NEWSBYJOY ECKSTINE

She sat in my office, light reflecting from her rippling jet black hair, her dark eyes shining  with tears dripping incessantly over the chiseled planes of her face.

She told me the history associated with each scar and injury: this one from a stabbing, this one from a gunshot, this one from a beating by her man. It was easier for her to tell me those stories than to recount what brought her to my office that day. Finally she told me of the concussion, the broken jaw, the bleeding from her ears, and the reconstructive surgery she needed "down there."

She and her 11 year old son had accepted help from a man whom she didn't know well. He kidnapped her and shoved her son out of the car. He went to the police station, but she was not found until three days later. Fortunately, the kidnappers neighbor saw her emerge naked and bleeding from his apartment, and called the police. Her assailant had finally fallen asleep and she was able to untie herself and flee, shaking in fear that he would wake up and use the gun he had threatened her with so often.

Sometimes advocacy has results, and boy, is it gratifying when it does. But to keep it coming, the leaders that have been able to change should be recognized.

There were a number of articles on Change.org last year about Boulder's camping ticket law, and how silly it is to arrest people when they have no legal alternative. The law is, I'm sorry to say, still on the books.

But things are improving for Boulder's homeless, with the help of local government and a truly energized and empowered group of homeless people.

Boulder Outreach for Homeless Overflow has expanded the number of nights that they operate Emergency Warming Centers. So far this season, they have offered 62 nights, a big increase from last season with a total of 81 nights. The City of Boulder gave them special funding in order to ensure their operation this winter. Best of all, everyone that works for BOHO is either homeless or formerly homeless.

The author of a recent opinion piece on homelessness, David Bornstein, wrote: “One of the jolting realizations that I had while researching this column is that anybody could become like a homeless person — all it takes is a traumatic brain injury. A bicycle fall, a car accident, a slip on the ice, or if you’re a soldier, a head wound — and your life could become unrecognizable.”

Bornstein identified one of the more common but less recognized paths into homelessness, which is of incredible value to state in the New York Times. However, even in his piece about the heterogeneity of homelessness, he doesn’t say a whole lot about the underlying structural and economic issues in our country which doom many to homelessness.

No good deed goes unpunished, and those that commented on his piece wrote extensively about the high cost of housing, low wages, unemployment, as well as the abdication of governmental and family responsibility. While I could not agree more fervently that these root causes of homelessness deserve a lot more media time in a world which loves to blame the downtrodden, the commentators appear to miss his point.

It is imperative that homeless shelters and services embrace the best practice of trauma-informed care. The sequelae, or after-effects, of childhood trauma can literally ruin one's life or lead to deadly circumstances. The Substance Abuse and Mental Health Services Administration, or SAMHSA, provides an excellent curriculum and lots of resources and research to help homeless providers get up to speed on this approach, though I can imagine the response of the typical director of an agency (having heard it just a few times): "We save people's lives by providing overnight shelter. That is the most important thing." "We don't have the time and money to train staff." "We have to treat everyone the same way, otherwise we are not being fair."

There are simple answers to each of these responses — the SAMHSA training is free and the entire curriculum and resource guide to providing trauma-informed care is on its website. And yes, it is important to treat everyone the same way. However, the standards of care outlined are a way to treat everyone humanely, not just trauma survivors. The irony is that so many adult homeless people are trauma survivors that treating the eight percent or so who are not is not likely to offend anyone.

Indeed, I would argue that homelessness is so traumatic that even without a history of trauma, by the time a homeless person has observed a few beatings or struggled through a winter on the streets, they are pretty darn traumatized. And I do understand that providing overnight shelter is the central mission of most shelters, but for those who are interested in saving lives, please read this real-life example to understand how understanding trauma can save lives, too.

Rod has worked his way out of homelessness twice in the time that I have known him. Most recently, he got a job on the night shift at a 7-11, and saved money until he was able to afford a run-down trailer. He slowly fixed it up, and has a picture of himself standing proudly in front of the repainted trailer. Last spring he was running to catch a bus, and slipped on the ice. Nine months later his leg is still swollen from a blood clot, and the doctors are suggesting amputation. Rod is hesitant to agree to the amputation, although he is exhausted, taking drugs to prevent clotting and fighting infection. He is allergic to opiate pain medications and does not drink alcohol, so he is using meditation to deal with his pain. He chooses to sleep in a tree rather than accept a medical respite program in a different city.

