LGBTQ young people are at greater risk of developing mental health problems and report higher rates of depression and suicidality than their cisgender/heterosexual peers. Parent-child relationships play a central role in LGBTQ young people's development and behavioral health. The childrearing practices parents use - also known as parental socialization - might offer a potential route to reducing negative health outcomes among LGBTQ young people. Drawing from the constructs of the racial-ethnic socialization framework, the current study explored the parental socialization experiences of LGBTQ young people with non-accepting, cisgender/heterosexual parents in the Southeast U.S. Results provide one of the first descriptions of parent socialization experiences among LGBTQ young people with non-accepting parents, and confirm the adaptability of the racial-ethnic socialization framework to LGBTQ-specific experiences. Findings show that while some themes, such as cultural socialization, needed little adaptation, others, such as promotion of mistrust, require greater modification to better fit LGBTQ-specific experiences. By developing an LGBTQ-specific parental socialization framework for LGBTQ youth with non-accepting parents, this research may offer valuable insight for future research and interventions that aim to strengthen parent-child relationships and reduce disparities in health outcomes between LGBTQ young people and their cisgender/heterosexual peers.

Introduction Sexual minority women represent one of the highest-risk groups for hazardous drinking and comorbid mental health problems (eg, depression, anxiety). Research has identified cognitive (eg, expectations of rejection), affective (eg, emotion dysregulation) and behavioural (eg, avoidant coping) pathways through which minority stress (eg, stigma) places sexual minority women at disproportionate risk of hazardous drinking and comorbid depression/anxiety; yet no evidence-based interventions have been tested to address these pathways in this population. This article describes the design of Project EQuIP (Empowering Queer Identities in Psychotherapy), a randomised controlled trial of a transdiagnostic lesbian, gay, bisexual, transgender, queer (LGBTQ)-affirmative cognitive-behavioural therapy intervention (CBT) designed to improve minority stress coping and reduce sexual minority women’s hazardous drinking and mental health comorbidities.Methods and analysis This two-arm randomised controlled trial, funded by the National Institute on Alcohol Abuse and Alcoholism, has two objectives: (1) test the efficacy of 10 sessions of LGBTQ-affirmative CBT compared with 10 sessions of supportive counselling for sexual minority women in the community (anticipated n=450) who report hazardous alcohol use and meet criteria for a Diagnostic and Statistical Manual of Mental Disorders - 5 diagnosis of a depression or anxiety disorder and (2) examine psychosocial mechanisms and demographic factors as potential mediators and moderators, respectively, of the treatment-outcome relationship. This study’s primary outcome is change in the proportion of heavy drinking days. Secondary outcomes are changes in depressive and anxious symptoms.Ethics and dissemination The Yale University Human Subjects Committee reviewed and approved the research protocol. Results of this study will be disseminated to researchers and practitioners through peer-review publications and conference presentations, and directly to study participants.Trial registration number Registered on 17 August 2022 (ClinicalTrials.gov identifier: NCT05509166).

Transgender and gender expansive (TGE) individuals face minority stress and associated health risks, especially in high-stigma contexts. Lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ)-affirmative cognitive-behavioral therapy (CBT) is one of the only evidence-based interventions developed to address minority stress to improve psychosocial health. Yet, trials of this treatment have mostly enrolled cisgender sexual minorities, TGE youth, and those living in North American contexts. This study tested the feasibility, acceptability, and preliminary efficacy of LGBTQ-affirmative CBT for TGE adults living in the high-stigma context of Romania. Twenty-five TGE individuals (Mage = 25.16, SDage = 6.39; 44% transgender women, 40% transgender men, 16% nonbinary) reporting depression and/or anxiety symptoms received 16 virtual sessions of LGBTQ-affirmative CBT from trained psychologists. Assessments of mental (e.g., depression), behavioral (e.g., hazardous drinking), and sexual (e.g., HIV-transmission risk behavior) health outcomes, and minority stress and universal risk mechanisms were administered at baseline and 5-month follow-up. Results showed reductions in depression and anxiety symptoms and certain minority stress (e.g., anticipated stigma, identity concealment) and universal risk (e.g., unassertiveness) mechanisms from baseline to follow-up. The intervention was highly feasible (e.g., timely recruitment, high session attendance), and exit interviews revealed high acceptability in terms of the treatment's relevance, goals, imparting minority stress knowledge and identity-related hope and acceptance, format, and therapeutic alliance. LGBTQ-affirmative CBT shows feasibility, acceptability, and preliminary efficacy among TGE individuals living in Romania, with promise for other high-stigma contexts. Future randomized controlled trials and reductions in structural determinants remain priorities.

