Engaging women with lived experience of homelessness: Using the Community of Solutions Framework

Abstract

The interaction between homelessness and domestic violence exacerbates health inequities. To combat this problem, people with lived experience must be involved in community health improvement initiatives to improve ecological validity and sustainability. The authors understand homelessness through lived experience of homelessness or working with populations impacted by homelessness. A guiding framework (e.g., Community of Solutions) is useful when partnering with people with lived experience. The Community of Solutions framework builds skills in leading together, leading from within, leading for outcomes, leading for equity, and leading for sustainability to create meaningful, authentic collaboration and sustainable improvements in health, well-being, and equity. This paper highlights a novel use of the Community of Solutions framework by Downtown Women’s Center, located in Skid Row, Los Angeles, to guide community health improvement work with women who are survivors of domestic violence and have lived experience of homelessness. This work is written from the perspective of the Downtown Women’s Center as an organizational community. The aim of the paper is to highlight Downtown Women’s Center as an organizational bright spot in this work. It provides lessons learned and examples of Community of Solutions skills relevant to community practitioners working in partnership with women with lived experience to combat the lack of shared support services for the intertwined issues of domestic violence and homelessness.

Access to affordable and safe housing is linked to positive health outcomes. In contrast, inequitable access to housing leads to inequities in economic, social, health, and environmental well-being. Unfortunately, millions in the United States experience housing insecurity, which is linked to homelessness.¹

One leading cause of housing insecurity and homelessness for women in the United States is domestic violence (DV), through a complex interplay of direct (e.g., insufficient income) and indirect (e.g., PTSD brought on by DV) pathways.² Women who experience homelessness and DV are often served by separate, siloed systems, yet experience similar challenges (e.g., high rates of victimization/trauma; poverty).² Thus, homeless and DV service systems would benefit from coordination and integration, to meet overlapping and unique needs. Implementation of a coordinated approach is challenging, due to differences in history, philosophy, and practices between the two. This leaves women who have lived experience of both DV and homelessness to navigate service silos that never fully meet their needs.³

To combat homelessness and its precipitating factors, such as DV, and reduce health inequities, community health improvement work must make transformative changes in power, equity, and justice.⁴ Community coalitions (i.e., volunteers, citizen groups, public/private organizations, and professions), often aim to improve community health. Increasingly, people with lived experience of inequities (PWLE) are involved. Sectors are realizing that, to make transformative community change, PWLE must be included as equal partners for ecological validity and sustainability. ^5-6 Specifically for PWLE of homelessness and DV, empowerment based advocacy is a useful guiding frame; survivors increase their power in personal, interpersonal, and political arenas.⁷ In our specific example, empowerment based advocacy is expanded to include survivor involvement in leadership and advocacy efforts.

The current paper highlights a nonprofit and its use of the Community of Solutions (COS) framework⁸ to advance equity and justice through partnering with PWLE of homelessness and DV in work to increase coordination and integration among DV and homeless services. The authors understand homelessness through lived experience of homelessness and/or working with populations impacted by homelessness. We describe the coalition development, framework, examples of the use of COS skills with PWLE, and lessons learned, using qualitative data from staff members’ perspectives gleaned from the evaluation of this work.

Downtown Women’s Center

Skid Row has the highest concentration of individuals experiencing homelessness in the nation; 25% are women.⁹ The Downtown Women’s Center (DWC) is the only social service exclusively focused on women experiencing homelessness in downtown Los Angeles. DWC provides permanent housing (i.e., Housing First), case management, showers, meals, and laundry. DWC has health programming (i.e., nutritional counseling, chronic disease education and screening, peer support groups). According to LAPD crime report data from 2017-2019, sexual violence against women experiencing homelessness in Skid Row increased. In 2019, 59 unhoused women reported being a victim of rape, compared to 39 in 2018 and 20 in 2017.¹⁰ Over the past five years DWC led the effort to develop partnerships to address these issues (Table 1).

Table 1.

Partners involved in the community health improvement work.

