ra

for W

uma-In

omen Veterans Experiencing Homelessness 

formed Care 

A Guide for Service ProviderS 
This project was supported by the U.S. Department of Labor under contract DOLB09J420634 with The National Center on Family 

Homelessness. 

The views expressed herein are those of the author and do not necessarily reflect the official position of the U.S. Department of Labor. 

All references to nongovernmental companies or organizations, their services, products, or resources, in this report are offered for 

informational purposes and should not be construed as an endorsement by the Department of Labor of the companies or organizations, 

or their services, products, or resources. 

The Department of Labor does not endorse, takes no responsibility for, and exercises no control over nongovernmental organizations’ 

websites mentioned in this report or their views or contents; nor does it vouch for the accuracy of the information contained in the 

organizations’ websites. 
Acknowledgements 

Trauma-Informed Care for Women Veterans Experiencing Homelessness was commissioned by the U.S. Department of Labor (DOL) 

Women’s Bureau (WB) as one of its many efforts to help women veterans who are experiencing homelessness find jobs and successfully 

reintegrate back to civilian life. This document is an outcome of a two-phase Women’s Bureau project that included coordination 

of listening sessions with women veterans experiencing homelessness and the subsequent development of quality resources for the 

community-based organizations that serve them. In addition to this document, the Women’s Bureau has prepared fact sheets on the 

subject, conducted a “Woman-to-Woman Stand Down” for female veterans and is developing case studies to further shed light on the 

important issues affecting homeless women veterans. 

Over the past several years, the federal government has made great strides in addressing the issue of homelessness among women veterans. 

The U.S. Department of Veterans Affairs (VA) has greatly expanded services for women veterans at medical centers and community-based 

outpatient clinics. The VA has teamed with the U.S. Department of Housing and Urban Development (HUD) in providing the HUDVASH supportive housing voucher program and, under the leadership of Secretary of Labor Hilda L. Solis, the U.S. Department of Labor’s 

Veterans’ Employment and Training Service has initiated a separate Homeless Women Veterans and Homeless Veterans with Families 

program that awarded 26 employment assistance grants in fiscal year 2010. 

Pursuant to a contract with the Women’s Bureau, Trauma-Informed Care for Women Veterans Experiencing Homelessness was developed 

and written by The National Center on Family Homelessness (Kathleen Guarino, LMHC). Contributions were also made by 

community partners who participated in the pilot project: Interfaith Community Services, Oceanside, CA; St. Vincent De Paul Village, 

San Diego, CA; and Westcare’s San Joaquin Valley Veterans, Fresno, CA. A number of individuals – including Suzanne Zerger, Dawn 

Jahn Moses, and Risa Greendlinger – provided feedback that greatly improved the quality and relevance of these materials. 

For more information about this guide, or additional Women’s Bureau projects for women veterans experiencing homelessness, please 

contact the U.S. Department of Labor Women’s Bureau at (202) 693-6710 or visit the WB website at www.dol.gov/wb. 

The Women’s Bureau would like to acknowledge the tremendous effort and teamwork of its staff in making this project a success. 

Special thanks to the women veterans who have served our country with distinction and who shared their experiences that greatly 

contributed to Trauma-Informed Care for Women Veterans Experiencing Homelessness. 

Trauma-Informed Care for Women Veterans Experiencing Homelessness was adapted from the Trauma-Informed Organizational Toolkit 

that was developed by The National Center on Family Homelessness. 

Public Domain Notice 

All material appearing in this report is in the public domain and may be reproduced or copied without permission from the U.S. 

Department of Labor Women’s Bureau. Citation of the source is appreciated. No fee may be charged for the distribution of this 

material. 
 

Dear Service Providers: 

The number of women veterans serving our country has grown significantly over the last several years. Women are 

estimated to comprise 20 percent of new recruits, 14 percent of the current military, and approximately eight percent 

of the entire veteran population. 

While the transition from military to civilian life is challenging for both male and female veterans, the trauma 

experienced by women veterans during military service often makes the transition more difficult for women and 

contributes to an increased risk of homelessness. Women veterans are more likely to end up homeless than women 

who have not served in the military. Over the last decade, the number of homeless women veterans has nearly 

doubled. 

As Secretary of Labor, I am very concerned about this increase in homelessness and other challenges our women 

veterans face as they reintegrate back to their families, communities, and civilian workplaces. Too often women 

veterans are neither aware of the available services nor comfortable accessing them. Something must be done. 

I am committed to addressing the issues that lead to increasing rates of homelessness among veterans, to shedding 

light on the challenges of homelessness, and to helping create solutions that bring about positive changes. The Labor 

Department’s own Women’s Bureau and Veterans’ Employment and Training Service are part of this effort to ensure 

that women successfully transition back into the working world. 

Last year, the Women’s Bureau hosted a series of listening sessions with homeless female veterans and service 

providers across the country to gain further insight into reintegration challenges specific to our women veterans. As 

a result of these sessions, Trauma-Informed Care for Women Veterans Experiencing Homelessness was developed by 

the Women’s Bureau to equip service providers with a deeper understanding of the unique experiences and needs of 

women veterans. 

Members of our armed forces make enormous sacrifices for this nation. The least we owe them when they return to 

civilian life is a chance to earn a living, support their families, and have a stable place to rest their heads each night. 

This resource is an important tool for building capacity among providers to better serve our courageous women 

veterans. 

HILDA L. SOLIS 

Secretary 

U.S. Department of Labor 
Greetings: 

In 1920, two months before women were granted the right to vote, Congress created the Women’s Bureau, an agency 

charged with safeguarding the interests of working women and advocating for their equality and economic security. 

After 90 years, the Women’s Bureau continues to advance its mission, thus our anniversary theme: “90 Years: Still 

Working.” 

Today, the vision of the Women’s Bureau is to empower all working women to achieve economic security by 

preparing them for higher-paying jobs, ensuring fair compensation, promoting workplace flexibility, and helping 

homeless women veterans reintegrate into the workforce. 

At this time in our Nation’s history, we have more women serving in the military than ever. The number of women 

serving in our Armed Forces is steadily rising. Currently, there are 1.8 million women veterans. 

The Women’s Bureau recently hosted a series of listening sessions with homeless women veterans and service 

providers across the country. The primary objective was to gain further insight into the factors that lead to 

homelessness among women veterans, as well as how to improve services and resources for this population. 

The sessions revealed that the experience of multiple traumas severely impacts the woman veteran’s ability to readjust 

to civilian life. The most vulnerable women veterans informed us that their needs are not being met. Their stories 

made clear that these multiple traumas increase the risk factors for homelessness. 

Consequently, the Women’s Bureau commissioned Trauma-Informed Care for Women Veterans Experiencing 

Homelessness. This guide seeks to share the unique experiences and needs of women veterans, while providing 

organizational self-assessment tools to service providers on how to appropriately treat this population. The guide 

underscores the need for organizations to recognize how trauma from military experiences impacts the reintegration 

process for women veterans and offers a comprehensive approach to help organizations create effective traumainformed care environments. 

The Women’s Bureau proudly salutes our women veterans for serving our country with honor and distinction. 

SARA MANZANO-DIAZ 

Director 

Women’s Bureau, U.S. Department of Labor 
dedicAtion 

Trauma-Informed Care for Women Veterans Experiencing Homelessness is dedicated to the female veterans who shared their 

experiences and insights throughout the project and to all of the women who have served our country. 
8 

tAble of contents 

introduction 

Section One: Understanding the Experiences and Needs of Female Veterans 

background 

department of labor women’s bureau 

Homeless women Veterans Project – Phase one 

Section Two: Providing Trauma-Informed Care in Homeless Service Settings 

defining trauma-informed care 

Accessing Related Resources for transforming Principles into Practice 

Section Three: Developing and Piloting the Organizational Self-Assessment 

for Providers Serving Female Veterans 

Homeless women Veterans Project – Phase two 

Understanding the domains of the Self-Assessment 

Section Four: Implementing the Self-Assessment 

9 

18 

22 

36 

Organizational Self-Assessment for Providers Serving Female Veterans 48 

Resource lists 73 

Appendix i: 

enhancements to VA services for women Veterans 79 

Appendix 2: 

Additional enhancements for women Veterans through the 

women Veterans Health strategic Health group 81 

References 82 
 

 

 

	 		 	 	 	 	 	 	 	 	

	 		 	 	 	

	 		 	 	 	 	 	 	

 

 

8 Trauma-Informed Care for Women Veterans Experiencing Homelessness 

IntroduCtIon
 

The number of women in the military – both active duty 

and veteran populations – is growing rapidly. They face 

unusual challenges because of their military experiences and 

for many, multiple roles as breadwinner, parent, and spouse. 

Often their return to civilian life is difficult. An estimated 

75,609 veterans are homeless, sheltered or unsheltered, on 

any given night. Women were 10,214 (7.5%) of the 136,334 

homeless veterans who were sheltered sometime between 

October 1, 2008 and September 30, 2009 (U.S. Department 

of Housing and Urban Development and U.S. Department 

of Veterans Affairs). Female veterans have a greater risk of 

homelessness compared to their civilian counterparts. Risk 

of homelessness for recent veterans, particularly women who 

served in Iraq and/or Afghanistan, is increasing. 

The experience of trauma prior to enlistment coupled 

with trauma experienced while in uniform is a common 

denominator among homeless female veterans. Research 

suggests that 81-93% of female veterans have been exposed 

to some type of trauma, significantly higher rates than 

the civilian population (Zinzow et al., 2007). Traumatic 

experiences include childhood abuse and neglect, domestic 

violence, military sexual trauma, and combat-related stress. 

These experiences have a significant impact on mental and 

physical health, family relationships, and housing and job 

stability. 

Trauma Informed Care for Women Veterans Experiencing 

Homelessness is designed to be used by community-based 

service agencies that work with homeless female veterans 

in a variety of settings (e.g., emergency shelters, domestic 

violence shelters, transitional and supportive housing 

programs, outpatient settings). Leaders within these 

organizations who are looking to improve their effectiveness 

in engaging the female veterans they serve can use this 

guide to begin the process of becoming trauma-informed. 

Trauma-Informed Care for Women Veterans Experiencing 

Homelessness includes: 

1. A user’s guide that offers organizations: 

•	 Information on the experiences and needs of female

veterans, what it means to provide trauma-informed 

care to this population, and resources for staff 

training and education. 

•	 Background information on the Organizational SelfAssessment for Providers Serving Female Veterans (the 

Self-Assessment). 

•	 A step-by-step process for using the Self-Assessment 

to incorporate new practices and institute change. 

2. The Organizational Self-Assessment for Providers 

Serving Female Veterans. The Self-Assessment consists 

of concrete trauma-informed practices that can 

be integrated into daily programming within 

organizations serving female veterans who are 

homeless. 

3. Resource Lists consisting of printed materials, videos, 

and websites on the following topics: Female Veterans, 

General Trauma Information, Homelessness and 

Trauma, Cultural Competence, Trauma-Informed 

Services, Consumer Involvement, and Self-Care for 

Service Providers. 

Community-based organizations can achieve the goal 

of effectively delivering trauma-informed services if 

they combine the process and information contained in 

Trauma-Informed Care for Women Veterans Experiencing 

Homelessness with training and knowledge of the unique 

needs of the populations they serve. 
SeCtIon 1

UNDErstaNDiNg tHE ExPEriENcEs 

aND NEEDs of fEmalE VEtEraNs

SeCtIon 1
 UNDErstaNDiNg tHE ExPEriENcEs 

aND NEEDs of fEmalE VEtEraNs 
 

	 	 	 	

	 	 	 	 	 	

	 	 	

	 	 	 	 	

	 	 	

	 	 	

10 Trauma-Informed Care for Women Veterans Experiencing Homelessness 

1section 

underStandIng the experIenCeS and needS of female VeteranS
 

i. Background 

The percentage of women in the military 

and among the ranks of veterans is 

growing dramatically. Female deployment 

has increased exponentially from 41,000 

in the Gulf War to more than 200,000 

in Operation Enduring Freedom and 

Operation Iraqi Freedom (OEF/OIF) 

(Women in Military Service for America 

Memorial Foundation, Inc., 2009). Women 

serve in all branches of the military, but 

are most likely to serve in the Army and 

least likely to serve in the Coast Guard 

(Women in Military Service for America 

Memorial Foundation, Inc., 2009). 

Throughout U.S. military history, various 

rules and regulations have limited official 

involvement, rank attainment, and role 

within the services (Murdoch et al., 2006). 

However, this is changing, and in OEF/ 

OIF more women have been in combatrelated roles (Alvarez, 2009; LaBash et al., 

2009). In addition, assignment to supply 

operations in the OEF/OIF theatres means 

female service members frequently fight 

alongside their male counterparts in stark 

contrast to the back line historic role of 

supply operations (Alvarez, 2009). 

Female Veterans 

According to U.S. Department of Veterans 

Affairs (VA) estimates, the number of female 

veterans will grow from 1.8 million (8.2% of 

all veterans) in 2010 to 2.1 million (15.2%) 

in 2036. At the same time, the number 

of male veterans is expected to decline. 

Women veterans are up to four times more 

likely to: 1) be younger than their male 

counterparts, with a median age of 47 for 

female veterans versus 61 for male veterans; 

2) identify themselves as a racial minority; 

3) have lower incomes than male veterans; 

and 4) be unemployed (U.S. Department of 

Veterans Affairs, 2006). Prior to the recent 

recession, female veterans ages 18-24 had an 

unemployment rate of 16% – double that of 

their non-veteran counterparts and higher 

than male veterans in the same age group 

(Foster & Vince, 2009). 

Female Service Members: 

•	 14% of Active Duty force

•	 18% of National Guard and

Reserve 

•	 20% are new recruits

•	 11% are single parents,

compared to 4% of military 

males 

Increased Female Deployment: 

•	 41,000 in Gulf War

•	 About 200,000 in OEF/OIF

(Foster & Vince, 2009) 

serVice needs and 

Utilization 

Increasing numbers of women in the 

military and the expanding role of 

women in theatre reinforces the need 

VA has taken some steps to improve the availability of services for women veterans, including requiring that all VA 

medical facilities make the Women Veterans Program Manager – an advocate for the needs of women veterans – a fulltime position and providing funding for equipment to help VA medical facilities improve health care services for women 

veterans. Additionally, in November 2008, VA began a system-wide initiative to make comprehensive primary care for 

women veterans available at all VA medical centers and community-based outpatient clinics. In announcing this initiative, 

VA established a policy defining comprehensive primary care for women veterans as the availability of complete primary 

care – including routine detection and management of acute and chronic illness, preventative care, gender-specific care, 

and mental health care – from one primary care provider at one site. (U.S. Government Accountability Office, 2010) 
 

Trauma-Informed Care for Women Veterans Experiencing Homelessness 11 

military sExUal traUma 

The VA defines Military Sexual Trauma (MST) as “sexual harassment that is threatening 

in character or physical assault of a sexual nature that occurred while the victim was in 

the military, regardless of geographic location of the trauma, gender of victim, or the 

relationship to the perpetrator.” 

for physical and psychological services 

for returning women veterans. In 2003, 

experts forecasted that the percentage of 

female veterans seeking services at the 

VA would double in the next 10 years 

because of women’s increased presence 

in the military and the high costs of 

alternative medical care (Gamache et al., 

2003). The increase in female veterans has 

caused demand for women’s health care 

in the VA to steadily increase (Kelly et al., 

2008). Women’s health care in the VA has 

significantly expanded in response and 

now includes, for example, prenatal care, 

maternity services, and fertility treatments 

(Washington, Caffrey, Goldzweig, Simon 

& Yano, 2003). Female veterans may also 

receive care in separate women’s health 

clinics, which have increased in number 

in the past several years (Yano, Goldzweig, 

Canelo & Washington, 2006). In these 

clinics, which tend to have more female 

providers than do traditional VA centers, 

there is a focus on women’s health. (Yano, 

Washington, Goldzweig, Caffrey & Turner, 

2003). In addition, recent legislation 

known as the Caregivers and Veterans 

Omnibus Health Services Act adds VA 

funds to expand health care for female 

veterans. 

Despite these efforts to improve women’s 

health services, there is evidence that 

female veterans are less likely to choose the 

VA as a care provider than male veterans 

(Perl, 2009, Williamson, 2009). In fiscal 

year 2007, 15% of women veterans used 

VA’s health care services, compared to 

22% of male veterans (U.S. Government 

Accountability Office, 2010). Women 

who had experienced combat were more 

likely to feel that services provided at the 

Veterans Health Administration (VHA) 

were too male-centered (Kelly et al., 2008). 

A study found that, while providers at 

VHA centers were knowledgeable and 

supportive of female patients, many 

providers lacked a complete understanding 

of the increased likelihood of a female 

patient being in a caregiver role and its 

implications for her health (Vogt et al., 

2001). Female survivors of military sexual 

trauma do not always feel comfortable 

using the VHA (Kelly et al., 2008). Women 

who use VA services at higher rates have 

certain characteristics, including being 

older, unmarried, not having children, 

and having lower socioeconomic status 

than less frequent users (Ouimette, Wolfe, 

Daley & Gima, 2003). Please see Appendix 

2 (p. 81) for information about services 

provided by Women Veterans Health 

Strategic Health Care Group. 

experiences oF traUma 

Research suggests that 81-93% of female 

veterans have been exposed to some 

type of trauma (Zinzow et al., 2007). 

Rates of trauma for female veterans 

are significantly higher than those of 

the civilian population. Often these 

experiences begin prior to military service. 

Researchers have found that more than 

half of female veterans experienced some 

type of trauma or abuse before joining 

the military. Twenty-seven to 49% of 

women veterans experienced childhood 

sexual abuse and 35% have experienced 

childhood physical abuse (Zinzow et al., 

2007). Traumatic experiences continue in 

adulthood with 29-40% of female veterans 

experiencing sexual assault and about half 

experiencing physical assault. Domestic 

violence is a significant issue for this 

population, as 18-19% of female veterans 

have experienced it (Zinzow et al., 2007). 

In a 2002 survey of active duty military 

women, more than one out of every five 

reported physical and/or sexual assault by 

intimate partners, often partners who were 

active duty or retired military. 

Military Sexual Trauma (MST) in the form 

of sexual harassment and assault remains 

a significant concern for female soldiers. 

Twenty percent of female veterans who 

served in Iraq and Afghanistan have been 

identified as having experienced MST (U.S. 

Department of Veterans Affairs, 2010). 

According to the Department of Defense, 

approximately one in three military 

women has been sexually assaulted 

compared to one in six civilians (Foster & 

Vince, 2009). 

Prevalence of military sexual assault 

among female veterans ranges from 20­

48%, and 80% of female veterans have 

reported being sexually harassed (Foster & 

Vince, 2009). Despite the implementation 

of prevention programs and improved 

reporting mechanisms, female soldiers 

continue to experience sexual harassment 

and assault and are reluctant to report 

incidences. Of significant concern is this 

under-reporting of MST and a lack of 
 

12 Trauma-Informed Care for Women Veterans Experiencing Homelessness 

information about services for survivors 

of MST. 

In addition to the high rates of MST, 

women in the military face challenges 

that may differ from their male 

colleagues. According to a report by Iraq 

and Afghanistan Veterans of America, 

more than 40% have children and 

approximately 30,000 single mothers have 

been deployed. Women report higher 

levels of stress over the impact of their 

deployment on family and relationships 

(Vogt, Pless, King & King, 2005). Due 

to these factors, women are less likely to 

feel prepared for deployment than men 

(Carney et al., 2003) and are often highly 

stressed (Vogt et al., 2005). Women are in 

the minority when serving in the military 

and have fewer opportunities for peer 

support, which may lead to feelings of 

isolation (Myers, 2009; Vogt et al., 2005). 

Traumatic experiences can have a 

significant impact on a person’s overall 

health and well-being. The effects of 

multiple experiences of trauma, such 

as those that are statistically common 

among female veterans, may include: 

difficulties trusting others and forming 

and maintaining healthy relationships; 

struggles understanding, talking about 

and managing feelings; adopting highrisk behaviors as coping mechanisms 

(e.g., eating disorders, substance abuse, 

self-harm, sexual promiscuity, violence); 

and developing severe and persistent 

physical and mental health issues such as 

post-traumatic stress disorder (PTSD). 

The impact of military sexual trauma on 

female veterans is especially pronounced. 

Female veterans assaulted in the military 

are nine times more likely to exhibit 

PTSD symptoms; are more likely to have 

problems with alcohol or drugs; have lower 

economic and educational outcomes; 

and experience difficulty maintaining 

relationships as well as stable housing and 

employment. 

Homelessness 

Experiences of trauma and the subsequent 

impact on daily functioning can present 

a significant challenge as women veterans 

readjust to civilian life, and can be a risk 

factor for homelessness (Perl, 2009). 

Research indicates that female veterans 

who experience MST, for example, are at 

a higher risk for a variety of problems, 

from PTSD to homelessness (Gamache, 

Rosenheck, & Tessler, 2003). Indeed, 

rates of homelessness among female 

veterans are of growing concern. Female 

veterans are at four times greater risk 

of homelessness than their civilian 

counterparts (Foster, 2010). 

