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Trauma-informed Care: Services That Heal

Spring 2012

Trauma-informed care is a promising service delivery approach for those working with homeless and low-income people. UNCENSORED asked three professionals working with people experiencing trauma to share what unites their work, and what trauma-informed care means in practice.


Susan Reider, clinical director of Compass Family Services, is a licensed therapist with over 25 years of experience in nonprofits serving children and families. She holds a master’s degree in infant and parent development from Bank Street College of Education and a master’s degree in psychology from the San Francisco School of Psychology. Prior to working at Compass Family Services, she spent 15 years at the San Francisco Child Abuse Prevention Center, initially as a volunteer on the center’s parental stress line, later as a graduate intern and program director, and for three years as executive director.


Lorraine McMullin is the director of the Mental Health Association in New York State’s Parents with Psychiatric Disabilities Initiative and co-director of Building Connections: The Sexual Assault and Mental Health Project. She conducted research and evaluations on family homelessness, co-occurring disorders, health care, and the justice system. McMullin serves on the New York State Parent Education Partnership Steering Committee and the New York Protection and Advocacy for Individuals with Mental Illness Advisory Council. She is a parent and has used mental health, trauma, and homeless services.


Chrys Ballerano co-directs Building Connections: The Sexual Assault and Mental Health Project and coordinates the New York State Coalition Against Sexual Assault library, previously working as community educator and victim service coordinator at the REACH Center in Catskill, N.Y. She provides technical assistance, resources, and training throughout New York state, and leads presentations on the importance of using trauma-informed approaches in all work with homeless and low-income people. Ballerano also leads therapeutic drumming circles for people of all ages.



UNCENSORED: Help demystify trauma-informed care for our readers, who are from varied backgrounds. What does it mean, in general, and what does it mean in terms of working with at-risk, homeless, or formerly homeless families?


Reider: Trauma-informed care starts with the premise that clients have had some form of trauma in their lives and that the trauma often impacts the way they access or respond to services. It impacts the way people make sense of their surroundings, and it influences how they form relationships. Trauma is self-perpetuating, often keeping families stuck in vicious cycles of poverty and homelessness. We see families who have been homeless, or marginally housed for generations, living in poverty and still suffering from early-childhood trauma such as abuse and neglect. Trauma-informed care provides services and sets up systems to help trauma survivors regain a sense of safety and stability in the world.

Ballerano: The vast majority of individuals who seek services for mental health, substance abuse, homelessness, and family support have experienced traumatic events at sometime in their lives with varying degrees of severity. Being trauma-informed, then, in simple terms means that this lens of seeing people as potential survivors is always used. It is better to assume someone has lived through trauma and use a strength-based approach in supporting his or her recovery than to assume otherwise. Systems themselves can be re-traumatizing by being overly controlling, rigid and racist, classist, or dehumanizing to people perceived as “other.”

UNCENSORED: What are some misconceptions about trauma and how to work with homeless or low-income people who have experienced trauma?

Reider: Trauma looks different for each individual; what is traumatizing for one person may not be so for someone else. So it is important to be fully educated about the nature of trauma, how it manifests itself, and what impact it has on human development. A child who has lived in a shelter environment most of his life and, as a consequence, moved frequently has probably been exposed to multiple traumatizing situations, which have impacted his overall development. Studies bear this out, continually pointing to poor school performance in children experiencing trauma. This cycle needs to be, and can be, broken by providing trauma-informed care.

McMullin: One misconception about trauma is only thinking about trauma as a specific incident as opposed to multiple and ongoing incidents over the lifespan. In working with both children and adults who have histories of trauma, it is important to realize that living in the turmoil of homelessness can trigger symptoms that can be misdiagnosed or blamed on “noncompliance.” An example of this is being too stressed to hear or remember what is said to you so that you are unable to remember appointments or resources that are explained to you during a shelter intake.

UNCENSORED: What do people experiencing trauma have in common? How do you use that knowledge to help them initially?

Reider: Most traumatized people will have basic difficulty trusting that they can be helped. By the time they get to our program, they may have attempted to get help for years from various other resources without success. And since trauma makes people “act from their gut” (the fight-or-flight response), their initial engagement with us often ends up replicating their past experiences. They don’t really believe that we will be different than their previous service providers. This is a really challenging dynamic to work with. I think being open and honest about what we can and can’t do, and how help will be provided, is greatly appreciated and often convinces someone to stick with us through the long haul.

Ballerano: By helping people distinguish between the patterns that helped them survive during the time of traumatic experience and the present, we can help them see their strengths and success in having survived. We can acknowledge their ability to survive painful, sometimes brutal experiences and honor them by thanking them for sharing their story, acknowledging the privilege of being trusted with their story, and helping them see their dignity in the present time. For some, this is a huge contradiction from anything they have ever been told or shown. Simply saying to the person, “I am sorry this happened to you. It was not your fault,” and thanking them for telling you about it can be incredibly healing for the survivor.

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