Sexual and gender minorities (SGM) experience among the largest mental health disparities of any population. One driver has been the lack of evidence-based practices (EBPs) addressing the distinct mechanisms underlying SGM’s risk. LGBTQ-affirmative cognitive-behavioral therapy (CBT) is among the only EBPs specifically for SGM mental health. LGBTQ community centers represent an ideal implementation setting for LGBTQ-affirmative CBT given their wide reach. Although direct training of mental health providers at LGBTQ community centers by experts has been shown to improve providers’ LGBTQ-affirmative CBT skills, it is unclear how such training should be optimally delivered. This paper describes the protocol of a trial that seeks to compare the effectiveness of three training strategies for implementing LGBTQ-affirmative CBT, identify center-level moderators of implementation success, and examine the impact of the three strategies on client mental health through theory-informed organizational and provider mechanisms. This hybrid type III effectiveness-implementation trial will randomize 90 centers to receive one of three additive strategies for implementing LGBTQ-affirmative CBT: [1] a suite of self-paced digital learning materials (Materials Only condition); [2] these materials plus weekly live webinar training for 12 weeks (Direct Training condition); or [3] the above plus one year of supervision from a local supervisor who will receive expert consultation in a train-the-trainer format (Local Supervision condition). The primary outcome will be provider fidelity assessed via simulated practice. Implementation determinants (e.g., center resources, provider/client characteristics), mediators (e.g., implementation climate, provider self-efficacy), and other outcomes (e.g., intervention adaptation, sustainment) will be captured using a mixed-methods design. Clinical effectiveness outcomes (i.e., client mental and behavioral health symptoms) will be assessed through client surveys among a subset of 15 centers. Now that LGBTQ-affirmative CBT has shown efficacy across several trials and generated high demand, research is needed to determine nationwide implementation strategies. This study will identify optimal means through which to implement this treatment innovation in the US’s large network of LGBTQ community centers, thereby producing generalizable guidance for EBP implementation across low-resource settings nationwide in which mental health disparities populations are likely to seek treatment. NCT05890404 (05/25/2023), https://clinicaltrials.gov/study/NCT05890404 .

The co-occurrence of physical, psychological, and sexual intimate partner violence (IPV) is associated with heightened risk for deleterious mental and physical health outcomes, including PTSD symptoms and substance use. However, few studies have investigated the heterogeneity of experiences with respect to this co-occurrence among women who experience IPV as it unfolds naturally in women’s daily lives. In this study, we developed a novel approach to classify and visualize daily patterns of IPV experiences, PTSD-related distress, and substance use among women who experience IPV. Women (N = 244, Mage = 37.1 years) who reported experiencing IPV and using substances were recruited from the community. Micro-longitudinal data were collected four times per day for 14 days using automated telephone-based data collection. Analyses included latent class analysis (LCA) and multilevel analysis (interval-, day-, and person-level), complimented by novel data visualization tool (EventFlow). We identified three classes that significantly differed in the prevalence of and patterns among IPV types, PTSD, and substance use. Based on examination of LCA results and visualization of the latent classes in EventFlow. Different patterns of associations among IPV types, PTSD symptoms, and substance use were identified within classes at the interval-, day-, and person-level. Results from this study provide greater insight into the heterogeneity of women’s lived experiences than do studies solely relying on cross-sectional survey data. Findings with this type of data collection can inform the development of interventions to increase the precision in clinical practice, identify new avenues for future research, and have important policy implications.

