Trauma-informed training helps reach Ashland’s severe weather shelter clients

By Morgan Rothborne, Ashland.news 

Mackenna Park leaned forward on the stack of print outs and notes in her lap to ask the semi-rhetorical question: “What is trauma-informed care?”

In a circle of chairs at the Rogue Valley Metaphysical Library, volunteers for Ashland’s severe weather shelter were gathered for a training in how to offer this kind of care to shelter guests. Park is a nursing student and member of the street nurses team at Oregon Health & Sciences University, and was helping lead the training with her fellow student Jess Amieva and instructor Aina Hale.

“It’s an approach to helping others that recognizes the impact trauma has on people’s lives,” Park said. “We want our focus to be on listening, being nonjudgmental, giving people choices in their care. We just want to create a safe and supportive environment where people can feel understood and respected.”

The street nurses team has offered these trainings for Jackson County library staff; Opportunities for Housing, Resources & Assistance; La Clinica; and other organizations as part of its overall work, Hale said. The team which includes students, a family nurse practitioner and psychiatric nurse practitioner, primarily offers foot soaks, resources and clinical care to homeless people, Hale said. 

For everyone, trauma can be large or small — big “Ts” and little “ts,” Park said. Big T’s might include physical abuse, death of a loved one or a severe injury. Little t’s build momentum over time, such as bullying, isolation or repeated failure to meet basic needs such as warmth and food. Trauma can make people feel unsafe, not accepted, or lead to challenges in school, work and relationships. 

Avram Sacks, volunteer coordinator for the shelter, asked to discuss the little t’s further. Ruby Nichols identified herself as living in a vehicle and serving as a volunteer for the shelter. As the mother of a trans child, she sees children rejected by the groups that would have otherwise supported them, such as church or family. 

Eric Janoski, a coordinator for the family self-sufficiency program at the Jackson County Housing Authority, said little t’s can be very little. Some of his clients lose their homes, stabilize and find an overdraft notice from the bank overwhelming. 

“It can be these sustained, quiet ways that we all suffer,” he said. 

People don’t react to trauma in the same way. Some people become hyper-aroused — agitated, angry and otherwise highly visible emotions. Some people become hypo-aroused — withdrawn, resisting expression and potentially emotionally numb or shut down, Hale said. 

“We see this a lot in our unhoused community. It’s a constant shut down, disconnected, not wanting to look at us, you know?” Amieva said. 

A graphic on one of the print outs shared with the group, showed an open space for the window of tolerance between the hyper and hypo state. That window is the space where a person’s mind is open, decisions can be made and open conversation is possible, Hale said. 

“We’re all born with a window that’s maybe this big, but trauma can just continually beat that down and make it smaller. Whether a person is housed, unhoused, hungry, cold, all of us are vulnerable to being pushed outside that window,” Park said. 

The balance to be learned in offering trauma-informed care is how to spot when someone is outside that window and how to react. Hale said, for herself, hyper-arousal is a natural stress response while her husband becomes hypo. He has learned it does not work to tell her to calm down just as much as it is not effective for her to urge him to talk. 

She asked the group to consider a situation — a guest coming into the severe weather shelter and experiences something that pushes them outside their window. 

“Let’s say they become hyper-aroused, what happens now?” she said. 

Establishing relationships is critical. Whenever possible, the exchange of names or something in common can lay the foundation to more easily de-escalate in future, Park said. 

Street nursing is focused on offering “radical humility,” Hale said. 

“We’re showing up and just being of service, really, so approaching a situation like, ‘Help me to understand,’” she said. 

Nichols offered the perspective from the side of someone who “stands in those lines,” to access services such as the shelter. 

“It’s freezing out there. We don’t sleep real well. We’re just trying to find the basics. … Where’s our bathroom? We’re trying to get some fresh water, we’re trying to find a place to charge our phones, find some food, can you give me a cup of coffee please? Is there no sugar? ‘Oh my God, there’s my last straw,’” she said. 

“It’s like, how much can I take before I’m screaming at you, because you are the system. It’s not you personally, it’s just that you are the doorkeeper and all I need is to come in and use the bathroom and get warm. … We’re not swearing at you, we’re swearing at — we’re in this hole and we don’t know how to get out.”

Feeling that one’s basic needs are not met or can’t be met is often the simple source of someone escalating, Hale said. Sometimes offering food, water, a cup of tea, a phone charger or a quiet moment alone can be enough. 

Janoski said he has found, “there’s nothing as important as the ability to be truly present with another human being,” and simply “getting curious,” about what someone else needs while establishing relationships through clear, consistent communication can create trust and make it possible to reach and care for those who are traumatized and have become escalated. 

Hill-Wagner said she has found building that trust can be a matter of time and no small investment. Some people coming to the community meals with Uncle Food’s Diner take six months to a year to say hello to herself and other volunteers.

Simply to see someone can be “an incredibly beautiful, powerful tool,” Janoski said. 

“Not to underestimate just the power of being seen, and how hard it is to ask for help like for any of us. Added to all the other things that layer on top of that. The shame … you’re going to judge, there’s all these things that just continually layer on top of trauma,” he said. 

Sacks said in his experience working in the city’s shelter, sometimes separating individuals who may be triggering each other can be helpful. Vanessa Houk said in her varied volunteer experience, isolating the individual “so that there’s not an audience,” can create an opportunity to ask that question of “help me to understand,” in an effective way. 

Hale said the only way to heal trauma is connection, which people who are traumatized struggle to create and sustain. Struggling to meet basic needs as part of the reality of homelessness deepens the anti-social effect of trauma. But those who try to learn to meet people where they are and help them back into their window of tolerance can potentially heal that person, she said. 

Street nurses also use a few other tools to try to prevent those aroused states in the first place.  Park emphasized “person-first language,” such as “a person with substance-abuse disorder,” rather than “an addict.”

Body language is also important, Hale said: Make eye contact. Get on the same level, rather than standing over someone whenever possible. Keep one’s body language overall relaxed. 

Giving people choices can also be empowering, Park said. Homeless people in particular often are not free to choose where they may sleep or depend on accepting what they are given. In working with them, Park said she has found them excited even to choose which doughnut they want rather than being given something chosen for them. 

Hill-Wagner asked the street nurses for help reaching a gentleman who has been coming to the community meals but keeps to himself and avoids eye contact. He has a visibly obvious medical problem, but approaching him may offend him, she said. 

Hale re-emphasized the importance of establishing a relationship first. Once trust is established, it’s important to bring up the issue with the goal of encouraging the person in need of care to drive their own care by asking something like, “Does that hurt your eye?” rather than a “you should,” statement. 

But street nurses may soon be able to intervene with these issues, as they will begin making rounds at the community meals in addition to their existing presence at OHRA Thursdays from 10 a.m. to noon and the Ashland library Wednesdays from 11 a.m. to 1 p.m. 

“At the end of the day, we just want to show these people love,” Park said. “That’s what all it’s about.”

Email Ashland.news reporter Morgan Rothborne at [email protected].