VA Homeless Programs
September 15, 2022
Karen Guthrie, LICSW
CATCH Team Coordinator and Supervisor
VA Boston Health Care System
Q: Can you share some background on your role in the homeless program at the VA Boston Health Care System?
A: I came to the VA Boston Health Care System after being at VA White River Junction Health Care System for 19 years. At White River, I was a mental health therapist in the post-traumatic stress disorder (PTSD) clinic serving Veterans diagnosed with PTSD. I worked with individual Veterans and their families as well as couples.
When I moved to VA Boston in 2008, I was hired as the Director of the Health Care for Homeless Veterans Program. We only had a staff of 3. A couple years later, the Secretary of Veterans Affairs at the time, Eric Shinseki, announced that ending Veteran homelessness would be a national priority. This expanded our homeless programs and services by leaps and bounds, offering opportunities to collaborate within VA, with community partners, and with Veterans across the entire region. It was a time of great hope within our program as well as a time of significant expansion of meaningful resources.
Prior to the changes Secretary Shinseki helped implement, we had primarily been an outreach-focused program, helping Veterans experiencing homelessness access VA services. However, our focus soon shifted to providing Veterans with permanent housing; within 4-5 years, our program had distributed more than 700 Housing and Urban Development-VA Supportive Housing (HUD-VASH) vouchers and grew to a team of over 60 staff members! Our expansion included a new Safe Haven program, more beds for our Grant and Per Diem program, and many other opportunities.
Additionally, since 2015, I have led a small team called CATCH (Care Coordination, Advocacy, Treatment and Connections to Housing), which provides enhanced services to Veterans experiencing homelessness who, for multiple reasons, are high utilizers of urgent care services. These Veterans are those who may feel left behind or need additional support. CATCH aims to serve these Veterans through a trauma-informed lens.
Q: What is trauma-informed care and why is it important?
A: Trauma-informed care is a perspective that asks, “What happened to you?” rather than a more traditional question, “What’s wrong with you?”
There are 6 guiding principles of trauma-informed care: safety; trustworthiness and transparency; peer support; collaboration and mutuality; empowerment and choice; and cultural, historical, and gender issues. Admittedly, these are not easy concepts to implement, no matter how intuitive they may seem. For me, providing trauma-informed care involves honest self-reflection regarding how I interact with others, and letting go of many of my preconceptions.
Trauma-informed care asks us to lean on mutuality and challenges us to improve our understanding of how a person’s life experiences have influenced their perspective – both of themselves and the world at large. It also asks us to regularly check in with the people we serve and explore how they experience our work together. Many people bristle at labels, and rightly so. While categorization can be useful to for us to better understand some of what another person experiences, using labels to define who a person is as opposed to what they have experienced can lead to a harmful power dynamic that triggers fear and survival mechanisms within the very people we are trying to help. While I think this is true for all humans, it is especially true for those who have experienced complex trauma over their lifetime, as they are extremely attuned to use of power.
Clinicians, counselors, therapists, psychiatrists, psychologists – we’re often thought of as experts. But we often over-generalize our expertise and forget that the people we serve are the experts of their own lives. Trauma-informed care invites us to harness our clients’ expertise in themselves to shift how we see and treat them, and to be mindful of the overt and covert messages that we give them about how we perceive their value.
Interestingly, trauma-informed care is not a treatment modality. Instead, it’s a way of relating to others, and can take place in a variety of situations and settings – from a single interaction with a desk clerk, to short-term collaboration with a housing specialist, to a long-term relationship with a primary care doctor. Trauma-informed care is about the messages we send through our words and bodies, as well as the messages that we send through the policies and procedures that shape our systems of care.
Trauma-informed care is important because it challenges us to think, feel, and see a person beyond their diagnosis; we must seek to understand them fully and completely. Without organizational shifts to this perspective, we will never be able to fully understand and effectively serve those who rely on our care. Worse, we may inadvertently re-traumatize our clients when they need us most.
Q: What inspired you to become a trauma-informed care expert?
A: Veterans inspire me to do this work.
Throughout my career I took all kinds of courses and pursued certifications in a variety of specialty areas. Yet, I always felt that something was missing; I knew it had something to do with how our systems of care saw our Veterans. I wasn’t fully able to define what was missing until I started learning about trauma-informed care.
I realized that my desire to protect the Veterans I worked with could be problematic, as it was a pathway to exerting power over them instead of empowering them. Sometimes we try so hard to make things better for others that we forget to trust that the answer can only truly come from the person we are serving. Time and time again, Veterans are the ones who teach me the most.
Q: What motivates you to do the work you do?
A: There are many things that motivate me in this work, some dating back to my childhood. But as I grew into an adult, I also learned that both of my parents had experienced traumas that shaped how they loved and cared for me and my sisters.
My dad was a medic in World War II. He returned on leave during the war to marry my mom, and after just 4 days, he left to go back to war for another 3 years. After the war, he became a nurse and worked for VA for over 40 years. He was 80 years old when he died – at the very same VA that he worked at for most of his life. The very doctors he had worked alongside cared for him, and they cried when they could not do more for him. He was able to die in a place that was his second home, with colleagues who loved and cherished him. He was allowed to have a room to himself so that I, or one of my sisters, could sleep in the extra bed in his room during those difficult days.
To me, this is what VA is about: serving each unique Veteran in the most humane and caring way that fits with their experiences and honors the life they lived. My father told me many times that if it hadn’t been for my mom’s love and support, he did not know what would have happened to him after his return from war. His humility and my mom’s compassion have greatly influenced my love of humanity and my concern for those that are categorized and set aside.
During my time as the Director of the Health Care for Homeless Veterans here at VA Boston, I became very concerned about those Veterans who fell back into homelessness after being housed for less than 6 months. I reviewed many of these Veterans’ records and found most had histories of traumatic experiences. This began my journey of trying to understand how to better serve Veterans experiencing homelessness.
I don’t believe that anyone chooses to be homeless. I believe there are many complexities around societal equity, safety, trust, avoidance, isolation post-service, and what I would call “systemic categorization” that can lead to a Veteran becoming homeless.
Q: What is one thing you want all Veterans to know about your work?
A: You are not alone. We are working toward a system of care that is more aware of your life experiences, and in what way those experiences influence how you see yourself, and how you feel about VA. We need your voice to help us understand your needs, and to find solutions together. We have our personal and professional life experiences that sometimes cause us to work with you without knowing you. We want to change this.
Q: What is your suggested first step towards recovery for a Veteran or family member who may be impacted by trauma?
A: Listen, listen, listen. Be open. Know that it all doesn’t have to be resolved today. Your kindness and presence with each other goes a long way. Breathe.