Traumatic Brain Injury and Homeless Populations – a role for Philanthropy?

In October 2011, I attended a session at the Annual Meeting of Philanthropy Roundtable with the title: Four Models for Addressing Chronic Unemployment and Homelessness.  Four Models for Addressing Chronic Unemployment and Homelessness

Homelessness, hunger, and unemployment cry out for solutions. The most sustainable solutions, however, often depend on the homeless, hungry, and unemployed building self-reliance and in turn reclaiming their lives and restoring their positions in their families and their communities. Training programs can help people to accomplish this for themselves in a variety of ways. On this panel, representatives of four exemplary social service organizations will outline the best ways for private charity to help people to help themselves—from faith-based approaches and getting people off the streets to providing permanent housing and re-purposing unused food for job training.

Barbara Elliott, president and founder, Center for Renewal and board member, Work Faith Connection
Sister Mary Scullion, executive director and president, Project Home
Jennifer Vigran, chief executive officer, Second Helpings
Matt Minkevitch, executive director, The Road Home
Betsy Bikoff, vice president and chief grant making officer,Richard M. Fairbanks Foundation (Moderator)

Each of the panelists described programs they developed to assist the homeless as they identify a path to self-sufficiency.  It was evident that the number of homeless people is increasing in each of the geographic areas represented by the panel.  “Overwhelming” was a word used to describe the pressures the increased numbers place on their organizations.     Every one of these programs is able to describe success for a large number of the clients they served; but at the same time, they admitted to seeing an increasing number of people for whom the simplest steps to recovery and “self-help” remains a challenge.

Those studying the homeless populations now make distinctions among the people they serve: (1) those who are homeless due to sudden changes in economic situation or temporary set-back and (2) the “chronically homeless” who appear to be mentally and/or emotionally ill and/or with substance dependency.   Typically this group faces a longer time horizon to stabilization and the rates of recidivism are very high.  Some never reach stabilization.      During the question and answer period, I referenced an article from the December 24, 2010 New York Times called, “The Street Level Solution.” The article cites studies that find a significant number of chronically homelessness people having a history of Traumatic Brain Injury (TMI). The author David Bornstein writes that it is important for providers to distinguish the chronically homeless in order to better understand the true problem.  His research brought him to Dr. James O’Connell,“…a doctor who has been treating the most vulnerable homeless people on the streets of Boston for 25 years, (he) estimates that 40 percent of the long-term homeless people he’s met had such a brain injury. ‘For many it was a head injury prior to the time they became homeless,’ he said. ‘They became erratic. They’d have mood swings, bouts of explosive behavior. They couldn’t hold onto their jobs. Drinking made them feel better. They’d end up on the streets.’ ”     I asked the panelists if they were aware of this and related research and; if so, were they seeing it?  Every one of the panelists shook their heads in agreement and suggested that there was little understanding among those in the public sector about the gravity of this problem.  Matt Minkevitch said he is certain that many clients at The Road Home have had a history of past brain injury.

In his opinion, the crisis is rooted in the fact that clients often present symptoms that look more like those that need to treated by an assortment prescribed psychotropic drugs usually through mental health departments.  He described one client in particular who had been in and out of the mental health system treated as a schizophrenic and sedated.  He never responded to the pharmacopeia of psychotropic medications which puzzled the many physicians and mental health providers. The client who was well-known to all at the Road Home discussed his suffering on many occasions.  He killed himself after a particularly violent episode.  His case was of enough interest that an autopsy was performed.  The autopsy report showed that the man was not schizophrenic at all, but had been experiencing brain seizures related directly to a traumatic brain injury.

Clearly the chronically homeless will remain a challenge for many in the years to come.   Most disturbing to us and the providers is the increasing number of veterans who are appearing at homeless shelters across the country.  This phenomenon parallels the stories of men and women returning from Iraq and Afghanistan suffering from Post Traumatic Stress Disorder – a subset of whom have experienced brain trauma.