Partner	Description	Support Provided
Downtown Women’s Center (DWC)	501(c)(3) organization, more than half of their total revenue comes from foundations, corporate, and governmental grants	Provides a wide array of housing and health services to connect women experiencing homelessness to permanent housing and pathways to stability.
Domestic Violence Homeless Services Coalition	survivor-centered system to increase access to safe housing and supportive services for survivors of domestic violence and homelessness	Co-led by DWC and Rainbow Services to create cross-sector partnerships. Has three work groups. Client centered workgroup created the Advocates Program.
Corporation for Supportive Housing	Technical assistance housing agency; train advocates with lived experience	Share their curriculum for the Advocates Program; Co-lead meetings with PWLE
Allies	Executive directors and systems leaders of non-profit and government entities	Support PWLE professional development and growth of advocacy skills as part of the Advocates Program
Institute for Healthcare Improvement	Mission to improve health and healthcare worldwide	Supported SCALE and coalitions via capacity building in community of solutions skills during leadership academies
People with Lived Experiences Institute	The work of the institute centers on People with Lived Experiences of inequities as the experts to inform change.	People with lived experiences of inequities provide their lived experience of inequities as expertise to inform change and drive solutions.

Coalition Timeline

Prior to 2016, women who experienced homelessness and DV were falling through the cracks of two separate service systems.

Fall 2015.

LA county coordinated listening/planning sessions for homeless initiatives. Few DV service agency representatives were invited.

January 2016.

The session report was released, without strategies to help women experiencing both DV and homelessness. To address this issue, DWC contacted the Domestic Violence Alliance for coordinated advocacy; they sent letters to the mayor, city council, and Board of Supervisors.

Spring 2016.

The Board of Supervisors directed the homeless initiatives office to create a workgroup to identify and address the needs of women experiencing homelessness and DV, and strengthen collaborations between DV and homeless service agencies. The workgroup, involving agency representatives, collaborated with the federally funded DV and Housing Technical Assistance Consortium to review barriers, challenges, and opportunities for these groups.

Fall 2016.

With support from the Conrad N. Hilton and the Blue Shield of California Foundations, DWC approached Rainbow Services, a DV service provider, to co-lead a Domestic Violence Homeless Services Coalition focused on DV and homelessness. It aimed to create a survivor-centered system to increase access to safe housing and services with an emphasis on integrated, trauma-informed care (Table 2).

Table 2.

Domestic Violence Homeless Services Coalition vision and goals.

Vision
Decreased number of women entering homelessness from DV situations in LA
Decreased number of women entering chronic homelessness in LA as a result of past experiences of DV and other forms of violence
Increased number of women moving from homelessness to permanent housing in LA
Replicable Coalition model designed for dissemination across the country
Goals
Establish a cross-sector coalition that will facilitate systems change and maintain effective collaborative relationships, buy in, and representation from DV & homeless services organizations
Promote increased skills and knowledge sharing between DV and homeless systems
Increase coordination between DV, homeless services, housing providers and government agencies
Create a workable Coordinated Entry (CE) system for DV victims, either parallel or part of the mainstream homeless system
Enhance safe housing options for survivors
Ensure survivor confidentiality in all data collection mechanisms
Ensure lived experience voice is included in all aspects of systems alignment work

January 2017.

Alongside representatives from the city attorney’s office, the LA county supervisor’s office, and the LA Homeless Services Authority, the coalition met and narrowed their scope of work to center on bringing DV and homeless services together.

February 2017.

The coalition invited homeless service and DV agencies to meet to discuss results of a community scan: the process of obtaining permanent housing was arduous, lengthy, and riddled with requirements and barriers. Coalition members committed to prioritizing survivor needs and creating a system of care to aid service navigation. The coalition created a client-centered workgroup prioritizing survivor needs (focus of this paper), a training/education workgroup for both systems to increase shared knowledge, and the systems and funding workgroup, to effect systems change.

Fall 2017.

Women with lived experience of homelessness were recruited to join the client centered workgroup via a flyer and word of mouth within the pre-existing DWC peer leader structure (peer leaders were women experiencing homelessness). The client-centered workgroup, including PWLE, conducted twelve, 1.5 hour county-wide focus groups from September to December in LA, with 81 total participants, to assess the needs of female survivors of DV who had been, or were at risk of, homelessness. Open-ended questions were developed by the client-centered workgroup and the National Alliance for Safe Housing, and addressed survivor-related issues (e.g., safety, services, housing). See the focus group³ report for information about the protocol and analysis. Four main findings emerged: 1) many service access barriers exist, leading to feelings of hopelessness, re-traumatization, and disconnection, 2) survivors need support and advocacy to access complex systems, 3) survivors want to stay connected to their communities/social networks, and 4) when survivors receive trauma informed services and safe housing, their trust in themselves and others increases. These findings informed the development of a workgroup goal: create and implement advocacy and empowerment workshops for survivors to leverage their experiences to influence policy makers, educate communities, and improve programming. During Fall 2017, the coalition also hosted the first symposium in LA on DV and homelessness, and the client centered workgroup contributed to its successful implementation.

