Q&A: Trauma ‘Types’ Versus ‘Numbers:’ Which Has the Bigger Impact on Homeless Youth?

A young person looking sad.

We’ve seen that many homeless youth experience more than one type of trauma both before and after leaving home. But do the types of trauma young people face, and the combinations of those specific events, matter more than the sheer number of traumatic experiences? Yes, says Carolyn Wong, assistant professor of research at Children’s Hospital Los Angeles.  

Wong and her colleagues analyzed the experiences and mental health symptoms of nearly 400 Los Angles youth who had recently experienced homelessness or “precarious housing.” By collecting data on a range of lifetime experiences like substance use and physical violence, the researchers hoped to compare and contrast the impact of single traumatic episodes on mental health against the combined effects of multiple events—a concept often described as complex trauma.

We spoke to Wong to find out more about complex trauma and what she wants family and youth workers to know about what her study found.

NCFY: How would you explain complex trauma to a lay person?

Wong: Traumatic experiences are not necessarily isolated in one instance. It can be something chronic or something that co-occurs with something else. It can be something that does not seem severe to one person but does to others. For example, some people might not think of not having enough to eat or being neglected as a form of trauma, but [these experiences] can be very traumatic for individuals. [In the same vein], complex trauma doesn’t necessarily have to be related to something someone did to you; it could be simply not getting the care you need for healthy development.

[Read a recap of our recent Twitter chat on homeless youth and complex trauma.]

NCFY: What motivated you to look at complex trauma alongside specific traumatic experiences of homeless youth?

Wong: There’s an emerging discussion in the literature about the way trauma has been conceptualized and how we measure PTSD [post-traumatic stress disorder], one of the key outcomes for the experience of trauma. We are still trying to understand [the best ways] to think about complex trauma and [how to] measure it.

"Compound trauma" is how we conceptualize complex trauma in our study. We didn’t assess the chronicity or the magnitude, just whether or not certain events happened and whether it was before or during a homelessness experience. One of the [reasons for] introducing this concept of compound trauma is to point out that the way other researchers have been thinking about complex trauma is to say, "Let’s sum it up." But specific traumatic experiences, such as neglect and sexual abuse, are very different. How would each particular traumatic experience impact mental health differently if it’s also experienced in addition to sexual abuse versus not, for example? This is our way of thinking about it and contributing to the literature.

NCFY: Was there anything that surprised you in doing this research? If so, what was it?

Wong: I was surprised that the poly-victimization variable, which is the sum of all the traumatic experiences that had occurred, and one of the ways we measured compound trauma, didn’t add to the prediction of the outcomes. The type of trauma mattered more than the sheer number of traumatic experiences. Getting at type rather than number was what was interesting and different than other studies.

NCFY: What do you most want homeless youth service providers to take away from your study?

Wong: It’s really important for providers who see trauma in their clients to know that the kinds of instruments they are using to assess it might not fully capture the youth’s experience. It’s important to allow themselves to ask additional questions that get outside the box and consider that the research may not have caught up to the reality of how we are assessing trauma in the population. The assessment is ultimately what is going to determine whether we are providing the right kinds of treatment for this population.

[Learn more about assessment and screening.]


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