Objective LGBTQ-affirmative cognitive-behavioral therapy (CBT) addresses minority stress to improve sexual minority individuals’ mental and behavioral health. This treatment has never been tested in high-stigma contexts like China using online delivery. Method Chinese young sexual minority men (n=120; ages 16-30; HIV-negative; reporting depression and/or anxiety symptoms and past-90-day HIV-transmission-risk behavior), were randomized to receive 10 sessions of culturally adapted asynchronous LGBTQ-affirmative internet-based CBT (ICBT) or weekly assessments only. The primary outcome included HIV-transmission-risk behavior (i.e., past-30-day condomless anal sex). Secondary outcomes included HIV social-cognitive mechanisms (e.g., condom use self-efficacy), mental health (e.g., depression), and behavioral health (e.g., alcohol use), as well as minority stress (e.g., acceptance concerns), and universal (e.g., emotion regulation) mechanisms at baseline and 4- and 8-month follow-up. Moderation analyses examined treatment efficacy as a function of baseline stigma experiences and session completion. Results Compared to assessment only, LGBTQ-affirmative ICBT did not yield greater reductions in HIV-transmission-risk behavior or social-cognitive mechanisms. However, LGBTQ-affirmative ICBT yielded greater improvements in depression (d=-0.50, d=-0.63) and anxiety (d=-0.51, d=-0.49) at 4- and 8-month follow-up, respectively; alcohol use (d=-0.40) at 8-month follow-up; and certain minority stress (e.g., internalized stigma) and universal (i.e., emotion dysregulation) mechanisms compared to assessment only. LGBTQ-affirmative ICBT was more efficacious for reducing HIV-transmission-risk behavior for participants with lower internalized stigma (d=0.42). Greater session completion predicted greater reductions in suicidality and rumination. Conclusions LGBTQ-affirmative ICBT demonstrates preliminary efficacy for Chinese young sexual minority men. Findings can inform future interventions for young sexual minority men in contexts with limited affirmative supports.

Despite increasing attention to the importance of examining factors that impact housing instability and homelessness, the field lacks a validated scale of housing instability. The current study examined the reliability and validity of a seven-item scale that measures housing instability. Data were taken from a larger study which implemented the Domestic Violence Housing First model across five domestic violence agencies in the Pacific Northwest. A total of 406 participants were interviewed every six months over a period of two years. A Spanish version of the scale was administered to Spanish-speaking participants. Results provide an overview of the psychometric functioning of the scale and support its utility in assessing housing instability and homelessness. Specifically, the scale demonstrated concurrent and predictive validity, and showed evidence of scalar equivalence over time and across both language and locality. The current scale is therefore a succinct and psychometrically sound measure of housing instability which can be used moving forward to track housing instability in English and Spanish speakers, as well as in urban and rural settings.

Objective: Research concerning the relationship between transgender and gender nonconforming (TGNC) youth and religion and spirituality is sparse with mixed findings. The research that has been done focuses on spirituality and religion as both a source of joy and a stressor for TGNC youth. Method: The current study uses qualitative data collected from 141 TGNC youth and 103 caregivers to capture the experiences of TGNC youth and their families in relation to their spiritual and religious communities and commitments. Results: Findings revealed the majority of TGNC youth reported having a religious or spiritual affiliation. Approximately one-third of youth responses discussed their affiliations positively with many feeling affirmed in their place of worship. Two-thirds of respondents reported neutral or negative experiences related to their affiliation. The majority of youth and guardian dyads reported alignment in their religious or spiritual affiliation. Conclusions: This study is the first to showcase TGNC youth and their guardians' views about religious and spiritual affiliation. Findings highlight the need for religious/spiritual interventions and programming such as chaplaincy as a part of an interdisciplinary care team and revised intake questions that seek to understand both the spiritual and religious elements of patients' lives.