Community of Solutions Framework to Addressing Homelessness

DWC utilized the community of solutions (COS) framework to engage PWLE in the client centered workgroup to address the gap between DV and homelessness services in LA County.⁸ The application of the COS skills to this topic area is a novel use of this framework. The aim of the COS framework is to promote behaviors, processes, and systems that create sustainable improvements in health, well-being, and equity. The COS framework includes: Leading from Within, Leading Together, Leading for Outcomes, Leading for Equity, and Leading for Sustainability. DWC used specific strategies linked to each principle to develop and implement the workshops and symposium in partnership with PWLE. These strategies are a focus of this paper.

Leading from within involves one’s inner journey as a leader in health equity work, including demonstrating vulnerability through self-awareness about strengths and areas for growth. Leading from within can unlock the leadership of others, especially PWLE. Leading together is grounded in community as a dynamic network of people, organizations, structures, and systems. It cultivates the leadership of others, especially PWLE. As relationships strengthen, difficult conversations become easier, and work more rewarding. Leading for outcomes supports communities in developing design skills to co-create theories of change, identify measures, test theories, and plan for implementation and scaling up. Participants embrace opportunities to learn from others, display humility and willingness to adopt new solutions, and focus on community strengths and bright spots to approach challenges as opportunities. Leading for equity focuses on improving the health outcomes of those who need it most, while addressing equity at a structural level. Leading for sustainability facilitates an ongoing community transformation process via four elements: environment (physical, political, cultural), resources (intrinsic will for change, financial support), people (cultivation of leaders), and change. The goal of leading for sustainability is to foster scaled and lasting systems change, which will not happen without foundational pre-relationship work with PWLE. These COS skills were integrated into every aspect of co-creating with PWLE in the coalitions’ health improvement efforts.

Development and Evaluation of COS Skills

Funded by the Robert Wood Johnson Foundation as part of the 100 Million Healthier Lives by 2020 initiative, Spreading Community Accelerators through Learning and Evaluation (SCALE) provided training in COS skills. It aimed to build capabilities in local leaders and PWLE to transform systems and improve community health, well-being, and equity. DWC was one of 24 coalitions across the country that received SCALE training. The Institute for Healthcare Improvement (IHI), Community Solutions, Communities Joined in Action, and Network for Regional Healthcare Improvement provided capacity building.

Training and improvement resources were obtained during Community Health Improvement and Leadership Academies. The academies were week-long events in which SCALE coalitions met to build COS skills through workshops led by IHI and/or community leaders. Initial sessions focused on relationship building and discussion of inequities. Later sessions centered on data and outcome tracking. Skills were reinforced through a support system (i.e., coaching, peer networks, group webinars) in between meetings. Coalitions met virtually to share stories of their use of the skills. SCALE was evaluated by teams from the University of South Carolina (of which the first author was a member) and The University of Chapel Hill (PI: Rohit Ramaswamy). This work was determined to be exempt by the Institutional Review Board. Additional evaluation findings are discussed elsewhere.^11-12

This paper represents DWC’s reflections on their experience engaging PWLE of homelessness and DV using COS skills during SCALE (2015-2019). Data were collected by interviews and surveys of DWC staff about their progress in engaging PWLE. The data were synthesized using a participatory strategy by the Telling Our Amazing Story Together (TOAST) workgroup, comprised of PWLE, community members, coaches, and the implementation and evaluation teams. ¹³ We organize our current reflections around two key milestones: the development and implementation of the Advocates Program and the Domestic Violence Homeless Services Summit (Table 3).

Table 3.

Engaging PWLE in the Advocate’s Program and Domestic Violence Homeless Services Coalition summit.

