How can we incorporate Trauma Informed Care into service delivery?

Canadian Observatory on Homelessness
April 18, 2018

What is Trauma Informed Care? 

Trauma Informed Care (TIC) is an approach that embraces an understanding of trauma at every step of service delivery. This model requires a compassionate and understanding attitude, in order to address the intersecting effects that trauma can have on people’s lives. It seeks to create a culture of nonviolence, learning, and collaboration in all aspects of treatment, while also recognizing the physical, psychological and emotional importance of clients’ and providers’ safety.

Trauma Informed Care does not have to be directly focused on delivering trauma-related services or treatments. Rather, it is an approach that is incorporated into the structure of a variety of practices, including housing, primary care, mental health, and addictions services. The aim is to provide services in ways that are appropriate and welcoming for those who may have been affected by trauma.

While the effects of trauma frequently have an impact on services and organizations, trauma often goes undetected. Thus, interfering with their recovery and healing, individuals may be re-traumatized by the services and organizations that they interact with.

Many people experiencing homelessness have faced traumatic events, such as being exposed to violence, experiencing losses, and dealing with severed relationships. The experience of homelessness itself is traumatic, as it involves a lack of stability, a loss of safety and the disconnection from one’s community at large.

Research has found that a large proportion of mothers (79%) who accessed emergency shelters, transitional housing and permanent supportive housing programs, experienced traumatic events during their childhoods. Most commonly, mothers reported past experiences of interpersonal violence, physical assaults, and sexual abuse. Many also met the criteria for Post Traumatic Stress Disorder (PTSD). Furthermore, intergenerational trauma affects Indigenous communities, which have been gravely impacted by colonial practices, such as: the destruction of Indigenous institutions, disruption of traditions (including Indigenous systems of governance), linguicide, and the implementation of the reserve system, to name a few. Interwoven in many Indigenous experiences of homelessness are the impacts of individual and community traumas, often leading to high levels of mental, cognitive, behavioural, social and physical challenges.

Trauma, depression and substance abuse tend to occur simultaneously, and also have the potential to impact the ability of mothers to form healthy relationships, work consistently and parent effectively.

The effects of trauma have serious health outcomes for individuals, families and communities, and services must recognize the role they play in creating supportive and welcoming environments. As there are many different types of trauma affecting people of all ages, and across all socioeconomic backgrounds in society, a trauma informed care approach should be an essential component for all services and organizations.

Solutions

Traditionally, responses to homelessness in Canada have placed a great deal of emphasis on emergency services, such as shelters and temporary housing. However, since the challenges that many people experiencing homelessness face are complex, the necessity for different approaches to address their needs have become clear. One example of this includes the integration of trauma informed care (TIC) practices into service delivery and housing programs.

Adopting a TIC approach as a service provider, organization or system involves:

In addition to providing permanent supportive housing for trauma survivors, individuals with serious mental illnesses (SMI) need programs that directly address their mental health needs. One suggestion involves the developmental assessment of children, and mental health assessments for all members of families. Mental health services that address the needs of both mothers and their children are a recommendation for trauma informed care approaches. As research has indicated the experiences of trauma in early childhood are different from trauma experienced later on in life, trauma informed care takes into account age-appropriate service delivery. For mothers, these services may include dealing with major depression and Post-traumatic Stress Disorder (PTSD). For children, services should include therapy or supportive services to address their learning and emotional needs, a safe and supportive environment, and the presence of continuous and nurturing caregivers.

Furthermore, case management should address both individual, short-term needs along with the long-term needs of clients. Some examples of short term needs include: income, education, and employment, whereas long-term needs may involve addressing histories of trauma, health/ mental health, and emotional difficulties.

It has also been suggested that organizations make a number of changes to their overall service delivery structure, in order to incorporate a Trauma Informed Care approach. Organizations should include written statements and policy implementation that express their commitment to delivering Trauma Informed Care, such as:

Overall, housing that quickly stabilizes families while also ensuring that the individual needs of those accessing services have better outcomes for the long-term stability of families; that includes taking the affordability of the placement into consideration.

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The analysis and interpretations contained in the blog posts are those of the individual contributors and do not necessarily represent the views of the Canadian Observatory on Homelessness.