IMPORTANCE Intimate partner violence (IPV) is a leading cause of homelessness and a serious threat to public health and well-being. OBJECTIVE To determine whether the Domestic Violence Housing First (DVHF) model improves safety, housing stability, and mental health over 2 years. DESIGN, SETTING, AND PARTICIPANTS This longitudinal comparative effectiveness study interviewed IPV survivors and reviewed their agency records. All unstably housed or homeless IPV survivors entering domestic violence (DV) services were eligible to participate in the study, ensuring capture of typical variability in service delivery (eg, some survivors would enter services when agencies had the capacity to provide DVHF and others would receive services as usual [SAU]). Clients from 5 DV agencies (3 rural and 2 urban) referred by agency staff in a Pacific Northwest state of the United States were assessed between July 17, 2017, and July 16, 2021. Interviews were conducted in English or Spanish at entry into services (baseline) and at 6-, 12-, 18-, and 24-month follow-up visits. The DVHF model was compared with SAU. The baseline sample included 406 survivors (92.7% of 438 eligible). Of the 375 participants retained at the 6-month follow-up (92.4% retention), 344 had received services and had complete data across all outcomes. Three hundred sixty-three participants (89.4%) were retained at the 24-month follow-up. INTERVENTION The DVHF model has 2 components: housing-inclusive advocacy and flexible funding. MAIN OUTCOMES AND MEASURES Main outcomes included housing stability, safety, and mental health, which were assessed using standardized measures. RESULTS Of the 344 participants (mean [SD] age, 34.6 [9.0] years) included in the analyses, 219 (63.7%) received DVHF and 125 (36.3%) received SAU. Most participants identified as female (334 [97.1%]) and heterosexual (299 [86.9%]). Two hundred twenty-one participants (64.2%) were from a racial and ethnic minority group. Longitudinal linear mixed-effects models showed that receiving SAU was associated with greater housing instability (mean difference, 0.78 [95% CI, 0.42-1.14]), DV exposure (mean difference, 0.15 [95% CI, 0.05-0.26]), depression (mean difference, 1.35 [95% CI, 0.27-2.43]), anxiety (mean difference, 1.15 [95% CI, 0.11-2.19]), and posttraumatic stress disorder (mean difference, 0.54 [95% CI, 0.04-1.04]) compared with receiving the DVHF model. CONCLUSIONS AND RELEVANCE Evidence in this comparative effectiveness study suggests that the DVHF model was more effective than SAU in improving the housing stability, safety, and mental health of survivors of IPV. The DVHF's amelioration of all of these interconnected public health issues-relatively quickly and with long-term continuance-will be of substantial interest to DV agencies and others working to support unstably housed IPV survivors.

Objective:Victims of intimate partner violence (IPV) often fear their intimate partners and the abuse they perpetrate against them. Fear in the context of IPV has been studied for decades yet, we lack a rigorously validated measure. The purpose of this study was to comprehensively evaluate the psychometric properties of a multi-item scale measuring fear of an abusive male partner and/or the abuse he perpetrates.Method:We used Item Response modeling to evaluate the psychometric properties of a scale measuring women's fear of IPV by their male partner across two distinct samples: 1) a calibration sample of 412 women and 2) a confirmation sample of 298 women.Results:Results provide a detailed overview of the psychometric functioning of the Intimate Partner Violence Fear-11 Scale. Items were strongly related to the latent fear factor, with discrimination values universally above a = 0.80 in both samples. Overall, the IPV Fear-11 Scale is psychometrically robust across both samples. All items were highly discriminating and the full scale was reliable across the range of the latent fear trait. Reliability was exceptionally high for measuring individuals experiencing moderate to high levels of fear. Finally, the IPV Fear-11 Scale was moderately to strongly correlated with depression symptoms, posttraumatic stress symptoms and physical victimization.Conclusions:The IPV Fear-11 Scale was psychometrically robust across both samples and was associated with a number of relevant covariates. Results support the utility of the IPV Fear-11 Scale for assessing fear of an abusive partner among women in relationships with men.

Women who have experienced intimate partner violence (IPV) are disproportionately likely to engage in sexual risk behavior, including sex with a secondary partner (i.e., sex partners outside their primary relationship). Social disconnection has been identified as a social determinant of health that may enhance understanding of sex with a secondary partner. This study extends past research by using an intensive longitudinal design consisting of multiple daily assessments to examine event-level associations between women IPV survivors' social disconnection and sex with a secondary partner concurrently (i.e., during the same aggregated assessment) and temporally (i.e., social disconnection during one assessment predicting sex with a secondary partner in a subsequent assessment) over a 14-day period, in consideration of physical, psychological, and sexual IPV, and alcohol and drug use. Participants (N = 244) were recruited from New England through 2017. Results from multilevel logistic regression models indicate that women who experienced greater social disconnection on average were more likely to report sex with a secondary partner. However, after including IPV and substance use in the model, the strength of this relationship was attenuated. Sexual IPV emerged as a between-person predictor of sex with a secondary partner in temporally lagged models. Results provide insight into the relationships between daily social disconnection and sex with a secondary partner among IPV survivors, particularly regarding the effects of substance use and IPV both concurrently and temporally. Taken together, findings emphasize the importance of social connection for women's well-being and highlight the need for interventions that enhance interpersonal connectedness.