Advocates Program
Why it was created: It was developed because of needs identified in focus group data and ideas generated over the course of a year.
How PWLE contributed: PWLE of DV and homelessness on the work group collaborated on its development, and participated in the program.
What it accomplished: PWLE of DV and homelessness gained leadership and advocacy skills that they used to advocate for service system changes to local decision leaders. They also gained professional development skills and support through peer support groups and one-on-one mentoring.
DVHS Summit
Why it was created: The summit was created to bring people and systems involved in DV and homelessness sectors together to increase opportunities for information sharing, collaboration, and integration
How PWLE contributed: PWLE were involved in all stages of the planning and implementation process, and were paid for their efforts. They led a plenary solely focused on the perspectives of PWLE of homelessness and DV.
What it accomplished: The summit now occurs regularly and is a bridge for the siloed systems. Interest in the work of the coalition increased dramatically during and after the summit, leading to additional funds to support PWLE.

Design of Advocates program

Leading from within

DWC utilized skills learned from the academies in their monthly client-centered workgroup meetings. Relationship building was the exclusive focus in year one. The Habits of the Heart¹⁴, a leading from within skill, was used as a guidepost for self-awareness during initial conversations. In Habits of the Heart, value of difference is appreciated, tension is held in life-giving ways, and voice, agency, and capacity are gained to create community. The workgroup reflected: unless we embrace a shared understanding that we are all in this together, we risk blaming/shaming; we must find ways to hold tension in creative ways to test new ideas.

Touchstones for Creating Safe Spaces¹⁵ was a leading from within strategy also used in this phase. Workgroup members chose how and when to participate, made space for silence and reflection, embraced differences, turned to wonder (instead of judgment), asked open and honest questions, and observed confidentiality. Asking open and honest questions allowed a variety of people to contribute, rather than only the most vocal. Open questions left space for others to share (e.g., What happened? How did that make you feel? What did you learn?). They focused on listening deeply to understand, versus what they would say next. Norms were created in which people who tended to hold back stepped up, and vice versa, which created psychological safety (i.e., people felt comfortable being themselves), critical for effective group work.

Based on ideas from the year-long relationship building/reflection process, and focus group results, the client-centered workgroup decided to host empowerment and advocacy workshops through a formal program, the Advocates Program. DWC conducted an informal screening to inform interested women about program activities and verify that they had lived experience. Stable housing and safety needs were necessary prerequisites to participation. The program was capped at ten women to ensure all were fairly compensated. Some of the ten women in the Advocates Program also participated in the workgroup that helped form it.

Leading together

Co-design principles were used to develop the Advocates Program curriculum. The staff leaders did not have pre-planned lessons. Advocates determined their learning outcomes, and requested supports for their advocacy. During co-design, a leading together and for equity skill was utilized: distributed power structure. The co-creators developed a shared purpose and collective definition of the work, which is crucial to ensure that all group members are equally valued. They also set group norms, and made a public commitment. A distributive leadership structure ensured clear role responsibilities, based on strengths and capacities. A DWC staff member reflected on what Leading Together has meant for their work:

“Leading together has created a unique coalition, where time to reflect, challenge status quo, and lean-in is more common than any other group structure that I am a part of in my work. We have learned how to intentionally co-design; I believe we were doing it before, but we were less transparent with people with lived experience about teaching the skills and being part of the whole process from start to finish.”

The Advocates Program guiding theory posits that, with adequate support of peers and staff attuned to survivor needs, sharing personal trauma narratives is an empowering tool for healing.¹⁰ The Advocates Program has four monthly components. The first is skills-based training in advocacy, policy, and public presentation of stories, led by a key partner, the Corporation for Supportive Housing (CSH). CSH is a technical assistance agency that helps organizations use housing to provide supportive services. CSH adapted their SpeakUp! program for survivors of DV. This adapted protocol was used in the Advocates Program to train PWLE in advocacy. CSH built PWLE capacity for public speaking by co-leading meetings with them. The second component is practice “business meetings” to study policies, plan advocacy, and coordinate speaking schedules. Related to leading together in advocacy, a staff member shared:

“Having PWLE involved helped me consistently be mindful of linking any potential policy decisions back to the individuals we serve. The PWLE were a constant source of knowledge that helped guide policy formation, both inside and outside of the program.”