Female veterans who are homeless or at 

risk of homelessness have tremendous 

service needs, many of which are going 

unmet. Needs include therapy to address 

the impact of trauma; supportive 

services that create community among 

veterans, such as linkages to faith-based 

communities; transitional employment 

and job training; safe living environments; 

and options for substance abuse treatment 

(The National Center on Family 

Homelessness, 2009). Since mixed-gender 

living arrangements and therapy groups 

can present risks for sexual harassment 

and assault and can invite interactions 

that are reminiscent of perpetrator–victim 

relationships, separate female veteran 

homelessness transitional housing 

programs that are not co-located with 

programs/housing for male veterans are 

recommended (The National Center on 

Family Homelessness, 2009). 

The VA has enhanced current programs 

and implemented new initiatives to 

address homelessness among veterans. 

Many of these programs have the capacity 

to serve women, including women with 

children. However, this subsection of the 

symptoms of post-traumatic stress disorder 

Avoidance – Avoiding situations or experiences that remind the person of a past traumatic 

experience. 

Hyperarousal – A persistent feeling of heightened anxiety that includes being constantly on alert 

for danger and focused on survival. 

Re-experiencing – Re-experiencing the traumatic event in the form of flashbacks, nightmares, 

intrusive thoughts, images, etc. 

Emotional Numbing – Disconnecting or “dissociating” from overwhelming feelings associated 

with the traumatic experience. This disconnection can lead to difficulties feeling and expressing a 

range of positive and negative emotions. 

(Monson et al., 2009) 
Trauma-Informed Care for Women Veterans Experiencing Homelessness 13 

female veteran population is expected to 

increase and additional special services will 

be needed. 

ii. U.s. Department of 

labor Women’s Bureau 

Demonstration Project: 

Women Veterans Who are 

Homeless 

The U.S. Department of Labor Women’s 

Bureau’s mission is to improve the 

status of wage-earning women, improve 

their working conditions, increase their 

efficiency, and advance their opportunities 

for profitable employment. This mission 

encompasses helping women veterans 

who are homeless to find gainful 

employment, thereby restoring them 

to financial stability. In the summer of 

2009, to address the growing issue of 

homelessness among female veterans and 

the need for clarity regarding the service 

needs of this population, the Bureau 

designed the Women Veterans Who Are 

Homeless Demonstration Project. This 

project funded pilot programs in the seven 

states with the highest concentrations 

of homeless female veterans (California, 

Kansas, New York, Oregon, Pennsylvania, 

Texas and Washington) to gain a better 

understanding of the needs of this 

population and to inform the competitive 

solicitation process for new Homeless 

Female Veterans and Homeless Veterans 

with Families Program grants that 

were issued in the spring of 2010 by 

the U.S. Department of Labor Veterans’ 

Employment and Training Service. 

Twenty-six grants in 14 states and the 

District of Columbia will provide job 

training, counseling, and placement 

services (including job readiness, and 

literacy and skills training) to expedite 

the reintegration of homeless female 

veterans into the labor force. The program 

will provide services to more than 2,300 

female veterans who are homeless and is 

being carried out in coordination with the 

Women’s Bureau. 

The National Center partnered with 

the Women’s Bureau, Region IX (San 

Francisco) to conduct a two-phase pilot 

program to listen to California’s homeless 

female veterans and service providers and 

design a strategy for meeting the needs 

of this population. During Phase One, 

The National Center conducted listening 

sessions with homeless female veterans 

and community-based service providers 

in San Diego County. These sessions 

focused on: women’s experiences in the 

military and as veterans; factors that lead 

to homelessness; challenges in overcoming 

homelessness; services available to women 

veterans; and barriers to accessing services. 

These listening sessions were part of a 

broader series of sessions with female 

homeless veterans that were sponsored by 

the Women’s Bureau in the other six states 

with the highest concentration of homeless 

female veterans. Towards the conclusion of 

the project, the Women’s Bureau decided 

to augment the project and include a series 

of listening sessions in Florida (Tampa Bay 

area) because of the recorded large total 

number of homeless veterans, male and 

female. Information from these multisite listening sessions was synthesized 

into a national report for the Veterans’ 

Employment and Training Service. The 

information that follows captures the main 

findings from the listening sessions with 

female veterans and represents anecdotal 

experiences that were voiced by these 

women. 

Findings From tHe 

caliFornia Women 

Veterans WHo are 

Homeless listening 

sessions 

The findings from the listening sessions 

echo much of the current literature on the 

experiences and service needs of homeless 

female veterans. Themes of violence and 

trauma in childhood and adulthood were 

pronounced, as was expressed frustration 

concerning the paucity of services for 

female veterans and more specifically, 

homeless female veterans. The National 

Center incorporated the listening session 

information into the development of 

Trauma-Informed Care for Women Veterans 

Experiencing Homelessness during Phase 

Two of the pilot program. The following 

is a summary of the key findings from the 

Region IX Phase One listening sessions: 

female veterans who are homeless 

have significant histories of trauma. 

The female veterans who participated in 

the listening sessions had experienced 

multiple layers of trauma, both systemic 

and interpersonal, that contributed to 

their current experience of homelessness. 

Traumatic experiences included: childhood 

abuse; intimate partner violence; combatrelated stress; military sexual trauma; 

and the loss of social supports and stable 

housing. 

A common theme across listening sessions 

involved the stress associated with being a 

female service member in a predominately 

male-oriented military culture where 

power imbalances, harassment, and sexual 

assault were prevalent. The women used 

phrases such as “the boy’s network” and a 

“male-dominated world” to describe the 

military culture. Most of the women felt 

that in the military there is “a lot more 

pressure on women” and women have to 

work “twice as hard as men.” Experiences 
14 Trauma-Informed Care for Women Veterans Experiencing Homelessness 

of sexual harassment and sexual assault 

while in the military were also common. 

As one woman explains, “I heard that they 

want to say PTSD is only combat-related. 

What about those raped in the military? . . . 

Trauma is trauma. Some women come into 

the military with stuff from their childhood 

and that exacerbates, especially when you 

have to prove yourself equal to the guys. You 

think you’re fine, and then something comes 

up. We have been shoved off to the side for 

so long, and given so much less than the 

men, it’s time for the women to start fighting 

back.” Though some women had positive 

experiences while in the military (e.g., 

having access to additional educational 

opportunities or career advancement), 

being a female service member has unique 

stressors apart from combat-related 

experiences. As one participant expressed, 

“The stress of surviving as a woman in 

the military is its own type of trauma.” 

Whether surviving military sexual trauma 

or surviving in a male-dominated culture, 

these experiences have a significant adverse 

long-term impact. 

In addition to military trauma, listening 

session participants struggled with their 

own experiences of violence and trauma 

in childhood and adulthood. As one 

participant explained, “We all joined the 

military to get away from our families.” 

Another stated, “I joined the military to get 

away from abuse as a child,” and another 

shared, “I grew up with low self-esteem 

and depression.” Many of the participants 

were also survivors of domestic violence. 

One woman commented, “DV starts the 

downward spiral . . . You end up homeless 

and afraid.” Similar comments were 

echoed by others in the sessions. “When I 

got into domestic violence – brutal from the 

very beginning – I didn’t know how to deal 

with it, get out of it, or handle it at all.” 

Exposure to trauma impacts all 

aspects of daily functioning. 

The impact of the traumas described 

by participants was overlapping and 

devastating. Repeated experiences of 

trauma both within and outside of the 

military environment contributed to 

a high prevalence of substance abuse, 

mental health issues, difficulty accessing 

and maintaining employment, and 

difficulty accessing services and supports. 

This section includes examples shared 

by some of the women veterans about 

how these factors contributed to their 

homelessness. 

Experiences in the military had a profound 

impact on these participants. One woman 

explained, “When I was in the Navy in 

1979, I was raped. I was never treated by 

the military for anything” and suggested 

“Maybe I have problems now because 

I didn’t address the issue originally.” 

Several of these women linked their 

military service to subsequent struggles 

with substance abuse. They described 

the frequent use of alcohol while in 

the military. One woman shared, “I 

didn’t drink a lot before, but within a few 

months [of joining the military] I went to 

mandatory rehab.” Military sexual trauma 

was another source of stress connected to 

substance use: “There was a lot of sexual 

harassment and sexual assault that probably 

factored into my drinking more. I think my 

homelessness came from my poor choices 

because of my drinking.” 

The demand for self-reliance among 

women in the military and the pressure 

to prove that one is strong and capable 

creates a culture where seeking services 

is seen as a sign of weakness, further 

contributing to the risk of homelessness. 

As one participant said, “The veterans 

are probably the last ones to go and ask 

for help.” Providers agreed that women 

veterans are “socialized not to seek help.” 

They commented that reporting military 

sexual trauma is “particularly difficult to 

reach out and get help for. You don’t tell.” 

For most of the women in the listening 

sessions, the combination of violence 

in adulthood and childhood trauma 

resulted in struggles with addiction that 

contributed to their homelessness. One 

woman shared, “[I had] PTSD through 

circumstances in the military. [The] last few 

years of my marriage were very mentally 

abusing . . . left me with scars, depression. I 

grew up with low self-esteem and depression. 

Mental abuse was like a hole that I couldn’t 

get out of. On the outside it looked like I 

could do the part. Could get a good job 

but couldn’t maintain it. Physical heals, 

the mental does not.” Another woman 

explained, “I filled my pockets in the drug 

world, trying to get out of this relationship 

I was in.” The presence of mental health 

issues prior to entering the military adds 

another layer of trauma that further 

complicates the current situation. One 

participant identified untreated mental 

illness as a factor in her homelessness. “I 

used and numbed, became suicidal [and] 

did not know where to go or how to get 

help.” Another shared, “I fight addiction, 

I’m on psych meds – so mine has been a 

combination of things.” Service providers 

agree that past traumatic experiences 

contribute to the current difficulties 

that many homeless women veterans 

experience interacting with others and 

maintaining stable employment and 

housing. 
Trauma-Informed Care for Women Veterans Experiencing Homelessness 15 

female veterans do not always 

self-identify. 

Many of the women who participated in 

the listening sessions did not self-identify 

as veterans, and felt society in general did 

not readily acknowledge female veterans 

or their needs. A few of the comments we 

heard included: 

“When you think veterans – you don’t 

think of women. As much as society 

is trying to change, it’s still a man’s 

world.” 

—Female Veteran 

“I thought veteran meant you had been 

in combat. If in church, on Veteran’s 

Day, I don’t want to stand up. I don’t 

want to raise my hand. It just doesn’t 

seem right to me.” 

—Female Veteran 

“I never thought of myself as a veteran 

even though I served. I didn’t think 

those words applied to me.” 

—Female Veteran 

This lack of identification with veteran 

status is a barrier to seeking veteranspecific services. Service providers also 

noted that many women did not identify 

Women saw themselves as wives, mothers, 

and survivors of addiction and violence. 

However, their lack of connection to their 

veteran status meant that they were less 

likely to be aware of and access the benefits 

and resources that they earned based on 

their time in the military. 

female veterans often find 

themselves without a support 

network. 

Isolation and a lack of social supports 

was also a common factor contributing 

to homelessness. One woman reflected, 

“Things began to spiral down after a while. I 

became subservient in marriage, lost female 

friendships, felt isolated.” 

Another woman explained, “A lot of 

women join the services to get away from 

what you had. [You] get out of the service, 

don’t want to go back, have no connections, 

[you are in a] strange place, don’t have 

anybody. People will party with you before 

they will feed you. You don’t know how 

you crossed the line; you don’t know how 

to get back. You’re just lost, not having any 

resources and anyone you can trust.” Others 

talked about the military as being their 

only family. Once discharged, many of the 

women stayed in the same geographical 

their military experiences as sources of 

potential trauma for which they could 

receive supportive services. One homeless 

program director put it this way, “The 

segment of the population we serve is so 

focused on their day to day survival that 

being a veteran may not be part of their 

identity but it is part of their history.” 

area where they were stationed, though 

they had no connections outside of the 

military. 

services that are trauma-informed 

and tailored to female veterans are 

minimal. 

Participants in all listening sessions 

agreed that there are very few services 

available for women veterans in general 

and even fewer for women veterans 

experiencing homelessness. As one woman 

expressed, “We’re the forgotten veterans.” 

One participant noted, “There seems to 

be so much more out there in the way of 

programs, shelters, sobriety homes – so much 

more for men,” and another expressed, 

“A Vet’s a Vet – they should have things 

for everyone.” The range of services is 

also limited, so if a group setting or type 

of group or treatment does not work, 

few other services are available. Women 

specifically expressed frustration at the 

lack of services for survivors of intimate 

partner violence. 

The women expressed an overall need 

for more services and programs for 

women and more spaces for women 

within existing programs. In general, the 

women who participated in the listening 

sessions seemed less likely to participate 

in programs that were perceived as mainly 

designed for men. Women were looking 

for programs that offered “culturally 

competent” service provision (e.g., services 

designed with an understanding of and an 

ability to meet the unique needs of women 

who are also veterans and experiencing 

homelessness). Some women described 

positive experiences with individual 

service providers who were “thoughtful 

about the situation,” provided support for 

a range of issues, helped women access 

services, and served as advocates. As 

one participant summarized, “We need 

networking groups and safe places with the 

right people to direct us down the pathways 

we want to go.” 

“Some women come into the military with stuff 

from their childhood and that exacerbates, 

especially when you have to prove yourself equal 

to the guys.” 

—Female Veteran 
 

 

16 Trauma-Informed Care for Women Veterans Experiencing Homelessness 

Participants also agreed that there is little 

outreach and communication about the 

few available services and programs. Many 

women veterans found the transition out 

of the military into civilian life difficult 

and that resources to assist them were 

inadequate or non-existent. As one 

participant said, “There’s a big gap when 

you’re leaving the military. They keep secrets. 

It’s like they keep all the resources tight and 

close, if you’re special enough maybe they’ll 

tell you.” 

Across sessions, women said that they were 

unaware of available services for women 

veterans and/or confused regarding their 

eligibility for services. Regardless of age or 

time served in the military, these women 

were confused about benefits and the 

purpose of the VA. 

Community-based service providers 

also expressed confusion regarding how 

to best support women veterans within 

their programs. They acknowledged that 

many programs are designed for men, and 

there is a limited understanding of how 

to change both the physical environment 

and the culture of an organization once 

women are admitted. There is a lack of 

communication between communitybased and veteran-specific service 

providers such as the VA or Vet Centers 

regarding available services. 

“We need networking 

groups and safe 

places with the right 

people to direct us 

down the pathways 

we want to go.” 

—Female Veteran 

service provider working with female veterans seeking assistance. 
Trauma-Informed Care for Women Veterans Experiencing Homelessness 17 

Based on the results of the listening sessions, The National Center designed a strategy during Phase Two of the pilot 

program to address the following key issues: 

•	 Homeless female veterans have experienced 

traumatic stress. Research and conversations with 

homeless female veterans suggest that most of these 

women have experienced some form of trauma 

(Zinzow et al., 2007). Many female veterans have 

experienced multiple traumas before, during, and 

after military service. Traumatic experiences include 

childhood abuse, violent relationships, and military 

sexual trauma. In addition, the experience of being 

homeless is, in and of itself, traumatic (Goodman and 

Harvey, 1991). 

•	 Responses to traumatic stress are adaptive. In the 

face of traumatic experiences, people learn to adapt 

to keep themselves safe. Responses to traumatic 

stress may include withdrawing from others, 

becoming aggressive, dissociating (“spacing out” or 

disconnecting from certain thoughts, feelings, or 

memories associated with traumatic experiences), 

engaging in self-injurious behaviors such as cutting, 

or abusing substances in an effort to manage 

overwhelming feelings. The National Center found 

that many of the homeless female veterans who 

participated in the listening sessions struggled with 

mental health issues and substance abuse that had a 

significant impact on their ability to manage day to 

day. While these behaviors may appear to be unhealthy 

or ineffective to providers, they should be understood 

as coping skills that were once useful in the past, 

and which can slowly be replaced with healthier 

alternatives. 

•	 Trauma impacts how female veterans access services. 

People who have experienced ongoing trauma may 

view the world and other people as unsafe. Those 

who have repeatedly been hurt by others may come to 

believe that people cannot be trusted. This lack of trust 

and a need to be constantly on guard for danger makes 

it difficult for people to ask for help, trust providers, 

or form relationships. For homeless female veterans, 

these challenges are compounded by the absence of 

services for women veterans and the perceived lack of 

acknowledgement of and respect for their service. 

•	 Homeless female veterans require specific, tailored 

interventions. Healing for trauma survivors, 

specifically female veterans, is not supported by “one 

size fits all” services that fail to consider trauma and 

its impact. In addition to addressing the impact of 

trauma, female veterans require services that are 

specifically tailored to their experiences as military 

service members. How an organization responds to the 

needs of female veterans who have experienced trauma 

has a significant impact on their process of recovery. 

Currently, there are no clearly defined guidelines or 

strategies for providing trauma-informed care to 

female veterans who are homeless. There is a growing 

need for trauma-informed tools and program models 

for serving homeless female veterans that can be 

implemented and evaluated in an effort to garner a set 

of best practices for working with this population. 
 

SeCtIon 2
 ProViDiNg traUma-iNformED carE 

iN HomElEss sErVicE sEttiNgs 
 

Trauma-Informed Care for Women Veterans Experiencing Homelessness 19 

2


section 

proVIdIng trauma-Informed Care In 

homeleSS SerVICe SettIngS 

i.	 Defining trauma-informed 

care 

Some people experience very few 

traumatic events over the course of a 

lifetime, while others are chronically 

exposed to traumatic experiences. Research 

and first-hand knowledge tells us that 

the rate of trauma is extraordinarily high 

for those who are homeless. In the case 

of homeless female veterans, traumatic 

experiences often include childhood abuse, 

domestic violence, and experiences in the 

military (including combat-related trauma 

and military sexual trauma). In addition, 

the loss of place, safety, stability, and 

community associated with homelessness 

is, in and of itself, traumatic. These 

experiences have a significant impact 

on how people understand themselves, 

the world and others. As traumatic 

experiences accumulate, responses become 

more intense and have a greater impact 

on functioning. Ongoing exposure to 

traumatic stress can impact all areas 

of people’s lives, including biological, 

cognitive, and emotional functioning; 

social interactions/relationships; and 

identity formation. 

Because people who have experienced 

multiple traumas do not relate to the 

world in the same way as those who 

have not had these experiences, they 

require services and responses that are 

tailored to their needs. In response to the 

impact of trauma on people experiencing 

homelessness, the homelessness field is 

moving toward a new way of providing 

care. People can and do recover from 

trauma, and it is imperative to design 

services and service environments 

that best support healing. Meeting the 

needs of trauma survivors requires that 

organizations become “trauma-informed” 

(Harris & Fallot, 2001). Providing 

“trauma-informed” care involves using 

what we know about trauma and its 

impact to respond differently. Maxine 

Harris (2004) describes a traumainformed service system as “a human 

services or health care system whose 

primary mission is altered by virtue of 

knowledge about trauma and the impact 

it has on the lives of consumers receiving 

services.” This means looking at all aspects 

of programming through a trauma 

lens, constantly keeping in mind how 

traumatic experiences impact consumers. 

Organizations that are informed by an 

understanding of trauma respond best to 

consumer needs and avoid engaging in 

practices that may cause additional harm. 

This type of change requires providers at 

all levels and in all roles and organizations 

as a whole to modify what they do based 

on an understanding of the impact of 

trauma and the specific needs of trauma 

survivors. 

What makes an experience 

traumatic? 

•	 The experience involves a

threat to one’s physical or 

emotional well-being. 

•	 It is overwhelming.

•	 It results in intense feelings of

fear and lack of control. 

•	 It leaves people feeling		

helpless. 

•	 It changes the way a person

understands themselves, the 

world, and others. 

(American Psychiatric Association, 2000) 

“The veterans are 

probably the last ones 

to go and ask for help.” 

—Female Veteran 
	 	

20 Trauma-Informed Care for Women Veterans Experiencing Homelessness 

FoUndational principles 

The National Center has identified eight foundational principles that represent the core values of trauma-informed care. These 

principles were identified on the basis of knowledge about trauma and its impact, findings of the Co-Occurring Disorders and 

Violence Project (Moses, Reed, Mazelis, & D’Ambrosio, 2003), literature on therapeutic communities (Campling, 2001), and 

the work of Maxine Harris and Roger Fallot (Harris & Fallot, 2001; Fallot & Harris, 2002) and Sandra Bloom (Bloom, 2008). 

Principles of trauma-informed care include: 

•	 Understanding Trauma and its Impact. Understanding traumatic stress and how it impacts people and recognizing that 

many behaviors and responses that may seem ineffective and unhealthy in the present, represent adaptive responses to past 

traumatic experiences. 