Intimate partner violence remains a significant public health issue and survivors often need various forms of support to achieve safety. The increased likelihood of experiencing housing instability and homelessness among survivors has led to an uptake in domestic violence agencies implementing housing-based interventions, such as Domestic Violence Housing First (DVHF), to address survivors' needs. The present study expands on prior research supporting the effectiveness of DVHF to examine situational factors that moderate the outcomes associated with this model among 406 survivors seeking services from domestic violence agencies located in the Pacific Northwestern region of the United States. Using latent profile analysis, participants were grouped into three latent classes: (a) "high abuse/instability," (b) "still affected," and (c) "doing better." Latent transition analysis was used to estimate the probability that participants would transition into a different latent class over time with social support (SS), material hardship, and receipt of DVHF services included as model predictors. Receipt of DVHF predicted improvements in survivors' safety, housing stability, mental health, and well-being, such that receiving DVHF was associated with higher odds of survivors transitioning into the "doing better" class. Social support and material hardship also emerged as significant factors predicting class membership, such that higher levels of social support and financial stability predicted membership in the "doing better" class. Additionally, social support and financial stability appeared to augment receipt of DVHF services, with DVHF being more strongly associated with positive outcomes among participants who also had high levels of social support and lower levels of material hardship. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Intimate partner violence (IPV) is a leading cause of homelessness, yet little evidence exists about effective strategies to assist IPV survivors as they work to avoid homelessness while freeing themselves from abuse. An ongoing demonstration evaluation is examining if and how one promising model assists IPV survivors in obtaining safe and stable housing over time. The Domestic Violence Housing First (DVHF) model involves providing IPV survivors with mobile advocacy and/or flexible funding, depending on individual needs, in order to attain these goals. We hypothesized that those receiving DVHF would experience greater housing stability and less re-abuse compared to survivors receiving services as usual. The current study evaluated the short-term efficacy of the DVHF model with a sample of 345 homeless or unstably housed survivors who sought services and who completed in-person interviews shortly after contacting the DV agency, as well as six months later. Those who received the DVHF model showed greater improvement in their housing stability compared to those receiving services as usual, as well as decreased economic abuse. Both groups experienced a sharp decline in all forms of abuse. The Domestic Violence Housing First model shows promise in helping unstably housed DV survivors achieve safe and stable housing. Study findings have implications for DV agencies as well as those funding such services. Understanding which interventions work best for which survivors is critical to ensuring that service providers are effectively working toward long-term housing stability and well-being for IPV survivors and their children.

Intimate partner violence (IPV) is a widespread and devastating phenomenon resulting in a myriad of long-term consequences for survivors and their children. IPV victimization not only has negative health and economic consequences, it has also been linked to homelessness and housing instability. In response, the Domestic Violence Housing First (DVHF) model is being used in some domestic violence (DV) agencies to help survivors attain safe and stable housing. The model includes using individualized advocacy and/or flexible funding to help survivors meet these goals. Using a longitudinal, quasi-experimental design, the current study involved conducting interviews with survivors and examining agency records to investigate the effectiveness of this model. We hypothesized that survivors who received DVHF would experience less re-abuse and greater housing stability over 12 months compared to those who received services as usual (SAU). The sample included 345 IPV survivors who had been homeless or unstably housed when they approached one of five DV programs for help. Interviews were spaced 6 months apart (when survivors first sought services as well as 6 months and 12 months later). Longitudinal analyses showed that survivors who received the DVHF model reported greater improvements in housing stability at both the 6-month and 12-month time points compared to those receiving SAU. At the 12-month time point, survivors who had received DVHF reported decreased physical, psychological, and economic abuse, as well as the use of their children against them as a form of abuse. This study adds to a growing body of evidence supporting this model's effectiveness and adds to our understanding of factors impacting the long-term housing stability and safety for IPV survivors.

