describes what leaders can do to foster organizational compassion in times of trauma. They recount real-world examples, including a story of personal tragedy at Newsweek, natural disasters that affected Macy's and Malden Mills, and the events of September 11, 2001. During times of collective pain and confusion, compassionate leaders take some form of public action, however small, that is intended to ease people's pain and inspire others to act. By openly demonstrating their own humanity, executives can unleash a compassionate response throughout the whole company, increasing bonds among employees and attachments to the organization. The authors say compassionate leaders uniformly provide two things: a "context for meaning"--creating an environment in which people can freely express and discuss how they feel--and a "context for action"--creating an environment in which those who experience or witness pain can find ways to alleviate their own and others' suffering. A leader's competence in demonstrating and fostering compassion is vital, the authors conclude, to nourishing the very humanity that can make people--and organizations--great.

Disasters↗

The impact of homeless shelters on food access and choice among homeless families in Minnesota.

OBJECTIVE: To determine how and where homeless families access food, and to determine factors that influence food choice. DESIGN: Seven focus groups (90 minutes each) were conducted by two moderators and audio-taped. SETTING: Two homeless shelters serving families. PARTICIPANTS: Fifty-three parents or guardians (M = 11; F = 42) with children 3-12 years of age. Most participants had completed high school or higher education. PHENOMENON OF INTEREST: Food choice and food access among homeless families. ANALYSIS: Transcripts evaluated for consistency, coded, and evaluated for dominant themes. RESULTS: Limited cooking and storage space, and poor meal timing and food options at the shelters resulted in participants developing strategies to alleviate hunger. Strategies used to obtain food included using food stamps, stealing food, eating food in grocery stores, pawning personal items, using savvy shopping habits, scavenging in dumpsters (obtaining items such as food from dumpsters), and sacrificing food for children. CONCLUSIONS AND IMPLICATIONS: Homeless families find strategies to prevent food insecurity. Food stamp usage is a common strategy, but it often is insufficient to meet monthly needs, indicating the need for reevaluation of program components. The shelter environment's impact on families' food choices suggests a role for nutritionists in ensuring availability of adequate, nutritious foods. Future research is needed to evaluate the impact of the shelter environment on homeless families' overall nutritional status.

Adult↗

Responding to the needs of the homeless mentally ill.

The homeless mentally ill represent a pivotal and urgent challenge to the mental health field in the 1980s. Those homeless who have extended histories of psychiatric hospitalization stand as harsh reminders of the failures of deinstitutionalization, while young mentally ill homeless adults who never have been treated as inpatients testify to the gaps and unrealized promises of community-based care under deinstitutionalization. Homelessness and mental illness are social and clinical problems, respectively, distinct in some ways but intertwined in others. Some of the factors that contribute to homelessness--such as economic deprivations, a dearth of low-cost housing, discontinuities in social service systems, and radical changes in the composition of American families--are felt particularly keenly by many persons who are mentally ill. And symptoms of mental disorders, in turn, frequently impede an individual's capacities to cope with those, as well as other, stressors. Developing appropriate and effective responses to the needs of homeless people who are mentally ill requires precise definition and identification of the target population, innovations in the mental health service system, encouragement of those who staff it to work with homeless mentally ill patients, and public education. Ultimately, however, fundamental answers will be found in an improved understanding of severe mental illness, enhanced treatment capacities, and greater attention to the rehabilitative needs of mentally ill persons.

Adolescent↗

[High prevalence of mental disorders and addiction problems among the homeless in Utrecht].

OBJECTIVE: To determine the prevalence of psychological disorders and addiction problems amongst homeless people in Utrecht, the Netherlands. DESIGN: Descriptive cross-sectional study. METHOD: In 1998, the Trimbos Institute in Utrecht held 150 interviews with adult homeless people by means of a random sample taken from six centres for the homeless. The following screening instruments were used to determine the prevalence of a depressive episode, schizophrenia and other non-affective psychotic disorders, an antisocial personality disorder and an alcohol or drugs dependency/abuse problem: the depression screener from Schrijvers et al., the schizophrenia section from the Composite International Diagnostic Interview (CIDI) a modified questionnaire from Schrijvers, related to the DSM-III-R, about aggressive behaviour and the Addiction severity index, European variant, version III. By means of comparative research, optimum threshold values for the presence of the aforementioned disorders were determined with respect to extensive diagnostic interviews that were taken to be the gold standard. RESULTS: In the homeless population studied (n = 150 (response: 68%); 138 men and 12 women) 32% had a more narrowly defined form of depression, 15% a schizophrenic disorder (DSM-III-R-codes 295.00-295.70) and 52% an antisocial personality disorder. In the case of depression and schizophrenia it concerned a 6-month prevalence and in the case of antisocial personality disorders it concerned the lifetime prevalence. The lifetime prevalence of alcohol dependence or abuse was 59% in the population studied (n = 131) and the monthly prevalence was 22%. The lifetime prevalence of drug dependence or misuse was established to be 76% and the monthly prevalence 54%. The prevalences were high in comparison with international figures. A so-called double diagnosis was identified for 27% of the homeless population. CONCLUSION: Homeless people in Utrecht suffer from a poor mental health.

Adult↗

A tuberculin screening and isoniazid preventive therapy program in an inner-city population.

As tuberculosis transmission decreases, case rates decline and an increasing proportion of cases arises from the pool of persons with latent infection. Elimination of tuberculosis will require preventing disease from developing in infected persons. From 1994 to 1996 the Atlanta TB Prevention Coalition conducted a community-based tuberculin screening and isoniazid preventive therapy project among high-risk inner-city residents of Atlanta, Georgia. We established screening centers in outpatient waiting areas of the public hospital serving inner-city residents, the city jail, clinics serving the homeless, and with outreach teams in neighborhoods frequented by drug users. All services were provided free. A total of 7,246 persons participated in tuberculin testing; 4,701 (65%) adhered with skin test reading, 809 (17%) had a positive test, 409 (50%) fit current guidelines for isoniazid preventive therapy, 84 (20%) we intended to treat completed therapy. The major limitations of this community-based tuberculin screening and preventive therapy project were the low proportion of infected individuals who were eligible for isoniazid preventive therapy and the poor adherence with a complete regimen among those we intended to treat. For community-based programs to be efficacious, preventive therapy regimens that are of shorter duration and safe for older persons will need to be implemented.

Adolescent↗

Health and home for homeless people in transition.

In recent years, increasing focus has been placed on the relation between environmental qualities and the promotion of well-being. This paper explores this relationship from an environmental psychological approach that emphasizes the broader social and physical context and the central significance of individual goals. In particular, the qualities of home and their potential value in the promotion of well-being are discussed. This paper presents a review of recent literature, followed by an empirical study of homelessness in London. A sample of 531 adults was staying in squats, hotels, hostels, and on the streets. Each setting was examined in terms of qualities of home and a general level of well-being. The results suggest that this sample experienced low levels of well-being, typical of persons experiencing such upheaval. Furthermore, there may be a positive relation between levels of well-being and home-like qualities for some homeless settings. The paper concludes that a focus on qualities of home may contribute to a broader understanding of health and well-being that values individual experience and goals.

Adaptation, Psychological↗

AIDS and homelessness.

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AIDS-Related Complex↗