•	 Promoting Safety. Establishing a safe physical and emotional environment where basic needs are met, safety measures are 

in place, and provider responses are consistent, predictable, and respectful. 

•	 Ensuring Cultural Competence. Understanding how cultural context influences one’s perception of and response to 

traumatic events and the recovery process; respecting diversity within the program, providing opportunities for consumers 

to engage in cultural rituals, and using interventions respectful of and specific to cultural backgrounds. When working with 

female veterans, this requires that programs ensure “military cultural competence,” which includes knowledge of military 

language, acronyms, paperwork, service delivery systems, culture, and experiences of female military service members and 

veterans. 

•	 Supporting Consumer Control, Choice and Autonomy. Helping consumers regain a sense of control over their daily lives 

and build competencies that will strengthen their sense of autonomy; keeping consumers well-informed about all aspects 

of the system, outlining clear expectations, providing opportunities for consumers to make daily decisions and participate 

in the creation of personal goals, and maintaining awareness and respect for basic human rights and freedoms. 

•	 Sharing Power and Governance. Promoting democracy and equalization of the power differentials across the agency; 

sharing power and decision-making across all levels of an organization, whether related to daily decisions or in the review 

and creation of policies and procedures. 

•	 Integrating Care. Maintaining a holistic view of consumers and their process of healing and facilitating communication 

within and among service providers and systems. 

•	 Healing Happens in Relationship. Believing that establishing safe, authentic, and positive relationships can be corrective 

and restorative to survivors of trauma. 

•	 Recovery is Possible. Understanding that recovery is possible for everyone regardless of how vulnerable they may appear; 

instilling hope by providing opportunities for consumer and former consumer involvement at all levels of the system, 

facilitating peer support, focusing on strength and resiliency, and establishing future-oriented goals. 
Trauma-Informed Care for Women Veterans Experiencing Homelessness 21 

Shelter from the Storm: Trauma-Informed Care in Homelessness 

Services Settings, (Hopper et al., 2010) puts forth the following 

“consensus-based definition” of trauma-informed care based 

on principles identified by organizations including the National 

Child Traumatic Stress Network, The National Center on 

Family Homelessness, The National Association of State Mental 

Health Program Directors, and various workgroups, researchers, 

and expert panels: Trauma-Informed Care is a strengthsbased framework that is grounded in an understanding of and 

responsiveness to the impact of trauma, that emphasizes physical, 

psychological, and emotional safety for both providers and survivors, 

and that creates opportunities for survivors to rebuild a sense of 

control and empowerment. This definition reflects a set of core 

beliefs (e.g., trauma-awareness, safety, control, and strengthsbased care) that should inform service provision for trauma 

survivors across service settings. Whether providing shelter and 

housing services, medical or mental health care, education or 

employment services, providers can adopt these trauma-informed 

principles to assist consumers in reaching goals and achieving 

success. 

Shelter from the Storm identifies the following key components 

to providing trauma-informed care in homeless settings, for 

example: 1) staff training on trauma and its impact; 2) ongoing 

supervision and consultation to reinforce trauma-based concepts; 

3) assessment and screening that include trauma history; and 4) 

trauma-informed services for children that include specialized 

programming, assessments, and resource coordination. 

oUtcomes oF traUma-inFormed serVice 

proVision 

Shelter from the Storm identifies preliminary outcomes of 

trauma-informed care, such as: 

•	 Improved functioning and a decrease in psychiatric

symptoms and substance use in adults 

•	 Increased housing stability

•	 A decrease in intensive services such as hospitalization and

crisis intervention 

•	 Enhanced self-identity and coping skills among children

Further research is needed to define and evaluate traumainformed programming, particularly in homeless service settings 

and with special populations such as veterans. 

ii.	 accessing related resources for 

transforming Principles into Practice 

In 2009, The National Center published the Trauma-Informed 

Organizational Toolkit (the Toolkit) to provide homeless service 

organizations with a roadmap for becoming trauma-informed. 

Developed over several years, the Toolkit served as the baseline 

for Trauma-Informed Care for Women Veterans Experiencing 

Homelessness. The information from the Phase One Listening 

Sessions, site visits, and input from veterans service providers 

participating in the Phase Two pilot program combined to adapt 

this baseline to address the specific needs of female veterans 

experiencing homelessness. 

In addition to the foundational principles, community service 

providers should collaborate with the U.S. Department 

of Labor’s One-Stop Career Centers, Job Corps, Office of 

National Response (dislocated workers’ programs), Office 

of Unemployment Insurance, Office of Apprenticeship, and 

Veterans’ Employment and Training Service. Community service 

providers should work with other Federal agencies as well, 

including the U.S. Department of Education’s Rehabilitation 

Services Administration, and Office of Vocational and Adult 

Education; the U.S. Department of Housing and Urban 

Develpment’s Office of Community Planning and Development 

(Community Development Block Grants and economic 

development programs); the U.S. Department of Health and 

Human Services’ Administration for Children and Families 

(Temporary Assistance for Needy Families), Health Resources 

and Service Administration (Community Health Centers), 

and Center for Medicare and Medicaid Services (Medicaid); 

and the U.S. Department of Agriculture’s Food and Nutrition 

Service (Supplemental Nutrition Assistance Program and Special 

Supplemental Nutrition Program for Women, Infants and 

Children). 
 

SeCtIon 3 

DEVEloPiNg aND PilotiNg tHE 

orgaNizatioNal sElf-assEssmENt for 

ProViDErs sErViNg fEmalE VEtEraNs 
 

Trauma-Informed Care for Women Veterans Experiencing Homelessness 23 

3


section 

SeCtIon three: deVelopIng and pIlotIng the 

organIzatIonal Self-aSSeSSment for proVIderS 

SerVIng female VeteranS 

i. U.s. Department of labor 

Homeless Women Veterans 

Project: Phase two 

The Organizational Self-Assessment for 

Providers Serving Female Veterans (see 

Self-Assessment on p. 48) consists of 

concrete, “trauma-informed” practices 

that reflect the needs and ideas shared by 

women veterans and service providers 

during Phase One, as well as the areas of 

need identified in the literature (see The 

National Center on Family Homelessness 

Military Literature and Resource Review at 

www.familyhomelessness.org/media/100. 

pdf). Phase Two of the Homeless Women 

Veterans Project involved developing 

and piloting the Self-Assessment in 

three homeless service organizations in 

California and included the following key 

activities: 

1. oUtreacH and 

recrUitment oF pilot 

sites 

The National Center utilized relationships 

developed during Phase One of the 

U.S. Department of Labor Women’s 

Bureau’s Women Veterans Who Are 

Homeless Demonstration Project to 

recruit organizations from the San Diego 

provider network as well as the Central 

Valley (which includes the San Joaquin 

Valley) provider network to pilot the 

Self-Assessment. The National Center 

also reached out to organizations such as 

the Corporation for Supportive Housing 

for additional feedback. The following 

organizations agreed to participate in 

the pilot project: Interfaith Community 

Services, Oceanside, CA; St. Vincent 

De Paul Village, San Diego, CA; and 

Westcare’s San Joaquin Valley Veterans, 

Fresno, CA. 

2. condUcting additional 

listening sessions and 

deVeloping a draFt oF 

tHe selF-assessment 

The National Center conducted additional 

listening sessions with providers and 

women veterans at the pilot sites to obtain 

their feedback and ideas regarding the 

service needs of female veterans and the 

specific practices that should be included 

in the Self-Assessment. The National Center 

modified the previous Trauma-Informed 

Organizational Self-Assessment based on 

feedback from female veterans and service 

providers to create an initial draft of the 

current version of the Self-Assessment for 

homeless service providers working with 

female veterans. 

3. implementing and 

eValUating tHe selFassessment 

The National Center provided each 

organization with foundational training 

on trauma and its impact, the needs and 

experiences of women veterans, and what 

it means to be trauma-informed, along 

with instructions for using the SelfAssessment. Staff at each site evaluated 

the extent to which they currently 

incorporated each of the practices set 

out in the Self-Assessment. Based on 

this assessment of their programming, 

agencies identified goals for more fully 

incorporating these trauma-informed 

practices. The National Center’s evaluators 

conducted interviews with program staff 

to: 1) document the process by which 

organizations used the Self-Assessment, 

including challenges, barriers, and 

facilitators in its implementation; 

2) collect information necessary to refine 

the tool for future replication; and 3) 

identify changes in operations, culture, 

policies, or other outcomes associated with 

the implementation of the Self-Assessment. 

4. Finalizing tHe selFassessment 

The National Center made further 

refinements to the Self-Assessment based 

on implementation, evaluation activities, 
24 Trauma-Informed Care for Women Veterans Experiencing Homelessness 

and feedback, and created a final version 

of the tool. 

ii. Understanding the 

Domains of the selfassessment 

The National Center created the SelfAssessment to offer service providers 

guidelines on how to provide traumainformed care in general and traumainformed care to female veterans more 

specifically. Some trauma-informed 

strategies and practices are essential 

regardless of the type of population being 

served, while others are implemented in 

response to the unique needs of female 

veterans. 

This section explores the six domains or 

areas of programming within the 

Self-Assessment offering: 

•	 An explanation of each domain – A 

review of the six domains to explain 

why they were chosen as the primary 

areas of focus 

•	 Essentials for providing quality 

programming to homeless female 

veterans – This section offers 

summary guidelines for providing 

quality care to female veterans 

experiencing homelessness 

•	 Additional tips for creating traumainformed settings –These tips 

supplement the Self-Assessment 

items, and provide organizations 

with additional ideas about how to 

further incorporate trauma-informed 

practices 

domain 1: sUpporting 

staFF deVelopment 

Trauma can impact every aspect of a 

survivor’s life, and its effects can appear in 

areas directly related to the trauma as well 

as those that initially seem unrelated. 

Coping strategies used to survive and 

manage traumatic experiences may 

be seen by others as inappropriate or 

“maladaptive.” A lack of awareness of 

trauma and its impact on adults and 

children often leads to misunderstandings 

between staff and consumers that can retraumatize consumers and cause them to 

disengage from services. 

Creating trauma-informed services and 

settings requires organizations to expand 

on basic, traditional staff development 

efforts to include a range of trauma-related 

training and support activities. Training 

and education on trauma, supervision that 

includes discussions about trauma, and a 

focus on self-care for the provider are all 

key components of a trauma-informed 

organization. Providing trauma-informed 

care to female veterans adds an additional 

layer of staff development activities to 

meet the needs of this special population. 

training and Education 

Staff training and education are crucial 

to becoming trauma-informed. Training 

everyone – administrators, direct care 

staff, case managers, support staff, etc. – 

about trauma and trauma-related topics 

ensures that all staff members are working 

from the same level of understanding and 

are capable of providing the same types of 

trauma-sensitive responses. 

Agencies may begin with basic training 

about traumatic stress and its impact on 

the brain and the body and move on to 

offer more specific information on various 

types of trauma common among female 

veterans (e.g., military sexual trauma, 

combat-related trauma, intimate partner 

violence, homelessness). To understand 

the impact of the early trauma that is 

often reported by female veterans, it is 

important for staff to learn about how 

trauma impacts child development and 

attachment to caregivers. Staff education 

should also include a focus on how 

working with trauma survivors can 

impact staff (e.g., vicarious traumatization 

or “compassion fatigue”) to raise staff 

awareness about their own triggers and 

level of burnout, and how these issues can 

impact their work with consumers. 

“Training is helpful in its focus on 

women veterans . . . planting seeds 

that it’s different.” 

California multi-service agency program 

director 
 

Trauma-Informed Care for Women Veterans Experiencing Homelessness 25 

Experiences of trauma can lead to a variety 

of mental health and substance abuse 

issues and more severe responses that 

include suicidal behaviors. Given the high 

rates of mental health issues and substance 

abuse among homeless female veterans, 

it is important for service providers to 

receive basic education on common 

mental health and substance abuse 

disorders that may impact their work with 

this group. 

Becoming trauma-informed also involves 

incorporating education about the 

cultural backgrounds of consumers being 

served, including how individuals from 

different cultures understand and respond 

to trauma. When working with female 

veterans, it is essential for providers to 

understand not only the personal culture 

of each individual being served, but also 

the military culture and how that impacts 

a female veteran’s experience. This type of 

education is essential to doing outreach 

and providing services to homeless female 

veterans, particularly for communitybased providers who do not have a depth 

of military expertise. Military-specific 

staff education includes the following: 

general military knowledge (e.g., structure, 

branches, terms, and acronyms); military 

culture (e.g., philosophy, norms, rules of 

conduct, experiences of military service 

members); specific experiences of female 

service members; types of discharges; 

benefits and forms; eligibility criteria for 

various services and benefits; and specific 

resources for female veterans. 

Once staff members are educated on 

topics including trauma and its impact 

and military-related topics, they require 

additional training on how to apply this 

information to their daily work. Skills 

and strategies for working with trauma 

survivors may include: using motivational 

interviewing techniques; providing staff 

trainings on crisis management (e.g., how 

to help consumers identify triggers, express 

their feelings safely, and use healthy coping 

skills); learning how to develop safety 

and crisis-prevention plans; learning how 

to support female veterans by providing 

services; and creating connections with 

veteran-specific service providers. 

Large group trainings are helpful forums 

for initial staff education about trauma, 

but these trainings alone are insufficient. 

Supervision and team meetings offer 

smaller settings in which to convey and 

clarify information. Smaller team meetings 

are a forum for open communication, 

peer support, and additional training and 

education (see Figure 1 on p. 26). 

staff supervision, support and 

self-care 

Staff support is crucial to providing quality 

care to trauma survivors. Issues such as 

poor working conditions, confusion about 

roles and responsibilities, lack of attention 

to self-care, inconsistent supervision, 

and minimal input into programming 

contribute to high rates of burnout and 

staff turnover within social service settings. 

Making staff support a priority sends the 

message to employees and consumers that 

all are valued and respected. Elements of 

staff support include regular supervision 

and team meetings, an organizational 

commitment to promoting staff self-care, 

and opportunities for staff members to 

have a voice in programming decisions. 

One-on-one supervision offers service 

providers an opportunity to think about 

their work and how they understand 

and respond to consumers. It is also an 

avenue for monitoring job frustration 

or burnout. Individual supervision by 

someone who is trained in understanding 

trauma is an essential follow-up strategy to 

trauma training. Having opportunities for 

supervision or consultation from someone 

with military expertise is also a key 

component to working with the veteran 

population. 

As a result of the challenges faced 

by providers who work with trauma 

survivors, organizations must focus on 

how to encourage self-care at individual 

and programmatic levels. Mechanisms for 

encouraging self-care include addressing 

topics related to self-care in team 

meetings, encouraging staff members to 

understand their own stress reactions and 

develop their own self-care plans, devoting 

part of supervision to talking with staff 

members about the impact of working 

with trauma survivors, and providing 

trainings about compassion fatigue 

and self-care strategies. The program 

can support staff over the long term by 

creating a culture of self-care that includes 

encouraging staff members to take breaks, 

eat lunch, use vacation time, and develop 

strategies for creating a balance between 

their personal and professional lives. The 

agency may also develop ongoing ways to 

assess job satisfaction and staff need for 

additional support. 
26 Trauma-Informed Care for Women Veterans Experiencing Homelessness 

Figure 1: tips for sustaining education and awareness 

One-time trainings are insufficient to support organizational change. 

Organizational change is a continuous process, and new approaches take time to 

be reinforced and deepened. Additionally, high turnover rates necessitate repeated 

training to provide knowledge and skills to new staff. To be trauma-informed, 

programs can build an infrastructure for sustaining trauma-awareness and 

awareness of the needs of female veterans in the following ways: 

•	 Creating a “trauma workgroup” — A core group of staff members from all

levels of the organization, sanctioned by management, who come together 

to take what they have learned about trauma and strategize about how to 

apply this knowledge to daily program practices, and facilitate continued 

education about trauma for all staff. Workgroup activities may include 

examining the environment and program practices for potential triggers, 

arranging for further staff training and consultation by outside agencies, 

and identifying and taking advantage of smaller opportunities such as 

supervision and staff meetings to provide further education about trauma 

and how these concepts can be applied in real world situations. The trauma 

workgroup would be responsible for incorporating additional practices that 

might be needed to meet the unique needs of female veterans. 

•	 Incorporating trauma language — Using the term “trauma” in program

mission statements and handbooks, and incorporating questions about a 

potential employee’s understanding of trauma concepts into the interview 

process represents another way to integrate trauma into daily practice and 

convey the message that understanding trauma and providing traumasensitive care is a priority. 

•	 Maintaining military-specific knowledge — Enhancing and maintaining

organizational knowledge of military structure, protocol, and culture; 

maintaining staff knowledge of benefits, service needs, and resources for 

veterans (specifically female veterans). 

•	 Establishing external networks of support — Organizations can sustain

trauma-awareness by establishing regular contact with outside agencies 

with expertise in trauma, including the use of outside consultants to 

provide ongoing education and case consultation. Organizations can also 

make connections to agencies with expertise in serving veterans (e.g., 

VA, Vet Centers, veteran-specific service agencies) to stay current on new 

information, avoid isolation, and focus on areas where the program is most 

in need of guidance. 

(Harris & Fallot, 2001; Harris, 2004) 

domain 2: creating a 

saFe and sUpportiVe 

enVironment 

“The first task of recovery is to 

establish the survivor’s safety. This 

task takes precedence over all others, 

for no other therapeutic work can 

possibly succeed if safety has not 

been adequately secured.” 

(Herman, 1992) 

Traumatic experiences violate our 

fundamental belief that the world is a 

safe place and people can be trusted. 

Creating a safe, supportive, welcoming, 

and respectful environment is essential 

in any service setting. People are not 

successful in environments where they do 

not feel physically and emotionally safe, 

heard, and respected. For people who 

have experienced trauma, issues of safety 

become even more prominent. Accessing 

services requires consumers to enter into 

new relationships at a time when this 

is most difficult. Establishing a sense of 

physical and emotional safety is essential 

to relationship-building and recovery. 

Establishing a safe Physical 

Environment 

Creating a safe physical environment 

is one of the primary components 

of a trauma-informed organization. 

Specific areas within the building, such 

as bathrooms and bedrooms, can be 

particularly triggering for those who have 

abuse histories. Poor lighting or building 

security and a lack of control over personal 

space and belongings can also trigger 

past feelings of fear and helplessness. Key 

safety features include providing adequate 

lighting inside and outside of the program, 

making sure consumers can lock bathroom 

doors and have locked spaces for their 

belongings when applicable, and having 

a program securing system (see Figure 2). 
Trauma-Informed Care for Women Veterans Experiencing Homelessness 27 

For female veterans, creating a safe and 

welcoming physical space includes offering 

spaces just for women and incorporating 

military-related decorations and materials 

that include and are relatable to women 

veterans. 

Establishing a supportive 

Environment 

In addition to ensuring physical safety, 

establishing a supportive environment is 

an essential aspect of trauma-informed 

care. How consumers are welcomed and 

how staff responds to their individual 

needs sets the stage for future success 

or difficulty. Establishing a safe and 

welcoming emotional environment 

requires programs to create a culture of 

open communication, tolerance, respect, 

and community. Trauma-informed 

programming involves providing 

consumers with as much information 

as possible; being aware of the impact 

of culture; demonstrating respectful 

interactions; maintaining consistency; 

predictability and transparency; and 

thinking proactively. 

information sharing 

Experiences of trauma leave people feeling 

helpless and powerless. To avoid recreating 

these same feelings, providers must be 

conscious of sharing detailed information 

about program rules, expectations, 

schedules, etc. Providing consumers 

with information enhances their sense of 

safety and control. Traumatic experiences 

can have a significant impact on 

people’s ability to integrate information, 

particularly under stressful circumstances. 

This potential difficulty in assimilating 

information requires providers to be 

ready to review agency information on a 

continual basis. Information about rules 

and consumer rights needs to be given to 

consumers verbally and in written form, 

and posted throughout the building. 

Programs should also post information 

about trauma, how it impacts people, and 

available trauma-specific resources. For 

organizations that serve female veterans, 

information sharing should be tailored to 

address the experiences and needs of this 

group. Topics should include information 

about different types of trauma, including 

military sexual trauma, information on 

community- and Web-based resources for 

female veterans, and local VA resources. As 

female veterans sometimes do not selfidentify, it may also be helpful to change 

intake procedures to not ask for veteran 

status, but rather any military service 

experience, and to provide information 

that government and community-based 

services are available to those without 

combat experience or physical injuries. 

Figure 2: tips for enhancing the physical environment 

•	 Put up colorful, culturally diverse artwork.

•	 Incorporate military-related decorations that include female veterans.

•	 Incorporate living items into the decorating such as plants and fish tanks.

•	 Integrate child-friendly areas, decorations, and engaging play materials

when appropriate. 

•	 Provide calming music.

•	 Have comfortable, soft seating.

•	 Offer quiet rooms or spaces and places to exercise.

•	 Have rocking chairs/gliders.

•	 Involve consumers in designing and decorating the space.

