Hey Homeless Services, First Do No Harm

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."

Traditional social service settings safety maximize routine and predictability — but don't allow for choice when maximizing choice might lessen trauma or de-escalate conflict. Having assigned staff based on availability is another traditional model, versus developing authentic interpersonal relationships, and honoring them. "Setting limits" is considered to be the most important basic skill a human services worker can have, and indeed relationships  that are exploitative are very dangerous to those with a history of profound betrayal. However, SAMHSA spells out in very clear steps how to speak to someone in a homeless service agency without engaging in the language of power and control, and in a way that preserves everyone's safety and yet respects the traumatized person.

Over-reliance on diagnosis is yet another pattern in traditional social service agencies. Diagnosis can be used as the only lens through which to see someone. It becomes a battle between describing a person in the light of symptoms and dysfunctional behavior versus allowing that person the dignity of self-definition. Instead of providing information proactively, settings that provide information only as an afterthought risk triggering trauma responses. Trauma responses are unpredictable and occasionally volatile,  and if at that time you automatically make the choice of threatening force in order to de-escalate the crisis, you risk truly damaging results.

SAMHSA has spelled out in concrete, easily understandable language how to work with people in a way that honors their strength and resilience, keeps shelter workers safer and does not wound people unnecessarily. There are many that dismiss this kind of approach as too soft. Yet any self-aware prison guard can tell you that management of groups of people is done with the tacit cooperation of that group. It only makes sense to practice in a way that honors a person's dignity. Inclusion creates a dialogue which humanizes everyone.

I am pretty sure that everyone (or almost everyone) who works in the human services sector began with the drive of service and compassion. These are the tools that we can give people to return to empathy without fear. Let's make sure we share these tools and speak to each other in a language of love.

Photo credit: oedipusphinx — — — — theJWDban