rcasa

RCASA Friday Facts: Sexual Assault and Homeless Women Part 2

In Friday Facts, Sexual Assault Awareness on March 25, 2011 at 8:00 am
Taken from No Safe Place: Sexual Assault in the Lives of Homeless Women
 

By Lisa Goodman, Katya Fels, and Catherine GlennWith contributions from Judy Benitez

Question of Causality

A range of factors increase homeless women’s risk of adult sexual victimization, including childhood abuse, substance dependence, length of time homeless, engaging in economic survival strategies (such as panhandling or involvement in sex trade), location while homeless (i.e. sleeping on the street versus sleeping in a shelter) and presence of mental illness (Kushel, Evans, Perry, Robertson, & Moss, 2003; Nyamathi, Wenzel, Lesser, Flaskerud, & Leake, 2001; Wenzel, Koegel, & Gelberg, 2000; Wenzel, Leake, & Gelberg, 2001). Many of these factors, discussed in more detail below, coexist, interact with, and exacerbate each other over time, creating a complex and distinctive context for each woman.

It is important to note that all of these factors would have a much more tenuous connection with sexual assault if social institutions were in place to prevent homelessness, to protect vulnerable women, and to help them recover and become safe following an initial assault while addressing the myriad other challenges they face. And yet to date, no research has been conducted on the impact of institutional failures on the prevalence or correlates of sexual assault among homeless women. For example, research has not yet examined the unsuitability of traditional sexual assault crisis services, such as hotlines and in-office counseling, for individuals who lack access to a telephone, transportation, literacy skills, and safe housing.

Sexual Assault Prior to Homelessness

The relationship between sexual assault and homelessness is complex, with either experience potentially laying the groundwork for the other.   Indeed, given the traumatic lifestyles of so many homeless women, sexual abuse may precede and follow from homelessness in a vicious cycle downward.   In the next two sections, we take a closer look at existing research on two different types of sexual assault (child sexual abuse and sexual violence at the hands of a partner) as precursors to adult homelessness and subsequent victimization.

Childhood Sexual Abuse

A number of studies have emphasized the correlation between childhood sexual abuse and homelessness among adult women (Bassuk and Rosenberg, 1988; Davies-Netzley & Hurlburt, & Hough, 1996; Simons & Whitbeck, 1991; Stermac & Paradis, 2001; Wenzel et al., 2004; Zugazaga, 2004). For example, one study of women seeking help from a rape/sexual assault crisis center found that childhood sexual abuse was reported by 43% of the homeless participants, compared to 24.6% of the housed participants (Stermac et al., 2004). Another study that took a qualitative approach found that homeless women identified child sexual victimization as a cause of their homelessness (Evans & Forsyth, 2004).

Childhood sexual abuse is also correlated with adult victimization among homeless women (Nyamathi et al., 2001; Terrell, 1997; Tyler, Hoyt, & Whitbeck, 2000; Whitbeck, Hoyt, & Ackley 1997).   One study found that homeless women with histories of childhood sexual abuse were twice as likely to experience adult violent victimization as those without such histories (Nyamathi et al., 2001). For homeless women with serious mental illness (SMI), the connection between child sexual abuse and adult victimization is even stronger.   In one study of women with serious mental illness and histories of homelesness, the chance of revictimization for women who had experienced child physical or sexual abuse was close to 100% – difficult odds to beat (Goodman, Dutton & Harris, 1995; Goodman, Johnson, Dutton, & Harris, 1997).

A number of explanations have been offered for the relationship between child sexual abuse and subsequent homelessness and sexual assault, respectively.   It is possible, for example, that child sexual abuse survivors may find it difficult to trust others, so they develop fewer of the sustaining and supportive relationships necessary to avoid homelessness (Bassuk, 1993). Also, the posttraumatic stress disorder that often results from child sexual abuse can cause women to miss danger cues in their environments due to hypervigilance (attending to everything as a threat) or dissociation (shutting down when faced with threatening situations), resulting in risk for further victimization (Salomon, Bassuk, & Huntington, 2002; Tyler, Hoyt, & Whitbeck, 2000; Whitbeck, Hoyt, & Ackley, 1997). Finally, women who experience childhood sexual abuse have been shown to be at increased risk for developing substance abuse disorders, which put women at increased risk for both assault and homelessness (Burnam, Stein, Golding, Siegal, Sorenson, & Telles, 1988; Salomon, Bassuk, & Huntington, 2002; Simmons & Whitbeck, 1991; Tyler, Hoyt, & Whitbeck, 2000).

