How Trauma-Informed Care Can Transform Homeless Services

On a cold Ottawa morning, a peer support worker named Jen sits across from a man at a drop-in center. He’s wary—one eye on the door, one hand on his coffee. She doesn’t start with a checklist or clipboard. She starts with a question: “How are you sleeping?”

It’s not small talk. It’s a lifeline.

For people who’ve lived through homelessness, trauma isn’t an abstract word—it’s an everyday reality. Behind the numbers are lives marked by loss, instability, and violence. Yet what this new study from BMC Health Services Research shows is that healing doesn’t start with medication or mandates—it starts with trust.

The Hidden Trauma of Homelessness

People who experience homelessness are far more likely to have survived multiple forms of trauma. Nearly 90% report at least one adverse childhood experience, and half report four or more—rates nearly ten times higher than the general population.

Homelessness itself compounds that pain: daily uncertainty, violence, discrimination, and constant loss of safety. Over time, that burden translates into high rates of post-traumatic stress disorder (PTSD) and complex PTSD—sometimes exceeding 60%.

Yet despite this, traditional health and mental health systems often miss the mark. Strict appointment schedules, sterile offices, and one-size-fits-all therapy models can feel like an extension of the very systems that caused harm in the first place.

That’s why researchers led by Dr. Simon Hatcher and Nicole Edgar set out to answer a simple but profound question:

What would a truly trauma-informed therapy look like for people experiencing homelessness?

Listening to the Experts: People With Lived Experience

The study team conducted 12 in-depth interviews with peer support workers—individuals who had experienced both trauma and homelessness and now work within service organizations. These peers bridge two worlds: they know what it means to sleep in a shelter, and they know what the health system looks like from the inside.

Their insights paint a vivid picture of how trauma-informed care can—and must—look different for this population.

Key Findings: Designing Care That Heals, Not Hurts

1. Lower the Barriers, Not the Standards

Rigid rules and appointment systems keep people out. Peers recommended “therapy tasters” or informal drop-in days that let people meet providers without pressure. Engagement often begins not in a therapy room, but in shared, ordinary spaces—over coffee, food, or art.

2. Communication That Builds Trust

Accessible, honest communication was central. Many participants described traditional service language as “a barrier.” Using plain, transparent language—and having trusted community partners explain what therapy entails—made the difference between withdrawal and willingness.

“You gotta be really honest about what the service is… exactly what’s going to go on,” one participant said. “That’s how you build trust.”

3. Safety Starts With the Space

Safety meant far more than locks and lighting. Emotional safety—feeling respected, seen, and unjudged—was the foundation for engagement. “Come as you are” spaces, where clients can sit quietly, eat, or just be, mattered more than polished procedures.

One participant explained:

“Consistency is the biggest key because things in their life—the only thing consistent is the drugs.”

4. The Power of Peer Support

Having a counselor or staff member who shares lived experience builds immediate credibility. Clients are more willing to open up when they know their provider understands life on the street.

“If I know somebody’s experienced something similar,” one peer said, “I feel less judged.”

5. Culture, Food, and Community as Therapy

Trauma isn’t just individual—it’s structural and cultural. Participants described how “country food days” and culturally grounded activities helped restore belonging. Healing, they said, can happen over a shared meal as much as in a therapy session.

6. Choice, Control, and the Freedom Not to Engage

For people whose autonomy has been repeatedly stripped away, choice is healing in itself. That means giving clients real agency—even the right to say “not today.” As one peer put it, “It’s not about forcing someone to go—it’s about offering an on-ramp.”

7. Language That Doesn’t Wound

Participants were clear: calling people “survivors” or “resilient” can sometimes sting. Those words, while meant to empower, can feel dismissive—like the pain was worth it. “Sometimes survival is actually awful,” one said. “I’m tired of being resilient. I just don’t want to go through this anymore.”

The Systemic Barriers: When Compassion Meets Constraint

Participants also named the real-world challenges that block trauma-informed practice:

• Overburdened staff who lack time to listen deeply.
• Rigid institutional rules that feel more like control than care.
• Lack of leadership buy-in to make trauma-informed care more than a buzzword.

As one peer put it bluntly:

“Working in a building where we have no say in the rules makes it hard to create a trauma-informed space. We end up creating a jail on the outside.”

The study’s authors note that organizational leadership and funding are critical to sustain trauma-informed approaches—especially in resource-strapped systems.

What This Means in Practice

For local health departments, shelters, and community-based organizations, the study offers clear, actionable guidance:

✅ Start with peer leadership. Hire and empower people with lived experience to co-design and deliver services.
✅ Design for flexibility. Offer drop-ins, walk-ins, and “no wrong door” access.
✅ Make spaces feel human. Replace fluorescent lighting and sterile walls with warmth, art, and comfort.
✅ Be transparent. Use plain language and consistent follow-up.
✅ Address cultural and structural trauma. Include Indigenous healing practices, racial equity training, and culturally meaningful food or rituals.
✅ Rethink language. Move beyond “resilience” talk—focus on validation and shared humanity.

Why It Matters

This isn’t just a call for better therapy—it’s a call for a different kind of system. A system that acknowledges trauma not as a personal flaw, but as a public health consequence of inequality.

When care feels safe, accessible, and affirming, people are far more likely to show up, stay engaged, and heal. That’s not just good practice—it’s good public health.

What’s Next

This study is part of a broader research effort to co-design and test a trauma-informed PTSD therapy specifically for people experiencing homelessness. Future phases will integrate these findings into real-world interventions, building a model that could be replicated in shelters and community programs across Canada—and beyond.

Questions for the Field

• How might your agency redesign services to feel less institutional and more human?
• What rules or expectations might inadvertently re-traumatize clients?
• Could peer support be the bridge between outreach and recovery?