As a foundation that hopes to address the root causes of poverty, I think this apparent link between homelessness and TBI is worth exploring. I would suggest that other foundations that support programs dealing with homeless populations do the same. Since January 1, 2002, The Nord Family Foundation trustees approved 70 grants totaling $1,460,300 that provided support in some form or another to homeless populations.   This number includes grants across both the Health and Human Services &Civic Affairs program areas, and includes supportive programs such as Children’s Garden that provides child care for homeless families and the Lorain County Furniture Bank that provided furniture to families transitioning out of homelessness.   Other foundation grants by geographic areas (excluding matching grants) include:

Lorain County: 

Family Promise of Lorain County
Catholic Charities Family Center and St. Joe’s Shelter

Cuyahoga County:

Interfaith Hospitality Network of Greater Cleveland
West Side Catholic Center


Damen Project
The Delores Project
The Gathering Place
St. Francis Center
Urban Peak
Warren Village
Step 13


Family Shelter
Salvation Army Midlands
Women’s Shelter

The Nord Family Foundation’s concern for the homeless can be traced to the early 1940’s when Walter Nord became invested in creating the Nord Center due to the large number of returning war veterans who suffered from “shell shock” and who had little support.   How many of those men had experienced some form of TBI in their service?  Then, as now, the more severe manifestations of TBI were referred to the mental health system.  Advances in biotechnology have improved the understanding of the brain and its functions.  Doctors are now discovering what many front-line providers have sensed for a long time; that is. the cognitive and physical manifestations in the homeless that people attribute to mental illness, mental retardation and or drug use have deeper idiopathic explanations.  Consequently the way to really help these people is advocating for expanded primary health care access to those suffering from homelessness. Forging partnerships between mental health providers and primary health care workers who can better diagnose TBI will help to relieve the crush on the overtaxed mental health systems and at the same time better address the root causes of homelessness.

In September 2011, I was introduced to the Craig Hospital in Denver Colorado.   Craig is dedicated exclusively to Spinal Cord Injury (SCI) and Traumatic Brain Injury (TBI).  In follow-up to my visit, I asked several staff members if they too were looking at this topic.  I made connection with Kristi Staniszewski, RPT Clinical Specialist from the Research Department.  Kristi let me know the link between TBI and homeless populations is recognized as underreported and an important policy item for the Brain Injury Alliance of Colorado.   Kristi asked she thought there might be value in the Nord Family Foundation helping the alliance convene a meeting of clinicians, and providers who are seeking support to advance the recommendations of the Executive Order on Traumatic Brain Injury – Final Report which was presented to Governor Bill Ritter, Jr. in December 2009.     With minimal investment of funding, the foundation is in a position to convene a discussion on the subject to include providers and appropriate medical practitioners to gather more information on TBI and its impact on the social service sector.  My research revealed that in one conference on the topic took place in 2010 in Maine.  I included an opening talk by one of the presenters.   Please notice that she starts her talk saying that few conference on the topic of homlessness every address the link with TBI.  We can serve as a catalyst and hopefully bring this topic to NE Ohio, Columbia, SC; and perhaps Boston.

I welcome any comments from foundation representatives or service providers.

2 thoughts on “Traumatic Brain Injury and Homeless Populations – a role for Philanthropy?

  1. Tom Tatlock

    Thank you for raising this issue. I have been working to “Create a Community Coalition to Address the Issues of TBI among the Persons who are Homeless.”
    We have created a coalition of 6 groups that provide services to the persons who are homeless and the 2 service providers who work with persons who have been abused. We have obtained an initial grant from The Community Foundation of the Fox Valley Region, in Appleton, WI to initiate this.
    The goal is to train the front line staff so that they can recognize TBI and to train them in the techniques of Cognitive Rehabilitation (Remediation) Therapy so that the staff can teach those skills. The staff will Not become Cognitive Rehabilitation therapists but will teach the cog. rehab. skills in the classes on “life-skills” and incorporate the lessons in their client-staff interactions.
    I have developed both a list of “Recommended Resources” that I would be happy to share with you. Also, I can send some of my Power Point presentations if you want them.
    At present, it seems to me, a lot of effort is directed to identifying the persons who have sustained a TBI and who are homeless. This usually leads to an application for SSDI. I’m not aware of any active TBI treatment efforts — but that might just be my fault.
    I became interested in this topic after sustaining a TBI in 1999, that forced me to retire.
    Can you send me an address so that I can contact you directly?

  2. Pingback: Understanding the Trauma in Traumatic Brain Injury | Broken Brain – Brilliant Mind

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