Ep. 014 | Trauma-Informed Care for the Homeless
Today, we chat with guest, Alex Robinson, a board-certified music therapist, about the impacts of compounded trauma for the under/unhoused.
LEARN MORE
The Body Keeps the Score by B. van der Kolk | Book
Harm Reduction Coalition | Website
Ehmling, Amelia E., “PEOPLE EXPERIENCING HOMELESSNESS WITHIN MUSIC THERAPY SETTINGS: A DESCRIPTIVE STUDY” (2018). Theses and Dissertations–Music. 106. | Thesis
TRANSCRIPT
Erica: Welcome, friends! You’re listening to The Feeling is Musical — as presented by the Snohomish County Music Project. My name is Erica Lee, and, in honor of national mental health month, this week we are talking about: Trauma-Informed Care for the Homeless, with board certified music therapist, Alex Robinson, as the second episode in our 4 part series all about various topics within the field of mental health care.
Alex is a board certified music therapist, and works in case management at a homeless shelter in Seattle, Washington. In their work, they strive to bring trauma-informed music therapy to houseless folks. Additionally, Alex teaches music, and has a long list of instruments that they’d like to learn.
[Podcast intro music plays]
Erica: Welcome, Alex. Thank you for being on the podcast today. How are you doing?
Alex: I’m doing pretty good. Thanks for having me.
Erica: Yeah! Um, so I really wanna start with just like a couple of things to give us context for this conversation - one of them being how do you define homelessness, or homeless - how do you - how do you define, like, that term? Because people have different perceptions of what that term means.
Alex: So, the general like definition is just like not having a home or a place to stay. Um, there’s a - also a definition called chronic homelessness. Um, that is used for helping people get housing - there’s certain opportunities that like people can get if they’re chronically homeless that they might not be able to get before that. Um, the definition of chronically homeless is, um, they’ve been homeless for a while, or they have been homeless several times in the past three years.
Erica: Okay. And what is the difference in like services that they can receive if they’re like chronic versus non chronic? Is it a significant difference, or does it just make them eligible for like different programs?
Alex: So, there aren’t a ton of differences, because, unfortunately, there just aren’t a lot of resources. Um, if they’re chronically homeless, they’re more likely to qualify for housing assistance. Um, right now, there’s like Seattle Housing Authority, King County Housing Authority, Snohomish County Authority. SOme of them are open - some of them are closed - pretty much all of ‘em have a really long waitlist. Um, that one has the broadest like being able to get into it, but it’s like a really long waitlist, and the waitlist is closed in a lot of the places because they just don’t have that much housing. Another big thing right now is like, SSI um is less than $1000 a month - like the most you can get - which means that you just can’t afford rent —
Erica: Yeah —
Alex: In this area —
Erica: Yeah —
Alex: Without out - outside assistance. Um, and then there’s also supportive housing. Most supportive housing requires chronically homeless people. Um, it also requires like 2 assessments basically. There’s the VI-SPDAT, and that one assesses like vulnerability. That one I’m not a huge fan of because white people tend to score higher than people of color —
Erica: Okay —
Alex: So there are some biases there.
Erica: Got it.
Alex: Um, because white people are not more vulnerable. And then, there’s also VAT, which is Vulnerability Assessment Test. That one is not used as broadly, but it can be used to like, if someone has the same VI-SPDAT score, they’ll go with the VAT - who has the highest VAT.
Erica: Mmm.
Alex: That one is more equitable, and there’s like a push right now to just go with the VAT assessment because it’s —
Erica: More —
Alex: It’s not bias.
Erica: Yeah. So, for more context - or to provide more context to our conversation, can you share with us um more about the shelter you’re specifically working at right now? What kind of services does it offer? Who are you seeing as a case manager? Um, anything else that you think might be relevant.
Alex: Just as a disclaimer, I am not representing the place I work at right now - I’m just talking as a music therapist —
Erica: Yes —
Alex: Who wants that to happen.
Erica: Yes.