How does this relates to the after-effects of trauma? Trust.

On October 16th, homeless people in Boulder are going the extra mile to show that they are a valuable part of the community. As part of Global Hope International Network's ServeHope project, a team of homeless people will be cleaning the banks of Boulder Creek. The money raised will go to support efforts to help African villages become sustainable.

Teams of local student activists will do the online fundraising for homeless participants. There is a growing desire among local student groups and others to develop legitimate relationships with the homeless, and this project is giving them an outlet to support and connect with street people in a tangible and compelling way.

One reason this is such a powerful symbol of community-building in Boulder is the perception that much of the litter along the banks of Boulder Creek is due to homeless people. While there are many camps along the banks which undoubtedly contribute to the detritus, the creek is also used by families, sightseers and the ubiquitous fitness buffs. So while not all of the litter is from homeless people, this multi-use area is one of those zones of homeless/public interaction. For that reason, resentment has been building from the mainstream community. It probably doesn't help that the street community has developed a ritual of throwing people in the creek to express displeasure or censure.

Organizer Ken Miller is one of those visionaries who understands our interconnectedness. In addition to a lifetime of international mission work, service on multiple non-profit boards and his role as an elder at his church, he conceived this project as a way to express the integral role of homeless people in our community, as people who have something to give.

Experts estimate that 92 percent of homeless women have experienced intense physical or sexual violence in their lifetimes. The Substance Abuse and Mental Health Services Administration (SAMHSA) has an entire website dedicated to explaining how to design agencies and programs in a way that is appropriate for trauma survivors. Although trauma has not been as thoroughly studied in homeless men, the rates are generally assumed to be similarly high, with some studies citing rates of 90 percent.

So why do we have homeless programs that treat people in ways that are not only demeaning but make PTSD worse?

There seems to be a misconception that designing trauma-informed services is to create systems that do not have structure or consequences, while nothing could be further from the truth. Not every person who has severe trauma in his life develops post-traumatic stress disorder, and not every person who has PTSD is disabled by it. But if we were talking about agencies for physically disabled people, you probably wouldn't find service providers behaving in ways which are contraindicated for that particular physical disability.

Trauma-informed (pdf) services are defined as services that: "assume that people are doing the best they can at any given time to cope with the life-altering and frequently catastrophic effects of trauma. Because childhood and adult victimization can lead to disconnection with self and isolation from others, the challenge is to develop services and systems that create authentic reconnection, reparation, and healing. In trauma-informed services and systems, all staff members — from grounds-keepers, to maintenance staff to administrators — are trained to respond to individuals in distress."

Is the Housing First program in your community faithful to the principles of the theory?

This is a more important question than you might realize. After all, Housing First programs  have data going back at least 10 years which shows both incredible cost savings and better personal outcomes for the homeless individuals who participate. Housing First, which is just what it sounds like, emphasizing getting people in apartments rather than routing them through a continuum of care, is a win-win for everyone, but if your community does not stick to the original ideas, it won't experience all the benefits.

It is generally an uphill battle to get any housing program going in a community, and this one is a labor-intensive, fairly expensive model to implement. After all, when you are giving the most compromised people housing, many others will complain. But the most compromised people are the most expensive for the community, and show the greatest improvements once housed. However, I challenge you to explain this to a homeless person who is putting her all into self-sufficiency or a housed person working three jobs in a way that does not make them furious.

What I dimly remember from my statistics class is that good research means that you only change one factor at a time, so that you can prove that what you think is causing a positive change is in fact the thing that creates change. When you are providing real time services in a community to real people, though, it's hard to have a true research trial. In that case, according to the scholarly stuff, "fidelity may be simply defined as 'the adherence of actual treatment delivery to the protocol originally developed.'"

So what is the original protocol? And how do you judge adherence? Here are some research-based questions to ask your community's Housing First provider.