During co-design, the Advocates identified a supportive environment as most critical. Thus, PWLE led the creation of components three and four: peer support for the emotional burden of advocacy, and one-on-one mentoring from allies advanced in their careers for professional growth and skill building. The allies were executive directors and leaders of non-profit/government entities (e.g., Rainbow Services, Los Angeles County Department of Public Health, Los Angeles City Mayor’s Office, Los Angeles Homeless Services Authority, Valley Oasis, Community Legal Aid SoCal). Additional community partners included the LA County Domestic Violence Council and County Supervisor Sheila Kuehl’s office.

The DWC CEO and third author reflected on the need for tailoring in co-design:

“When it first started, it did not include the peer support groups. However, we learned that emotional needs would be expressed in the practice "business meetings” if they were not expressed elsewhere. This created conflict, because some attendees wanted to adhere to the agenda, while advocates wanted to discuss emotional needs triggered by an agenda topic. The Advocates decided that they needed separate space dedicated to emotional support. One advocate volunteered to lead a peer support group. Staff intentionally do not attend; DWC prepares the advocate to facilitate the sessions. It was also important to tailor support. Some advocates needed little preparation for advocacy events. Others needed one-on-one time with staff to gain knowledge about the issue, draft talking points, and practice their presentations.”

Logistically, the program requires 10-20 staff and 4-15 advocate hours per month. Implementation duties include outreach/engagement, agenda setting, meeting reminders and facilitation, advocacy education/coordination, scheduling training/trainers, and communication with allies/advocates. The CEO and third author reflected on the necessary time commitment:

“I have been very stretched with capacity and time that is needed to ensure that they are informed, aware of opportunities, educated about what we are trying to accomplish. Every meeting takes 1.5 hours of additional time to outreach, engage, and inform PWLE. This is not a complaint, it’s just a reality and needs to be factored into the structure.”

Leading for Outcomes

During the academies, DWC created driver diagrams, a leading for outcomes tool to develop a shared theory of change. They also participated in workshops on dashboards, survey selection, and outcome tracking. A DWC staff member highlighted challenges in measuring community change, “moving from traditional, program-based outcomes to understanding root cause/system change makes it harder to concretely measure impact.” However, that staff member also recognized its importance, “when someone is fleeing DV, the first thought is not “let’s collect data,” but rather, “how can I ensure this person’s safety.” However, in order for lasting change, data collection does need to be in the mind of direct service providers.”

Improving the well-being of PWLE was one of DWC’s driver diagram aims. Nine participating advocates’ well-being was measured quarterly using the 100 Million Healthier Lives Wellbeing Survey Tool.¹⁶ They chose a tool that focused on wellbeing because, “this is a population that is highly traumatized and have often “told their story” so many times they do not like to tell it anymore. Having them complete surveys that highlight potential problems in their life can be traumatic for clients.” (DWC Staff). The SCALE team analyzed the results, and engaged PWLE in creating feedback. This approach provided increased receptivity for advocates to identify and discuss improvement areas as part of peer support and one-on-one with allies.

Leading for Equity

DWC incorporated equity into their daily work and programming, framing it as, “it’s like dating, in the beginning it feels weird and awkward and we want to get to a place where it feels normal…where we aren’t asking whether we have community voice or equity, it’s just natural.” (DWC staff) The focus on equity included intersectionality, as DWC recognized the intersection of DV and homelessness with race, gender, sexual orientation, and gender identity/expression. DWC provided the advocates with Trauma-Informed Care training, giving them tools to understand their unique triggers, and decide which parts of their stories to share publicly. They were then able to engage in self-care while making public comment at city council meetings, meeting one-on-one with elected officials, and speaking on a conference panel. An intersectional and trauma informed lens was critical to support the advocates and their experiences of individual, racial, and generational trauma, and to advance solutions to homelessness and DV.

Related to financial inequities, the Advocates program had initial internal struggles. Advocates voiced concerns that staff were paid for their time while they remained volunteers. Financial compensation became a non-negotiable. DWC staff set initial compensation parameters based on available grant funds. Advocates finalized it, prioritizing funding transportation to meetings and cash gift cards. DWC compensates advocates $25 per meeting, $50 per speaking engagement, and supports up to $600 for professional development certifications and conference attendance. For continued compensation, DWC raises general funds for stipends and solicits gift card donations. During advocacy events, DWC provides food and professional clothing as necessary. Though these resources help, finances are still an area of tension. The use of COS skills helps all parties have crucial conversations necessary for continued collaboration. When hired, pay limitations are transparently shared with PWLE.

