Interventions to treat post-traumatic stress disorder (PTSD) in vulnerably housed populations and trauma-informed care: a scoping review

Abstract

ObjectivesThe goals of this study are to identify and analyse interventions that aim to treat post-traumatic stress disorder (PTSD) and complex PTSD in people who are vulnerably housed and to describe how these treatments have been delivered using trauma-informed care.DesignScoping review.Search strategyWe searched electronic databases including MEDLINE, Embase, PsycINFO, CINAHL, the Cochrane Library, Web of Science and PTSDpubs for published literature up to November 2021 for any studies that examined the treatment of PTSD in adults who were vulnerably housed. Websites of relevant organisations and other grey literature sources were searched to supplement the electronic database search. The characteristics and effect of the interventions were analysed. We also explored how the interventions were delivered and the elements of trauma-informed care that were described.Results28 studies were included. We identified four types of interventions: (1) trauma focused psychotherapies; (2) non-trauma psychotherapies; (3) housing interventions and (4) pharmacotherapies. The trauma-informed interventions were small case series and the non-trauma focused therapies included four randomised controlled trials, were generally ineffective. Of the 10 studies which described trauma-informed care the most commonly named elements were physical and emotional safety, the experience of feeling heard and understood, and flexibility of choice. The literature also commented on the difficulty of providing care to this population including lack of private space to deliver therapy; the co-occurrence of substance use; and barriers to follow-up including limited length of stay in different shelters and high staff turnover.ConclusionsThis scoping review identified a lack of high-quality trials to address PTSD in people who are vulnerably housed. There is a need to conduct well designed trials that take into account the unique setting of this population and which describe those elements of trauma-informed care that are most important and necessary.

PTSD Symptoms Comparison EMDR and NFB with IPV Survivors: Ex-Post-Facto Study by

“…Literature has considered the impact of environmental factors playing a role in the treatment of PTSD symptoms in various populations (Bennett et al, 2022;Greene et al, 2022;Monahan & Hersschaft, 2022). As noted in the literature, environmental factors pertaining to the residence of participants that participated in the therapies, for instance, within an emergency shelter or residing with an abuser versus in an own residence or with family and friends, may have in uenced the length and focus of treatment from the clinician's and participants standpoint (Bennett et al, 2022;Greene et al, 2022;Monahan & Hersschaft, 2022). As such, it is unknown what the average length of sessions timeframe was within each group and between the two groups.…”

Substance use and posttraumatic stress disorder: 12‐month outcomes among adults experiencing chronic homelessness in Australia

“…Harm reduction approaches are effective and preferred by people experiencing homelessness [ 11 ]. Future research should aim to improve the evidence base for PTSD treatments that are effective and acceptable for people with experience of homelessness [ 12 ]. Interventions that address both substance use and PTSD, while meeting individual housing requirements, are needed.…”

“…Harm reduction interventions (e.g., managed alcohol programs) can improve substance use outcomes and reduce substance‐related harm [ 9 , 10 , 11 ]. For PTSD, there is limited evidence on effective treatments for people who are marginally housed, though trauma‐informed care is recommended [ 9 , 12 ].…”

Feasibility and acceptability of Narrative Exposure Therapy to treat individuals with PTSD who are homeless or vulnerably housed: a pilot randomized controlled trial

“…Finally, this optimized intervention is tested in a definitive randomized controlled trial (RCT). Using the outcomes from this study, a review of the literature on treating PTSD in people who are vulnerably housed [41], and consultation with people with lived experience, we will construct a model of the potential factors that may influence outcomes in this population when treating PTSD. We will then test this model to identify the most important factors in a factorial RCT.…”

“…This study was the first of three components of the preparation stage of a multiphase optimization strategy (MOST). The second is a scoping review [41] which we have published separately on the treatment of PTSD in the homeless including the use of trauma-informed care to deliver such therapy. This scoping review found no RCTs of trauma-focused psychotherapies (like NET), an overall lack of high-quality trials to address PTSD in this population, and elements of safety, the experience of being heard, and flexibility of choice as being important components of trauma-informed care when providing treatment.…”