However, these explanations alone do not tell the whole story.    A much fuller explanation for these devastating correlations emerges from an exploration of the complex array of historical and current contextual factors many women face, including multiple oppressions, lack of appropriate, culturally relevant, and timely resources, and growing up in unsafe settings without sufficient material and emotional support. Rather than one causing the other, we suggest that the contextual factors that often precede child sexual abuse (and repeated victimization) also precede homelessness.    For example, poor families; people of color; and immigrants, refugees, and victims of sex trafficking may experience systems such as law enforcement, social services, foster care, or welfare not as sources of care and assistance, but of neglect or punishment.   Childhood sexual abuse survivors in particular may have experienced caregivers acting appropriately in public and inappropriately in private, and therefore may be reluctant to trust people whose job it is to help them. As children and as adults, they may be reluctant to seek help from people in “the system” and therefore remain particularly vulnerable to ongoing victimization and homelessness, in addition to self-medication through substances and isolation.

Abuse by Partners

Not surprisingly, a number of studies point to abuse–including rape–at the hands of a current or former partner, as a risk factor for homelessness among women (Toro, Bellavia, Daeschler, Owens, Wall, Passero, & Thomas, 1995).   This is particularly evident for women who experience partner violence at the more severe end of the continuum, and who have been isolated by their abusers from family and friends who might have offered to help them (Baker, Cook, & Norris, 2003).   Indeed, it is estimated that half of all homeless women and children have become homeless while trying to escape abusive situations (Browne & Bassuk, 1997, as cited in Evans & Forsyth, 2004). Experiences of partner violence have also been shown to predict risk of repeat homelessness and shelter use (Metraux & Culhane, 1999).   Yet, there are few studies documenting the impact of partner violence on women who are currently homeless, how the threat of such violence might shape women’s decision-making while homeless, or the nature of the complicated tradeoffs many partner violence victims make to survive on the streets.   For example, a homeless woman may stay in a relationship with a person who abuses her physically or sexually because the risks associated with leaving—homelessness, hunger, poverty, violence on the streets, lack of resources for children, risk of further abuse by additional perpetrators —seem worse than the abuse. Furthermore, the abusive partner may also provide protection and companionship some of the time.

Homelessness as Risk Factor for Sexual Assault

Although childhood sexual abuse and intimate partner violence often precede, and may contribute to women’s homelessness and risk for revictimization, the condition of homelessness itself dramatically increases women’s risk of being sexually assaulted.   Women on the streets do not enjoy the same degree of safety as women who have four walls and a roof to protect them.   Despite being in very close quarters with many others, women staying in shelters often lack robust and nurturing social connections, as people in crisis have fewer resources to dedicate to developing mutual trust than those who feel safer and more grounded (Goodman, 1991).    The need to serve a maximum number of people with limited dollars, combined with some communities’ unwillingness to host shelters in their neighborhoods, often leads shelters to locate within or close to high-crime areas (Burt, et al., 2001; Wenzel, Koegel & Gelberg, 2000).   Moreover, as discussed in subsequent sections, many homeless women have little choice but to participate in activities that place them at further risk for sexual assault, such as panhandling or trading sex for needed resources (Kushel, et al., 2003; Lee & Schreck, 2005).

Individual vulnerabilities also play a role.   Homeless women are more likely than non-homeless women to suffer from substance abuse (Toro et al., 1995; Wenzel et al, 2004), a mental illness that may include psychosis (Toro et al., 1995; Wenzel et al, 2004), domestic violence (Toro et al., 1995), or severe physical health limitations (Wenzel, Leake & Gelberg, 2000) that make self-defense in a dangerous situation harder.   In one of the most rigorous studies of antecedents of sexual assault while homeless, Wenzel, Koegel, and Gelberg (2000) found that women who were dependent on drugs or alcohol; who received income from survival strategies such as panhandling, selling items on the street, or trading sex for drugs or other items; who lived outdoors; who experienced mania or schizophrenia; or who had physical limitations were especially likely to have endured a recent (at most, 30 days prior) sexual assault.   The next sections review our knowledge of some of these factors in more detail.

