Trauma informed care and a psychologically informed environment can support young people at risk of homelessness on their journey towards independence, writes Spiros Georgiou, Supported Housing Operations Manager at Homes for Cathy member Hightown Housing Association.

During the past year the homelessness crisis has seen new challenges. Covid-19 has exacerbated some of the disadvantages faced by people, with family tensions, loss of jobs and income and mental ill health being key drivers for homelessness.  Evidence shows that experience of trauma can lead to homelessness and losing your home and becoming homeless can be very traumatic. 

There is also evidence of the strong link between homelessness and adverse childhood experiences, such as abuse, neglect and domestic violence.  People who have experienced trauma can be left feeling helpless and terrified.  They often feel a lack of control and a sense of unpredictability, a loss of safety and, in the worst case scenarios, a fear of serious harm or death.  Trauma is defined by the experience of the individual and not the event, so not everyone who experiences trauma will develop chronic symptoms – it depends on their resilience.  What we do know is that early childhood has more of an effect than experiencing trauma as an adult.

Preparing young people for an independent, self-sufficient life

At Hightown, we identified the need for us to take a more trauma informed approach in our young people’s care and supported housing service. The service provides semi-independent living for young people aged 16-24 who may have left care or become estranged from family and are at a high risk of homelessness.  Our goal with the service is to prepare our young people for an independent, self-sufficient life.  We believed that by implementing a psychologically informed environment (PIE) – that was sensitive to their emotional needs – we could overcome some of the barriers that were impeding their journey to independence. 

It was the start of a significant learning curve for the team, requiring us to consider the thinking, emotions, personalities and past experiences of service users and adapt the design and delivery of the service to meet their needs.  Importantly, it also helped us gain a deeper insight into our own personal attitudes and beliefs and reaffirmed our faith in our service users’ ability to change.

In practice, adopting a PIE approach meant support workers building a therapeutic relationship with service users, which involved being non-judgmental, validating individuals’ emotions and feelings and helping them create a safe environment.  It also meant taking the time to understand the past traumas our service users may have experienced and understanding how this may affect their boundaries, their relationships with others and their sense of safety.

Direct impact on evictions and abandonments

Being trauma informed has had a direct impact on the warnings we give out and ultimately on evictions and abandonments, as we are able to find alternative ways to promote a change in behaviour that might otherwise put a tenancy at risk.  In our young people’s housing, we meet weekly as a team to discuss creative and flexible ways to find what works for the individual when it comes to escalating needs and risks.  For example, when an incident occurs, staff deal with the immediate event, before allowing time for individuals to reflect on the incident and come up with personalised and co-produced response.  This may mean that instead of issuing a generic warning – which can be overused or even misused – we provide a support intervention to address the issues at play. 

Most recently, we had a service user who repeatedly refused us access to their property for maintenance works.  They would either become extremely distressed and angry when the staff visited or would prepare for the visit, then self-harm and refuse access.  Instead of issuing a warning, we worked with them as a team to understand and validate the way they were feeling, so that we could build trust and help them feel safe.  We began to look at why they had become homeless in the first place and learned that they had witnessed domestic violence in the home as a child, for which they had never received appropriate support.  We quickly understood that they were becoming overwhelmed with emotion and fear during each visit, triggering a fight or flight response, and their coping strategy was either to become angry or self-harm.  Instead of asserting our authority, we personalised our response, empowering them to access therapy and coaching for their anger, as well as facilitating regular visits from the community mental health team.  We also introduced them to one of our maintenance workers and supported them to build a trusting and professional relationship with that person, so the works could take place.

We have also recently launched a new way of dealing with substance misuse, in response to an ongoing issue around the use of cannabis amongst young people in the scheme.  In the past, this was dealt with by the traditional warnings system.  However, we found that the young people were soon exhausting the warning system and were therefore at risk of eviction and sometimes even evicted as a result, which is something we wanted to avoid.

Traffic light warnings for substance misuse

We know that using illegal substances can be a coping mechanism to deal with stress or emotionally distressing thoughts and/or childhood adversity and unresolved complex trauma. However, we also know that the use of illegal drugs in our services can be problematic, as we have a duty of care to all service users and staff.  Instead, we created a traffic light system for substance misuse, the idea being that before we issue a formal warning that indicates the tenancy is at risk (and could ultimately lead to an eviction), we put in place a tiered support intervention first.

The traffic light system has various support actions and interventions to explore at each stage, for example understanding the young person’s substance misuse habits and patterns through workbooks and surveys, organising support meetings with any professionals involved, referring the young person to drug and alcohol agencies in the community, engaging the young person in meaningful activity, goal setting and support to reach aspirations, facilitating contact with community mental health team, counselling and much more.  Since launching the traffic light system, we have only had one young person reach the amber card stage and no young people reach the red card stage, and there has been a dramatic decrease in substance misuse related incidents.  In addition to this, our young people have engaged really well with the support interventions and benefited from the change in approach.

A PIE approach is not only about being sensitive to the emotional needs of service users; working in homelessness services can sometimes result in staff experiencing secondary trauma, where they are themselves affected by what they see and hear from service users.  Ultimately this can lead to burnout and staff feeling hopeless, depressed, stressed, uncreative and frustrated in their roles.  We therefore actively invite staff members to ask for help if they need it and build in time to reflect as a team, as well as encouraging everyone to do things they enjoy, so that their own basic needs are met too.

Implementing a trauma informed approach and a psychologically informed environment takes time – it’s not something that can be introduced overnight.  However, it’s only a framework – there are no policies or prescriptive set of rules to adhere to.  Essentially, it’s about being person-centred.  At Hightown, we have found that improving our own reflection as a staff team and building our relationship with service users have been positive steps in the right direction.

Spiros Georgiou, Supported Housing Operations Manager, Hightown Housing Association

Interested in finding out how other Homes for Cathy members are implementing a psychologically informed approach in homelessness services and housing? Register for our free online workshop on 26 May.