•	 Set up an “environment” committee where consumers can determine ways

in which they would like to improve/change the physical space. 
28 Trauma-Informed Care for Women Veterans Experiencing Homelessness 

cultural competence 

While traumatic events happen to people 

from all racial and ethnic backgrounds, 

culture plays a significant role in the types 

of trauma that may be experienced, the 

risk for continued trauma, how survivors 

manage and express their experiences, 

and which supports and interventions 

are most effective. Violence and trauma 

have different meanings across cultures, 

and healing takes place within one’s own 

cultural system. For the female veteran 

population, cultural awareness includes 

developing “military cultural competence” 

or an understanding of the military culture 

and how that impacts a service member’s 

world view (see Figure 3). Military cultural 

competence includes understanding the 

spoken and unspoken “rules” within the 

military culture; the fundamental attitudes, 

values, and beliefs that drive the military 

system; and the unique experiences of 

female veterans. For example, talking 

about trauma that occurred while servin

may be viewed as disloyal or taboo for 

many female veterans based on their 

experiences within the military system. 

The military’s culture of independence 

and self-sufficiency may impact a vetera

desire to ask for and accept help from 

others, particularly service providers wit

a limited understanding of the military. 

g 

n’s 

h 

Cultural awareness may also include 

offering people opportunities to engage 

in various cultural rituals or religious 

services, cook specific foods, speak in 

their language of origin, and access peer 

supports. A culturally competent approach 

helps to create a respectful environment 

in which survivors can begin to rebuild 

a sense of self and a connection to their 

communities. 

Privacy and confidentiality 

Often, trauma survivors (in this case 

female veterans who have experienced 

trauma) have had their privacy violated 

and their dignity taken away. Respecting 

privacy and confidentiality includes: 

asking permission and outlining clear 

boundaries before entering consumers’ 

spaces; providing private, confidential 

spaces to conduct assessments and have 

conversations with consumers; addressing 

individual issues in private; avoiding 

having discussions about consumers in 

public places; and clearly explaining the 

limits of privacy and confidentiality. 

safety and crisis Prevention 

Planning 

Trauma-informed care requires proactive 

interventions that consider potential 

safety issues ahead of time. Considering 

the high rates of violence in the lives 

of homeless female veterans, ways to 

incorporate proactive responses into daily 

practice include creating plans to keep 

female veterans safe from outsiders such 

as violent partners who may try to locate 

them (e.g., safety plans) and helping 

them to identify and respond to potential 

triggers before they become overwhelmed 

(e.g., crisis prevention plans or “self-care 

plans”). These plans are most effective 

when they are in writing, developed before 

the crisis happens, communicated to all 

providers working with a veteran, and 

incorporated into individual goals and 

plans. Components of a crisis prevention 

plan can be found in Figure 4. 

“I learned in the military to take care 

of my own business. If I go report 

this, it will be public knowledge. We’re

taught to do our own thing, not ask for

help.” 

—Female Veteran 

Figure 3: components of military cultural competence 

•	 General military knowledge (e.g., language, acronyms,

branches of service, rules/regulations, processes) 

•	 Ongoing information-gathering regarding the experiences

of military service members (in-person interviews and focus 

groups; and online tools and resources offering a perspective 

on military service, combat and the experiences of specific 

populations, including female veterans) 

•	 An understanding of the military culture among and across

branches of service 

•	 An understanding of the VA system (processes, benefits,

services, eligibility) 

•	 Knowledge of how the military culture impacts a veteran’s

world view 

(Greendlinger & Spadoni, 2010) 
 

Trauma-Informed Care for Women Veterans Experiencing Homelessness 29 

open and respectful communication 

Trauma survivors often enter service 

settings with past experiences that include 

being mistreated, ignored, and silenced. 

For female veterans who have experienced 

trauma while in the military, there is 

often a sense of secrecy and a feeling that 

it is unacceptable to report incidences 

of harassment or violence for fear of the 

personal and professional ramifications. 

Providers are faced with the challenge 

of encouraging honest communication 

with consumers and demonstrating an 

ability to listen to and accept the range 

of thoughts and feelings that consumers 

may share. Open communication with 

consumers involves using active listening 

skills such as open-ended questions, 

affirmations, and reflective listening (see 

Miller and Rollnick on p. 82). These 

techniques are designed to demonstrate 

respect and empathy for the consumer 

experience at any given moment. 

Respectful communication also involves 

an awareness of the language used to talk 

to or about consumers. This includes 

using “people first language” such as 

“people experiencing homelessness” rather 

than “homeless people” and avoiding 

negative and derogatory labels that foster 

disrespect (e.g., referring to the consumer 

as “manipulative” or “lazy”). This type of 

communication also focuses on a person’s 

strengths and capabilities as opposed to 

her deficiencies. Female veterans take 

pride in their military service and the 

skills that they have developed. These 

unique qualities and strengths should 

be acknowledged as part of establishing 

respectful dialogue. 

consistency and Predictability 

Feelings of uncertainty and confusion can 

trigger intense trauma responses related to 

past experiences. Maintaining a consistent 

and predictable environment can help 

to instill a sense of calm, which in turn 

allows the consumer to focus on recovery. 

Consistency at the service level creates 

trust between the female veteran and the 

provider, and serves as a foundation for 

building healthy relationships. Ways to 

establish consistency and predictability 

with consumers include having regular 

meetings; keeping and being on time 

for appointments; following up on the 

veteran’s requests or concerns; clearly 

defining roles and boundaries; and 

maintaining empathetic responses to 

consumers in the face of both successes 

and setbacks. 

Figure 4: creating consumer crisis prevention plans 

A written, individualized consumer self-care or crisis-prevention plan 

should include the following: 

•	 A list of situations that the consumer finds stressful or

overwhelming and remind her of past traumatic experiences (e.g., 

triggers) 

•	 Ways that the consumer shows that she is stressed or overwhelmed

(e.g., types of behaviors, ways of responding, etc.) 

•	 Staff responses that are helpful when the consumer is feeling upset

or overwhelmed 

•	 Staff responses that are not helpful when the consumer is feeling

upset or overwhelmed 

•	 A list of people to go to for support

(Guarino et al., 2009) 

“We’re strong. I walked 

miles and miles for over 

three months straight. I had 

to prove myself every day. 

There should be just a little 

bit more respect than what 

we get.” 

—Female Veteran 
30 Trauma-Informed Care for Women Veterans Experiencing Homelessness 

domain 3: assessing and 

planning serVices 

In all service settings, completing a 

thorough intake assessment and referring 

consumers to appropriate services is 

essential to providing quality care. 

Considering traumatic experiences and 

the impact of these experiences on female 

veterans should be a routine part of the 

assessment and service planning process. 

In addition, when serving female veterans, 

their veteran status and related service 

needs must be a routine part of the intake 

process (see Figure 6 on p. 31). 

conducting intake assessments 

People who have experienced trauma 

have specific needs that may remain 

mislabeled or misinterpreted if their 

history of trauma is not addressed as part 

of the intake process. Research indicates 

that female veterans who are homeless 

have suffered high rates of trauma in 

childhood and adulthood, within and 

outside of their military service. Therefore, 

the intake assessment process should 

include questions regarding emotional, 

physical, and sexual abuse and other types 

of trauma (e.g., military sexual trauma, 

combat-related stressors). Given the high 

rate of domestic violence within the female 

veteran population, it is important to 

include questions about current levels of 

danger from other people (e.g., restraining 

orders, history of domestic violence, 

and threats from others). In light of the 

increase in women serving in combat 

roles, it is also important to ask about 

previous head injuries. Given the risk 

for post-traumatic stress disorder and 

traumatic brain injury among female 

veterans, screening tools should be used 

to diagnose these issues. 

Intake assessments involve asking 

consumers to meet with a new person 

and share intimate details about their 

life experiences, including experiences 

of trauma. This process involves sharing 

information that is often emotionally 

painful. This experience can be intense 

and may trigger many difficult feelings and 

emotions for the consumer. It is important 

for providers to be aware of these 

challenges throughout the intake process. 

This means creating an environment 

that is as safe, secure, and respectful as 

possible during the assessment process. 

Conducting the intake assessment in a 

trauma-informed manner may include 

conducting the intake in a private space; 

offering consumers options about where 

to sit, who is in the room with them, and 

what to expect; asking consumers how 

they are doing throughout the assessment; 

offering water and breaks; and being aware 

of body language that may indicate that a 

consumer is feeling overwhelmed. Using a 

strengths-based approach also sets a tone 

of respect for the consumer and enhances 

the process of relationship-building 

between consumer and provider. 

Intake assessments are only the first 

step in a process of linking people with 

appropriate services. Consumers should 

be referred for more in-depth assessments 

when there is a need for further 

intervention and more specific types of 

services that require outside professionals. 

For programs serving female veterans, this 

means determining eligibility for VA and 

non-VA benefits and services and helping 

women connect to these resources. 

Figure 5: important services to consider 

For Homeless Female Veterans 

•	 Individual and group therapies to address the impact of trauma

•	 Substance abuse treatment options

•	 Gender-specific services and service providers

•	 Peer-to-peer supports

•	 Job programs and skills-training

•	 Legal assistance that includes, but is not limited to, child support

•	 Housing programs/vouchers for Veterans

•	 Child care options
Trauma-Informed Care for Women Veterans Experiencing Homelessness 31 

Developing goals and Plans 

For trauma survivors, developing 

goals and plans for obtaining housing, 

employment, and other types of services 

may seem intimidating and overwhelming. 

In these situations, it is easy for the 

consumer to “freeze” and for providers 

to take over. This pattern only serves to 

recreate past traumatic experiences and 

dynamics, and leaves consumers feeling 

helpless and powerless. Encouraging and 

helping consumers to create their own 

goals allows them to take control of their 

lives and futures. Trauma-informed goal 

planning is individualized; goals and 

plans are reviewed on a regular basis and 

updated as needed. 

offering services and supports 

to female Veterans Experiencing 

Homelessness 

Female veterans often require a number 

of services and supports, both emotional 

and instrumental. A community-based 

organization may provide many of 

these services in-house, or it may make 

referrals to other agencies, including the 

VA when applicable. A trauma-informed 

agency makes it a priority to facilitate 

communication among different service 

providers. Making referrals to agencies 

that have expertise in working with trauma 

survivors is a good first step towards 

assuring that female veterans receive 

adequate mental health services. Female 

veterans have also voiced their desire for 

all-female therapy and support groups, 

including groups that address the impact 

of trauma. Opportunities for peer-to-peer 

support are important to female veterans 

who are looking to connect with and learn 

from others with similar experiences (see 

Figure 5 on p. 30). 

Figure 6: essentials for assessing and planning services with Female 

Veterans Who are Homeless 

Intake Assessments 

Intake assessments include questions about: 

•	 Personal strengths.

•	 Current level of danger from other people (e.g., restraining orders, history of

intimate partner violence, threats from others). 

•	 Suicidal thoughts and behaviors.

•	 Military service (branch, rank, job in the military).

•	 Experiences in the military.

•	 History of trauma (e.g., physical, emotional, or sexual abuse; neglect; loss;

intimate partner violence; community violence; combat-related experiences; 

military sexual trauma; past homelessness). 

•	 Head injury.

•	 Past experiences with VA/Vet Center-based services.

Intake assessment tools include: 

•	 A screening for post-traumatic stress disorder.

•	 A screening for traumatic brain injury.

Based on intake assessments: 

•	 Program staff determines female veterans’ eligibility for VA and non-VA

benefits and services. 

Developing Goals and Plans 

The following are basic components of goal development that are assumed to be 

routinely implemented: 

•	 Goals are generated by the female veterans themselves.

•	 Goals are recorded in written, individualized plans.

•	 Goals are reviewed and updated regularly.
32 Trauma-Informed Care for Women Veterans Experiencing Homelessness 

The impact of trauma is often felt at 

the body level. It may be extremely 

difficult for trauma survivors to verbalize 

their thoughts, feelings, and memories 

related to their trauma. It is helpful for 

organizations to provide opportunities 

for consumers to express themselves 

using alternate strategies (e.g., art, theater, 

dance, movement, and music). 

In addition to emotional supports, female 

veterans who are homeless identify a 

number of practical or instrumental 

supports that are necessary to achieve 

stability. These include legal services, 

educational advocacy, job skills-building, 

housing services, transportation, and child 

care. While an organization may not offer 

all of these services, it is important that 

providers increase their rolodex of possible 

services for homeless female veterans based 

on an understanding of eligibility rules and 

available benefits. There is also a need for 

female veterans to have access to genderspecific care when possible. 

For community-based service agencies, 

a significant aspect of serving homeless 

female veterans involves outreach to Vet 

Centers and the VA, including identifying 

and connecting with the state VA 

designated Women Veterans Coordinator. 

It is also helpful for organizations that 

are educated about needs of homeless 

female veterans to provide outreach to 

other community providers as they learn 

about available resources (e.g., through 

fliers, workshops, stand-downs). According 

to homeless female veterans and service 

providers, this type of community 

outreach is lacking. As a result, many 

women do not access the services that they 

have earned. 

staffing and Hours 

Throughout the listening sessions, female 

veterans expressed concern about their 

lack of access to female service providers. 

For women who have a history of abuse 

by men, working with men can be very 

“triggering,” reminding them of past 

trauma and impacting their ability to build 

a relationship with a male service provider. 

Some women had positive experiences 

with male providers; however, there was 

an overall preference for female service 

providers. In addition to female service 

providers, female veterans preferred 

providers who were veterans themselves 

or had a military affiliation, such as the 

parent of a military member. Service 

providers also expressed that it is easier 

to work with veterans if you are a veteran 

yourself. If a provider is not a veteran, she 

can be successful, but it may take longer 

to build rapport, and building military 

knowledge is a key component to making 

these connections and providing support. 

Female veterans who are homeless 

often struggle to manage all of the 

requirements necessary to maintain 

housing, employment, mental health, 

etc. Consistent across listening sessions 

with female veterans was the need for 

organizations to have more flexible hours, 

particularly for women who work day and 

evening shifts. 

domain 4: inVolVing 

consUmers 

Recovery and success for trauma survivors 

is largely based on their ability to regain 

control of their lives. Female veterans 

who are homeless have experienced 

many events, both interpersonal and 

economic, that have resulted in a loss of 

control over their lives. Organizations 

can facilitate empowerment by giving all 

consumers, including female veterans, a 

voice in what happens on a daily basis in 

the program. Giving consumers a voice 

can begin by facilitating regular meetings 

where consumers can address questions, 

concerns, and ideas about the program. 

Involving consumers also means providing 

opportunities for them to be directly 

involved in developing program activities 

and evaluating program practices. In the 

case of female veterans, this may include 

having veterans involved in developing 

programming for other veterans. Involving 

consumers in program development 

enhances the quality of the services 

provided and affirms the belief that 

consumers are the experts in what works 

best for them (see Figure 7 on p. 33). 

Former consumers have a unique and 

invaluable perspective. People who have 

experienced homelessness in the past 

know first-hand what was helpful and 

what was not along their road to recovery. 

veterans have a unique perspective that 

offers an advantage when providing 

services to other veterans. It is important 

“In order to be trauma-informed, an 

organization must integrate consumers 

in designing, providing, and evaluating 

services. Significant consumer 

involvement not only creates a better 

program, but provides an empowering 

growth experience for the consumers 

involved.” 

(Elliot et al., 2005) 
 

 

Trauma-Informed Care for Women Veterans Experiencing Homelessness 33 

Figure 7: tips and strategies 

for involving consumers 

•	 Support consumers running a

“resident voice” meeting and put 

them in charge of developing 

the agenda and facilitating the 

discussion. 

•	 Provide consumers with choices

about their services. If there 

is a minimum requirement of 

mandatory services, make more 

services available to offer choices. 

•	 Give consumers opportunities to

evaluate the program and offer 

their suggestions for improvement 

in anonymous and/or confidential 

ways (e.g., suggestion boxes, 

regular satisfaction surveys, 

meetings focused on necessary 

improvements). 

to involve formerly homeless staff and 

women veterans in program development 

and service provision (e.g., peer-run 

support groups, question and answer 

sessions, educational and therapeutic 

groups). Organizations can make a 

broader commitment to involving former 

consumers by recruiting people to their 

board who have similar experiences to 

those being served in the program (e.g., 

veterans, formerly homeless men and 

women) and hiring them as paid program 

and operations staff. 

domain 5: adapting 

policies 

Establishing Written Policies 

Establishing policies that protect the safety 

and well-being of those being served is 

essential to providing quality care. A traumainformed organization considers trauma 

and its impact when creating policies to 

avoid recreating feelings associated with 

traumatic experiences (e.g., powerlessness, 

shame, lack of control, etc.). As the needs 

of consumers evolve and the role of the 

organization changes, policies that were once 

effective may no longer be helpful. 

Trauma-informed policies include a formal 

acknowledgement that consumers have 

experienced trauma and a commitment 

to understand trauma and its impact and 

engage in trauma-sensitive practices. As part 

of this commitment, programs establish 

written policies based on an understanding 

of the impact of trauma on consumers. 

Agencies focus first on creating policies 

that address issues of safety, including 

the program’s response to threats made 

to consumers by others outside of the 

program. A policy outlining the program’s 

response to a consumer crisis is also 

important when serving trauma survivors 

who may frequently feel unsafe within 

their own bodies. Organizations who serve 

female veterans should also have a written 

commitment to understanding the needs 

of this population and tailoring services to 

meet these needs. Within a trauma-informed 

agency, there is a formal commitment to 

hire staff with similar life experiences to 

those being served. In organizations serving 

homeless female veterans this includes hiring 

staff who have experienced homelessness 

and providers who are veterans themselves 

(see Figure 8). 

reviewing Policies 

Creating trauma-informed organizations 

requires continual review of policies to 

see what works and what may be retraumatizing to trauma survivors. For 

policies to be effective, they must be 

enforced properly, considered helpful, 

and not be re-traumatizing. The more an 

organization’s staff learns about trauma, 

the more modifications it may need to 

make to their policies and services. A 

regular review of policies will be required 

to update practices and guidelines to make 

them as relevant as possible to the people 

being served. The effectiveness of policies 

and the impact of enforced policies on 

consumers can be accurately assessed only 

when staff and consumers are part of the 

policy review process (see Figure 9 on p. 

34). 

Figure 8: essential policies 

for serving Female Veterans 

Who are Homeless 

• The program has a written

statement that includes a 

commitment to understanding 

trauma and engaging in traumasensitive practices. 

The program has a written

statement that includes a 

commitment to understanding 

the needs of female veterans and 

tailoring services to meet those 

needs. 

The program has a written

commitment to hire female 

veterans and formerly homeless 

female veterans. 

•

•
34 Trauma-Informed Care for Women Veterans Experiencing Homelessness 

Figure 9: tips and strategies for reviewing policies 

When evaluating policies or rules, here are some helpful criteria: 

•	 Is this policy or rule necessary?

•	 What purpose does it serve?

•	 Who does it help? Who does it hurt?

•	 Does the policy facilitate/hinder consumer inclusion and control?

•	 Were consumers included in its development?

•	 Could this policy or rule re-traumatize the consumer (e.g., limit consumer control and power or lead to fear

and confusion)?

•	 Does this policy require additional tailoring to meet the needs of female veterans?

domain 6: Working WitH 

cHildren 

Children of military families face unique 

challenges. Children have to cope with the 

stress of moving periodically to new bases; 

having a parent deploy, be absent, and 

reintegrate; and potentially managing a 

parent’s death or injury. For some children, 

these experiences may be overwhelming or 

even traumatic. Becoming homeless adds 

an additional layer of stress that can have 

a significant impact on a child’s health 

and well-being. As more female veterans 

with children are returning to unstable 

living conditions and limited employment 

opportunities, the number of homeless 

veteran families is likely to increase. 

The homeless service system is focused on 

meeting the needs of adults. Obtaining and 

maintaining housing and employment are 

among the first steps towards stability and 

success for the family as a whole. However, 

this focus on adults means that children’s 

needs are often overlooked. The impact 

of trauma on child development and the 

parent/child relationship is profound, and 

it is essential that children receive services 

as soon as possible to lessen the negative 

impact of these experiences on their 

emotional, physical, cognitive, and social 

development. To meet children’s needs, 

questions about their exposure to trauma 

must be included in the intake assessment. 

In addition to questions about traumatic 

experiences, it is important to ask about 

children’s achievement of developmental 

tasks, and the quality of the parent/ 

child relationship. Providing thorough 

intake assessments often results in a 

need for access to child-specific services. 

Organizations serving homeless women 

and their children should be prepared to 

make referrals to agencies that provide 

the following services: early intervention, 

mental health, physical health, and 

education. For children of veterans, it 

is important to ask about the children’s 

experiences during a parent’s deployment 

and upon their return. It is helpful for 

organizations serving female veterans to 

make connections with agencies that offer 

child-specific services that are also specific 

to children of veterans, and familiarize 

themselves with printed materials and 

online resources for this population. In 

smaller ways, programs can focus on 

children’s needs by incorporating childfriendly materials and providing a space for 

children to play (see Figure 10 on p. 35). 

a word about children . . . 

