—Based on our clinical and research experiences, we agree with the hypothesis of Ms Plummer and colleagues that posttraumatic stress disorder and depression may inhibit high-risk women from participating in long-term services and programs. While we have data to examine these issues, we have not yet conducted the analyses to support this conclusion. We know that barriers to participation go well beyond mental health and include factors such as racial discrimination and inadequate income, child care, and transportation.1 In addition, some low-income women have had difficulty accessing traditional services and understandably have become distrustful of clinicians and institutions.Programs for low-income women must include specific approaches for responding to the extremely high rates of violent victimization and its aftermath (ie, posttraumatic stress disorder and its associated disorders—major depressive disorder and substance abuse) and for identifying women who have been abused or assaulted. At the least, treatment programs modeled from
Bassuk EL, Buckner JC, Browne A, Salomon A, Bassuk SS, Weinreb LF. Providing Support and Assistance for Low-Income or Homeless Women-Reply. JAMA. 1996;276(23):1875. doi:10.1001/jama.1996.03540230025018
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