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Substance Abuse and Mental Health Services Administration
“This Was the First Time I Felt Safe”: SAMHSA Grantee Reduces PTSD Through Trauma-Informed Care
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Youth on Fire, a drop-In center for youth, has helped reduce prost-traumatic stress disorder among youth members. Program staff share how they worked to create a trauma-informed space and focused on fostering attachment and self-efficacy for the youth and understanding the sources of triggers and reactions to help promote healing.

A young man stores his belongings at a drop-in shelter for young people. Without recognizing the possible impact of their actions, staff members move the items from where they are stored. His emotional response appears to be out of proportion to the situation. However, the young man has experienced situations in which his life felt out of control as a result of complex trauma and living on the streets. Understood through a trauma lens, his behavior is congruent with the responses of many trauma survivors.

Disproportionate responses are not uncommon for people, including youth, experiencing homelessness. Traumatic experiences often contribute to homelessness, and the experience of living without a home is traumatic in itself. Youth on Fire, a youth drop-in center in Cambridge, MA and a program of The AIDS Action Committee of Massachusetts, see these trauma responses every day.

Five years ago, Youth on Fire received a SAHMSA grant through the Minority AIDS Bureau of the Center for Substance Abuse Prevention to fund a program called “Phoenix Rising: Reducing the Progression of Substance Use Among Homeless Youth.” When they evaluated the program, they discovered something unexpected – substance use had not declined, but youth participants showed reduced symptoms of posttraumatic stress disorder.

Phoenix Rising is a trauma-informed intervention based on an understanding of the ARC framework. The ARC framework emphasizes the importance of attachment, emotion regulation, and confidence building. They developed a six session low-threshold educational intervention for program participants to build attachment, emotional regulation and self-efficacy. As part of the intervention, Youth on Fire implemented staff trainings on trauma-informed care for all staff. Additionally, a trauma-informed consultant from the National Child Traumatic Stress Network assessed the drop-in center’s physical space.

The educational intervention centers on trauma education, risk reduction, and HIV prevention, using Motivational Interviewing techniques. The six sessions establish the concepts of trauma and triggers, arousal and coping mechanisms, the stages of change, risk reduction, and confidence building.

When educating youth about trauma and triggers, it is critical not to expose too many details in the discussion. However, as non-clinical staff, this can be challenging. “We discuss trauma very generally as the bad things that happen to people, and the good things that don’t happen for people. This is a dance we walk very carefully as youth often want to talk very specifically about their trauma histories,” says Ayala Livny, Program Director. Staff acknowledges their need to talk about this and offer other opportunities to do so in a separate environment. “Many youth cannot tolerate talking about their trauma histories at all.”

The trauma-informed space assessment is designed to encourage safety, independence, and control. Recommendations included changing the placement of the television in the main drop-in space, reducing the number of participants who were exposed to television images without choice. Ayala also explained that they put locks on the shower doors. One member shared, “This was the first time I have felt safe taking a shower. I had no idea that I hadn’t felt safe before until I experienced the safety of a locked shower door.”

An additional recommendation was for Youth on Fire to screen members for criminal histories to reduce the perpetuation of further trauma. However, Youth on Fire decided that this was not realistic for their organization. Ayala explains, “Because we give trust and respect, we receive trust and respect within our space.”

As a result of trainings on trauma-informed care, both clinical and non-clinical staff understand that disproportionate emotional responses are often coping mechanisms that have kept these young people safe. “We don’t take these kinds of trauma responses personally. Nor do we judge behaviors that appear to be out of proportion,” says Ayala.

“If a youth experiences flashbacks from a previous traumatic experience, they may use substances as a quick method to make these responses go away,” explains Ayala. Youth on Fire tries to give them another perspective on trauma responses, by showing youth that their bodies have responded by protecting them. Ayala shares, “We try to show that what gets them through the short term may not get them through the long-term. We take the approach that their bodies and minds are brilliant, and they have survived so many things.”

For youth who have completed Phoenix Rising, Youth on Fire has used a SAMHSA-funded Government Performance and Results Act (GPRA) assessment tool. They have added scales for trauma skills, post-traumatic stress disorder (PTSD), and self-efficacy. As a result of the intervention, they are seeing a reduction of PTSD symptomatology . Youth on Fire hopes to collaborate with other youth organizations to develop a training manual based on what they have learned.

To learn more about trauma and trauma-informed care, visit HRC’s Homelessness and Traumatic Stress Training Package.

To learn more about trauma-informed care at Youth on Fire, listen to HRC’s archived webcast, Creating Trauma-Informed Programs: Youth Drop-In Centers and Beyond.

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