Collaborating with CHOP to understand trauma and homelessness in childhood

Nurse educators know that optimal and potentially transformational learning occurs when content taught in the classroom can be applied to real life experiences.

Thanks to a successful collaboration with the Homeless Health Initiative at the Children’s Hospital of Philadelphia (CHOP), senior nursing students in the Nursing Care of Children and Adolescents course have opportunities to apply their theoretical knowledge of growth and development, Adverse Childhood Experiences (ACES), trauma informed care and protective factors while participating in fitness, nutrition and wellness programs in the shelters serving women and children. They are part of an interdisciplinary team of nurses, social workers, fitness instructors, nutritionists, physicians, dentists and medical students who travel to the shelters to provide wellness programs.

Sally Poliwoda, MSN, RN, Community Nurse Advocacy Fellowship Coordinator at the Children’s Hospital  of Philadelphia and alumna of the Fitzpatrick College of Nursing  has been facilitating this relationship since its initiation in 2011. Mellissa Berrios Johnson, MSW, Homeless Health Initiative Social Work Trainer has provided expert mentoring to the students from the social work perspective.   Misty Conlan, MSN, RN, alumna, adjunct faculty and emergency nurse at CHOP was also instrumental in the development of this experience.

Students learn about Adverse Childhood Experience (ACES) from Professor Elizabeth Dowdell, PhD, RN, FAAN, an expert on the effects of violence on children.  ACES is a term that comes from the Center for Disease Control’s 1997 research which shows a correlation between childhood trauma and adult health outcomes.  The child’s developing brain is affected by ACES and can lead to many chronic diseases, mental health and substance abuse problems and violence.  The 10 ACEs measured in the research are physical abuse, sexual abuse, verbal abuse, physical neglect, emotional neglect, a family member who is diagnosed with a mental illness, a family member addicted to substances, a family member in the prison system, witnessing a mother being abuses and losing a parent to separation, divorce or death. There is evidence that Children, Adolescents and Mothers experiencing homelessness are often affected by multiple ACES.    

Students are able to grasp the importance of asking not “What is wrong with you?” but “What happened to you?” a foundation of trauma informed care.

Following a trauma-informed model, the students are pre-briefed by the nurse leader and social worker to identify children needing additional support during the fitness/ nutrition activities. Strategies that promote positive interactions and emotional regulation are discussed. Nursing students serve as role models for children.  During the interdisciplinary debriefing students are able to share their concerns and observations and benefit from the perspectives of the team members. Students are able to grasp the importance of asking not “What is wrong with you?” but “What happened to you?” a foundation of trauma informed care.

Students are required to complete a reflection paper, one student commented:  

“Trauma informed care is necessary because some health care professionals may believe that a child is just shy when there can be psychological issues.  It is also important to recognize a very violent child for the same reasons.  Catching these signs early and providing interventions is necessary to prevent lifelong problems of trauma.”  

Senior nursing students benefit from this transformational clinical experience that challenges their assumptions and preconceptions about the problem of homelessness.  They can see the impact of adverse childhood experiences and it pushes them to think about the Nurses role in ACEs.   The nursing workforce must be prepared to assess and respond to ACEs.  This experience is especially valuable due to excellent preparation in the classroom, expert preceptorship at the site, opportunity to pre-brief and de-brief with the team, and an in-depth reflection paper.  This successful partnership with Homeless Health Initiative of Children’s Hospital of Philadelphia has provided rich clinical experiences for our students for over seven years.