Survival Sex and Prostitution

Survival for some homeless women is contingent on trading sex for money, goods (food, shelter, clothes, medicine, drugs), services, transportation, and protection on the street (Wenzel et al, 2001).   It is debatable whether sex under these circumstances is ever really a choice; certainly, it is often a requirement last resort strategy for survival.   Further, outright sexual violence is a common occurrence for women who engage in sex trade (Dalla, Xia, & Kennedy, 2003; Nyamathi, et al., 2001).   Wenzel, Koegel and Gelberg (2000) found that over the course of a year, homeless women who panhandled or traded sexual favors for drugs or money were three times more likely to experience sexual assault and other forms of violence relative to their homeless peers who did not engage in sex trade.   Indeed, 84% of women who use prostitution as an income strategy report current or past homelessness – which can mean living with abusive pimps or “customers” in the absence of a more stable option (Farley & Barkan, 1998); and homeless prostituted women are at much greater risk for sexual assault than their non-homeless counterparts (El Bassel, Witte, Wada, Gilbert, & Wallace, 2001). When substance use (often “paid for” by sex) is a factor, the risk of sexual assault increases further, as described in the next section.   Because these assaults often occur in the context of an illegal act (prostitution) and among drug users, victims may be seen by perpetrators as attractive targets, as they are less likely to report the crime or to be believed or seen as worthy of services and protection by authorities.

Substance Use

Homeless women are more likely to have substance abuse problems and to engage in substance use than low-income housed women (Wenzel et al., 2004).   Although substance use and abuse among homeless women may represent their best method of coping with the chaos, unpredictability, and isolation of homelessness, as well as previous victimizations, it is also strongly associated with risk for further sexual assaults. One study found that homeless women who had experienced either physical or sexual victimization in the past month were three times more likely to report both drug and alcohol abuse or dependence than homeless women who were not victimized (24.3% vs. 7.9%) (Wenzel, Leake, & Gelberg, 2000).   As with so many aspects of homeless women’s lives, the causal relationships between substance abuse and victimization are far less clear than the correlation itself. Nevertheless, substance abuse and dependence may put women at risk for victimization in a number of ways, such as by altering women’s perceptions of what is dangerous; leading them to engage in risky survival strategies; causing disorientation that may make it difficult to ward off an attacker; making them a target for assault because authorities will be less likely to believe them; or putting them in an environment that involves interactions with criminals.   Indeed, offenders often rely on drugs and alcohol to incapacitate their victims (Lisak & Miller, 2002).   Furthermore, drug and alcohol services and rape crisis services largely remain fragmented, which can make it difficult for individuals to receive the services they need to recover.

Severe Mental Illness (SMI)

Homeless women with serious mental illnesses such as major depression, schizophrenia, and bipolar disorder are highly vulnerable to victimization. Indeed, in one in-depth study 97% of the participants, all of whom were homeless and had a mental illness, reported experiences of violent victimization at some point in their lives (Goodman, Dutton & Harris, 1995; Goodman, Johnson, Dutton, & Harris, 1997), with an astonishing 28% reporting at least one physical or sexual assault in the month preceding the interview.   Another large-scale study of 1,839 ethnically diverse, homeless women and men with mental illnesses from 15 cities across the US found that 15.3% of the women participants reported being raped in the past 2 months (Lam & Rosenheck, 1998), compared to 1.3% of the men. For homeless women with mental illnesses, rape appears to be a shockingly normative experience. This is deeply troubling, as no one should ever become “used” to being raped or assaulted. To the contrary, there is evidence that the cumulative effects of multiple victimizations may be far deeper than single rape events (Goodman & Dutton, 1996).   Moreover, these women’s ability to get help are greatly compromised by social attitudes that people with mental illnesses   do not experience violation as searingly as others; that their accounts of the abuse and assault are “made up” (Goodman & Dutton, 1996; Goodman, et al., 1999); or that women with mental illnesses cannot clearly communicate a lack of consent. Homeless women with mental illnesses who are also victims of sexual violence shoulder the burden of three forms of social stigma—against poor or homeless people, people with mental illnesses, and victims of rape.

Barriers to Accessing Institutional Support

Although more research is needed to understand the relationship between sexual assault and homelessness, especially research that explores the social and institutional contributions to this enormous social problem, action is also needed.   In this section, we provide an overview of situational, contextual and systemic barriers homeless women face in finding the support they need to heal in the wake of sexual assault.

