Improving Traumatic Stress in Black Women Experiencing Homelessness: Evaluation of a Stakeholder Engaged Intervention

PROJECT SUMMARY/ABSTRACT Homelessness and associated traumas disproportionately impact Black women. While women experiencing homelessness (WEH) universally face traumatic stress, Black WEH are disproportionately impacted by trauma, including racial trauma. Repeated exposure to trauma contributes to the inequitable development of

posttraumatic stress disorder (PTSD), preventable biopsychosocial health adversity, and worsening of existing health inequities. Our research has shown that Black WEH identify trauma as a priority health issue, yet, evidence-based standard of trauma care remains largely unrealized in this population. In response to the dearth

of culturally acceptable trauma care models, our team pilot tested Narrative Exposure Therapy (NET)—a brief, human rights-informed trauma-focused treatment approach for complex PTSD. Our pilot showed strong feasibility and effects of nurses delivering NET within shelter settings within six sessions. Interviews with Black

WEH, shelter staff, and mental health professionals, however, highlighted a missing element of cultural resonance to enable trust building and long-term engagement with trauma care. Stakeholders desired a peer to be included in the research—involving women with lived experience of homelessness, who most culturally and

experientially mirror participants—to complement and support nurse-delivery of NET. In response to stakeholders, our solution, NurseNET, integrates a woman with lived experience, or “peer”, into the NET delivery process. In NurseNET, “a Woman of Color”, “a person who’s been through it, who knows what it feels like” and

“is going to communicate differently” is positioned to be “a solution” to trauma. In this randomized controlled trial (RCT), we will: Aim 1. Determine the effects of NurseNET in reducing PTSD and co-occurring symptoms in Black WEH, accomplished via an RCT with 210 Black WEH; Aim 2. Demonstrate the effects of NurseNET in

addressing the social determinants of health (SDoH), including healthcare access, social support, racial trauma impact, and financial self-efficacy (peers); Aim 3. Assess the acceptability, appropriateness, and feasibility factors that impact implementation of and engagement with NurseNET, via validated surveys and in-depth

qualitative interviews. Cutting across all five NINR research lenses, we will (1) promote heath equity by reducing and aiming to eliminate individual and structural inequities related to traumatic stress; (2) address and improve the SDoH, focusing on trauma, particularly racial trauma; (3) foster population and community health, addressing

trauma as a growing public health challenge; (4) encourage prevention and health promotion, engaging Black WEH in trauma-informed relationships that model optimal care engagement; (5) assess an innovative nurse-led care model that can be embedded within existing healthcare systems, solving for long-standing clinical and policy

challenges. Our study will advance nursing research towards discovery of scalable nurse-led solutions to close gaps in trauma care across disinvested communities to promote health equity.