Alex: Um, I work at Downtown Emergency Services Center, um it is a homeless shelter that is housing first. That means that they think that you need housing to be able to work on anything in your life - so that includes drug use, like you can’t get off drugs if you’re houseless - or it may include if you want to get a job, it’s gonna be a lot harder to get a job if you’re houseless. So the first step towards any goal that someone might be working on is getting housing.
Erica: Getting housing - interesting.
Alex: Um, and then, also, it’s a harm reduction agency. So that means that most of the sites allow people to be drug users - there’s a lot of shelters that don’t allow that, which is unfortunate because it’s hard to be sober when you’re experiencing a lot of trauma and houselessness.
Erica: Yeah.
Alex: So, harm reduction is also a set of principles to reduce the harm of drug use specifically, but it can be used in other contexts. Um, so for example, it’s providing needles for people that are clean, so they don’t contract diseases from using a dirty needle. Um, it’s giving people access to condoms. It’s, like there’s a housing project that um is for heavy alcohol users, and they’ll um do rationing with alcohol - so they’ll like hold on to people’s like alcohol, and then like - they’ll like give it - distribute it throughout the day —
Erica: [Says something as Alex is speaking] Yeah - yeah —
Alex: And like, help them make choices, where it’s like a smaller percentage of alcohol, so it’s not just like going cold turkey, but it is limiting the damage that may come from that.
Erica: Mmm. Okay —
Alex: It’s also having Narcan, um which is a drug that stops an overdose from opioids. Um, also, the other big thing that my - where I work does that is a little different than a lot of other homeless shelters, is that we focus on the most vulnerable - and particularly people with mental health issues. Um, so that means that there’s a lot of clients who have a lot of behavioral issues that may not be tolerated in other places —
Erica: Mmm —
Alex: And we try to like give them as many chances as possible, while still like holding boundaries and safety.
Erica: So what is your like day to day like role at the shelter?
Alex: Well, everything’s a little different right now —
[Erica and Alex laugh]
Alex: But when it’s normal - as in not a pandemic —
Erica: [Chuckling] Yes —
Alex: Uh - um, it might be anything from interacting with clients - making sure that they have clothing and that they’re eating - stuff like that.
Erica: Mmm.
Alex: Um, it may also be going to social security and getting a social security card. It kind of depends a lot on the client and what they’re needing right then, and like, what they’re ready to do.
Erica: Awesome. SO, in my preparation - in my reading for this episode, it became super evident to me that the fact of being homeless significantly impacts the healthcare that a person is able to receive, both physically and mentally. Um, how does the lack of adequate access to mental health care affect the people that you’re working with?
Alex: That’s a big question - um —
Erica: We only do big questions [laughs]
Alex: Fair. Um - I mean, like, the typical set up for like mental health care, right, is going in, sitting down, talking about your problems - like, that is how a lot of therapy happens —
Erica: Yeah —
Alex: Um, for a lot of people. But, you know, if you’re worried about where am I gonna sleep tonight, what am I gonna eat, I have a lot of internal stimuli - internal stimuli, as a note is when someone has a lot of um auditory hallucinations, or they have like a lot of mental health stuff happening, um at my work we call that internal stimuli.
Erica: Okay.
Alex: Um, if you have all of those things happening, um it’s hard to like sit down. It’s also hard to follow a schedule - it’s hard to remember and get to a like traditional therapy appointment - if you happen to have insurance, which is also a big barrier.
Erica: Sure.
Alex: Um, part of how trauma works is like, it kind of can cause a couple different things. So freezing would be like - someone may experience a lot of deperession, they may start dissociating or disconnecting from their body - so they might not feel their body and what’s happening around them - that can also be evidenced in like drug use —
Erica: Mmm —
Alex: So they might drink a lot so they don’t have to like think about their situation - or they might use like an opiate or another type of drug. Or sleeping a lot - stuff like that. Fight is usually like anger - it can be really motivating, but it also can be really destructive. So that might mean like they try to start fights all the time —
Erica: Mmm —
Alex: Or they get really irritated really easily - they have less patience.
