Creating trauma-informed Day Services

Homelessness and trauma are closely connected. The experience of becoming homeless is traumatic, and research has shown that people who have experienced homelessness exhibit the symptoms of Post-traumatic Stress Disorder (Goodman et al, 1991).

We also know that many people experiencing homelessness, and other forms of multiple disadvantage, have experienced trauma in their past (Oasis Community Housing, 2022; Lankelly Chase, 2015). In many cases this may be complex trauma from ongoing abuse or traumatic events during childhood (Herman, 1992).

The experiences that people have while homeless may also be traumatic. Research by Crisis showed high rates of abuse and criminal behaviour towards people experiencing rough sleeping (Crisis, 2016).

Whilst trauma impacts each person differently, it's important for Day Services to have a general awareness of how it may affect people who are attending.

Trauma can leave a lasting impact on the brain and body, particularly if it takes place during childhood when the brain is still developing. This can affect language, emotion, memory and the autonomic nervous system, making someone more likely to tip into “fight, flight or flop” mode with a heightened sense of danger. This is sometimes called toxic stress and can have a knock-on effect on a whole range of health outcomes.

Trauma also has significant psychological impact which can affect perceptions of relationships, damage self-esteem, make it difficult to build trust and change how people view authority. This can lead to challenges engaging with services and systems, as well as different coping mechanisms such as unhealthy relationships or dependence on substances.

It’s possible for people to experience re-traumatisation when they’re in situations or locations that mimic the experience of their previous trauma. Homelessness services need to have an awareness of this as a key risk factor. Whilst each persons’ experiences and triggers may be different, there are common themes around noise, safety perception and also authority and institutional settings that can be particularly re-triggering for people.

Some examples of things that may be traumatising in a Day Service setting include:

• Being asked personal questions by a stranger – can you take time to make someone feel comfortable and relaxed first?
• Having to repeat information about traumatic events
• Trying to follow rules, attend appointments, achieve specific actions while struggling to cope
• Being in a building that feels institutional, among strangers, CCTV, unfamiliar noise and smells

Experience of trauma can make people feel physically and emotionally unsafe, and it's crucial that Day Services consider how the atmosphere within the service could trigger a trauma-response.

Day Services need to provide psychological safety, and staff and volunteers are often in a good position to create a friendly and welcoming atmosphere and build trusting, trauma-informed relationships with people accessing the service. A key example of this in action is giving new attendees time to settle in, to avoid them feeling overwhelmed.

Relationships should be authentic, respectful, have clear boundaries, be in and be built on an awareness of different experiences and needs. Consistency is key, for example, not changing workers frequently. Being transparent about your limitations as a worker means an individual knows what to expect and isn't given false hope, which could reduce trust and feelings of safety. As workers, being reliable and doing what you say you'll do will help avoid re-traumatisation.

Trauma-informed design requires a recognition of the fact that the physical environment has an impact on wellbeing and plays a significant role in people moving beyond crisis. It recognises the importance of designing spaces that intentionally aim to foster empowerment and positivity (Forbes, 2022).

A number of factors have been found to have an impact on how people engage with a service. These include :

• Noise levels and acoustics
• Light and colours which can affect mood
• Arts and aesthetics
• Connection to nature

You can read more in the guide Psychologically-Informed services for Homeless People.

Ensuring a space is physically safe for everyone is a key part of being a trauma-informed service. This can include reviewing the layout to understand entry and exit points as well as any hidden areas where people may feel unsafe. Understanding who is present and how people are admitted may be useful, as well as auditing any incidents to better understand areas for improving safety.

Being trauma-informed involves (re)building control through empowerment and collaboration. Re-gaining a sense of control and empowerment is vital within recovery, and helping people to identify and build their strengths reinforces a sense of competence. Strengths-based approaches and working in a collaborative way are key to helping people to rebuild control.

Strengths-based approaches

Strengths-based approaches focus on the person’s strengths (what they're good at, their positive social networks and what they want to achieve), rather than their deficits (such as their ‘problems’ and what is ‘wrong’ in their lives). They also encourage people to make decisions for themselves and develop their capabilities, so they can build confidence, control and move to lives beyond homelessness.

The broader activities that are offered by many Day Services provide opportunities for people to explore their strengths and interests. Learning new skills, art, music and sport can all help people to build confidence, self-esteem, and develop aspects of their life beyond homelessness.

Collaboration and Co-production

Collaboration and peer support are also key to taking a trauma-informed approach. For organisations to be trauma-informed, people accessing services need to play an active role in shaping the services and the support they receive. This might be through consultations, feedback groups and involving peer support in some way. This ensures that people feel heard and valued as well as giving opportunities to build self-esteem.

Co-production means designing and delivering services in a partnership between people accessing services, people with past experience of using services and staff or volunteers. Services work better when they are co-produced because they are more closely matched to what people actually want. Involving people also helps to build self-confidence and can help people to step forwards with their lives.