Traumatized children may behave in ways 

that are consistent with a diagnosis of 

attention deficit hyperactivity disorder, 

bi-polar disorder, oppositional-defiant 

disorder, or reactive-attachment 

disorder (Cook et al., 2005). Without 

a thorough assessment that includes a 

history of trauma, providers are likely to 

make a diagnosis or label a child based 

on presenting behaviors and miss the 

traumatic experiences that may be the 

source of the symptoms and the necessary 

focus of treatment. 
Trauma-Informed Care for Women Veterans Experiencing Homelessness 35 

Figure 10: tips for supporting children 

•	 Provide child-friendly spaces in your facility. Child-friendly spaces include

developmentally appropriate toys, chairs, and books; colorful pictures and 

paintings; and learning materials and posters with “feelings faces” and 

“feelings thermometers” to foster skill-building. 

•	 Identify “safe spaces” for children to go when they are feeling

overwhelmed. These safe places may include: 1) a reading corner in a 

classroom; 2) the guidance counselor’s office or an area of the playroom 

separate from the main activities; 3) a particular chair in an office; and 4) a 

“calming room” where children can draw, listen to music, rock in a chair, 

or take a nap. 

•	 Create child-specific crisis prevention plans that include: 1) a list of

triggers; 2) a list of “warning signs” that a child is escalating or becoming 

overwhelmed; 3) responses that are helpful when a child is in distress (e.g., 

physical touch, space away from the group, offering him or her a specific 

toy or stuffed animal); 4) responses that are not helpful when a child is in 

distress (e.g., physical touch, multiple adults attempting to help, offering 

to call a child’s parent); and 5) safe people and places for a child when he 

or she needs to calm down. 
SeCtIon 4
 imPlEmENtiNg tHE sElf-assEssmENt 
	 	 	 	 	 	 	 	 	 	 	

	 	 	 	 	 	 	 	

	 	 	 	 	 	 	 	 	

Trauma-Informed Care for Women Veterans Experiencing Homelessness 37 

section 

4ImplementIng the Self-aSSeSSment

i. Becoming trauma-informed 

Creating a trauma-informed organization requires system-wide 

transformation. This type of change is not found just at the 

direct care level or only in the administrative arena. Becoming 

trauma-informed requires a commitment to changing the 

practices, policies, and culture of the entire organization. This 

type of change requires staff at all levels and in all roles to 

modify what they do based on an understanding of the impact of 

trauma and the specific needs of trauma survivors. This section 

outlines the steps to begin the process of becoming traumainformed and implementing specialized practices to meet the 

needs of homeless female veterans. These steps are based on 

The National Center’s experiences and lessons learned while 

working with community-based organizations as they moved 

through the assessment process and worked to create changes 

in both individual behaviors and organizational processes. An 

organization’s ability to move through this step-by-step process 

will depend on several factors including staffing, resources, and 

time. 

BUilding knoWledge and gaining BUy-in 

Becoming trauma-informed is an ongoing process that begins by 

raising awareness through education and training about trauma 

and its impact and gaining buy-in from staff across an agency to 

make changes based on this knowledge. 

step 1: 

The program has a person or group of people who have the 

desire to help their organization become trauma-informed. 

At least one of these people has the authority to make systemwide changes in the program. This person or group of people 

is willing to shepherd the program through the transformation 

process. These are the “leaders” or “champions of change” for 

the organization. 

Tips and Strategies: 

•	 It is helpful to have co-leaders to facilitate the change

process so that one person is not the sole champion of this 

cause. 

•	 Try to choose trauma-informed leaders who represent

different roles in the organization (e.g., the program 

director and a case manager). This increases buy-in across 

the organization and assures that many different voices are 

heard. 

•	 Program leaders must have the authority to institute

programmatic change and the support of the broader 

agency to implement these changes. Program leaders 

who are dedicated to the change process but have no 

real authority to make programmatic changes will have a 

difficult time implementing new practices and creating a new 

culture. Program leaders also need to be given the time in their 

work life to devote to the change process. Without the time 

to devote to the process, change efforts are likely to fall by 

the wayside. 
	 	 	 	 	 	 	 	 	 	 	 	 	

	 	 	 	 	 	 	 	 	 	 	 	

	 	 	 	 	 	 	 	 	 	 	 	

	 	 	 	 	 	 	 	 	 	

38 Trauma-Informed Care for Women Veterans Experiencing Homelessness 

step 2: 

In order to “set the stage” for trauma-informed organizational 

change, program leaders introduce the concept of becoming 

trauma-informed and the need for organizational change (see 

Resource Lists on p. 73). Education and discussions about these 

concepts can be done in all-staff meetings, in smaller lunch 

meetings or shift change meetings, or in whatever ways work best 

in your program to include everyone in the conversation. 

Tips and Strategies: 

•	 It is important to clarify that this process is not just about

increasing individual trauma knowledge, but about setting 

the stage for organization-wide change. 

•	 Addressing the need for change with all staff is not a onetime conversation. Commitment to change is a process 

that requires ongoing discussions around what it means 

to be trauma-informed and what it will take to begin the 

transformation. 

•	 All staff needs to have an understanding of how the change

process is going to begin and what to expect moving 

forward. 

step 3: 

The concept of being trauma-informed involves educating all 

staff on how to respond in a safe and sensitive manner. Before an 

organization uses the Self-Assessment to develop goals and plans, 

it is important that all staff receive basic training and education 

on the following: 1) what trauma is and how it impacts people; 

2) the relationship between homelessness and trauma; 3) 

traumatic stress and its impact on the lives of homeless female 

veterans; 4) information about what it means to provide traumainformed care; and 5) education on the unique needs of female 

veterans who are homeless. Training recipients include everyone 

from the executive director to administrative assistants and 

maintenance staff. This type of foundational education ensures 

that everyone is using the same language and working from a 

similar level of understanding. The National Center has included 

a list of resources on page 73 that offers programs a variety of 

possibilities for educating staff on these topics, particularly when 

more formal in-person trainings by outside experts are not an 

option. 

Tips and Strategies: 

•	 When using outside trainers, it is helpful (when possible)

to have experts who can also provide ongoing consultation 

and can be called on for additional help and support during 

other steps in the change process. 
	 	 	 	 	 	 	 	 	 	

	 	 	 	 	 	 	 	 	 	 	 	

	 	 	 	 	 	 	 	

Trauma-Informed Care for Women Veterans Experiencing Homelessness 39 

step 4: 

Once all staff have participated in the initial discussions about 

the need for change (Step 2) and have received a more formal 

training in trauma, trauma-informed care, and the specific 

experiences and needs of female veterans (Step 3), it is essential 

that the program leaders evaluate the organization’s interest in 

and readiness for change. If staff “buy-in” is an issue or if there 

are conflicting views within the organization about whether 

this type of change is necessary or helpful, these issues must be 

addressed before the Self-Assessment is introduced as a tool for 

change. 

Tips and Strategies: 

•	 It is important to read and acknowledge staff frustrations

or confusion about the need for change early in the process. 

Use initial meetings to gauge readiness. If there is an 

overarching negativity about change, program leaders may 

want to think about how to begin the process more slowly 

and on a smaller scale. (For example, start with additional 

training and conversations before beginning to talk about 

evaluating and changing program practices.) 

•	 In order to gain buy-in, the process has to identify “hooks”

for all participants, addressing the benefits of becoming 

“trauma-informed.” For some staff, the “hook” may 

be improved safety due to a reduction in patterns of 

interaction that are more likely to lead to escalation and 

crises. For others, directly addressing the emotional impact 

of this work on the provider, via discussions of secondary 

trauma, is immensely relieving and worthwhile. For some, 

gaining insight into the effective treatment strategies 

and approaches for consumers previously thought to be 

“untreatable” is the value. The possibility of improved 

outcomes as a result of trauma-informed programming 

provides administrators with the potential for new funding 

opportunities or evidence that this type of work has benefits 

for the broader system. 

•	 Communication is an important key to success. If

communication between staff is strong, it is easier to lay 

out a plan and assess people’s interest, understanding and 

readiness. If communication between staff members in 

various roles is a challenge, it is essential that these issues be 

resolved before attempting to make system-wide changes 

that will require ongoing dialogue and peer support. 

step 5: 

Program leaders introduce the Self-Assessment (see SelfAssessment on p. 50) as a tool to help the organization become 

trauma-informed and, more specifically, to better meet the 

needs of homeless female veterans. Leaders explain that the SelfAssessment includes a list of concrete practices that should be 

incorporated into daily programming in a “trauma-informed” 

organization that serves homeless female veterans. Leaders 

inform staff members that they will begin by evaluating the 

extent to which the program currently incorporates the practices 

outlined in the Self-Assessment and, based on the results, develop 

an action plan for implementing those practices that are not 

currently being used. Organizations may choose to have their 

staff complete the entire Self-Assessment at once, or complete 

it one category at a time (e.g., start with “Supporting Staff 

Development” or “Creating a Safe and Supportive Environment” 

and move on to additional categories later). 
 

 

	 	 	 	 	 	 	 	 	 	 	 	 	

 

	 	 	 	 	 	 	 	 	 	 	 	 	 	

	 	 	 	 	 	 	 	 	

 

	 	 	 	 	 	 	 	 	 	 	 	

	 	 	 	 	 	 	 	 	 	 	 	

	 	 	 	 	 	 	 	 	 	 	 	 	

40 Trauma-Informed Care for Women Veterans Experiencing Homelessness 

completing tHe selF-assessment 

step 6: 

Agency leaders provide each staff member with a copy of the SelfAssessment, review instructions for completion, and set a deadline for 

when the completed Self-Assessment should be returned. Instructions 

are provided in ways that everyone can understand. Confidentiality of 

answers is reinforced to ensure that staff members are able to answer 

freely and with no repercussions for honesty. Information from this 

assessment process is an essential component of goal-setting moving 

forward. 

Agency staff completing the Self-Assessment are asked to read 

through each item and use a scale ranging from “Strongly 

Disagree” to “Strongly Agree” to evaluate the extent to which they 

agree that their program incorporates each practice into daily 

programming. Staff members are asked to answer based on their 

experience in the program over the past six months. 

Example: “Material is posted about available benefits for women 

veterans.” Staff respond “Strongly Disagree, Disagree, Agree, 

Strongly Agree, Do Not Know, or Not Applicable to My Program.” 

Staff responses should remain anonymous, and staff should be 

encouraged to answer as honestly and accurately as possible. Staff 

members are not evaluating their individual performance, but 

rather the practices of the organization as a whole. Staff should 

complete the Self-Assessment when they have time to consider 

the items carefully. The Self-Assessment may be completed in 

one sitting or it may be filled out section by section. 

Tips and Strategies: 

• It is recommended that programs give staff a period of time,

whether at a staff meeting or another designated time, to focus 

specifically on completing the Self-Assessment. 

•	 People are less likely to invest in a process if they feel that

their feedback will not ultimately be used. Explaining the 

ways that the program will take all information given by 

staff into consideration when developing goals is a way to 

empower all individuals in the program to feel that they are 

contributing to the change process. 

•	 Staff members in different roles often have different

perspectives on the program and what needs to change. 

Becoming trauma-informed involves reconciling these 

perspectives and including staff at all levels in regular 

discussions about how to be more trauma-informed. 

step 7: 

All staff members complete the Self-Assessment within the 

designated timeframe (this will vary by program and will be based 

on discussions between program leaders and staff). There should 

be a designated box or location where staff can return the SelfAssessment. 

Tips and Strategies: 

•	 It is helpful for program leaders to be available to offer

additional help and support throughout the assessment 

process. There may be confusion about specific items in the 

Self-Assessment, and asking clarifying questions increases the 

likelihood of accurate answers. 

•	 It is important to remind people that they are not assessing

their behaviors alone, but rather the daily practices of the 

organization as a whole. 

•	 It can be difficult for staff members to talk about a program’s

weaknesses without feeling defensive. It is helpful to present 

this process as an opportunity for change and growth rather 

than a judgment on the program. 
Trauma-Informed Care for Women Veterans Experiencing Homelessness 41 

compiling tHe resUlts oF tHe selF-assessment 

step 8: 

The following is a suggestion for how to gather responses and examine results: Using an Excel spread sheet, enter each staff 

member’s response to each item in the Self-Assessment. 

Example: 

I. Staff Development Staff Member 1 Staff Member 2 Staff Member 3 

A. Training & Education 

Staff receive training on the following topics: 

1. What traumatic stress is Strongly Agree Agree Do Not Know 

2. How traumatic stress affects body and 

brain Agree Disagree Agree 

3. Military Sexual Trauma Strongly Disagree Strongly Agree Agree 

Using the information entered above, count the total number of Strongly Disagree, Disagree, Agree, Strongly Agree, Do Not Know 

and Not Applicable responses for each item. Enter these totals on a blank Self-Assessment that can be copied and distributed to all 

staff. 

Example: 

I. Staff Development 

A. Training & Education Strongly 

Disagree 

Disagree Agree Strongly 

Agree 

Do Not 

Know 

Staff receive training on the following topics: 

1. What traumatic stress is 1 1 1 

2. How traumatic stress 

affects body and brain 1 2 

3. Military Sexual Trauma 1 1 1 
	 	 	 	 	

	 	 	 	 	 	 	

	 	 	 	 	

 

42 Trauma-Informed Care for Women Veterans Experiencing Homelessness 

Understanding tHe resUlts 

step 9: 

Agency leaders bring staff together to begin conversations about 

the results of this organizational assessment process. These 

conversations may begin in staff meetings or in smaller group 

meetings, based on what is realistic and feasible for the program. 

Community-based organizations may decide to form a smaller 

multi-disciplinary group that examines results and reports back 

to the larger staff with ideas for possible program changes. 

To identify areas for change, the organization leaders and other 

champions of becoming trauma-informed should look at the 

following: 

•	 Specific practices in the Self-Assessment that most staff “Do 

Not Agree” are being done in the program (responses were 

“Disagree” or “Strongly Disagree”) 

•	 Specific areas that many people responded “Do Not Know,” 

which may mean that these things are not being done or that 

there is a lack of staff understanding about what is being 

done in the program 

•	 Items that had a range of responses, with some staff strongly 

agreeing that this practice is done, and others strongly 

disagreeing. These are helpful to clarify 

The following is an example of how this process may work: 

The staff in the veteran department at Interfaith Community 

Services in Oceanside, CA, completed the Self-Assessment. 

Assessments were returned to the designated point person, a 

mental health therapist in the program. Staff responses were 

tallied, and the results were examined. The program therapist 

looked for areas where there were a high number of “disagree” 

and “strongly disagree” responses, indicating that most people 

felt these practices were not being done, highlighting the areas 

for improvement. The Associate Director of Veterans Services 

also reviewed the results. Interfaith pulled together a “traumainformed committee” consisting of five staff members in various 

roles, who met to decide on specific goals and next steps for the 

program. 

Reviewing results can take a considerable amount of time and 

focus. It may be helpful to examine the results one domain at a 

time. For example, start with the “Supporting Staff Development” 

domain and clarify practices that are and are not being done 

before moving on to the second domain, “Creating a Safe and 

Supportive Environment.” 
 

	 	 	 	 	 	 	 	 	 	 	 	

	 	 	 	 	 	 	 	 	 	

	 	 	 	 	 	 	 	 	

Trauma-Informed Care for Women Veterans Experiencing Homelessness 43 

deVeloping a strategic plan 

step 10: 

A strategic plan for the program includes the following: 

1) identified and agreed upon goals; 2) specific steps to reach 

each goal; 3) resources needed to achieve each goal; 4) a realistic 

timeframe for achievement of each goal; and 5) the names of 

people responsible for monitoring progress. When identifying 

areas of change, the program may choose to focus on one domain 

at a time or identify specific short-term and long-term goals 

within several of the domains. Each goal includes the necessary 

action steps, resources, timeframe for achievement, and persons 

responsible for monitoring progress towards the goal. 

The sample described on page 44 can be used for all goal-setting 

that a community-based organization does based on the results of 

the assessment process. 

Tips and Strategies: 

•	 It is very important that the goals identified are realistic in

the current organization. If an organization has a great goal 

but no time or resources to achieve that goal, it could impact 

the entire change process. If people begin to feel hopeless 

that change cannot be made, it may impact their drive to 

make smaller, more manageable changes. With the creation 

of each goal, all staff should have a sense that it can be 

achieved, whether in the short term or in the long term. 

•	 Change is most effective when identified goals reflect the

needs of service providers in varying roles, at all levels of the 

organization. 

Example: Community-based organization “A” has just 

completed the Self-Assessment. Direct care staff members 

are feeling burned out and unsupported by the larger 

organization. They would like to focus their program 

goals in the area of “Supporting Staff Development.” 

Administrative staff members have other priorities and 

while they believe that staff support is important, they 

would like to focus their efforts in the area of “Adapting 

Policies.” In order to reconcile conflicting agendas, 

organization “A” will need additional discussions to 

identify goals that will meet everyone’s needs. Ideally 

this type of democratic change process encourages the 

“flattening” of these hierarchies among staff, and models 

the need for all to have a voice in how the program is 

run. 

•	 Becoming trauma-informed is as much about changing a

program’s culture as it is about changing program practices. 

Changing the culture of an organization can be much more 

difficult, as attitudes and values are often subtle, ingrained, 

and hard to identify and shift. As an organization begins to 

incorporate new practices, it is helpful to have continued 

discussions about the ways that these practices are attempts 

to shift tone, culture, and atmosphere in the program. 
	 	 	 	 	 	 	

 

 

 

 

	 	 	 	 	 	 	 	 	

	 	 	 	

44 Trauma-Informed Care for Women Veterans Experiencing Homelessness 

sample strategic plan 

The director of Social Services at St. Vincent De Paul Village 

in San Diego and her veteran team completed the SelfAssessment and examined the results, with a particular focus 

on Self-Assessment practices that were not being incorporated 

into the program. The director identified four possible areas 

of focus and e-mailed them to the group with a request that 

each person choose his or her top 1-2 priority areas. Goals 

were developed based on group consensus. The following 

plan was developed by St. Vincent De Paul Village and 

represents one goal for that organization: 

Staff Development Goal #1: “Staff is trained and 

knowledgeable about military and Veteran issues, with an 

emphasis on women Veterans.” 

action steps: 

1.	 In consultation with the U.S. Department of Veterans 

Affairs (VA) Liaison and partner agency Veterans Village 

of San Diego, develop training curriculum that includes 

information on the following topics: 

All Veterans 

•	 The different branches of the military

•	 Overview of the military “culture” and how it differs

from civilian life 

•	 The experiences of veterans serving in a combat zone

and during an active campaign 

•	 Types of discharges from the military

•	 Types of benefits available and eligibility criteria for

Veterans, including women Veterans (e.g., VA medical 

and disability services, U.S. Department of Housing and 

Urban Development’s Veterans Affairs Supportive Housing 

Program (HUD-VASH), Supplemental Security Income, 

housing options) 

•	 How to read and understand military forms (e.g.,

DD214) 

•	 Basics on how to access VA services

Women-Specific Issues 

•	 The experiences of women serving in the military

•	 The experiences of women upon discharge from the military

•	 How VA services differ for women veterans

•	 The specific service needs of women veterans (e.g., types

of services needed, how they are delivered, who provides 

the services) 

•	 The resources available to women veterans (e.g.,VA,

community-based, Web-based) 

• The barriers/challengesto accessing servicesfor women

veterans (e.g., availability, location, experiences with the VA) 

2.	 Determine if curriculum exists or needs to be developed 

3.	 Ask for help in developing curriculum, reviewing 

curriculum, and identifying trainers 

4.	 Write draft curriculum and distribute to VA Liaison, 

Veterans Village, and internal stakeholders for review 

5.	 Schedule and host training sessions for members of the 

Veteran Team 

6.	 Schedule, advertise, and host training sessions that are 

open to any Village staff members who are interested in 

the topic or who are recommended by their supervisor 

resources: 

•	 Line staff time for curriculum development, review of

curriculum, and attending training 

•	 Supervisor/Manager time for curriculum development

and facilitating training 

timeframe: 3 months 

Persons responsible for monitoring progress on 

action steps: 

•	 Program Project Coordinator

•	 Veteran Team Leader

•	 Social Services Program Manager
	 	 	 	 	 	 	 	 	 	 	 	 	

	 	 	 	 	 	

 

Trauma-Informed Care for Women Veterans Experiencing Homelessness 45 

implementing traUma-inFormed cHanges 

step 11: 

Once agency leaders and staff members identify goals for 

incorporating the trauma-informed practices outlined in the 

Self-Assessment, it is helpful to put structures in place to monitor 

progress towards goals and keep the commitment to being 

trauma-informed in the forefront. One way that an organization 

can do this is by creating a multi-disciplinary “trauma 

workgroup” consisting of a core group of staff representing 

all roles in the agency. This group makes a commitment to: 1) 

making sure objectives are being met for identified short-term 

and long-term goals related to becoming trauma-informed 

and providing trauma-informed care to female veterans; 

2) generating new ideas about further changes that may be 

necessary as the process continues; and 3) looking for additional 

education and training opportunities for the program at large. 

