Trauma-Informed Care

The idea of a psychologically informed environment, a PIE, first appeared in the context of the UK, as part of an overview of creative and constructive practice as found in homelessness resettlement work there. This approach however was contemporary with, and has many points in common, with new approaches developed in the US and Canada, such as Trauma Informed Care - or "TIC";  and also with "Pre-treatment", for which, see the pages on this site (HERE).

For the moment, to sum up briefly: where the PIEs approach talks of developing reflective practice, adopting a psychological approach, staff training and support etc, Trauma Informed Care stresses (see: Hopper et al) the need to promote, in services:

  • a safe and predictable environment
  • support personalised to the individual
  • a focus on strengths
  • gaining a sense of safety and control

In a slightly different - but clearly compatible - formulation, the Creating Cultures of Trauma-Informed Care (CCTIC) approach to organisational change is built on five core values of safety, trustworthiness, choice, collaboration, and empowerment (See column right, by Fallot & Harris). As they say:

"If a program can say that its culture reflects each of these values in each contact, physical setting, relationship, and activity and that this culture is evident in the experiences of staff as well as consumers, then the program’s culture is trauma-informed."

In this formulation, then, looking at the organisational culture as a whole, the parallel with the PIE concept is clearly very close.

The Transatlantic Exchange programme between the US and the UK is creating many useful opportunities to compare understanding and practice.  Jo Prestidge's paper and video describe her experience; and a webinar discussion with her and Claire Ritchie explores, with questions from the audience, the similarities and possible differences. These discussions culminated in a useful and concise policy briefing from Homeless Link, and a more in-depth article by Robin Johnson, exclusively for PIElink members. Over the coming months, we will continue exploring these parallel approaches, and the discussion will doubtless evolve.  Several workers from the US side of this exchange have come to see services in the UK, and two colleagues, Susan Hess and Elizabeth Eastlund  have recently launched their own training and consultancy services, to extend an understanding of what these approaches have to offer.   (You will find more on these initiatives, as applied in the context of "domestic"/"intimate partner" violence, in 'Further reading')

Further reading

We begin with two key papers, outlining the connections between psychologically informed environments and trauma informed care.

  • An introduction to Psychologically Informed Environments and Trauma Informed Care: a briefing for homelessness services from HomelessLink HERE
  • Core skills of engagement - pre-treatment, trauma-informed care and psychologically informed environments:   HERE

Then two examples of services – one in the UK, and one in the US - that are using both; in this case, in the context of domestic violence.

  • Rainbow services: Trauma Informed Care and Psychologically Informed Environments with Intimate Partner Violence services in Los Angeles: HERE
  • Person-centred, holistic, psychologically informed : the Young Women’s Housing Project approachHERE

Further background on TIC

'Creating Cultures of Trauma-Informed Care (CCTIC): A Self-Assessment and Planning Protocol'   by Roger Fallot & Maxine Harris

Shelter from the Storm:   Trauma-Informed Care in Homelessness Services Settings  by Elizabeth Hopper, Ellen Bassuk & Jeffrey Olivet

(See in particular the excerpt: 'How Common Trauma Reactions May Explain Some “Difficult” Behaviors or Reactions Within Homeless Service  Settings' [Table 3] - a useful tool. )


Principles and practice in psychology and homelessness: Part One, Johnson (2016)  for an overview

Jo Prestidge's account of an exchange visit to New York is based on a weblog from the Transatlantic Exchange programme, by Jo, now at HomelessLink, but then a worker from an outreach service in London. She describes in some vivid detail her impressions of TIC, and what might be learned from this approach, in her own work.  (There is also a short video interview with Jo now in the Voices collection in the Library.


Viewing and listening


Matt Bennett: Connecting paradigms: Talking trauma across the Atlantic with Jay Levy and Robin Johnson  (Episode 55) HERE

"Psychologically Informed Environments and Trauma Informed Care" - webinar records an on-line discussion, with questions from the online listeners, with Jo Prestidge and Claire Ritchie of No One Left Out Solutions.

For more on Trauma Informed Care and intimate partner violence, see the website of Susan Hess, another on the Transatlantic exchange programme.

Also more from Elizabeth Eastlund - Director of Programmes, Rainbow Services (website) - on the tensions between domestic violence programs and the current application of Housing First in the US context. Intersections between the Domestic Violence and Homelessness Programs

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