Erica: Sure. And so - there’s a lot of trauma happeningwith the clients, and so, because of that trauama, they can’t access traditional mental health care that somebody that maybe has less trauma, and is more regulated, can access - of - of course given that like there’s no financial barriers and all the other things that come with being able to access traditional mental health care. And so, within the scope of your role at the shelter and the scope of your work, what does providing mental health care look like, and um how are you providing trauma-informed care within that?
Alex: So, a big part of my role is actually just like calling mental health providers and setting up appointments. I have a music group, which isn’t music therapy because it’s not defined as such, and it’s in a community setting - so it’s a lot of in and out, so there’s not really enough privacy for the kind of depth that maybe a music therapy group might have.
Erica: Mmm.
Alex: But it also does serve a similar role as a music therapy might - might serve. Often times that’ll look like sing alongs, occasionally we’ll write a song parody together —
Erica: Okay —
Alex: So - several of the clients love writing the blues about the shelter. Um, it may also look like occasionally I’ll get dancers, so like, the clients will start dancing together, which is a lot of positive social interaction um when you’re not getting your basic needs met - it’s hard to have basic social interactions with other people.
Erica: Mmm.
Alex: So a big part of that group is helping people do that. Um, actually does create a space for helping people feel more vulnerable, even though it’s like not as vulnerable as maybe a community music therapy group might be.
Erica: Mmhmm.
Alex: Uh, I had one client come up to me after, and he was like ,hey, I realized today, I haven’t felt in a really long time - I should probably feel - I’m gonna go get a therapist now. And I was like, perfect.
Erica: That’s great. So you’re kind of um a gateway into mental health care, both facilitating that —
Alex: Mmhmm –
Erica: Both in an organizational manner for the clients, but then also through this community group that you’re doing - gently introducing them to the idea that therapy could be a good thing?
Alex: Yeah.
Erica: Yeah.
Alex: It’s kind of a slow process with a lot of our clients. They’ve had a lot of trauma, which includes trauma in the therapy system.
Erica: Mmm.
Alex: A lot of our clients have been forced to go to mental hospitals if they were unsafe, which can be traumatic —
Erica: Yes —
Alex: It could also be really good for them, but… Trauma-informed care for me means that I’m meeting the clients where they’re at.
Erica: Yeah.
Alex: So that means if their goal is just to like stay somewhere safe every night, that’s what we’re gonna work on.
Erica: Do you find that other professionals working in shelter settings use a trauma-informed approach, or is this a less common practice?
Alex: So, I feel like I use trauma-informed because of my music therapy background, but I think that there are very similar things happening in this setting that are called different things.
Erica: Mmhmm.
Alex: So like ,harm reduction I would consider the same thing as trauma-informed - or very similar.
Erica: Mmm.
Alex: Like, housing first, I would consider that trauma-informed, because they’re aware the trauma being houseless is affecting this person’s ability to do other things.
Erica: Sure. If you could have a music therapy group, um, what could the benefits be, and what kind of goals and objectives would you be working towards? You had said positive social interaction is a really big - really big thing…
Alex: Yeah. I think - I think it would be very, very beneficial for most of the clients I know who like music. Um —
[Erica and Alex chuckle]
Alex: So, probably what the goals would be like, emotion regulation type of goals. So like - we even did a couple songwritings about like emotions, but like, you know, like making sure that they have skills for when they’re angry, or when they’re really sad, or whatever emotions they may be feeling —
Erica: Mmm —
Alex: Like, making sure that they have tools to deal with those emotions, as well as like process what they’re feeling. Um, another goal might be positive social interaction like you said - learning what a healthy relationship might look like, um, ‘cause it gets a little weird when you’re in that much trauma all the time —
Erica: Mmhmm —
Alex: Um, a lot of clients probably would benefit from like confidence build - building. Oftentimes in my music group, I’ll hear clients be like, oh look at me, I can sing! I’m awesome!
[Erica chuckles]
Alex: [Chuckling] Um, one client was like, I have the voice of an angel!
Erica: Oh my goodness!
Alex: And I was like, yes you do!
