Use of Trauma-Informed Care in Homeless Programs for Families

Background/ Purpose:  Families who have experienced high levels of trauma comprise 50% of the sheltered homeless population. Traumatic stress can produce serious changes in physiological arousal, emotion, cognition, character, and memory and have a debilitating effect on mothers’ ability to form safe relationships, work consistently, parent effectively and sustain stable housing. Trauma-informed care (TIC) is a whole systems approach to care that understands the widespread impact of trauma, recognizes signs and symptoms of trauma, and integrates this knowledge into policies and procedures while resisting re-traumatization.  Despite that TIC is increasingly promoted, there is little agreement about what this looks like in residential programs for families experiencing homelessness. The purpose of this research was to explore practitioners understanding and utilization of trauma-informed care (TIC) and the factors that facilitate or deter its’ implementation within transitional housing programs for families experiencing homelessness. 

 Methods:  Transitional housing (TH) programs for families experiencing homelessness in eight counties of Pennsylvania (PA) were included in the sampling frame.  Using a qualitative research design, data was gathered via semi-structured telephone interviews.  Qualitative directed content analysis was used to analyze the data with a multi-pronged theoretical framework including trauma theory, the Consolidated Framework for Implementation Research (CFIR) and Bronfenbrenner’s Bioecological Systems Theory (BST). 

Findings:35 staff from 23 programs participated. Participants had an acute awareness of the client’s experience of trauma and the importance of addressing vicarious trauma in staff. The most frequently used TIC practices were related to 1) safety and 2) empowerment, voice and choice while the least used were related to 1) peer support and 2) cultural, historical and gender inclusivity. Barriers to cultural inclusivity included client exposure to micro-aggressions, lack of diverse staff, and U.S. structures that are traumatizing such as racism and capitalism.

 Conclusion and Implications: Participants understood TIC as a broad philosophical framework, overlapping with social work practice, that shifts the emphasis from rigid to flexible programs.  Practices used to enact TIC were varied and defied a rigid set of proscriptions.Flexibility,a person-centered approach to care, and the importance of a trustworthy helping relationship werecommon threads in the participants’ description of TIC practices. Various non-TIC specific practices were identified as related to TIC such as mindfulness and motivational interviewing, which serve as additional tools to support TIC practice. BST was used to expand the CFIR, accentuating the ways that external factors impact TIC implementation. Various barriers to TIC were identified including external social systems and policies that re-traumatize clients, the loss of government funding for transitional housing, partnering to provide the property management function of TH, and deficiencies in and inaccessibility of TIC models. There is a philosophical mismatch between government funding regulations as part of a market driven system and TIC, a human system of care.Factors that helped facilitate TIC included top leadership support, social work education, and reinforcing activities. This is one of the few studies that looks at service provider perspectives on TIC, apart from the echo chamber around it that is repeated with little practical reflection.