If a community-based organization is small enough (e.g., a staff 

of 12-15), the trauma workgroup can include all staff. In this 

case, trauma workgroup topics may be included in regular staff 

meetings or discussed at a different time. In larger programs, it 

may be unrealistic to get all staff together on a regular basis to 

discuss trauma and trauma-informed care in addition to general 

topics covered in staff meetings. Creating a smaller multidisciplinary group of staff may make things more manageable. 

This trauma workgroup can report back to all staff in order to 

give updates on progress towards goals and get staff feedback 

on how the change process is going. This includes discussions 

about challenges and barriers to change that inevitably arise. 

The trauma workgroup should maintain ongoing contact 

with program consumers, including female veterans, as one 

key method of assessing whether they are making progress on 

identified goals. 

Tips and Strategies: 

•	 Staff at all levels of an organization should have a voice in

the trauma workgroup. If all staff roles within a program 

are not represented in the workgroup, it leads to a sense 

that some positions are less valued than others. 

•	 Ongoing feedback from consumers provides organizations

with essential information about whether daily 

programming and services actually seem different. 

step 12: 

Becoming trauma-informed is a process that involves ongoing 

growth and development. There is no specific end-date at which 

point agencies are “trauma-informed” and therefore “finished” 

with the process. The Self-Assessment is one tool that programs 

can use to become more trauma-informed. As programs begin 

to incorporate practices from the Self-Assessment, the hope 

is that they will also begin to generate additional ideas for 

creating trauma-informed programming that go beyond 

what is outlined in the Self-Assessment. 

step 13: 

As organizations achieve their initial goals and modify their 

strategic plans to include new ideas for trauma-informed 

practices, it is helpful to begin to brainstorm ways to document 

the impact that this type of trauma-informed change is 

having in the program, specifically as it relates to consumer 

feedback and outcomes. This may include the use of staff and 

consumer focus groups, questionnaires, and documentation of 

information such as number of terminations from the program, 

number of successful housing and job placements, and rates of 

staff turnover. Documenting how becoming trauma-informed 

impacts consumer and staff experiences may be a helpful way 

for programs to advocate for additional resources and changes 

in broader systemic policies that may conflict with a traumainformed approach. 
	 	 	 	 	 	 	 	

	 	 	 	 	 	

	 	 	 	 	 	 	 	 	

	 	 	 	 	 	 	 	 	

	 	 	 	 	 	 	 	

	 	 	 	 	 	 	 	 	

	 	 	 	 	 	 	 	

46 Trauma-Informed Care for Women Veterans Experiencing Homelessness 

ii. What Does Becoming trauma-informed look 

like? 

Becoming trauma-informed is a process that involves striving 

towards a new way of understanding people and providing 

services and supports. This process involves a gradual integration 

of trauma concepts and trauma-sensitive responses into daily 

practice. What it looks like to become “trauma-informed” 

can vary from program to program. The community-based 

organizations participating in the Women veterans Who Are 

Homeless Demonstration Project have identified practical 

and attitudinal shifts as a result of receiving trauma training, 

completing the Self-Assessment, and developing strategic plans 

related to providing trauma-informed care and serving female 

veterans. Providers point out that understanding trauma 

“provides a context to staff regarding why we do/don’t do 

certain things.” Organizations participating in piloting the SelfAssessment found that it has allowed their staff to “step back,” 

and approach their work differently. They have become “more 

aware of possible traumas in the program.” They explain that 

with a better understanding of trauma, they have been able to 

be “more collaborative,” less punitive with consumers, and more 

“solutions-based” in their approach. Education on the prevalence 

of trauma in the lives of female veterans has resulted in programs 

asking about women’s experiences before, during, and after 

military service. Program leaders express their hope of being able 

to take an awareness of trauma-informed care and “translate [this 

awareness] into daily practice for all clients, including veterans, 

while also hoping to better serve female veterans specifically.” 

The following is a sampling of site-specific goals identified by 

pilot project participants: 

•	 Develop training curriculum that includes information on

all veterans and women-specific issues to ensure that all staff 

is knowledgeable about military-related issues and culture 

•	 Incorporate a commitment to providing trauma-informed

care to homeless female veterans as part of the broader 

organizational strategic plan 

•	 Assign female case managers to female veterans whenever

possible 

•	 Enhance organizational awareness of trauma and its impact

by having staff attend twice-yearly trainings on related topics 

•	 Enhance cultural competence across the organization and

within the veteran program 

•	 Enhance staff knowledge of available resources for female

veterans experiencing homelessness 

•	 Incorporate trauma-specific assessment tools for use with

female veterans (e.g., a PTSD scale) 
	 	 	 	 	 	 	 	

	 	 	 	 	 	 	 	

	 	 	 	 	 	 	 	 	 	 	

	 	 	 	 	 	 	 	

Trauma-Informed Care for Women Veterans Experiencing Homelessness 47 

iii. sustaining trauma-informed change 

The following are suggested “next steps” for sustaining traumainformed changes: 

•	 Ongoing review: Review of short-term and long-term

goals related to becoming trauma-informed. Programs 

can do a yearly reassessment of their program, using the 

Self-Assessment to identify changes. Other assessment tools 

include staff and consumer surveys, focus groups, and 

individual interviews. Have these strategies built into your 

long-term plan. 

•	 Ongoing training: Include trauma and military cultural

competence training as part of the new hire process and 

refresher trainings on trauma and trauma-related topics for 

all staff. 

•	 Making connections: Find ways to connect with experts in a

variety of areas including: trauma, mental health, substance 

abuse, and military-related experience. This includes 

building and maintaining relationships with the VA and Vet 

Centers. These consultants/agencies can provide ongoing 

support and consultation. Networking with other programs 

that are integrating trauma-informed organizational models 

and finding ways to share information and experiences are 

critical. 

•	 Bringing trauma-informed concepts to the broader system:

Program staff can bring their understanding of trauma, 

trauma-informed care, and the needs of homeless female 

veterans to the broader service system. This means educating 

providers and service systems working with female veterans 

on the importance and impact of trauma and traumasensitive responses. 

iV. conclusion 

Female service members play a significant and ever-growing 

role in military defense. The numbers of female veterans are 

growing, and it is the responsibility of our society to meet the 

needs of these women as they return home. Female veterans 

often face immense challenges as they reintegrate into civilian 

life. For female veterans, experiences of trauma, including 

chronic exposure to trauma, occur at higher rates than they do 

for male veterans or female civilian counterparts. For some, the 

combination of traumatic stress and economic hardship leads to 

residential instability and homelessness. Once homeless, female 

veterans find that services designed to meet their needs are 

minimal, and acknowledgment of and respect for their service 

and status as veterans is often lacking. The National Center 

created Trauma-Informed Care for Women Veterans Experiencing 

Homelessness to provide organizations with knowledge and 

guidelines for how to best engage with and meet the needs of this 

population. Understanding how experiences of trauma impact 

homeless female veterans and tailoring practices to provide 

trauma-informed care allows providers serving female veterans 

to respond in ways that best cultivate recovery and success. The 

ultimate goal is to create a network of community-based service 

organizations equal to the task of serving those women who 

have so proudly and courageously served our country. 
orgaNizatioNal sElf-assEssmENt for 


ProViDErs sErViNg fEmalE VEtEraNs
 
Trauma-Informed Care for Women Veterans Experiencing Homelessness 49 

InStruCtIonS for CompletIng the Self-aSSeSSment
 

The central component of Trauma-Informed Care for Women 

Veterans Experiencing Homelessness is the Organizational SelfAssessment for Providers Serving Female Veterans (the SelfAssessment). The Self-Assessment is a tool that community-based 

organizations can use to evaluate current practices and adapt 

their programming to respond to the needs of female veterans 

experiencing homelessness. The Self-Assessment should be 

completed by all staff in an organization working with homeless 

female veterans. This group may include direct care staff 

(full-time, part-time, and relief), supervisors, case managers, 

clinicians, administrators (e.g., program managers, directors, 

executive directors, etc.), and support staff (e.g., office support, 

maintenance, kitchen staff, etc.). 

The Self-Assessment is organized into six main “domains” or areas 

of programming: 

1) Supporting Staff Development 

2) Creating a Safe and Supportive Environment 

3) Assessing and Planning Services 

4) Involving Consumers 

5) Adapting Policies 

6) Working with Children 

Within each domain is a list of trauma-informed practices. 

For each item, please consider the extent to which you agree 

that your program incorporates this practice using the following 

scale: 

•	 Strongly Disagree (This rarely or never happens)

•	 Disagree (This usually does not happen)

•	 Agree (This happens some of the time)	

•	 Strongly Agree (This happens most of the time)

•	 Do Not Know (I don’t know if this happens in the program)

•	 Not Applicable to My Program (This practice is not

applicable to what we do in our program) 

For example: “The program incorporates military-related 

decorations and materials that include female veterans.” Staff 

respond, “Strongly Disagree, Disagree, Agree, Strongly Agree, Do 

Not Know, or Not Applicable to My Program.” 

When responding to Self-Assessment items, please answer based 

on your experience in the organization over the past six months. 

The Self-Assessment can be completed in one sitting or in sections 

and takes approximately 30-40 minutes to complete all at once. 

Community-based organizations serve female veterans as well 

as others who are homeless. Many items in the Self-Assessment 

refer specifically to female veterans and represent traumainformed practices for this unique population. Some items use 

the term “consumer.” These items represent trauma-informed 

practices that are applicable to all consumers served by the 

agency. The term “staff ” refers to paid and voluntary individuals 

providing services, which include but are not limited to: those 

working directly with consumers and children, administrators, 

policymakers, groundskeepers, maintenance, transportation 

specialists, and community service providers. “When you think 

veterans—you don’t 

think of women.” 

—Female Veteran 
 

 

 

 

 

50 Trauma-Informed Care for Women Veterans Experiencing Homelessness 

I. SupportIng Staff deVelopment 

A. Training and Education 

Staff serving female veterans at all levels of the organization receive training and education (e.g., face-to-face trainings, 

on-line courses, special presentations) on the following topics: 

i. supporting staff development 

 of 

a. training and education 

ee str disagr

oes 

e som

strongly Agree

most

m 

ongly 

Trauma and Mental Health 

(th ely or is rar

ver happens)

disagree

is usually d

not happen)

Agree

(this happens 

the time)

(this happens the time)

w not kno

not Applicable 

ogra my Pr

ne

(th

1. Traumatic stress and its impact on the brain and 

of 

doto

body 

2. Intimate partner violence and its impact 

3. Military sexual trauma and its impact 

4. Combat-related trauma and its impact 

5. Complex trauma and its impact 

6. Post-traumatic stress disorder (PTSD) 

7. Traumatic brain injury (TBI) 

8. How trauma affects development 

9. How trauma affects attachment to caregivers and 

others 

10. The relationship between childhood trauma 

and adult challenges and/or re-victimization 

(e.g., intimate partner violence, sexual assault, 

homelessness) 
Trauma-Informed Care for Women Veterans Experiencing Homelessness 51 

i. supporting staff development 

a. training and education 

Trauma and Mental Health 

(continued) 

strongly disagree (this rarely or never happens)disagree

(this usually does not happen)

Agree

(this happens some of the time)

strongly Agree

(this happens most of the time)

do not knownot Applicable to my Program 

11. Cultural differences in how people understand and 

respond to trauma 

12. How working with trauma survivors impacts staff 

(e.g., compassion fatigue/vicarious trauma) 

13. Common mental health disorders among people 

who are homeless, including female veterans (causes, 

symptoms, treatments) 

14. Substance abuse disorders (causes, symptoms, 

treatments) 

15. Suicide (risk factors, red flags, crisis intervention) 
 

 

52 Trauma-Informed Care for Women Veterans Experiencing Homelessness 

i. supporting staff development 

a. training and education 

Military Knowledge 

strongly disagree (this rarely or never happens)disagree

(this usually does not happen)

Agree

(this happens some of the time)

strongly Agree

(this happens most of the time)

do not knownot Applicable to my Program 

16. The different branches of the military 

17. Military-specific language/terminology, acronyms, 

rules/regulations 

18. How to read and understand military forms (e.g., 

DD214) 

19. The unique experiences of female service members 

20. Types of discharges from the military 

21. The experiences of female veterans upon discharge 

from the military 

22. Types of benefits for female veterans (e.g., VA, SSI, 

housing options) 

23. Eligibility criteria for various benefits 

24. The U.S. Department of Labor’s assistance 

programs for veterans (e.g., Homeless Female Veterans, 

a new Homeless Veterans’ Reintegration Program or 

Homeless Veterans with Families Program; Veterans 

Workforce Investment Program; Incarcerated Veterans’ 

Transition Program) 

25. The specific service needs and preferences of female 

veterans (e.g., types of services, methods of delivery, 

who provides the services) 

26. The resources available to female veterans (e.g., VA, 

community-based, Web-based) 

27. The barriers/challenges to accessing services for 

female veterans (e.g., availability, location, experiences 

with the VA) 

28. The process for attaining benefits and services 

through the local VA 
Trauma-Informed Care for Women Veterans Experiencing Homelessness 53 

i. supporting staff development 

a. training and education 

Skills and Strategies 

strongly disagree (this rarely or never happens)disagree

(this usually does not happen)

Agree

(this happens some of the time)

strongly Agree

(this happens most of the time)

do not knownot Applicable to my Program 

29. Motivational interviewing techniques 

30. De-escalation strategies (e.g., ways to help people 

calm down before reaching the point of crisis) 

31. Steps for helping female veterans identify triggers 

(e.g., reminders of dangerous or frightening things that 

have happened in the past) 

32. Developing safety and crisis prevention plans 

33. Establishing and maintaining healthy professional 

boundaries 

34. Case management strategies for helping female 

veterans make and maintain community-based 

provider connections (e.g., VA, housing, employment, 

education) 

35. Providing culturally competent services to 

female veterans from a variety of backgrounds and 

experiences 
54 Trauma-Informed Care for Women Veterans Experiencing Homelessness 

B. Staff Supervision, Support and Self-Care 

i. supporting staff development 

B. staff supervision, support, 

and self-care 

strongly disagree (this rarely or never happens)disagree

(this usually does not happen)

Agree

(this happens some of the time)

strongly Agree(this happens most of the time)do not knownot Applicable to my Program 

36. Staff members have regular team meetings. 

37. Topics related to the needs and experiences of 

female veterans are addressed in team meetings. 

38. Topics related to self-care are addressed in team 

meetings (e.g., vicarious trauma, burnout, stressreducing strategies). 

39. Staff members have a regularly scheduled time for 

individual supervision. 

40. Supervisors are trained in understanding trauma 

and trauma-informed care. 

41. Supervisors are knowledgeable about the VA and 

veteran-specific needs. 

42. Part of supervision time is used to help staff 

members understand their own stress reactions and 

how these impact their work. 

43. The organization has a process for helping staff 

members debrief after a crisis. 

44. The organization has a formal system for reviewing 

staff performance. 

45. The organization provides opportunities for 

ongoing staff evaluation of the program. 

46. The organization provides opportunities for staff 

input into agency practices. 
 

Trauma-Informed Care for Women Veterans Experiencing Homelessness 55 

i. supporting staff development 

B. staff supervision, support, 

and self-care 

strongly disagree (this rarely or never happens)disagree

(this usually does not happen)

Agree

(this happens some of the time)

strongly Agree

(this happens most of the time)

do not knownot Applicable to my Program 

47. Outside consultants or staff members with 

expertise related to female veterans provide ongoing 

education and consultation. 

48. Outside consultants or staff members with 

expertise in trauma and trauma-informed care provide 

ongoing education and consultation. 

49. Outside agencies with expertise in cultural 

competence (including military knowledge/ 

competence) provide ongoing training and 

consultation. 
56 Trauma-Informed Care for Women Veterans Experiencing Homelessness 

II. CreatIng a Safe and SupportIVe enVIronment 

A. Establishing a Safe Physical Environment 

ii. creating a safe and supportive 

environment 

a. establishing a safe physical 

environment 

strongly disagree (this rarely or never happens)disagree

(this usually does not happen)

Agree

(this happens some of the time)

strongly Agree(this happens most of the time)do not knownot Applicable to my Program 

1. The organizational facility has a security system. 

2. Agency staff monitors who is coming in and out of 

the program. 

3. The environment outside the organizational facility 

is well lit. 

4. The common areas are well lit. 

5. Bathrooms are well lit. 

6. Bathroom doors can be locked. 

7. The organization has a space that is only for women. 

8. The organization incorporates military-related 

decorations and materials that include and are 

relatable to female veterans. 

9. When applicable, there are private, locked spaces for 

belongings. 

10. The organization provides consumers with 

opportunities to make suggestions about ways to 

improve/change the physical space. 
Trauma-Informed Care for Women Veterans Experiencing Homelessness 57 

B. Establishing a Supportive Environment 

ii. creating a safe and supportive 

environment 

B. establishing a supportive environment 

Information Sharing 

strongly disagree (this rarely or never happens)disagree

(this usually does not happen)

Agree

(this happens some of the time)

strongly Agree(this happens most of the time)do not knownot Applicable to my Program 

11. The organization regularly reviews rules, rights, 

and grievance procedures with consumers. 

12. Consumers are informed about how the program 

responds to personal crises. 

13. When applicable, expectations about room/ 

apartment checks are clearly written and verbalized to 

consumers. 

14. When applicable, the organization obtains 

permission from consumers prior to giving a tour of 

its space (e.g., client notified of date, time, and who 

will see her space). 

15. Consumer rights are posted in places that are 

visible. 

16. Material is posted about traumatic stress (e.g., what 

it is, how it impacts people, and available traumaspecific resources). 

17. Material is posted about what it means to be a 

“Veteran.” 

18. Material is available about military sexual trauma 

(e.g., what it is, how it impacts people, and available 

resources). 

19. Material is posted about available benefits for 

female veterans. 

20. Material is posted about local VA resources for 

female veterans. 

21. Material is posted about community and Webbased resources for female veterans. 
58 Trauma-Informed Care for Women Veterans Experiencing Homelessness 

ii. creating a safe and supportive 

environment 

B. establishing a supportive environment 

Cultural Competence 

strongly disagree (this rarely or never happens)disagree

(this usually does not happen)

Agree

(this happens some of the time)

strongly Agree(this happens most of the time)do not knownot Applicable to my Program 

22. Organizational information (e.g., policies, 

procedures, services, requirements) is available in 

different languages. 

23. Consumers are allowed to speak their native 

language within the organization. 

24. When applicable, consumers are allowed to prepare 

or have ethnic-specific foods. 

25. The organization provides ongoing opportunities 

for consumers to share their culture with each other 

(e.g., potlucks, culture nights, incorporating different 

types of art and music, etc.). 

26. Staff shows respect for personal religious or 

spiritual practices. 

27. The organization demonstrates an understanding 

of the military culture (e.g., familiar with [and can 

refer to] acronyms, branches, forms, how the military 

system works, experiences of service members). 
Trauma-Informed Care for Women Veterans Experiencing Homelessness 59 

ii. creating a safe and supportive 

environment 

B. establishing a supportive environment 

Privacy and Confidentiality 

strongly disagree (this rarely or never happens)disagree

(this usually does not happen)

Agree

(this happens some of the time)

strongly Agree

(this happens most of the time)

do not knownot Applicable to my Program 

28. The organization informs consumers about the 

extent and limits of privacy and confidentiality (e.g., 

the kinds of records that are kept, where they are kept, 

who has access to this information, when the program 

is obligated to report information to child welfare or 

police). 

29. Staff does not talk in common spaces about 

consumers. 

30. Staff does not talk outside of the program about 

consumers. 

31. Staff does not discuss the personal issues of one 

consumer with another consumer. 

32. Consumers who have violated rules are approached 

in private. 

33. There are private spaces for staff and consumers to 

discuss personal issues. 
60 Trauma-Informed Care for Women Veterans Experiencing Homelessness 

ii. creating a safe and supportive 

environment 

B. establishing a supportive environment 

Safety and Crisis Prevention

Planning 

strongly disagree (this rarely or never happens)disagree

(this usually does not happen)

Agree

(this happens some of the time)

strongly Agree

(this happens most of the time)

do not knownot Applicable to my Program 

For the following items, the term “safety plan” is defined 

as a plan for what a consumer and staff members will 

do if the consumer feels threatened by another person 

outside of the agency. 

34. Consumers work with staff to create written, 

individualized safety plans. 

35. Written safety plans are incorporated into 

consumers’ individual goals and plans. 

For the following items, the term “crisis-prevention 

plan” is defined as an individualized plan to help each 

consumer manage stress and feel supported. 

36. Every consumer in the organization has a written 

crisis-prevention plan. 

Written crisis prevention plans include the following: 

37. A list of triggers (e.g., situations that are stressful 

or overwhelming and remind the person of past 

traumatic experiences). 

