I’ve spent the year working as a case manager in a shelter-based program for homeless 18-21 year olds. The setting is chaotic: 60 young men and women, coming straight from the streets, foster care placements, hospitals, juvenile justice centers, and a variety of family arrangements, to live with us for a couple months, looking for a new start, or at least a stepping stone to a more stable life.
The challenges are tremendous. New youth come every day, needing IDs, clothes, healthcare, food, and showers. Youth are quickly expected to seek and obtain employment in order to move into more stable housing. Frustrations run high, money runs low, arguments ensue, old demons surface frequently, and street survival habits die slowly.
As a young staff member, it can be difficult to comprehend the chaos of the many lives that intersect in our building, let alone respond in a helpful, caring, first-do-no-harm manner. We rarely have the luxury of black and white decisions when tackling the complex psychosocial puzzles we face daily. Below are a few memorable statements that I’ve heard that have most shaped my approach to our youth this year.
1.) “Being non-judgmental also means not judging a youth’s decision to return to the street life”
Our organization has a stated mission of treating all youth with absolute respect and a nonjudgmental, unconditionally loving attitude. For months, I thought of this as accepting youth “where they’re at” and not thinking poorly of them as a person for past decisions, trying as hard as possible to keep shame out of the room when discussing a youth’s past mistakes. One of the youth I admire most beat his girlfriend. He’s a good person, but he’s made some regrettable decisions in difficult moments.
However, we all have blind spots to our nonjudgementalness, our ability to accept youth as they are in all situations. In a training several weeks ago, one of our senior directors, a 15-year veteran of helping homeless youth, made the point that being nonjudgemental, also means not judging youth who opt to leave our path for them towards a decent, honest, working life, in favor of returning to the streets, which very possibly means surviving by means of theft, drug dealing, and/or prostitution. We try to talk them out of it, but, in the end, we are to send the message that, even if they make such a decision, we will support them and not think any less of them when they return to us a few months later to try the program again.
2.) “If we let a youth lie to us, it will probably not hurt either of us too much in the long run. However, if we accuse a youth of lying when they are being honest, it could cause irreparable damage”
Lying is an effective survival skill for the street life or residential placement life that many of our youth come from. Staff members in residential programs sometimes subscribe to a concept of not letting a client “get one over on you,” believing that “falling for” a client’s lie makes you a weak or disrespectable adult. Being an optimistic, trusting, probably somewhat naïve, young staff member, I found lie detection as difficult, and seeing youth as liars even more difficult.
The advice quoted above probably guided me through situations on a daily basis. We never need to assume someone is lying, which would be the opposite of “holding youth to high expectations,” a mantra for fostering resilience. To minimize people’s getting away with lying consistently, we can collect as much information as possible, and make decisions somewhat objectively, without assuming we can make decisions about someone’s integrity with our intuition in an effort to protect our pride from having someone “get one over on us”.
3.) “In a line, trauma-informed care is shifting from thinking ‘what’s wrong with this person?’ to ‘what happened to this person?’”
Our organization, like many other human service sites, has attempted to shift toward a trauma-informed approach. It seems that no one really agrees about what “trauma-informed care” means, but everyone agrees that it is important. I think, at its core, it’s a way towards empathy. It’s seeing “difficult behaviors”—poor impulse control, irritability, hypervigilance—as the result of ongoing physiological and neurobiological responses to the incredibly stressful past environments that our youth have navigated successfully, and helping to foster safety and connection as the foundation of any other goals in this world.
The line above seems to explain trauma-informed care succinctly. It shows you how to respond to the big young man, who upon being placed on hold by a welfare office employee, slams the phone down, curses, and storms out of my office. It’s easy to react with “what’s wrong with that dude? We must correct such maladaptive behavior,” but it is more helpful to think to yourself, “what happened to that dude that makes him react that way” and “how can we provide the safety and appropriate redirection to help make a slight, positive shift in his developmental trajectory?”
Tim's Ministry Placement is as Youth Advisor at Covenant House.
Growing up in the United States can be harsh. Growing up in Philadelphia can be debilitatingly harsh. The United States and Somalia, that bastion of human rights, share the dubious distinction of being the only countries not to have ratified the UN Declaration of the Rights of the Child, a commitment to a child’s access to the necessities of healthy development—a name, food, physical, social, and spiritual safety, play spaces, housing, medical attention, “an atmosphere of affection,” and education (1). Among developed countries, the US is second only to Romania in prevalence of childhood poverty (2). In Philadelphia, supposedly over 40% of children experience or witness violence (e.g., gunshots, stabbings, rape) before their eighteenth birthday. The youth we work with, at Covenant House, an adolescent crisis center for homeless and marginalized youth, have experienced many forms of pain and become stuck.