Objective: LGBTQ-affirmative cognitive-behavioral therapy (CBT) addresses the adverse impacts of minority stress. However, this treatment has rarely been tested in randomized controlled trials with LGBTQ youth and never using an asynchronous online platform for broad reach. This study examined the feasibility, acceptability, preliminary efficacy, and multi-level stigma moderators of LGBTQ-affirmative internet-based CBT (ICBT).Method: Participants were 120 LGBTQ youth (ages 16-25; 37.5% transgender or non-binary; 75.8% assigned female at birth; 49.2% non-Latino White) living across 38 U.S. states and reporting depression and/or anxiety symptoms. Participants were randomized to receive 10 sessions of LGBTQ-affirmative ICBT or only complete 10 weekly assessments of mental and behavioral health and minority stress; all completed measures of psychological distress, depression, anxiety, suicidal thoughts, alcohol use, and HIV-transmission-risk behavior at baseline and 4 and 8 months post-baseline; 20 LGBTQ-affirmative ICBT participants completed a qualitative interview regarding intervention acceptability.Results: Participants randomized to LGBTQ-affirmative ICBT completed, on average, 6.08 (SD = 3.80) sessions. Participants reported that LGBTQ-affirmative ICBT was helpful and engaging and provided suggestions for enhancing engagement. Although most outcomes decreased over time, between-group comparisons were small and non-significant. LGBTQ-affirmative ICBT was more efficacious in reducing psychological distress than assessment-only for participants in counties high in anti-LGBTQ bias (b = -1.73, p = 0.001, 95% CI [-2.75, -0.70]). Session dosage also significantly predicted reduced depression and anxiety symptoms.Conclusions: LGBTQ-affirmative ICBT represents a feasible and acceptable treatment. Future research can identify more efficacious approaches and modalities for engaging LGBTQ youth, especially those living under stigmatizing conditions, who might benefit most.

Binary gender norms in the U.S. contribute to the systemic marginalization of transgender and gender diverse (TGD) individuals. These norms shape beliefs and assumptions about TGD young adults; inform the policies that govern their rights, the settings they occupy, and research conducted about them. Experiences based on binary conceptions of gender may leave TGD young adults feeling disempowered and require they develop resilient strategies to maintain or reclaim power and control over their lives and decisions. The purpose of this study was to explore the mechanisms through which TGD young adults (ages 18 to 24) demonstrate resilience and resist oppressive gender norms. In collaboration with a TGD young adult advisory team, we used a participatory focus group method (Youth GO) to engage TGD participants in critically examining power and powerlessness in the context of their multiple identities and life experiences. Findings revealed distinct mechanisms of power that work to either restrict or restore TGD young adults' power over their identity and autonomy. Mechanisms operated differently as a function of age, race, gender identity, gender presentation, and socio-economic status. Findings point to concrete and actionable policy and practice interventions that would foster validation and inclusion of TGD young adults across several settings.

Domestic violence (DV) is a leading cause of homelessness for women, yet many DV agencies are just beginning to focus on helping clients stabilize their housing situations. The purpose of this study was to better understand the contexts and service needs of unstably housed and homeless DV survivors, to promote more efficient and successful service matching from DV agencies. We examined whether DV survivors could be grouped by particular features, histories, and contextual factors, and how these group differences impacted what they needed from DV agencies. The sample included 406 homeless and unstably housed DV survivors who had recently sought DV services. Latent class analysis supported the identification of four distinct classes: (1) highest disadvantages service seeker, (2) moderate disadvantages-criminal legal system service seeker, (3) moderate disadvantages service seeker, and (4) lower disadvantages service seeker. Additionally, we were able to profile each class, and test the types of services survivors in each class needed from agencies.

Survivors of intimate partner violence (IPV) seek services from domestic violence (DV) programs for a multitude of reasons. One critical need for many survivors, that has often been overlooked when considering the services DV programs provide, is stable housing. DV programs typically offer safety planning, counseling, advocacy, support groups, and some form of temporary safe housing (e.g., shelter, transitional housing), but increasingly, survivors need assistance securing safe and stable long-term housing. It is imperative, then, that program staff have the information, resources, and skills needed to effectively assist survivors with this essential need. This study examined the housing barriers facing 406 homeless or unstably housed intimate partner violence survivors seeking help from one of five domestic violence programs. In-depth interviews conducted shortly after they sought services revealed that many survivors had a prior history of homelessness, and the vast majority reported at least five issues they faced that made obtaining safe and affordable housing difficult. Findings emphasize the importance of advocates specifically asking about potential housing barriers, and having the knowledge, skills, and community connections needed to effectively assist homeless and unstably housed survivors.