TRAUMA-INFORMED CARE
BACKGROUND AND DEFINITION
Most individuals seeking homeless services have histories of physical and sexual abuse and other types of trauma-inducing experiences.
For example, in a survey of three British Columbian communities of persons experiencing homelessness:
- 51% of reported childhood sexual abuse
- 55% reported physical abuse
- 60% reported neglect
- 58% reported emotional abuse, and
- 57% met the criteria for post-traumatic stress disorder (PTSD) (BC Provincial Mental Health and Substance Use Planning Council, 2013).
The Adverse Childhood Experiences (ACE) Study showed that a strong, graded relationship exists between childhood abuse and household dysfunction to many of the leading causes of death in adults (Felliti, 1998). Diseases and disability include both mental health and medical conditions such as depression, substance use, ischemic heart disease and other chronic diseases. Social problems in particular include encounters with the criminal justice system. Awareness of this relationship, illustrated below, is imperative to providing culturally-competent care to persons experiencing homelessness.
Understanding the vulnerabilities or triggers of trauma survivors helps to provide supportive care while avoiding re-traumatization (eg. triggering PTSD). This understanding forms the basis for trauma-informed care (SAMHSA, 2013).
PRINCIPLES OF A TRAUMA-INFORMED PRACTICE
Four evidence-based principles guide the provision of trauma-informed care for persons experiencing homelessness (adapted from Hopper, 2010 and Prescott, 2009):
Trauma awareness
Emphasis on safety
Opportunities to rebuild control
Strengths-based approach
Four evidence-based principles guide the provision of trauma-informed care for persons experiencing homelessness (adapted from Hopper, 2010 and Prescott, 2009):
Trauma awareness
- Develop policies & procedures based on the assumption that people experiencing homeless have been impacted by trauma and that they are not re-traumatized while seeking care (ex. be open about confidentiality practices)
Emphasis on safety
- Create a physical environment that is welcoming and safe (ex. incorporate colourful artwork at your place of practice)
Opportunities to rebuild control
- Establish a wide-range of voluntary services and supports where consistent, caring relationships are offered and crisis prevention activities are ongoing, giving clients/patients the power of choice (ex. supporting client/patient involvement in advisory committees)
Strengths-based approach
- Focus on strengths and not deficits by helping patients develop coping skills, focus on the future and build their skills to further develop resiliency (ex. offer peer-to-peer support groups)