Compensation of PWLE is complicated. Competing realities exist when PWLE are equal partners with social services. Social services, predominantly funded through government contracts, may not have flexible funds to use for compensation, and most require personnel with credentials or higher education. For PWLE, accepting paid work may jeopardize affordable housing and healthcare by disqualifying them from government subsidized programs. Social services are recognizing hiring PWLE is invaluable. Some funders agree in principle, but it is challenging to find ones with structures in place to support it. The field is changing, but slowly.

DVHSC Summit

Leading together

The DVHSC hosted two summits in 2017 and 2019, with over 250 attendees. Rainbow Services, a leading victim services agency, was a critical partner. The Executive Directors of both agencies ensured that there was balanced representation of PWLE, homeless services, DV agencies, and system and philanthropic leaders. The partnership created extensive networks impossible to achieve independently, leading to the high turnout.

Distributed leadership, a leading together strategy, was utilized in summit planning. PWLE received financial compensation for participation. PWLE were planning committee members and informed all decisions (e.g., speakers, topics). They co-created agendas, co-facilitated meetings, crowdsourced ideas, and rotated team roles. A “jargon card” was used in meetings to call out unfamiliar terms. Anyone could raise a “jargon card” if more explanation was needed to understand and contribute to the discussion. The committee celebrated when people gave power to others during meetings, and when a decision was made together.

PWLE were also leaders during implementation of both summits. Each workshop included PWLE panelists. Both summits opened with a plenary panel composed exclusively of PWLE. Advocates shared how social services met their needs or, at times, re-traumatized them. Related to this, a staff member reflected: “the most motivating factor in our current work, is to spread and train how to be more trauma informed in a community that is simultaneously so traumatized by social services doing things horribly wrong and so resilient and beautiful.”

The effectiveness of the panel discussion was evident; providers vowed to change program practices. Directly after the 2017 plenary, an audience member from a large healthcare foundation made a sizable grant to the coalition. The grant provided additional financial assistance to PWLE to continue their work: “leading together has created trust to hear from PWLE, which leads to…solutions based on their experiences with service systems.” (DWC staff)

Leading for outcomes

PWLE participated in multiple presentation formats. They led for outcomes via songs, spoken word poetry, and expert presentations on trauma-informed practices and evidence-based housing models (e.g., Housing First). The way the summit was planned and executed, with the expertise of PWLE so prominently woven throughout, is a model for future conferences.

Sustaining motivation

Leading for sustainability

“Racism, race, and equity issues in Skid Row are so large, and built into societal structures that this task can often feel impossible or daunting. The challenges and hurdles that our clients face every day, which were created by equity issues, can lead to a lot of staff feeling confused on how to tackle this humanitarian crisis.” (DWC staff)

Due in part to the daunting equity challenges, building intrinsic motivation among the workgroup, especially PWLE, was an important component of sustainability planning. The workgroup did this through a leading for sustainability strategy: the creation of a public narrative with PWLE. A public narrative contains three stories: stories of self, us, and now. In the story of self, personal stories contribute emotional resources and values that lead to mindful action. In the story of us, collective stories access the emotional resources embedded in the shared group values. The story of now transforms the present moment into a narrative moment, tying people together to move through challenges with hope and mindfulness rather than fear.

An environment where PWLE go through cycles of co-design, share a common story, and have a power-sharing partnership with DWC staff to create programmatic and policy change fosters sustainability. Shared leadership ties meaning to a specific place/group, creating intrinsic motivation to sustain efforts when funding ends. Providing practical skills to PWLE helps maintain their engagement. They benefit personally and professionally, and are paid for their time, even if there is a dip in compensation. PWLE also live in the community, so directly benefit from their local advocacy. PWLE have a compelling frame of reference; a greater understanding of what is necessary and realistic for meaningful change, compared to coalition members who do not have first-hand experience of the inequities.

Lessons Learned

Leading from within during the development of the Advocates Program taught DWC an important lesson about collaboration. During the first year, they focused on creating mutuality; a shared purpose. They wanted to prevent competition for whose priority will be first, which can happen if everyone has their own agenda. When individual interests are recast as common interests, people are able to participate fully and be willing to combine assets.