Many costly and painful conditions and major causes of death vary along racial and socioeconomic lines—diabetes, heart disease, hypertension, obesity, cancer, mental illness, etc. A growing literature on Adverse Childhood Experiences has linked childhood exposure to stressors to most major health disparities in the US. These stressors include sexual abuse, physical abuse, emotional neglect, parental illness, among several others, and affect a whopping 60+% of the population (3). Stressful experiences disrupt the normal development of critical brain structures, including the hippocampus, amygdala, and prefrontal cortex. Mismodeled brains become less able to regulate emotions, control anxiety and aggression, think creatively, learn, and remember. These physiological and behavioral challenges often lead to unhealthy behaviors (e.g., unhealthy diets, substance abuse, risky sex), costly chronic diseases, and physical and psychic suffering. Among the gloomy data, one fact shines. The aforementioned negative outcomes of childhood stress are significantly buffered when the child has a stable, supportive, unconditionally loving relationship with an adult (4).
Given the developing understanding of the profoundly negative impact of unhealthy developmental contexts on health outcomes, we will hopefully begin seeing increased funding and attention for childhood programs. The American Academy of Pediatrics has proposed preventing toxic childhood stress as a primary concern of pediatric care and policy in upcoming decades (5). Healthy childhood environments, especially during the critical developmental period of the first three years of life when the brain matures rapidly, are critical in ensuring the future economic and social stability of the country. However, what about the many, many adolescents who have already experienced a traumatic childhood and developed the physiology and behaviors that result from it? The youth whose 0-3 critical developmental periods did not nurture them sufficiently? The youth who have been removed from abusive families, locked up, sold drugs or their body to survive, and tried to survive on the streets? The youth we work with at Covenant House, 24/7/365?
Fortunately, adolescence provides another critical developmental period, when the brain is still developing and being “rewired”. Youth who have been injured, developed bad habits, lived in hostile and impoverished environments, and survived receive a second chance from biology. Where do they get this chance from society? Schools? Not with behavior and attention problems. Employers? Not with a criminal record and drug habits. Family? Maybe. The state, via foster care? Only until your eighteenth birthday. These are the youth who come to us. Our job is to get them on their feet, by helping them become legal with IDs, helping them navigate legal and medical systems, and helping them find and maintain employment and housing. However, do yourecall that powerful buffer that protects developing brains from the negative effects of the stress that is inescapable at that point in their lives? A strong, supportive relationship with an adult. That is the critical part of the ambiguous job description that comes with all social service jobs. That is what enables the brain, creativity, learning and memory, and hope to thrive.
The power of positive relationships was underscored to me a few weeks ago during a conversation with our site’s pediatrician, after I asked how he saw the role of Covenant House in the greater medical/ social services infrastructure of the city. He drew a picture of a cliff. At the bottom of the cliff, were hospitals, ambulances, and life support to catch youth who had fallen all the way down the cliff. Between the top and bottom of the cliff, he drew a trampoline, to represent Covenant House, and said “our role, here, is to help youth bounce back.” Then he looked me in the eye and said “and the way we help them bounce back, is by falling in love with them.” The actual, daily challenges of this—of providing structure and boundaries, finding youth’s individual strengths and admirable qualities among red flags, and building a supportive relationship with someone who has had little experience to develop an internal model of that—those topics will have to wait for future posts.
(1) UN General Assembly. (1959). Declaration of the Rights of the Child. Resolution 1386 (XIV).
(2) UNICEF. (2012). Measuring Child Poverty. Report Card Series, 10. <http://www.unicef-irc.org/publications/pdf/rc10_eng.pdf>
(3) Bornstein. (2013) Protecting Children from Toxic Stress. NY Times. <http://opinionator.blogs.nytimes.com/2013/10/30/protecting-children-from-toxic-stress/?hp&rref=opinion&_r=0>
(4) Shonkoff, Boyce, and McEwen. (2009). Neuroscience, Molecular Biology, and the Childhood Roots of Health Disparities: Building a New Framework for Health Promotion and Disease Prevention. JAMA, 301, 2252-2259.
(5) Shonkoff et al. (2012). The Lifelong Effects of Early Childhood Adversity and Toxic Stress. Pediatrics, 129, e232-246.
Tim's ministry placement is as a Youth Advisor at Covenant House.