How can providers help care for people who have experienced trauma? People who are experiencing traumatic stress do not relate to the world in the same way as others. They require special care. In this article, the HRC shares best practices for trauma-informed care. These include understanding trauma and its effects, creating safe physical and emotional space, supporting consumer choice and control, and integrating trauma-informed care across service systems.
Some people experience very few traumatic events in their lives. For others, experiences of traumatic stress are chronic. Research and experience tell us that for people experiencing homelessness, rates of trauma are extraordinarily high. Many who enter the homeless service system have experienced violence, loss, and disruptions to important relationships from an early age.
Additionally, people who are homeless experience the loss of place, safety, stability, and community. These losses are also traumatic. They have a major impact on how people understand themselves, the world, and others. People who have experienced multiple traumas do not relate to the world in the same way as those who have not. They require services and responses that are uniquely sensitive to their needs.
What makes an experience traumatic?
- The experience involves a threat to one’s physical or emotional well-being.
- It is overwhelming.
- It results in intense feelings of fear and lack of control.
- It leaves people feeling helpless.
- It changes the way a person understands themselves, the world and others.
We know people can and do recover from trauma, and we want to provide services and environments that support healing. To be a “trauma-informed” provider is to root your care in an understanding of the impact of trauma and the specific needs of trauma survivors. We want to avoid causing additional harm to those we serve.
What does this mean in practical terms? How is this different than business as usual? Here are some concrete practices of trauma-informed care.
Understanding Trauma and its Impact
Educating providers on traumatic stress and its impact is essential. Trauma survivors, particularly those who have experienced multiple traumas, have developed a set of survival skills that helped them to manage past trauma. These survival strategies (like substance abuse, withdrawal, aggression, self-harm, etc.) make sense given what people have experienced. But they can be confusing and frustrating to others and often get in the way of current goals.
Without an understanding of trauma, providers may view those they serve in negative ways. Providers might describe behaviors as “manipulative,” “oppositional,” or “lazy.” Yet these behaviors may be better understood as strategies to manage overwhelming feelings and situations. Trauma-informed training can help providers understand these responses and offer trauma-sensitive care.
Promoting Physical and Emotional Safety
Traumatic experiences often leave people feeling unsafe and distrustful of others. Creating a sense of physical and emotional safety is an essential first step to building effective helping relationships.
Safe physical environments may include:
- Well-lit spaces
- Security systems
- The ability for consumers to lock doors
- Visible posting of consumer rights
- Culturally familiar decorations
- Child-friendly spaces
Practices that help to create a safe emotional environment include:
- Providing consistent, predictable, and respectful responses to consumers across an agency
- Asking consumers what does and does not work for them
- Being clear about how consumer information is used
- Providing opportunities for consumers to engage in their own cultural and spiritual rituals
Supporting Consumer Control and Choice Situations that leave people feeling helpless, fearful, or out of control remind them of their past traumatic experiences and leave them feeling re-traumatized. Ways to help consumers regain a sense of control over their daily lives include:
- Keeping consumers well informed about all aspects of their care
- Providing opportunities for consumers to give input into decisions about how a program is run
- Allowing for consumer control over their own spaces and physical belongings
- Having clear boundaries around and giving advanced notice for room or apartment checks
- Ensuring that consumers have input into their service goals
- Using interventions respectful of and specific to cultural backgrounds
- Maintaining an overall awareness of and respect for basic human rights and freedoms regardless of housing status.
Integrating Care Across Service Systems
Becoming trauma-informed means adopting a holistic view of care and recognizing the connections between housing, employment, mental and physical health, substance abuse, and trauma histories. Providing trauma-informed care means working with community partners in housing, education, child welfare, early intervention, and mental health. Partnerships enhance communication among providers, and help minimize consumers’ experiences of conflicting goals and requirements, duplicated efforts, and or of feeling overwhelmed by systems of care. It helps build relationships and resources to provide the best quality of care possible.
Becoming trauma-informed means a transformation in the way that providers meet the needs of those they serve. The ideas above are only a beginning. Change happens as organizations and providers take these ideas, as well as their own, and use them to evaluate and adapt their approaches to care.