Trauma-Informed
Services
MHSA Promising Practices TA Call
Corporation for Supportive
Housing
6/9/10
www.csh.org
Why Trauma-Informed Services?
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Homelessness is traumatic
People experiencing homelessness are living with
a multitude of losses:
– A person who is homeless has lost their home,
community, stability, safety, and social networks
– They are marginalized, isolated, and stigmatized
within the larger society
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People who are experiencing homelessness are
also highly vulnerable to violence and
victimization
What is Trauma?
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Trauma is an emotional shock that creates
significant and lasting damage to a person’s mental,
physical and emotional growth, and overwhelms a
person’s resources for coping.
Typical causes of psychological trauma are:
– Sexual abuse, violence, (and the threat of either,
or the witnessing of either), catastrophic events
such as earthquakes, war, mass violence, or longterm exposure to situations (ex: extreme poverty,
verbal abuse)
A traumatic event involves:
– A single experience, or
– An enduring or repeating event or events
Behavioral Manifestations
from Trauma
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Depression
Loneliness
Ostracized
Unaccepted
Non-trusting
Angry
Jittery
Sleeplessness
Violent
Confused
Isolated
Alone
Rejected
Misfit
Low self-esteem
Mood swings
Hurtful
Poor attachments
Suicidal
Emotionally unstable
Self destructive
Self injurious
Nightmares
Aggressive
Rebellious
Secluded
Tease
Drugs
Alcohol
Sexual activity
Vengeful
Sensitive
Touchy
Poor problem-solving
Poor comprehension
Slow cognition
Depression
Loneliness
Ostracized
Important Point:
 Different people will react differently to similar
events. One person may perceive an event to
be traumatic that another may not, and not all
people who experience a traumatic event will
become psychologically traumatized
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Trauma-Informed Care
Trauma-Informed Care (TIC) offers a framework
for providing services to traumatized individuals
within a variety of service settings, including
homelessness service settings.
 Service systems are designed to accommodate
the vulnerabilities of trauma survivors and allow
services to be delivered in a way that will avoid
inadvertent re-traumatization and to facilitate
consumer participation in treatment.
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Trauma-Informed Care
Consensus-Based Definition
 “Trauma-Informed Care is a strengths-based
framework that is grounded in an understanding of
and responsiveness to the impact of trauma, that
emphasizes physical, psychological, and
emotional safety for both providers and survivors,
and that creates opportunities for survivors to
rebuild a sense of control and empowerment.”
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Trauma-Informed Care
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Findings from numerous studies suggest that
we will be unable to solve the issue of
homelessness without addressing the
underlying trauma that is so intricately
interwoven with the experience of
homelessness.
Principles of Trauma-Informed Care
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Trauma awareness:
– Trauma-informed service providers incorporate
an understanding of trauma into their work
– Staff training, consultation, and supervision are
important aspects of organizational change
towards trauma-informed care.
– Dealing with vicarious trauma and self-care is
also an essential ingredient of trauma-informed
services.
Principles of Trauma-Informed Care
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Emphasis on safety:
– Program must provide a safe place – physically and
emotionally – for consumers.
– Providers should be aware of potential
retraumatization. Because interpersonal trauma often
involves boundary violations and abuse of power,
programs should establish clear roles and boundaries
that are an outgrowth of collaborative decision-making.
– Privacy, confidentiality, and mutual respect are also
important aspects of developing an emotionally safe
atmosphere.
– Acceptance of, and respect for, diversity is another
important aspect of a safe environment.
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How do our agencies
retraumatize consumers?
Not assisting survivors when they experience violations (e.g police
harassment, victim of crime)
Authoritarian staff
Triggering memories of abuse ( e.g vocabulary, people, smells, sounds,
the environment)
Staff being non-responsive to the concerns survivors have
Staff being impatient with survivors
Verbal abuse from staff
Stereotyping survivors
Survivors hearing the traumatic experiences of others
Placing too many expectations on survivors especially those with
impaired functioning
Being judgmental
Disrespect
Boundary violations
Lack of consistency when applying rules (favoritism)
Loud chaotic environment
Unsafe environment
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Principles of
Trauma-Informed
Care
Principles of Trauma-Informed Care
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Opportunities to rebuild control:
– Trauma-informed services emphasize the
importance of choice for consumers.
– They create predictable environments that allow
consumers to re-build a sense of efficacy and
personal control over their lives.
– This includes involving consumers in the design
and evaluation of services.
– Consumer choice and control are critical.
Principles of Trauma-Informed Care
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Strengths-based approach:
– TIC is strengths-based, rather than deficitoriented, and assists consumers to identify their
own strengths and develop coping skills.
– TIC service settings are focused on the future
and utilize skills-building to further develop
resiliency.
Review of Needs Assessments:
Trauma-Informed Care
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Providers feel that they need to be better
informed about trauma and violence
– Programs had little knowledge about trauma,
how to facilitate recovery, or how services might
help or retraumatize
Providers do not have systematic ways of
assessing for trauma-related issues
– Assessments were generally not conducted
systematically and did not utilize validated
measures
Review of Needs Assessments:
Trauma-Informed Care
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Consumers want services that are empowering
– Qualitative research suggests that homeless
individuals and families need and want traumainformed services, including desire for
autonomy, prevention of further victimization,
and assistance in restoring their devalued sense
of identity
Mental health services are an important need
for many homeless families and individuals.
– Mental health needs were the most prevalent of
all the intervention needs across sites with many
facing multiple challenges
Assessment Tool
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The National Center on Family Homelessness
developed the Trauma-Informed Organizational SelfAssessment to translate the principles of traumainformed care into concrete practices that can be
incorporated into daily programming in shelter and
housing programs. This tool is designed to be used
by programs to: 1) evaluate programming based on
how well they incorporate Self-Assessment
practices; 2) identify areas for organizational growth;
and 3) make practical changes using the SelfAssessment as a guide.
Assessment Tool
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Trauma-Informed Organizational SelfAssessment
I. Supporting Staff Development
II. Creating a Safe and Supportive Environment
III. Assessing and Planning Services
IV. Involving Consumers
V. Adapting Policies
Resources
To learn more about
Trauma-Informed Services
Resources
Shelter from the Storm: Trauma-Informed
Care in Homelessness Services Settings
Elizabeth K. Hopper, Ellen L. Bassuk, and Jeffrey
Olivet
In The Open Health Services and Policy
Journal, 2010, 3, 80-100
http://bentham.org/open/tohspj/openaccess2.htm
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Resources
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Trauma-Informed Organizational Toolkit for
Homeless Services
Guarino, K., Soares, P., Konnath, K., Clervil, R.,
and Bassuk, E. (2009). Rockville, MD: Center for
Mental Health Services, SAMHSA, and the
Daniels Fund, the National Child Traumatic
Stress Network, and the W.K. Kellogg
Foundation. Available at
www.homeless.samhsa.gov and
www.familyhomelessness.org.
Resources
The National Center for Trauma-Informed Care
CMHS’s National Center for Trauma-Informed
Care (NCTIC) is a technical assistance center
dedicated to building awareness of traumainformed care and promoting the implementation
of trauma-informed practices in programs and
services.
http://mentalhealth.samhsa.gov/nctic/
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For More
Information:
Anne Cory
CSH
anne.cory@csh.org
(510) 251-1910, ext. 208