Homelessness often involves spiraling crises, which means that homeless women might not deal with, attend to, or process sexual assault in the same way as housed women do.   For example, a rape may be followed only weeks later by a notice of loss of social security disability benefits because the victim failed to appear at a hearing scheduled the day after she was raped.    This new crisis may shift the woman’s attention temporarily, but the impact of the previous crisis—the rape—becomes interwoven with the impact of other crises. It is important, therefore, that the sexual assault be addressed in culturally sensitive ways as part of a complex context of trauma and crises.   Unfortunately, few services available to homeless victims of sexual assault are set up to deal with these compounding crises. This complexity presents a range of challenges both to staff at programs responding to the homeless, who are rarely trained to detect and respond appropriately and sensitively to trauma or sexual violence, and to rape crisis counselors, who are often unequipped to deal with the multiple challenges brought on by homelessness.

By their very nature, homeless shelters can worsen women’s psychological distress and compromise their ability to do what is necessary to regain residential stability and increased quality of life.   Homelessness is inherently chaotic, internally and externally, with others controlling access to such basic resources as food, clothing, and shelter. Indeed the very process of accessing the variety of programs necessary to rise out of homelessness may itself create a chaotic situation. There is little privacy, and entering many programs requires subjecting the private details of one’s life to regulation and/or scrutiny.   This lack of privacy and power differential can mirror and exacerbate the impact of the violence many homeless women have survived. This combination of chaos, power dynamics and feeling watched can trigger traumatic memories or symptoms that, in turn, make it more difficult to abide by shelter rules or stay “in control” as shelters require.   Many shelters are neither culturally sensitive nor “trauma-informed,” and have not provided staff adequate training to, for example, deal with women’s angry outbursts therapeutically rather than punitively, or recognize the differences between flashbacks and psychosis. Overburdened staff must balance the needs of the individual with the needs of many.   A woman whose trauma-related nightmares wake up an entire dorm, for example, may be told to leave.

At the same time, many of the options for self-care and self-soothing following a sexual assault are not available to homeless women. As noted earlier, homeless women lack telephones, making hotlines irrelevant.   A woman may become alienated from a traditional sexual assault support group when she cannot make weekly meeting times or finds that unlike her peers, her history includes so many assaults when others report significantly fewer. To make matters worse, general shelters are often full to capacity and may have to turn women away, while battered women’s shelters rarely offer beds to women who fear violence from people who are not traditional partners, leaving them no choice but to return to dangerous and out-of-the-way places to sleep (Amster, 1999, as cited in Evans & Forsyth, 2004).

There is a widespread, although increasingly disputed, belief that trauma must not, indeed cannot, be addressed before a woman is in a stable situation with regard to food, shelter, physical safety, and housing (Herman, 1992) Yet, few rape crisis centers are equipped to help provide the stability that they prescribe, making services fragmented at best, and possibly even irrelevant.   Furthermore, stability may be elusive until the trauma is named and at least partially explored. Fragmented services that force an individual to separate problems that are inextricable can exacerbate existing trauma.

The relationship between homeless sexual assault victims and law enforcement is equally complex.   Sexual assault and rape reporting rates are very low in general (Rennison, 2002).   Homeless women may lack someone, whether peer, volunteer or advocate, to support them through the often-intimidating process of reporting an assault.   Homeless women, already turning to bureaucracies for even their most basic needs (e.g. food stamps, housing vouchers and the like), may be reluctant to engage with yet one more system that they expect will be unresponsive.

Homeless women may not see the police in particular as providing protection and safety. They may be afraid to report a rape because they are involved in illegal activities (e.g. drug related, prostitution) or have outstanding warrants from other activities.   They may distrust police officers because their only contact with them is when they are kicked off park benches and forced to sleep under bushes that are far from the public eye and therefore more dangerous.   For women who engage in street-based sex trade, harassment and abuse by police is so commonplace that many women no longer perceived police as sources of help.   Homeless women of color, immigrants, refugees, and victims of sex trafficking may be even more skeptical about law enforcement and less likely to turn to them for help or protection. Further, law enforcement personnel are not immune from general social attitudes about stigmatized groups such as homeless, mentally ill, prostituting, or substance abusing women, resulting in discriminatory behavior.   Last, because homeless women are highly transient, they generally make poor witnesses in victimization cases; and the very public nature of life on the streets means that few women have a place to hide if an abuser or rapist learns she has “ratted” on him.   These obstacles result in shared feelings of helplessness between even the most sympathetic criminal justice personnel and homeless women.

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