In an episode of Call the Midwife, young nurse Jenny Lee works with a teenage-girl who has lived a life of poverty. A Catholic priest, who oversees the home where the girl has been sent to escape an abuser, tells an angry and distraught Jenny: “Poverty isn’t bad housing or dirty clothing. It’s never having been loved, or even respected. It’s not knowing the difference between love and abuse.”
This description of poverty was particularly striking to me as a Catholic and because at the time I was trying to devise a health education session specifically for people who have high blood pressure and are homeless. It’s well known that people who live in poverty often don’t do what they are “supposed” to – whether it’s take their medicine or hold down a job. Why is that and what can we do about it?
As I went through the various behavior change models, trying to convince my homeless clients to take even small steps to improve their lives, I found that traditional approaches for behavior change make two key assumptions that weren’t applicable to the people I was working with: first, traditional methods assume the sole responsibility for changing is on the individual. Secondly, they assume all people view themselves as worthy of good health and a good life. But these faulty assumptions create a disconnect that can harm the very people we are trying to help – and it ties back to the description of poverty given by Father Joe on Call the Midwife.
I then happened to attend a trauma-informed care training. Trauma-informed care is based on research that has been around for 20 years, and it changed how I saw and did everything as I interacted with people living in poverty. Most importantly, it gave me tools to connect with my homeless clients as we talked about their health and lives.
The idea is that emotional trauma – abuse, neglect, living in poverty – alters a person’s brain and body, and leaves them much more likely to suffer poor health and social outcomes. And while trauma affects all demographics, its effects are most severe in vulnerable populations, such as those who live in rough households, or distressed neighborhoods. There is hope, though. With trauma-informed schools, churches, hospitals, and social services, we can help people and communities build resilience and heal.
We are called to serve the poor and vulnerable among us; we must see that poverty is more than a lack of material resources. Therefore, our first step is to become trauma-informed and build our services upon this foundation. As we encounter the homeless, the incarcerated, the addicted, and those living in poverty or abuse, we then will open ourselves to a greater empathy and compassion in a productive, respectful manner.
Trauma-informed care is a tool that helps us be better servants to those who need us most.
Erica Smith is the executive director of Helping Hands of Springfield, a non-profit organization in Springfield that serves people who are homeless or at risk of homelessness. She is also a SAMHSA (Substance Abuse and Mental Health Services Administration)-certified Trauma-Informed Care educator.