Ryan stood in the middle of the room, orange juice trickling down his wild brown beard, with pure defiance in his deep eyes. He clutched the half gallon in his hand, legs akimbo, dressed in studded black leather. The staff summoned me, complaining that he was not listening to them when they asked him not to drink directly from the mouth of the container.

I approached him with some trepidation, as he was tall, muscular and clearly already annoyed. I know even a small incident can set off a large conflict in the day shelter where I work. Orange juice is a rarity for us and no doubt many of the others were hoping for some too. There were angry rumblings from the crowd. I had to set a limit but felt it wise to use diplomacy. I asked Ryan to speak to me outside. Nothing can push someone over the edge quicker than a crowd pressing in, yelling criticisms, jibes or threats.

As we stood outside, I told him that the orange juice was meant for everyone, not just for him and that the next time he came, I expected him to share. He stormed off without a word, jumping on his wildly-altered and welded bike, looking like a modern day Mad Max. As he swept by on his bike, someone pulled me aside, and said, "That's DefJam ... you know he is deaf, right?" putting a whole new perspective on what I thought was his glowering silence.

The next time he saw me, he apologized, and I heard the strained tones of a person who learned to speak again after he became deaf. I apologized to him too, as I knew that I had spoken with impatience. Over the months, I learned of his love of welding, and his hope to get a hearing aid so he could attend classes. There were also many times that he was drunk, and even some times when he was belligerent to those around him. He cut an imposing figure, with the painted black leather, extensive tattoos and dirty, matted brown hair and beard which caused most to immediately back off, something that frequently made him laugh.

"FEED went great today. We had about 75 people, and they all looked very happy. We ate, joked ... what a blessing to get to be part of their lives and share in their sorrows as well as their joys. To see them smile is more beautiful than the night time sky. Peace and be well."

Those are the words that Chris Mitchell, the founder of FEED, recently posted on Facebook. FEED stands for Friends Encouraging Eating Daily, an organization in Boulder, Colorado, that serves meals on the days that the more traditional non-profits and churches don't. FEED is three formerly homeless men who serve food in church parking lots, local parks and on the library's lawn. Jason Moore and "Rider" Conway round out the team. The men worked last winter for BOHO, Boulder Outreach for Homeless Overflow. BOHO, Boulder's non-profit emergency warming center, served up to 75 people on more than 60 wintry nights. Rider also works at Boulder's day shelter, where he greets each person with the single word "welcome."

Both organizations are labors of love, involving lots of hard work, little or no pay, and the vagaries of the weather. The emergency warming center operated on the principles of a Safe Haven, and allowed folks with any level of intoxication to enter, as long as their behavior was safe to others and respectful of the churches whose space they were borrowing. The men running the operation slept on the floor, worked 12+ hour shifts, and cleaned up urine and vomit as necessary. Chris, Jason and Rider are just some of the local people who inspire me by helping others even when they're struggling.

Halle Berry, Jim Carrey, Kelsey Grammer, Kurt Cobain, Drew Carey, Don Imus, Daniel Craig, Jewel, Lil' Kim, Dr. Phil, William Shatner, Martin Sheen, Hilary Swank, Jean Claude Van Damme, Shania Twain and more.

Surely there is someone for you to admire or appreciate in this list, no matter what your taste in popular culture. This disparate collection of folks have all experienced homelessness during their lifetimes. Although stardom is their defining characteristic, I like to imagine that those experiences have deepened their compassion and empathy, only heightening their artistic accomplishments.

However, I would like to introduce you to an individual who has used her experience of homelessness in a different way. Charniele Herring is a state delegate in Virginia. And although she is by no means a single issue politician, she discusses it openly and advocates for housing, education and employment assistance. Delegate Herring delivered a keynote speech at the National Alliance to End Homelessness conference this summer, and told her personal story.

Her story is like many others: it started with her parent's divorce, meandered through desperate attempts to keep their housing, and ended with her and her mother living at a family shelter. She vividly recounted her feelings of isolation and shame, and how she went without meals at school to avoid being stigmatized as a "free lunch" kid. She perceived that she was in physical danger from bullies if her homeless status was ever revealed. Her grades suffered due to her physical and emotional exhaustion. Her birthday present one year was a trip to a fast food restuarant and that meal was the only she ate that day.