[Erica and Alex laugh]
Alex: But, you know, like when you’re around that much disappointment all the time, it can be really beneficial to be like , oh! I can sing- or Oh! I learned the G chord on this guitar - I can play a little bit —
Erica: Yeah.
Alex: Or, I can play the drums!
Erica: Absolutely.
Alex: Um… Yeah, those are just some of the goals. But like, ultimately, I would like to see what their goals would be as well.
Erica: Yeah. If we’re gonna do trauma-informed therapy, it needs to be client aligned and client centered. [Chuckles]
Alex: [Chuckles]] Right.
Erica: In that study that you had provided to me - that I’ll make a available after I publish this episode - the researcher was looking at the number of music therapists that are working with homeless folks in the United States, and it really surprised me that there - in 2017 when the study was done, there was just over 6000 music therapists in the United States, but only a little over 200 of them said that they worked with homeless people. Um, imagine that that’s wildly inaccurate, because the homeless are not just in shelters and like, you’re interacting with people that are homeless all the time - it’s just whether you perceive them to be homeless or not, and if they self report or. self disclose. Why do you think there are so few music therapists that recognize that they’re working. With homeless people?
Alex: I think there’s a lot of shame around homelessness.
Erica: Mmm.
Alex: Um, homeless people are often really mistreated. Um, and you know, like homeless people don’t - aren’t just like people in shelters - they’re also people in tents, they’re also people living in their cars, people who like sneak into their office and sleep there if they don’t have a home - or like other places like that. Um… I think there is a lot of shame around it, and like, there is the tendency to like wanna hide the things that make us vulnerable. Um, you know, like a lot of employers might not wanna work with someone who’s homeless, just because of the biases, um, and I think that that could also translate into like - do I tell my music therapist that I’m homeless? Because like, what if they start perceiving all of these things - what is that gonna say about me - will they still help me? I also think that there’s a lot of barriers as well to receiving mental health care. So it could be - like, music therapists aren’t working with a ton of homeless people because of barriers that are happening. ‘Cause, you know, like if you’re having a hard time just like finding a stable place to sleep, getting to a therapy appointment can seem really overwhelming.
Erica: We were talking in April all about neurodiversity and um autism specifically, and talking somewhat about um various aspects of disability studies, and disability justice, etc… When there’s compounded trauma from being disabled - maybe you’re disabled, you have a mental illness, and you’re homeless - as the trauma compounds, what are the outcomes or effects of that, versus, say, you only have one factor of trauma? Does that make sense?
Alex: Yeah, I mean it kind of like starts feeding into itself, um, which is really unfortunate. Um, a lot of the people I see regularly do have multiple factors of oppression, so that means like, you’re more likely to be homeless if you’re a person of color, you’re more likely to be homeless if you’re a member of the LGBT community - and that also like - so something about our system in general, in that like ,if you’re homeless, that probably means that you didn’t have the community supports that you needed.
Erica: Mmm.
Alex: So, it’s like… of course you’re gonna have more issues, and they build on each other.
Erica: Yeah. Do the symptoms of trauma - like fight or flight - do they become more severe or more intense when you have more and more factors of oppression that lead to greater and greater compounded trauma?
Alex: So like, a lot of - like a major trigger for most mental illnesses is stress.
Erica: Mmm.
Alex: So, a lot of the times, either - it’s unclear if it like causes mental illness, or it just aggravates it - but mental illness does play a huge effect, especially with all of the compounded factors going into it.
Erica: Mmm. Do you have the opportunity to build long term relationships - long term maybe - maybe meaning like 6 months or more - with specific people as they come in and out of the shelter?
Alex: Mmhmm.
Erica: Okay.
Alex: Um, unfortunately, most people do not get out of homelessness very quickly. It’s pretty hard to do. Some of our clients have been there for years, unfortunately - some of them get out a little faster - but, um, there are a lot of long term clients. There’s also a lot of fluid clients - so like, we’ll also have like clients who like come in for a month - we won’t see them for a like a year, and then they’ll come back for like a couple months.
Erica: Mmm.
Alex: It is consistent enough that like you do develop relationships with people.
