Adhering to a Trauma-Informed Design and Care Approach Should be Included in California Legislation Concerning Homelessness

Requiring a Trauma-Informed Design and Care Approach
Should be a Condition to Receiving Homelessness Funding

Adhering to a Trauma-Informed Design and Care approach should be a legislative requirement for receiving State of California funding to implement solutions to prevent and end homelessness just like a Housing First approach is required.

Housing First Approach is Required

Adherence to a Housing First approach is included in state legislation as a condition to receiving funding to solve homelessness. Core components of Housing First are detailed in length in Welfare and Institutions Code Section 8255: CHAPTER 6.5. Housing First and Coordinating Council 8255. Legislation states thatany programs a California state agency or department funds (must) revise or adopt guidelines and regulations that incorporate the core components of Housing First, if the existing guidelines and regulations do not already incorporate the core components of Housing First.”

The lengthy descriptive list of core components of Housing First in the Code incorporate the core components of Housing First described in reports by federal agencies, which include a report by the U.S. Department of Housing and Urban Development entitled Housing First in Permanent Supportive Housing Brief; a report by the U.S. Interagency Council on Homelessness entitled Housing First Checklist: Assessing Projects and Systems for a Housing First Orientation; and a report from the National Alliance to End Homelessness entitled Fact Sheet: Housing First.

Trauma-Informed Design and Care Approach Should be Required

Adherence to a Trauma-Informed Design and Care approach should be a legislative requirement for receiving State funding to solve homelessness. A list of core components should be listed in State legislation based on the U.S. Department of Health and Human Services Substance Abuse and Mental Health Services Administration (SAMHSA) model that stems from SAMSHA’s definition of trauma.

Definition of Trauma

SAMHSA developed a framework for trauma and a trauma-informed approach and noted that

Decades of work in the field of trauma have generated multiple definitions of trauma. Combing through this work, SAMHSA developed an inventory of trauma definitions and recognized that there were subtle nuances and differences in these definitions.

SAMHSA turned to a panel of experts to review the existing definitions to craft a concept of trauma to provide guidelines for a model of trauma-informed design and care. The crafted concept is as follows:

Individual trauma results from an event, series of events, or set of circumstances that is experienced by an individual as physically or emotionally harmful or life threatening and that has lasting adverse effects on the individual’s functioning and mental, physical, social, emotional, or spiritual well-being.

Guidelines for Trauma-informed Design

SAMSHA’s model provides the following three principles that serve as guidelines for trauma-informed design 

  • Realizing how the physical environment effects [sic] an individual’s sense of identity, worth, dignity, and empowerment
  • Recognizing that the physical environment has an impact on attitude, mood, and behavior, and that there is a strong link between our physiological state, our emotional state, and the physical environment.
  • Responding by designing and maintaining supportive and healing environments for trauma-experienced residents or clients to resist re-traumatization.

Guidelines for Trauma-informed Care

SAMSHA’s guidelines for trauma-informed care includes six key principles fundamental to a trauma-informed care approach, which include

Safety: Throughout the organization, staff and the people they serve, whether children or adults, feel physically and psychologically safe; the physical setting is safe and interpersonal interactions promote a sense of safety. Understanding safety as defined by those served is a high priority. 

Trustworthiness and Transparency: Organizational operations and decisions are conducted with transparency with the goal of building and maintaining trust with clients and family members, among staff, and others involved in the organization. 

Peer Support: Peer support and mutual self-help are key vehicles for establishing safety and hope, building trust, enhancing collaboration, and utilizing their stories and lived experience to promote recovery and healing. The term “Peers” refers to individuals with lived experiences of trauma, or in the case of children this may be family members of children who have experienced traumatic events and are key caregivers in their recovery. Peers have also been referred to as “trauma survivors.” 

Collaboration and Mutuality: Importance is placed on partnering and the leveling of power differences between staff and clients and among organizational staff from clerical and housekeeping personnel, to professional staff to administrators, demonstrating that healing happens in relationships and in the meaningful sharing of power and decision-making. The organization recognizes that everyone has a role to play in a trauma-informed approach. As one expert stated: “one does not have to be a therapist to be therapeutic. 

Empowerment, Voice and Choice: Organizations understand the importance of power differentials and ways in which clients, historically, have been diminished in voice and choice and are often recipients of coercive treatment. Clients are supported in shared decision-making, choice, and goal setting to determine the plan of action they need to heal and move forward. They are supported in cultivating self-advocacy skills. Staff are facilitators of recovery rather than controllers of recovery. 

Cultural, Historical, and Gender Issues: The organization actively moves past cultural stereotypes and biases (e.g. based on race, ethnicity, sexual orientation, age, religion, gender-identity, geography, etc.); offers, access to gender responsive services; leverages the healing value of traditional cultural connections; incorporates policies, protocols, and processes that are responsive to the racial, ethnic and cultural needs of individuals served; and recognizes and addresses historical trauma.

SAMSHA’s guidelines for trauma-informed care also include the four “Rs” noted below as key assumptions to further our understanding of a trauma-informed care approach

  • Realizes the widespread impact of trauma and understands potential paths for recovery;
  • Recognizes the signs and symptoms of trauma in clients, families, staff, and others involved with the system;
  • Responds by fully integrating knowledge about trauma into policies, procedures, and practices; and
  • Seeks to actively resist re-traumatization. 

Next Steps

  1. Existing law should require agencies and departments administering state programs to collaborate with the Homeless Coordinating and Financing Council to adopt guidelines to revise or adopt guidelines and regulations to incorporate core components of trauma-informed design and care, which is similarly stated in AB 71 regarding Housing First.
  1. The Homeless Coordinating and Financing Council should oversee the implementation of trauma-informed design and care policies, guidelines, and regulations just as the Council oversees the implementation of Housing First policies, guidelines, and regulations to reduce the prevalence and duration of homelessness in California as noted on its web page.
  1. A definition of trauma should be included in appropriate legislation based on SAMSHA’s concept of trauma, which is

Individual trauma results from an event, series of events, or set of circumstances that is experienced by an individual as physically or emotionally harmful or life threatening and that has lasting adverse effects on the individual’s functioning and mental, physical, social, emotional, or spiritual well-being.

  1. The following core components of Trauma-informed care should also be included:
  • Understand that trauma begins with an event or experience that overcomes normal coping mechanisms;
  • Recognize that trauma is both the event or experience and the particular response to the event or experience;
  • Aware that re-traumatization can occur when someone is exposed to a person, place, event, situation, or environment that can cause the person to re-experience past trauma anew by replicating elements of the original trauma such as loss of power, control, or personal safety without replicating the actual event;
  • Understand the impact of power differentials and ways that someone can e diminished in vice and choice (e.g., coercive treatment);
  • Share decision-making, choice, and goal setting to determine the plan of action someone needs to heal and move forward;
  • Incorporate policies, protocols, and processes that are responsive to the racial, ethnic, gender, and cultural needs of individuals served including historical trauma.
  1. The following core components of trauma-informed design should also be included to help integrate the core components of trauma-informed care:
  • Realizing how a physical environment affects identity, worth, and dignity, and how it can promote empowerment;
  • Recognizing that a physical environment has an impact on attitude, mood and behavior because there is a strong link between one’s physiological state, emotional state and the physical environment;
  • Responding by intentionally designing and maintaining healing environments that reduce and remove known adverse stimuli and environmental stressors to resist re-traumatization.

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