The document discusses trauma-informed care and practice for those experiencing homelessness. It finds that homelessness populations experience trauma at much higher rates than the general population. For example, 100% of women who were homeless experienced at least one major traumatic event. It advocates adopting a trauma-informed approach that recognizes how trauma impacts all aspects of clients' lives rather than seeing problems as separate issues. This includes using compassionate engagement through active listening, developing trust-based relationships, prioritizing safety, choice and empowerment, and viewing clients as experts rather than passive recipients of care. Common themes of trauma-informed care are trauma awareness, emphasis on safety, opportunities to rebuild control, and using a strengths-based approach.

1. Trauma-Informed Care
and Practice
Meeting the Challenge
Specialist Homelessness Services

2. Trauma-Informed Care
and Practice
Meeting the Challenge
Specialist Homelessness Services

3. Project Origins
I thought I was doing the right thing…

4. Exposure to Trauma
Once in a lifetime?
100% 93%
Note: 90%
General Population 80%
At least 1 event 70%
57%
Homeless Population 60%
At least 2 events, but 6 50%
on average. 40%
100% of women who 30%
were homeless 20%
experienced at least one 10%
major traumatic event in 0%
their lives.
Traumatic Events
General Population People who are homeless
Hodder, Teesson & Buhrich (1998), Down and Out in Sydney:
Prevalence of Mental Disorders, Disability and Health Service Use among
Homeless People in Inner Sydney
Taylor (2006), PTSD Among Homeless Adults in Sydney

5. Home
75% of homeless people struggle to define ‘home’.
People who are housed:
House = just a house – four walls and a roof.
Home = a place of warmth and belonging among friends and family.
People who are homeless:
House = a shared dwelling that isn’t yours.
Home = a solitary living environment.
Homeless = escaping home.
Tomas and Dittmar (1995), The experience of homeless women: An
exploration of housing histories and the meaning of home

6. Compassionate Engagement
Listening
A key starting point to developing long-term solutions to iterative
homelessness by more effectively working to identify underlying rather
than presenting issues.
Core observation: those surviving both homelessness and violent
victimisation do not understand themselves as precious and worthy of
assistance.
For whom and how many will compassionate engagement, will
listening, come too late?
Robinson (2010), Rough living: surviving violence and homelessness

7. Compassionate Engagement
A persistent, reliable, intimate and respectful relationship
“the particular qualities which facilitate the development of an effective
working relationship in the context of case management. The quality of
intimacy is a consequence of the genuine emotional dimension and the
everyday nature of the case management activities”
Gronda (2009), What makes case management work for people experiencing homelessness?
Rapport PLUS
Rapport building that goes beyond, perhaps, our traditional or
professional understanding. It demands that we keep less of an arms-
length. It insists that some attachment is necessary and healthy.
Attachment ≠ Dependence
Serving ≠ Enabling

8. Trauma-Informed Care in SHS
Traditional Response Trauma-Informed Response
Impact of Not a primary defining event in Central, primary events impacting
Trauma people’s lives. everything else – all-encompassing.
Style of Proactive – services and systems
Reactive – services and systems
Service / focus on preventing further crisis
are crisis-driven.
Atmosphere and re-traumatisation.
Symptoms Discrete and separate. Inter-related and coping methods.
Shared power – everyone trained to
‘Objective’ and ‘distant’. respond to someone in distress and
Worker / about trauma’s impact on individuals
Client People who are homeless are active
Relationship Service-providers are the experts.
experts and partners in services –
Homeless clients are passive
they’re viewed as experts in knowing
recipients of services.
what is best for them.

9. Trauma-Informed Care in SHS
Traditional Response Trauma-Informed Response
Support Defined by service providers and Defined by the person and focus on
Goals focus on symptom reduction. recovering and healing.
Clients are broken, vulnerable, Recovery is possible. Maximising
Road to damaged and needing protection choice, autonomy, self-
recovery from themselves. Agencies are determination, dignity and respect is
responsible for ‘fixing’ the ‘problem’. central to healing.
Challenging behaviours are the
Difficult clients such as those with ordinary responses to trauma.
Challenging
behavioral problems and substance They’re opportunities to help people
behaviours
abuse issues are excluded. address the impact of their
behaviours in their own lives.
A Long Journey Home, National Centre on Family Homelessness, USA

10. Trauma-Informed Care in SHS
Common Themes
Trauma awareness
Emphasis on safety
Opportunities to rebuild control
Strengths-based approach
Hopper, Bassuk and Olivet (2010), Shelter from the Storm: Trauma-
Informed Care in Homelessness Services Settings

11. Reflections
Am I still not doing the right thing…?