Objective To learn how adverse childhood experiences (ACEs) impacted the life course trajectory of formerly homeless and at‐risk African American women. Design Intersectionality and life course theory informed this qualitative pilot study, based on an instrumental case study design. Sample Forty previously homeless and at‐risk African American women, who were graduates from a long‐term transitional living facility in Milwaukee, Wisconsin. Measurements Focus group interviews and one individual interview provided data about participants’ life experiences prior to, during, and following their time at the transitional living facility, which provided supportive wrap‐around services. Interviews were audiotaped, transcribed, and line‐by‐line thematic analysis was conducted to identify themes. Fifteen focus group participants also completed ACE questionnaires. Results Participants reported a high prevalence of multiple ACEs, and three themes were identified: childhood experiences with family conflict, childhood experiences of abuse, and negative coping mechanisms. One‐hundred percent of women had experienced at least one ACE, based on ACE questionnaire responses. Conclusions ACEs affect various parts of patient's lives as adults. For nurses and other healthcare professionals, connecting with community resources provides the opportunity to strategically approach health improvement with wrap‐around resources to improve health outcomes.

Women experiencing homelessness who are also survivors of violence require uniquely tailored programs to accommodate complex needs. To understand how violence shaped the lives of formerly homeless African American women, an instrumental case study design and community-based participatory research approach was utilized in this qualitative study. Focus group interviews with graduates ( N = 40) from a long-term transitional housing program were conducted. Using thematic analysis, identified themes included: cycles of violence, violence in the community, relationships with children, and coping with violence. These themes illustrated survivors’ growth through supportive programming and highlighted services dedicated to empowering women who have experienced violence.

Through the lens of Black Feminist Thought, the intersectionality of poverty, racism, and sexism in the lives of urban dwelling African American women was explored. Reflections on recovery among women previously enrolled in a transitional housing treatment program were gathered via semistructured interviews, using an instrumental case study design. Four major themes surrounding the context of recovery were identified and analyzed: Knowledge and awareness of addiction, importance of social support and support groups, peace of mind that resulted from a new lifestyle, and women's desire to maintain their recovery status. Many women did not realize that their drug use constituted an addiction prior to their enrollment in the program. Social support and support groups such as AA, NA, and AODA helped the women to maintain their recovery, and this newfound recovery resulted in additional stress relief. Finally, many women felt empowered to maintain their recovery, not only for themselves but also their children. Paradigm shifts in treatment and recovery processes are needed to better serve minority populations, specifically focusing on women and African Americans. Recovery services must shift from previously male centered, hegemonic, pathology-oriented treatment modalities to serve populations more efficiently and equitably. Furthermore, to create effective social change in recovery, programs must address the social determinants of substance misuse, addictive behaviors, and underlying structural inequalities resulting from the intersection of racism, sexism, and classism. Deeper understandings of complex social issues must be disseminated, particularly for women battling substance misuse who are homeless, racially discriminated against and marginalized. Public Health SignificanceShifts in recovery are needed to better serve Racial and Ethnic minority groups, including African American women who are addicted to drugs. To create effective social change, community programs must address both social determinants of substance use, addictive behaviors, and underlying structural inequalities due to racism and sexism. Prevention strategies, treatment rhetoric, and substance misuse services must recognize the intersecting and compounding realities dictating how African American women experience health and wellbeing.

Traditional substance misuse treatments have not always taken women or marginalized populations into consideration. A holistic approach that addresses how drugs may be used to cope with trauma caused by violence, poverty, and neglect as well as employment of engagement strategies that connect populations with culturally relevant support systems are key, especially in treating African American women. As substance misuse rates rise among African American women, characterizing how this may influence or be influenced by relationships (such as with children, intimate partners, and social relations) is especially important in the context of effective treatment. The purpose of this qualitative study was to examine the themes surrounding substance misuse and close relationships among women previously enrolled in a transitional housing treatment program grounded in social support. Many women discussed how the program itself was an impetus in addressing not only their own substance use but also intergenerational substance use within their families. Women also noted how relationships with their children were vastly different pretreatment compared with during and after treatment, specifically emphasizing a positive improvement. Regarding intimate relationships, African American women learned to establish assertiveness and navigate healthier social relationships, all while sustaining drug abstinence. It is important to acknowledge the role of the healthcare professional in ensuring effective and culturally relevant treatment for African American women; nursing curricula should include evidence-based practice education and training on mental health and substance misuse specific to marginalized communities to more deeply understand the complex intersections of substance misuse, poverty, and social relationships in the lives of women.