38. A list of ways that the person shows that she is 

stressed or overwhelmed (e.g., types of behaviors, ways 

of responding, etc.). 

39. Specific strategies and responses that are helpful 

when the person is feeling upset or overwhelmed. 

40. Specific strategies and responses that are 

not helpful when the person is feeling upset or 

overwhelmed. 

41. A list of people with whom the person feels safe 

and can go to for support. 
Trauma-Informed Care for Women Veterans Experiencing Homelessness 61 

ii. creating a safe and supportive 

environment 

B. establishing a supportive environment 

Open and Respectful

Communication 

strongly disagree (this rarely or never happens)disagree

(this usually does not happen)

Agree

(this happens some of the time)

strongly Agree

(this happens most of the time)

do not knownot Applicable to my Program 

42. Staff uses descriptive language, rather than 

characterizing terms, to describe consumers (e.g., 

describing a person as “having a hard time getting her 

needs met” rather than “attention-seeking”). 

43. The organization uses “people-first” language 

rather than labels (e.g., “people who are experiencing 

homelessness” rather than “homeless people”). 

44. Staff members use motivational interviewing 

techniques with consumers (e.g., open-ended 

questions, affirmations, and reflective listening). 

45. Staff acknowledges female veterans’ military service 

and strengths, skills, and past successes related to this 

service. 

ii. creating a safe and supportive 

environment 

B. establishing a supportive environment 

Consistency and Predictability 

strongly disagree (this rarely or never happens)disagree

(this usually does not happen)

Agree

(this happens some of the time)

strongly Agree

(this happens most of the time)

do not knownot Applicable to my Program 

46. When applicable, the organization regularly 

schedules community meetings for consumers. 

47. The organization provides advance notice of 

changes in the daily or weekly schedule. 

48. The organization has structures in place to support 

staff consistency with consumers across roles and shifts 

(e.g., trainings, staff meetings, shift change meetings, 

and peer supervision). 

49. The organization is flexible with rules, if needed, 

based on individual circumstances. 
62 Trauma-Informed Care for Women Veterans Experiencing Homelessness 

III. aSSeSSIng and plannIng SerVICeS 

A. Conducting Intake Assessments 

iii. assessing and planning services 

a. conducting intake assessments 

The intake assessment for female veterans includes 

questions about: 

strongly disagree (this rarely or never happens)disagree

(this usually does not happen)

Agree

(this happens some of the time)

strongly Agree(this happens most of the time)do not knownot Applicable to my Program 

1. Personal strengths 

2. Cultural background 

3. Cultural strengths (e.g., world view, role of 

spirituality, cultural connections) 

4. Social supports in the family and the community 

5. Current level of danger from other people (e.g., 

restraining orders, history of intimate partner violence, 

threats from others) 

6. Suicidal thoughts and behaviors 

7. Military service (branch, rank, job in the military) 

8. Experiences in the military 

9. History of trauma (e.g., physical, emotional or 

sexual abuse; neglect; loss; interpersonal violence; 

community violence; past homelessness; combat; 

military sexual trauma) 

10. History of mental health issues 

11. History of substance use/abuse 

12. Previous head injury 

13. Quality of relationship with child or children (e.g., 

caregiver/child attachment) 

14. Housing history 

15. Employment and job training history 

16. Perceived barriers to housing and employment 
Trauma-Informed Care for Women Veterans Experiencing Homelessness 63 

iii. assessing and planning services 

a. conducting intake assessments 

(continued) 

The intake assessment for female veterans includes 

questions about: 

strongly disagree (this rarely or never happens)disagree

(this usually does not happen)

Agree

(this happens some of the time)

strongly Agree

(this happens most of the time)

do not knownot Applicable to my Program 

17. VA services that they have received/are receiving 

and their experiences with them 

18. How best to receive information and communicate 

with providers (e.g., cell phone, text messaging, Webbased, in-person) 

Intake assessment tools for female veterans include: 

19. A screening for post-traumatic stress disorder 

20. A screening for traumatic brain injury 

iii. assessing and planning services 

a. conducting intake assessments 

Intake Assessment Process 

strongly disagree (this rarely or never happens)disagree

(this usually does not happen)

Agree

(this happens some of the time)

strongly Agree

(this happens most of the time)

do not knownot Applicable to my Program 

21. There are private, confidential spaces available to 

conduct intake assessments. 

22. Staff informs consumers about why questions are 

being asked. 

23. Throughout the assessment process, staff checks in 

with consumers about how they are doing (e.g., asking 

if they would like a break, water, etc.). 

24. The organization provides an adult translator for 

the assessment process if needed. 

25. Consumers are given the option of writing down 

responses to assessment questions, when preferred. 
64 Trauma-Informed Care for Women Veterans Experiencing Homelessness 

iii. assessing and planning services 

a. conducting intake assessments 

Intake Assessment 

Follow-up 

strongly disagree (this rarely or never happens)disagree

(this usually does not happen)

Agree

(this happens some of the time)

strongly Agree

(this happens most of the time)

do not knownot Applicable to my Program 

26. Based on the intake assessment, staff determines 

female veterans’ eligibility for VA and non-VA benefits 

and services. 

27. Based on the intake assessment, consumers are 

referred for specific services, as necessary. 

28. Releases and consent forms are updated whenever 

it is necessary to speak with a new provider. 

29. The assessment is updated on an ongoing basis. 

B. Developing Goals and Plans 

iii. assessing and planning services 

B. developing goals and plans 

strongly disagree (this rarely or never happens)disagree

(this usually does not happen)

Agree

(this happens some of the time)

strongly Agree

(this happens most of the time)

do not knownot Applicable to my Program 

30. Staff partners with consumers in setting goals. 

31. Consumer goals are reviewed and updated 

regularly. 

32. Staff offers consumers step-by-step support as they 

begin to access outside services. 
Trauma-Informed Care for Women Veterans Experiencing Homelessness 65 

C. Offering Services and Supports to Female Veterans 

iii. assessing and planning services 

c. offering services and supports to 

Female Veterans 

Emotional Supports 

strongly disagree (this rarely or never happens)disagree

(this usually does not happen)

Agree

(this happens some of the time)

strongly Agree(this happens most of the time)do not knownot Applicable to my Program 

33. The organization has connections with mental 

health agencies with expertise in trauma (e.g., 

interpersonal violence, military sexual trauma, 

childhood abuse, combat-related trauma). 

34. The organization has connections with mental 

health agencies with expertise in working with female 

veterans. 

35. The organization has connections with agencies 

that provide substance abuse treatment. 

36. The organization has connections with agencies 

that provide services specifically for veteran youth/ 

young adults. 

37. The organization has connections with agencies 

that can address the needs of the gay, lesbian, bi-sexual, 

transgendered veteran community. 

38. The organization provides or refers female veterans 

to gender-specific therapy groups. 

39. The organization provides or refers female veterans 

to support groups with other female veterans. 

40. The organization supports a variety of peer-to-peer 

activities among female veterans within the agency. 

41. The organization provides opportunities for former 

homeless female veterans to mentor female veterans 

who are currently homeless and receiving services. 

42. The organization provides opportunities for 

female veterans to express themselves in creative and 

nonverbal ways (e.g., art, theater, dance, movement, 

music). 
66 Trauma-Informed Care for Women Veterans Experiencing Homelessness 

iii. assessing and planning services 

c. offering services and supports to 

Female Veterans 

Instrumental Supports 

strongly disagree (this rarely or never happens)disagree

(this usually does not happen)

Agree

(this happens some of the time)

strongly Agree

(this happens most of the time)

do not knownot Applicable to my Program 

43. The organization has connections with agencies 

that provide a variety of services including housing, 

legal and educational advocacy, job training and 

placement programs, and health services. 

44. The organization has connections with the U.S. 

Department of Labor’s Veteran employment and 

training service providers. 

45. The organization offers child care support/ 

alternatives for female veterans while they participate 

in services. 

46. The organization offers transportation options 

(e.g., bus passes, stipends) for female veterans. 

47. The organization considers child care and 

transportation issues when referring female veterans 

for additional services. 

48. The organization has connections with area 

hospitals/clinics/organizations that can provide 

gender-specific health care (female physicians, 

mammograms, etc.). 
Trauma-Informed Care for Women Veterans Experiencing Homelessness 67 

iii. assessing and planning services 

c. offering services and supports to 

Female Veterans 

Staffing and Hours 

strongly disagree (this rarely or never happens)disagree

(this usually does not happen)

Agree

(this happens some of the time)

strongly Agree

(this happens most of the time)

do not knownot Applicable to my Program 

49. Female veterans have access to female case 

managers. 

50. Female veterans have access to female case 

managers who are veterans. 

51. The organization has clinicians with expertise in 

trauma and trauma-related interventions available (on 

staff or available for regular consultation). 

52. The organization has female clinicians who are 

veterans on staff or available for consultation. 

53. The organization has flexible hours for female 

veterans who work day and evening shifts. 

Community Outreach 

54. The organization has a relationship with its state 

VA women veterans coordinator. 

55. The organization has regular contact with the 

closest VA and Vet Center. 

56. The organization is aware of, and advertises, local 

stand-downs. 

57. The organization maintains communication and 

connections with a variety of agencies that provide 

services to female veterans. 

58. The organization educates community providers 

(mental health, homelessness, law enforcement, 

employers, schools, etc.) about the needs of female 

veterans. 

59. The organization provides community-based 

outreach regarding available resources and support for 

female veterans (street outreach, shelters and housing 

programs, colleges/universities, law enforcement 

agencies, employment and housing agencies, etc.). 
68 Trauma-Informed Care for Women Veterans Experiencing Homelessness 

IV. InVolVIng ConSumerS 

A. Involving Current and Former Consumers 

iV. involving consumers 

a. involving current and Former consumers 

Current Consumers 

strongly disagree (this rarely or never happens)disagree

(this usually does not happen)

Agree

(this happens some of the time)

strongly Agree(this happens most of the time)do not knownot Applicable to my Program 

1. The organization provides consumers with 

opportunities to express their needs and concerns. 

2. The organization provides opportunities for 

consumers to lead activities. 

3. Current consumers are involved in the development 

of agency activities and services. 

4. Current consumers are given opportunities to 

evaluate the organization and offer their suggestions 

for improvement in anonymous and/or confidential 

ways (e.g., suggestion boxes, regular satisfaction 

surveys). 

Former Consumers 

5. Formerly homeless consumers are involved in 

program development. 

6. Formerly homeless consumers are involved in 

providing services. 

7. Female veterans who have experienced homelessness 

are invited to share their thoughts, ideas, and 

experiences with the organization. 
Trauma-Informed Care for Women Veterans Experiencing Homelessness 69 

V. adaptIng polICIeS 

A. Creating Written Policies 

V. adapting policies 

a. creating Written policies 

strongly disagree (this rarely or never happens)disagree

(this usually does not happen)

Agree

(this happens some of the time)

strongly Agree(this happens most of the time)do not knownot Applicable to my Program 

1. The organization has a written statement that 

includes a commitment to understanding trauma and 

engaging in trauma-sensitive practices. 

2. The organization has a written statement that 

includes a commitment to understanding the needs 

of female veterans and tailoring services to meet those 

needs. 

3. The organization has a written commitment to 

demonstrating respect for cultural differences and 

practices. 

4. The organization has a written commitment to hire 

staff who have experienced homelessness. 

5. The organization has a written commitment to hire 

female veterans and/or female military-affiliated staff 

and former homeless female veterans. 

6. The organization has a written policy to address 

potential threats to consumers from persons outside of 

the agency. 

7. The organization has a written policy outlining 

program responses to consumer crises (e.g., self-harm, 

suicidal thinking, aggression towards others). 

8. The organization has written policies outlining 

professional conduct for staff (e.g., boundaries, 

responses to consumers, etc.). 
70 Trauma-Informed Care for Women Veterans Experiencing Homelessness 

B. Reviewing Policies 

V. adapting policies 

B. reviewing policies 

strongly disagree (this rarely or never happens)disagree

(this usually does not happen)

Agree

(this happens some of the time)

strongly Agree(this happens most of the time)do not knownot Applicable to my Program 

9. The organization reviews its policies on a regular 

basis to identify whether they are sensitive to the needs 

of trauma survivors. 

10. The organization reviews its policies on a regular 

basis to identify whether they are sensitive to the 

specific needs of female veterans. 

11. The organization involves staff in its review of 

policies. 

12. The organization involves consumers in its review 

of policies. 
Trauma-Informed Care for Women Veterans Experiencing Homelessness 71 

VI. WorkIng WIth ChIldren
 

Vi. Working with children 

The following are trauma-informed practices for 

working with children: 

strongly disagree (this rarely or never happens)disagree

(this usually does not happen)

Agree

(this happens some of the time)

strongly Agree(this happens most of the time)do not knownot Applicable to my Program 

1. The organization incorporates child-friendly 

decorations and materials. 

2. The organization provides a space for children to 

play. 

The intake assessment includes questions about: 

3. Children’s trauma exposure (e.g., neglect, abuse, 

exposure to violence). 

4. Children’s achievement of developmental tasks. 

5. Children’s history of mental health issues. 

6. Children’s history of physical health issues. 

7. Children’s prior experiences of homelessness. 

8. Children’s experiences during and after the 

deployment of their parents. 

9. Based on the intake assessment, children are referred 

for further assessment and services as needed. 

10. Staff works with consumers to identify a plan to 

address their children’s needs. 

11. Every child in the program has a written crisisprevention plan. 
72 Trauma-Informed Care for Women Veterans Experiencing Homelessness 

Vi. Working with children 

(continued) 

strongly disagree (this rarely or never happens)disagree

(this usually does not happen)

Agree

(this happens some of the time)

strongly Agree

(this happens most of the time)

do not knownot Applicable to my Program 

12. The program has connections with mental health 

agencies that have expertise in working with children 

who have experienced trauma. 

13. The program has access to early childhood 

education programming. 

14. The program has access to services that are 

designed for military families and children of veterans. 
Trauma-Informed Care for Women Veterans Experiencing Homelessness 73 

reSourCe lIStS 

selected resources on female Veterans, Homelessness, and trauma 

Below you will find additional resources that include those designed to address the needs of women veterans, particularly 

new programs to help women veterans who are homeless. 

All private sector publications and websites listed are for information purposes only. The inclusion of such references 

should not be construed as an official endorsement by the Department of Labor or the Women’s Bureau of the identified 

entities, their products, or their services. 

Female Veterans 

Printed material and Video 

Foster, L., & Vince, S. (2009). California’s women Veterans: 


The challenges and needs of those who serve. California Research 


Bureau, California State Library. Available at www.library.ca.gov/


crb/09/09-009.pdf
 

In Their Boots. Video documentary series. Available at www.
 

intheirboots.com/itb
 

Lohaus, D. (Director). (2006). When I Came Home [Lohaus Film

LLC]. Available at www.whenicamehome.com
 

McLagan, M. (Director) & Sommers, D. (Director). (2008).
 

Lioness [Room 11 Productions]. Available at www.lionessthefilm.

com
 

Mulhall, E. (2009). Women warriors: Supporting she ‘who has 


borne the battle.’ (Issue Report). Available at www.media.iava.org/

IAVA_WomensReport_2009.pdf
 

U.S. Department of Veterans Affairs Center for Women Veterans 

(September, 2010). Women Veterans – A proud tradition of service.

Advisory Committee on Women Veterans Report. Available at 

www.va.gov/WOMENVET/docs/ACWV_Report_2010.pdf 

Websites 

Grace After Fire. www.graceafterfire.org 

Service Women’s Action Network (SWAN). 

www.servicewomen.org 

Swords to Plowshares (Swords). www.swords-to-plowshares.org 

U.S. Department of Veterans Affairs, Center for Women Veterans.

www.va.gov/womenvet 

U.S. Department of Veterans Affairs, Homeless Veterans. 

www.va.gov/Homeless 

U.S. Department of Veterans Affairs, National Center for PTSD. 

www.ptsd.va.gov 

s 



 


 

 

U.S. Department of Veterans Affairs, Women Veterans Health. 

www.va.gov/womenvet 

general traUma inFormation 

Printed material 

American Psychological Association (2007, February). The 

psychological needs of U.S. military members and their families: 

A preliminary report. Presidential Task Force on Military 

Deployment Services for Youth, Families and Service Members. 

Available at www.apa.org/about/governance/council/policy/ 

military-deployment-services.pdf 

Bassuk, E.L., Dawson, R., Perloff, J., & Weinreb, L. (2001). Posttraumatic stress disorder in extremely poor women: Implications 

for health care clinicians. Journal of the American Medical 

Women’s Association, 56, 79-85. 

Herman, J. (1992). Trauma and recovery. New York, NY: Basic 

Books. 

Van der Kolk, B.A., McFarlane, A.C., & Weisaeth, L. (Eds.). (1996). 

Traumatic stress: The effects of overwhelming experience on mind, 

body, and society. New York, NY: Guilford Press, 214-241. 

Websites 

The Adverse Childhood Experiences (ACE) Study. 

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Community Connections. www.communityconnectionsdc.org 

National Center for Post Traumatic Stress Disorder (PTSD). 

www.ptsd.va.gov 

National Child Traumatic Stress Network. www.nctsnet.org 

Traumatic Brain Injury Model Systems National Data and 

Statistical Center (TBINDSC). www.tbindsc.org 
 

 

 

74 Trauma-Informed Care for Women Veterans Experiencing Homelessness 

Homelessness and traUma 

Printed material 

Bassuk, E.L., & Friedman, S.M. (2005). Facts on trauma and 

homeless children. The National Child Traumatic Stress Network, 

Homelessness and Extreme Poverty Working Group. Available at 

www.nctsnet.org 

Bassuk, E.L., Melnick, S. & Browne, S. (1998). Responding to the 

needs of low-income and homeless women who are survivors of 

trauma. Journal of the American Medical Women’s Association, 

53(2), 57-64. 

Bassuk, E.L., Weinreb, L., Buckner, J., Browne, A., Solomon, A., 

& Bassuk, S.S. (1996). The characteristics and needs of sheltered 

homeless and low-income housed mothers. Journal of the 

American Medical Association, 276(8), 640-646. 

Buckner, J., Bassuk, E.L., Weinreb, L., & Brooks M. (1999). 

Homelessness and its relation to the mental health and behavior 

of low-income school-age children. Developmental Psychology, 

35(1), 246-257. 

Fairweather, A. (2006). Risk and protective factors for homelessness 

among OEF/OIF Veterans. Swords to Plowshares’ Iraq Veterans 

Project. Available at www.nchv.org/docs/Microsoft%20Word%20 

-%20Risk%20and%20Protective%20Factors%20for%20 

Homelessness%20among%20OIF%20Veterans.pdf 

Goodman, L., Saxe, L., and Harvey, M. (1991). Homelessness 

as psychological trauma: Broadening perspectives. American 

Psychologist, 46 (11), 1219-25. 

Kim, M.M. & Ford, J. D. (2006). Trauma and post-traumatic 

stress among homeless men: A review of current research. Journal 

of Aggression, Maltreatment & Trauma, 13(2), 1-22. 

Melnick, S., & Bassuk, E.L. (1999). Identifying and responding 

to violence among poor and homeless women: A health provider’s 

guide. The National Center on Family Homelessness. Newton, 

MA. Available at www.familyhomelessness.org 

Nyamathi, A., Wenzel, S., Lesser J., Flaskerud, J., & Leake, B. 

(2001). Comparison of psychosocial and behavioral profiles 

of victimized and non-victimized homeless women and their 

intimate partners. Research in Nursing and Health, 24(4), 324-335. 

The National Center on Family Homelessness. (1999). Homeless 

children: America’s new outcasts. Newton, MA. Available at 

www.familyhomelessness.org 

Vostanis, P., Tischler, V., Cumella, S., & Bellerby, T. (2001). 

Mental health problems and social supports among homeless 

mothers and children victims of domestic and community 

violence. International Journal of Social Psychiatry, 47(4), 30-40. 

Wenzel, S., Leake, B., & Gelberg, L. (2001). Risk factors for 

major violence among homeless women. Journal of Interpersonal 

Violence, 16(8), 739-752. 

Zlotnick, C., Tam, T., & Bradley, K. (2006). Impact of adulthood 

trauma on homeless mothers. Community Mental Health Journal, 

43(1), 13-32. 

Websites 

Department of Housing and Urban Development and the 

Department of Veteran’s Affairs HUD-VASH Program provides 

housing vouchers for eligible homeless Veterans and families. 

More information available at www.hud.gov/offices/pih/ 

programs/hcv/vash/#1 

National Coalition for Homeless Veterans. www.nchv.org 

SAMHSA’s Resources for Returning Veterans and Their Families. 

www.samhsa.gov/vets 

The Homelessness Resource Center. www.homeless.samhsa.gov 

The National Center on Family Homelessness. www. 

familyhomelessness.org 

U.S. Department of Veterans Affairs Homeless Veterans Page. 

www.va.gov/homeless 
 

Trauma-Informed Care for Women Veterans Experiencing Homelessness 75 

cUltUral competence 

Printed material 

Bronheim, Suzanne. (2006). Cultural competence: It all starts 

at the front desk. National Center on Cultural Competence. 