During the leading for equity process with PWLE in the Advocates Program, DWC learned that compensation is crucial to respect PWLE time and labor. Without financial compensation, hierarchical power structures are reinforced. PWLE can feel uncomfortable voicing opinions to paid staff, and be further traumatized by pay inequities. Social services risk exploiting people for their stories if they do not have financial capacity to support the emotional and skilled labor of PWLE. Thus, it is critical that mechanisms to fairly compensate PWLE be built into funding priorities, and organizations working with PWLE incorporate adequate compensation into their budgets.

During the leading together process in the Advocates Program, lessons were learned about time required to engage PWLE in meaningful work. An additional hour and a half was added to meetings to prepare PWLE for advocacy. Low staffing and/or time can become a major barrier to doing this work well.

The leading together process also highlighted the importance of tailoring activities to meet advocate’s needs. Even though advocates attended the skills based “business meeting” session, they were not always ready for advocacy. The approach needed to be customized to make sure they each had what they needed to feel prepared. Tailoring also occurred when the advocates needed a separate place for emotional support. Allowing space for different types of support is important to serve the diverse needs of PWLE. Tailoring can be challenging if staff and time capacity is low. It is easier and more time efficient to implement a standard approach for everyone, but that may not actually meet anyone’s individual needs.

PWLE pushed back on completing surveys that focused on negative aspects of their well-being; for some women, the process stirred up traumatic memories. It will be helpful for researchers and evaluators to develop validated tools that measure overall health, while also taking into consideration trauma history.

A main overarching theme of this work with PWLE of homelessness and DV was, on top of their own trauma history, traumatization due to how they were treated, or not treated, in service systems. This theme aligns with the broader literature, in that there has been a long history of lack of coordination and integration between DV and homeless service systems. Many PWLE of homelessness and DV have similar risks and needs, and end up involved in both systems. However, without integration, one system is ill equipped in how to address in a comprehensive, trauma-informed way, concerns related to the other system. As highlighted in this work, this disconnect can lead PWLE to incur additional trauma. These reflections underscore the importance of increasing coordination and integration of the DV and homeless service systems, and using trauma-informed care in both, to prevent re-traumatization of PWLE.

Successes and Next Steps

The coalition continues to convene, organize, advocate, and teach in order to meet the goal of effecting systems change to better serve the need of DV survivors experiencing homelessness. The coalition now has a diverse stakeholder group of 450 individuals representing 80 community-based organizations, government officials, philanthropic circles, and individuals with lived experience of homelessness and DV. They are the largest coalition of its kind in the nation. Ten women have graduated from the Advocates program. PWLE have also contributed to numerous reports used to design and enact systems change. PWLE attended the in person training academies and are heavily involved in developing health workshops. Before a group provides a workshop, they must first meet with a staff member and PWLE to ensure the information is relevant and activities are appropriate.

The coalition has been documenting their model to share with other groups who want to work towards eliminating the silos between homeless and DV services, while simultaneously empowering PWLE. DWC has plans to continue to spread trauma-informed systems change, which: “includes working with the social services that do the most re-traumatizing work, that we spend hours trying to repair at DWC.” They are: “on to something” as the LA Homeless Services Authority, the County of LA, City, and United Way are demonstrating greater interest in figuring out Trauma-Informed Systems Change.” (DWC staff) Next steps include continuing to work with survivors of DV, social service providers, and civic leaders to provide needed and immediate resources. The coalition is finding sustainable ways to compensate PWLE. They will train a new cohort of advocates to increase reach for responsive systems change.

Summary

For decades, various groups have advocated for increased coordination and integration of housing and DV service systems. DWC pushed this agenda forward in partnership with PWLE through collective advocacy for change. Domestic Violence Housing First (DVHF) programs may benefit from similarly involving PWLE in the coordination, integration, and advocacy processes. Most DVHF programs integrate advocacy FOR PWLE;¹⁷ an additional benefit would be to advocate and share power WITH them.

The COS framework provided an intentional structure for community-driven health improvement. For DWC, it enhanced their collaboration with PWLE. They worked with PWLE in a power-sharing partnership process to plan and implement a summit. They co-created an advocates program to meet PWLE needs, enhance their strengths, provide financial support, and impact systems change. Going forward, DWC will continue to be “intentional in keeping PWLE voices at the center, question the balance of PWLE and others, and consider how to coach them to best use their stories of lived experience.” (DWC staff) The model, once complete, can help other organizations and housing first models do the same.

Figure 1.

Community of Solutions Theory of Change.