Publication Date

Fall 11-15-2023

Item Type

Text

Executive Summary

Coping Strategies to Promote Mental Wellness

Over eight weeks, our nursing school leadership team collaborated with a Seattle non- profit agency whose mission is to provide resources, planning, and housing to families with children experiencing homelessness. Our team’s overarching goal by the end of this project, based on the needs expressed by the agency, was to create a tool that provides resources and coping skills to families experiencing homelessness to improve mental health and promote wellness.

Background

The population that is served by the agency includes families with at least one child under the age of eighteen, children with medical needs, and pregnant women, all of whom are experiencing homelessness (Agency, personal communication, Sep 20, 2023). Outreach for these families is conducted on the phone by appointment, in the community, or by walk-in appointments; guests often don’t return after assistance and resources are provided. According to the agency liaison, there is a high level of stressors seen in this population, including gun violence, theft and other violent crime, past trauma, prevalence of past drug use that causes temptations, and additional personal stressors for the individuals in this community (Agency, personal communication, Sep 20, 2023). The agency serves the unhoused population in South Seattle and collaborates with a secondary agency that provides temporary housing. When our team completed a windshield survey of the area, we observed cracked sidewalks, abandoned buildings, and a large encampment for unhoused individuals across the street. The team also observed environmental stressors such as, loud construction sites, an abundance of liquor stores, convenience stores, abandoned vehicles, and a lack of grocery and retail stores.

According to Seattle statistics, “11,751 people [were] experiencing homelessness on one night in January, with 53% sheltered and 43% unsheltered... [which] reflects a 5% increase compared to 2019 count” (City of Seattle, 2023). Despite the continued efforts of the City of Seattle to create more affordable housing with a widespread movement to bring people indoors, the number of individuals who are unhoused continues to increase, and available city resources struggle to keep up with the growing population that is unhoused.

According to the Seattle Police Department, crime in the area has increased significantly since 2019. The violent crimes reached a 15-year high in 2022, which is a 4% increase compared to 2021 (Seattle Police Department, 2023). People who are unhoused are already at an increased risk of suffering from mental health disorders, with crime being a significant contributor of stress among individuals who are unhoused, especially for families with children (Lippert & Lee, 2015). Various stressors such as crime, commonly seen in individuals who are unhoused, can "exacerbate existing mental health problems by undermining economic stability, safety, and social integration" (Lippert & Lee, 2015). The increased stressors exacerbating mental illness prompted a need for education on coping strategies.

We established the nursing diagnosis for this population as a knowledge deficit related to healthy coping strategies, as evidenced by the agency liaison reporting the need for resources that promote mental wellness and provide healthy coping mechanisms.

Activities/Rationale

The priority coping strategies we chose are box breathing, guided imagery, and muscle relaxation (Norelli, 2018). These coping skills are clinically shown to reduce tension, anxiety, physical and psychological challenges. As pictured above, increased mental distress, mental health issues, and associated stress related to homelessness are extremely prevalent among the population the agency serves. The following coping skills can be used anywhere, without the need for equipment, materials, or internet access. The box breathing exercise involves breathing in through the nose, holding the breath, and slowly breathing out. The duration of each step can be adjusted per individual preferences. The second coping mechanism is guided imagery, which involves visualizing a calm environment by recalling a distant memory or imagining a happy place while using the five senses to visualize the setting. The final coping strategy involves progressive muscle relaxation, a series of tensing and relaxing the different muscles of the body.

The chosen delivery method is through a pamphlet, which can be disseminated to the agency's guests either in person or electronically in the form of a PDF. The pamphlet can be folded into a small, pocket-sized piece that can then be inserted into a protective plastic badge holder, attached to a badge reel. The plastic badge holder serves the purpose to ensure that the pamphlet is durable and sustainable even in the target community’s living environments with harsh weather conditions. In addition, we have included a QR code on the back of the pamphlet which can be utilized to keep the information available on personal devices.

Outcome

This project had two main goals; the first outcome to achieve was to give unhoused families access to mental health coping strategies and tools to manage stress and anxiety. This goal was met, as our group produced and provided a pamphlet to the agency that contains three different coping strategies that can be used to improve mental wellness. While there were many other possible coping strategies available, we strategically narrowed down to three evidenced- based tools that can be easily completed anywhere the families may be.

The second goal was to give unhoused families immediate access to mental health resources outside of the provided coping strategies. We provided the crisis line phone number on the front of the pamphlet, as well as in the coping card section. The rationale was to provide a resource for immediate assistance, that connects the guest to a trained crisis interventionist who can then provide additional resources.

Overall, both goals were met in terms of the content of the mental wellness pamphlet. The team sought to evaluate the implementation of the mental wellness pamphlet, a three- question qualitative survey was sent to the agency; however, there was inadequate time for agency to disseminate to staff, thus responses beyond our two agency liaisons could not be evaluated. In addition, assessing the effectiveness of the pamphlet is not feasible; firstly, the population will receive the pamphlet upon completion of the project and thus cannot be surveyed after use. Secondly, walk-in guests receive assistance and resources one time and often do not return.

Conclusion

The wellness pamphlet will provide a convenient and accessible resource for the South Seattle population dealing with stressors that negatively impact their mental health. We’ve accomplished this by creating flexibility and providing a choice between carrying the pamphlet, badge holder, or QR code. This enables the clients to readily execute the coping skills wherever they are. Limitations identified pertain to the inability to directly assess the population and evaluate implementation of coping strategies, and agency being given inadequate time to disseminate and return qualitative evaluation survey prior to the project deadline. Moreover, the goals were met by providing simplified mental health resources through implementation of coping strategies and providing the crisis line phone number. Lastly, future projects could include an outreach program that focuses on teaching coping strategies to the community.

References

City of Seattle. (2023). Addressing homelessness. https://www.seattle.gov/human- services/reports-and-data/addressing-homelessness

City of Seattle. (2023). Homelessness action plan. Office of the Mayor. https://www.seattle.gov/mayor/one-seattle-initiatives/homelessness-action-plan

Gibbs, K. D., Jones, J. T., LaMark, W., Abdulmooti, S., Bretz, L., Kearney, K. D., Narendorf, S. C., & Santa Maria, D. M. (2023). Coping during the COVID‐19 pandemic among young adults experiencing homelessness and unstable housing: A qualitative study. Public Health Nursing, 40(1), p. 17-27. https://doi.org/10.1111/phn.13136

Lippert, A., & Lee, B. (2015). Stress, coping, and mental health differences among homeless people. Sociology Inquiry, 85(3), p. 343-374. https://doi.org/10.1111/soin.12080

Mayne, S.L., DiFiore, G., Hannan, C., Virudachalam, S., Glanz, K., & Fiks, A. G. (2022). Association of neighborhood social context and perceived stress among mothers of young children. Academic Pediatrics, 22(8), 1414-1421.https://doi.org/10.1016/j.acap.2022.03.013

Norelli, S., Long, A., & Krepps, J. (2018). Relaxation techniques. StatsPearls Publishing, Treasure Island

(FL). https://europepmc.org/article/nbk/nbk513238#__NBK513238_dtls__ Seattle Police Department. (2023). Crime report 2022.

https://www.seattle.gov/documents/Departments/Police/Reports/2022_SPD_CRIME_RE PORT_FINAL.pdf

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