Erica: In a - in environments where there’s a lot of trauma… existing and happening and… in all of the different forms, there has to be vicarious trauma happening for the staff. Is that something you experience, or other staff members experience?
Alex: Yeah, for sure. I think all therapists should have therapists. I go to therapy - I would recommend it. [Chuckles] I also like would recommend being able to like separate yourself. Um, the people who last a long time without getting burned out - ‘cause there’s a high burn out rate - are people who know how to leave work at work when they’re done. Just can’t take it home. And like, you know, of course everyone does better at that sometimes than others, and that’s why you get a therapist to help you with that when you need it - but it is really important to be able to like go home and at the end of the day be like, you know, like I can only do so much. Um, self care is really important. It can mean developing a routine that works for you - that could mean - just different things work for a lot of different people. I would say that like, the more tools you have under your belt, the better you’ll be because - sometimes tools don’t like get you one day.
[Erica chuckles]
Alex: [Chuckling] I don’t know. I’ll have like a tool that works great for a while and then one day it will be like nope. And I’m like, okay, I guess I’ll try something else now.
Erica: Yeah. You’ve touched on it a little bit, but I wanted to ask you more specifically, how has your background as a music therapist supported you in this role? Because you’re not presently calling yourself a music therapist at work - you’re not functioning in that role. But your training as a therapist - you don’t really get away from your therapeutic nature.
Alex: I would say that it’s a big strength I have. Um, like, you know, like if you work with people with mental illness, understanding what is happening is really important. That also like helps with that whole self care piece of not taking it home - like if somebody yells at me one day and calls me all sorts of horrible names, I can be like, oh this is just, know, them having a bad day - this is their mental illness - this isn’t about me.
Erica: Mmm.
Alex: Um, and that is helpful. And also, has given me more tools to help people. So like, occasionally, like someone will be like, I don’t know what to do, and I’m like, I don’t know, do you - do you wanna color - should we like play some music? I can still give them some of the tools even if that’s not the primary focus.
Erica: Absolutely. Um, for a student - music therapy student or any other kind of like helping profession type student, what would your recommendations be for like preparing - if they’re really interested in working with the - with homeless people - with people that have very similar trauma, like what are a couple of things that they could or should do as they’re thinking about working with these people?
Alex: I think a lot of like, what I’ve learned is that you have to put yourself first - even though like you feel like - there’s a lot of feeling like, man, I should be putting all these people before me, but if you don’t put yourself first, um, that’s when you’re gonna burn out - that ’s when you’re gonna be less effective because when you’re not feeling great, it affects your therapeutic skills. Knowing how to feel hard thins in your body and how to process that is really important - um, and having skills that go along with that. Taking breaks is like also helpful - so like, I’ll go - usually once a day - and like just go on a walk around nature, just to like clear my mind a little bit before going back in - especially if I had like a really intense interaction with a client.
Erica: Mmm.
Alex: Um, I would definitely recommend reading The Body Keeps the Score, um and just really understanding how trauma interacts with the body, so that you can - not only see how it interacts with your clients, but also yourself.
Erica: Absolutely. We will put all of the resources that Alex has sent me, including this research study that I just read that I keep referencing, and I think there’s another online resource, and the Body Keeps the Score is one of our favorite books at the Music Project. Um —
Alex: As a note, I feel like that book is really intense, so it’s often helpful to read that book in chunks - and it’s often helpful to um use the skills that you’re tryna develop of how to feel hard things in your body while you’re reading.
Erica: While you’re reading - good to know. I found the same - I had to take a break from it. Those resources are available in our episode notes and on our website. Um, you can learn more about the Music Project at SCMusicProject.org, and you can also follow us on social media @SCMusicProject. Uh, next week, we’re gonna be talking with Britta Erikson, who is another music therapist um who works at a behavioral health hospital just south of Seattle, and she’s gonna be talking about trauma that comes as a result of institutional mental health care.
Thank you, Alex, so much for chatting with me today. Um, thank you, listeners, for listening, and we will talk to you next time.
[Podcast outro music plays]