Georgetown Center for Child and Human Development. 

Washington, DC. 

Center for Deployment Psychology, Course 101: Military Culture 

and Terminology available at www.deploymentpsych.org/ 

training/training-catalog/military-culture-and-terminology 

Department of Veteran Affairs, National Center for PTSD. 

Military culture. Available at www.ptsd.va.gov/professional/ 

ptsd101/course-modules/military_culture.asp 

Essential Learning, Military cultural competence. Available at 

www.essentiallearning.net/student/content/sections/Lectora/ 

MilitaryCultureCompetence/index.html 

Good, T.D. & Jones, W. (2000, Revised 2006). A guide to 

advancing family centered and culturally and linguistically 

competent care. National Center on Cultural Competence, 

Georgetown Center for Child and Human Development. 

Washington, DC. 

The National Child Traumatic Stress Network. (2006). Culture 

and trauma (Issue Brief). Available at www.nctsnet.org 

The National Child Traumatic Stress Network. (2006). Promoting 

culturally competent trauma-informed practices. Available at www. 

nctsnet.org/nccts/asset.do?id=817

The National Child Traumatic Stress Network. (2006). Trauma 

among lesbian, gay, bisexual, transgender, and/or questioning 

youth. Washington, DC. Available at www.nctsnet.org/nccts/asset. 

do?id=885

Website 

National Child Traumatic Stress Network. www.nctsnet.org 

traUma-inFormed serVices 

Printed material 

Harris, M. and Fallot, R. (Eds). (2001). Using trauma theory to 

design service systems. San Francisco, CA: Jossey-Bass. 

Jahn Moses, D., Huntington, N., & D’Ambrosio, B. (2004). 

Developing integrated services for women with co-occurring 

disorders and trauma histories: Lessons from the SAMHSA women 

with alcohol, drug abuse and mental health disorders who have 

histories of violence study. National Center for Trauma Informed 

Care. Available at www.mentalhealth.samhsa.gov/cmhs/ 

womenandtrauma 

Jahn Moses, D., Reed, B.G., Mazelis, R., & D’Ambrosio, B. (2003). 

Creating trauma services for women with co-occurring disorders: 

Experiences from the SAMHSA women with alcohol, drug abuse, 

and mental health disorders who have histories of violence study. 

National Center for Trauma Informed Care. Available at 

www.mentalhealth.samhsa.gov/cmhs/womenandtrauma 

Prescott, L., Soares, P., Konnath, K., and Bassuk, E. (2008). A 

long journey home: A guide for creating trauma-informed services 

for mothers and children experiencing homelessness. Rockville, 

MD: Center for Mental Health Services, Substance Abuse and 

Mental Health Services Administration; and the Daniels Fund; 

National Child Traumatic Stress Network; and the W.K. Kellogg 

Foundation. Available at www.homeless.samhsa.gov 

Website 

National Center for Trauma-Informed Care. www.mentalhealth. 

samhsa.gov/nctic 
 

76 Trauma-Informed Care for Women Veterans Experiencing Homelessness 

consUmer inVolVement 

Printed material 

Prescott, L. (2001). Consumer/survivor/recovering women: A 

guide for partnerships in collaboration. Delmar, NY: Policy 

Research Associates. Available at www.mentalhealth.samhsa. 

gov/cmhs/womenandtrauma 

Prescott, L. (2001). Defining the role of consumer-survivors in 

trauma-informed systems. In M. Harris & R. Fallot (Eds.). Using 

trauma theory to design service systems. San Francisco, CA: 

Jossey-Bass. 

Websites 

National Consumer Advisory Board to the National Health 

Care for the Homeless Council. www.nhchc.org/advisory.html 

National Empowerment Center. www.power2u.org 

employment 

Printed material 

Job Accommodation Network. Employees with mental health 

impairments. Available at www.askjan.org/media/Psychiatric. 

html 

U.S. Department of Labor, Bureau of Labor Statistics. 

Employment situation of Veterans. Available at www.bls.gov/ 

spotlight/2010/Veterans/ and www.bls.gov/spotlight/2010/ 

Veterans/ and www.bls.gov/news.release/pdf/vet.pdf 

Websites 

America’s Heroes at Work. www.americasheroesatwork.gov/ 

Ending Chronic Homelessness through Employment and 

Housing Grantees. www.csh.org/index.cfm?fuseaction=page.

viewPage&pageID=3641&nodeID=81

U.S. Department of Labor, Veterans Employment Training 

Services. Homeless Female Veterans’ & the Homeless Veterans’ 

Reintegration Program. www.dol.gov/opa/media/press/vets/ 

VETS20100917.html 

selF-care For serVice proViders 

Printed material 

Arledge, E. & Wolfson, R. (2001). Care of the clinician. In M. 

Harris & R. Fallot (Eds.). Using trauma theory to design service 

systems. San Francisco, CA: Jossey-Bass. 

Saakvitne, K., Gamble, S., Pearlman, L., & Lev, B. (2001). 

Module 5: Vicarious traumatization and integration: Putting 

it all together. In risking connection: A training curriculum for 

working with survivors of childhood abuse. New York, NY: Sidran 

Traumatic Stress Foundation. Available at www.sidran.org 

Stamm, B.H. (2005). The ProQOL manual: The professional 

quality of life scale: Compassion satisfaction, burnout 

and compassion fatigue/secondary traumatic stress scales. 

Washington, DC: Register Report: A Publication of the 

National Register of Health Service Providers in Psychology. 

Stamm, B.H., Varra, E.M., Pearlman, L.A., and Giller, E. 

(2002). The Helper’s Power to Heal and to be hurt – or helped 

– by trying. Register Report: A Publication of the National 

Register of Health Services Providers in Psychology. 

Volk, K., Guarino, K., Grandin, M.E., Clervil, R. (2008). What 

about you? A workbook for those who work with others. Newton, 

MA: National Center on Family Homelessness. Available at 

www.familyhomelessness.org 

Website 

National Health Care for the Homeless Council. www.nhchc. 

org/healthyenviron.html 
Trauma-Informed Care for Women Veterans Experiencing Homelessness 77 

interVentions and training resoUrces 

Printed material 

Clark, C., & Fearday, F. (Eds.). (2003). Triad women’s project: 

Group facilitator’s manual. Tampa, FL: Louis de la Parte Florida 

Mental Health Institute, University of Southern Florida. For more 

information, contact Dr. Colleen Clark at cclark@fmhi.usf.edu 

D’Ambrosio, B. & Jahn Moses, D. (2002). Nurturing families 

affected by substance abuse, mental illness, and trauma: A parenting 

curriculum for women and children. The Coordinating Center of 

the SAMHSA Women, Co-Occurring Disorders, and Violence 

Study. Available at www.mentalhealth.samhsa.gov/cmhs/ 

womenandtrauma 

Institute for Health and Recovery. (2002). Developing traumainformed organizations: A tool kit. Women Embracing Life and 

Living (WELL) Project and the WELL Project State Leadership 

Council of the Institute for Health and Recovery. Available at 

www.healthrecovery.org 

Foa, E.B., Keane, T.M., & Friedman, M.J. (2000). Effective 

treatments for PTSD. New York, NY: Guilford Press. 

Ford, J.D., Courtois, C., Steele, K., Van der Hart, O. & Nijenhuis, 

E., (in press). Treatment of the complex sequelae of psychological 

trauma. Journal of Traumatic Stress. 

Greendlinger, R. and Spadoni, P. (2010). The tool kit for 

effectively engaging and delivering services to America’s Veterans 

and their families. Newton, MA: The National Center on Family 

Homelessness. Available at www.familyhomelessness.org/ 

resources 

Guarino, K., Soares, P., Konnath, K., Clervil, R., and Bassuk, E. 

(2009). Trauma-informed organizational toolkit. Rockville, MD: 

Center for Mental Health Services, Substance Abuse and Mental 

Health Services Administration, and the Daniels Fund, the 

National Child Traumatic Stress Network, and the W.K. Kellogg 

Foundation. Available at www.homeless.samhsa.gov and www. 

familyhomelessness.org 

Harris, M., & Anglin, J. (1998). Trauma recovery and 

empowerment: A clinician’s guide for working with women in 

groups. New York, NY: Free Press. This and other resources about 

TREM are available at www.communityconnectionsdc.org/ 

Kinniburgh, K. and Blaustein, M. (2005). Attachment, selfregulation, and competency: A comprehensive framework for 

intervention with complexly traumatized youth. Brookline, MA: 

The Trauma Center. 

Najavits, L. (2001). Seeking safety: A treatment manual for PTSD 

and substance abuse. New York, NY: Guilford Press. 

Saakvitne, K., Gamble, S., Pearlman, L., & Lev, B. (2001). Risking 

connection: A training curriculum for working with survivors 

of childhood abuse. New York, NY: Sidran Traumatic Stress 

Foundation. Available at www.sidran.org 

SAMHSA Homeless Families Coordinating Center. (2005). Trauma 

interventions for homeless families: Innovative features and 

common themes. Washington, DC: Vanderbilt University Center for 

Evaluation and Program Improvement. 

The National Center on Family Homelessness. (2008). Developing 

trauma-informed services for families experiencing homelessness: 

An interactive training video and guide. Available at www. 

familyhomelessness.org 

Volk, K., Guarino, K., & Konnath, K. (2007). Homelessness and 

traumatic stress training package. Rockville, MD: Substance Abuse 

and Mental Health Services Administration. Available at www. 

homeless.samhsa.gov 

Wilson, J.P. & Keane, T. (Eds.). (2004). Assessing psychological 

trauma and PTSD. New York, NY: Guilford Press. 
 

78 Trauma-Informed Care for Women Veterans Experiencing Homelessness 

sUBstance aBUse and traUma 

Printed material 

Brenda, Brent B. (2006). Survival analyses of social support and 

trauma among homeless male and female Veterans who abuse 

substances. American Journal of Orthopsychiatry, 76(1), 70-79. 

Miller, D. & Guidry L. (2001). Addictions and trauma recovery: 

Healing the body, mind, and spirit. New York, NY: NP 

Psychotherapy Books. 

Moore, J., Buchan, B., Finkelstein, N. et al. (2001). Nurturing 

families affected by substance abuse, mental illness, and trauma. 

Cambridge, MA: Institute for Health and Recovery. Available at 

www.healthrecovery.org 

Najavits, L.M., Weiss, R.D., & Shaw, S.R. (1997). The link 

between substance abuse and posttraumatic stress disorder in 

women: A research review. American Journal on Addictions, 

6(4), 273-283. 

North, C.S., Thompson, S.J., & Smith, E.M. et al. (1996). 

Violence in the lives of homeless mothers in a substance abuse 

treatment program: A descriptive study. Journal of Interpersonal 

Violence, 11(2), 234-249. 

The Coordinating Center of the SAMHSA Women, CoOccurring Disorders, and Violence Study. (2000). Parenting 

issues for women with co-occurring mental health and substance 

abuse disorders who have histories of trauma. Available at www. 

mentalhealth.samhsa.gov/cmhs/womenandtrauma 

cHildren and traUma 

Printed material 

Bassuk, E., Konnath, K., Volk, K. (2007). Understanding 

traumatic stress in children. Newton, MA: National Center on 

Family Homelessness. Available at www.familyhomelessness. 

org 

Buckner, J., Beardslee, W., & Bassuk, E.L. (2004). Exposure 

to violence and low-income children’s mental health: Direct, 

moderated, and mediated relations. American Journal of 

Orthopsychiatry, 74(4), 413-423. 

Cook, A., Blaustein, M., Spinazzola, J., & van der Kolk, B. 

(Eds.). (2003). Complex trauma in children and adolescents: A 

white paper from the National Child Traumatic Stress Network 

Complex Trauma Task Force. Available at www.nctsnet.org 

Cook, A., Spinazzola, J., Ford, J.,et al. (2005). Complex trauma 

in children and adolescents. Psychiatric Annals, 35(5), 390 – 

398. 

Greenwald, R. (2005). Child trauma handbook. New York, NY: 

Haworth Press. 

Sesame Workshop’s Talk, Listen, Connect Initiative - Bilingual 

resources and support to military families with young children 

facing challenging transitions in their life including coping 

with deployments, homecomings, injuries, and death. More 

information available at www.sesameworkshop.org/initiatives/ 

emotion/tlc/fundingpartners 
	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	

Trauma-Informed Care for Women Veterans Experiencing Homelessness 79 

appendIx I: 

enhanCementS to Va SerVICeS for Women VeteranS
 

Women are one of the fastest growing subgroups of U.S. veterans. The number of women veterans is expected to increase dramatically 

over the next 10 years, and VA benefits, particularly health care, are in high demand by the women veterans of Operation Enduring 

Freedom and Operation Iraqi Freedom. The Department of Veterans Affairs is committed to meeting the needs of women veterans and 

is enhancing services in the following areas: 

HealtH care 

VA is enhancing health care services for women veterans in its endeavor to be a national leader in the provision of women’s health care. 

Current initiatives include: 

•	 Redesigning primary care for women veterans so that care for acute and chronic illness, gender-specific primary care, preventive

services, mental health services, and coordination of specialty care is delivered by one provider at one site 

•	 Integrating mental health into the primary care setting for better continuity of care

•	 Staffing every VA medical center with a full-time Women Veterans Program Manager to assist women veterans in navigating the

health care system 

•	 Creating a mini-residency training program to educate primary care providers on women’s health

•	 Supporting a multi-faceted research program on women’s health

•	 Improving communication and outreach to women veterans through a national health outreach campaign, spearheaded by the

Women Veterans Program Managers 

•	 Working to make the language, practices, and culture of the VA more inclusive of women veterans

•	 Exploring ways to enhance care for women veterans with disabilities through a Prosthetics Women’s Workgroup, focusing on

technology, research, training, and repair and replacement of prosthetic appliances specific to women 

Homelessness 

Women were 7.5% of the 136,334 homeless veterans who were sheltered sometime between October 1, 2008 and September 30, 2009. 

In 2009, Secretary of Veterans Affairs Eric K. Shinseki pledged to end homelessness among veterans within the next five years. Efforts to 

meet this goal include: 

•	 In 2010, making available $17 million in grants to community groups in 19 states, the District of Columbia, and Puerto Rico to

create 1,155 beds for homeless veterans this year 

•	 Launched a 24/7 National Call Center for Homeless Veterans staffed by VA counselors trained to help homeless veterans or 

veterans at risk for homelessness 1-877-4AID-VET (1-877-424-3838) 

•	 Operating the Health Care for Homeless Veterans Program to provide outreach, physical, and psychiatric examinations and

referrals for more than 40,000 veterans annually at 132 sites 

•	 Providing residential treatment to more than 5,000 homeless veterans each year in VA domiciliaries
80 Trauma-Informed Care for Women Veterans Experiencing Homelessness 

•	 In collaboration with the Department of Housing and Urban Development (HUD), created independent housing opportunities		

for homeless veterans through its HUD-VASH (VA Supported Housing) Program. Approximately 30,000 Section 8 Housing 

Choice Vouchers have been made available for homeless veterans, including homeless veterans with families. Veterans who receive 

vouchers are also provided with case management by VA Staff. 

BeneFits 

VA administers a variety of benefits and services that provide financial and other forms of assistance to veterans, their dependents, and 

survivors. VA is working to streamline paperwork and expedite the process for veterans seeking compensation for disabilities related to 

their military service. Recent progress includes: 

 

•	 Shortening application forms for veterans applying for the first time to the VA for disability compensation or pension benefits

•	 Introducing two new forms for veterans participating in the Department’s new, fully developed claim (FDC) program, which is one

of the fastest means to a claims decision 

VA has also recently added eBenefits.va.gov, an online resource for benefits-related information for veterans. 

readjUstment serVices 

VA Vet Centers provide professional readjustment counseling, military sexual trauma counseling, community education, outreach to 

special populations, and brokering of services with community agencies to veterans — men and women — who have served in combat 

zones or who have experienced military sexual trauma or harassment. More than 40% of Vet Center staff are women, allowing centers 

to offer gender-sensitive transition assistance, including military sexual trauma counseling, to women veterans. 

Recent efforts of special interest to women include: 

•	 Enhanced access to MST counseling – To increase the program’s capacity to provide MST counseling, a qualified MST counselor is 

planned for every Vet Center. During the interim, Vet Centers currently without a qualified MST counselor will minimally have the 

capacity to assess and refer MST veterans. 

•	 Improved access to Family counseling – Vet Centers recognize that family members are central to the combat veteran’s 

readjustment. To meet the need for qualified family counselors, the VA Readjustment Counseling Service has developed qualifying 

criteria for family counselors in Vet Centers. The Vet Center program is implementing a plan to place at least one qualified, 

specialized, family counselor in every Vet Center nationwide. 
 

 

 

 

 

 

Trauma-Informed Care for Women Veterans Experiencing Homelessness 81 

appendIx 2: 

addItIonal enhanCementS for Women VeteranS through the Women VeteranS
 

health StrategIC health group
 

The VA began providing medical and 

psychosocial services for women in 1988, 

when women represented 4.4 percent of 

all veterans. Currently, VA projects that 

women will make up 15% of the veteran 

population receiving care from VA by 2012. 

The Women Veterans Health Strategic 

Health Care Group (WVHSHG) provides 

programmatic and strategic support to 

implement positive changes in the provision 

of care for all women veterans. The VA is 

actively addressing resource needs so that 

the proper training, as well as equipment 

and supplies (including DEXA scans, 

mammography machines, ultrasound 

and biopsy equipment) are in place in its 

facilities. The WVHSHG is coordinating 

closely with Primary Care Services to 

redesign the delivery of primary care 

to women veterans to include genderspecific care at every VA site. Ultimately, 

comprehensive primary care delivered 

by a single provider in the same location 

— including gender-specific care and 

mental health — will be the predominant 

model of care throughout the VA health 

care network in alignment with the 

principles of Patient-Centered Medical 

Home. 

The WVHSHG partners with VA 

Employee Education Services to conduct 

mini-residencies in Women’s Health. To 

date, more than 400 VA providers have 

been trained. A second round of miniresidencies, covering additional women’s 

health topics will get underway in late 2010, 

focuses on more advanced women’s health 

topics. Grants released to the field allow 

for the training of additional providers 

by facilities. In addition, VA facilities are 

recruiting new providers interested and 

proficient in women’s health to meet the 

needs of its growing population of women 

veterans. 

In collaboration with VA experts, WVHSHG 

is tackling women’s reproductive health 

issues. Reducing the risk of birth defects 

due to teratogenic medications is a top 

priority for WVHSHG. Other important 

efforts include improving follow-up of 

abnormal mammograms, tracking the 

timeliness of breast cancer treatment, and 

developing specific clinical action strategies 

for women with human papillomavirus. 

The WVHSHG is leading development 

of a Veterans Health Administrationwide communication plan to enhance the 

language, practice, and culture of the VA 

to be more inclusive of women veterans. A 

national Women’s Health Communications 

Workgroup develops and disseminates 

standardized outreach materials to raise 

awareness of the women veteran population 

and their unique needs. Branding Women 

Veterans Health Care with a powerful 

identity, including a visual logo and 

tagline — You Served, You Deserve the Best 

Care Anywhere — is helping establish a 

consistent, nationally recognized symbol for 

high quality services that women veterans 

should expect at every VA facility. 

WVHSHG also works closely with VA 

analysts and data specialists to ensure 

that women veteran populations are 

represented clearly in statistical data, 

including demographics, epidemiology, 

health status, and quality of care. Enhanced 

web capabilities are continually being 

implemented to improve the transfer of 

information among field and leadership 

personnel. 

For the first time in 25 years, the VA 

surveyed women veterans across the 

country to: (1) identify in a national 

sample the current status, demographics, 

health care needs, and VA experiences 

of women veterans of the U.S. Armed 

Forces; (2) determine how health care 

needs and barriers to VA health care use 

differ among women veterans of different 

periods of military service; and (3) assess 

women veterans’ health care preferences 

in order to address VA barriers and health 

care needs. The interim report, released 

in summer 2010, informs policy and 

planning and provides a new baseline for 

program evaluation with regard to veterans’ 

perceptions of VA health services. The final 

report will be released in spring 2011. 

contact Us 

U.S. Department of Veterans Affairs 

Women Veterans Health Strategic Health 

Care Group (13E) 

810 Vermont Avenue, NW 

Washington, DC 20420 

Women veterans who are interested in 

receiving care at the VA should contact 

the nearest VA Medical Center and ask for 

the Women veterans Program Manager. 

Women Veterans Program Managers are 

designated at every VA medical center 

across the nation to advise and advocate for 

women veterans. 

to find the nearest Va health care 

facility: 

By phone: 877-222-VETS (8387) 

www.publichealth.va.gov/womenshealth 
 

 

 

	 	 	 	 	 	 	 	 	

82 Trauma-Informed Care for Women Veterans Experiencing Homelessness 

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