Peer Support Key for GBHI Grantee

Peer support is a key element of Palladia's Steps to Safety program for its homeless clients grappling with trauma and substance use.

Palladia, Inc.’s Steps to Safety program receives funding through SAMHSA's Grants for the Benefit of Homeless Individuals (GBHI) [link to the GBHI page]. Palladia primarily serves men with co-occurring issues of homelessness and trauma and substance use. The Steps to Safety program is a supplemental voluntary treatment system that seeks to reduce trauma symptoms, assist in recovery from substance use disorders, promote housing stability, and enhance coping skills and self-efficacy.

Developing Clients' Survival Skills

Palladia’s clinical staff developed a unique curriculum—Seeking Housing—to address the needs of its clients and to supplement the Seeking Safety evidence-based practice (EBP). It began with an extensive literature search on the Seeking Safety curriculum and additional research on creating effective programs to teach clients skills to obtain housing. To evaluate its effectiveness, Palladia plans on continued analysis and review of the Seeking Housing program, with the hope to eventually market it to other providers. Steps to Safety’s focus has been primarily on Seeking Safety and Seeking Housing, however, the program also incorporates the Motivational Interviewing EBP.

The Seeking Housing curriculum has been developed to supplement Seeking Safety, and at the same time this unique combined intervention helps staff to customize and better serve their clients’ particular needs. Steps to Safety consists of two connected groups. The Seeking Safety group addresses trauma and substance use, while the Seeking Housing group addresses homelessness and housing stability. The program has been well integrated into both an outpatient and residential setting where staff and clients understand and promote the purpose and continued success of the program.

Improving the Lives of Clients

The Steps to Safety program has seen improvements in its clients’ mental health outcomes. Clients have shown decreases in mental health symptoms and trauma-related symptoms, and improvements in coping skills. Clients also report decreases in substance use and criminal justice involvement, increased employment or enrollment in school, and increased enrollment in job training programs. In addition, they have become more knowledgeable about housing, independent living, and steps to prepare for housing, such as obtaining the necessary documentation, budgeting, and completion of forms. This preparation has resulted in an increase in their clients’ rates of permanent housing in the community.

In its fifth year of operation, Steps to Safety has run 360 groups and has served 435 clients. It has experienced a high rate of client attendance and completion, due in large part to its successful client engagement and its flexibility in serving clients’ needs. Clients have also overwhelmingly reported its helpfulness in their lives. One client stated, “It was one of the few groups that I actually looked forward to attending … the Steps to Safety [program] was more educational and it informed me. [It] actually made me come to the realization [of] where some of the feelings I have come from, and also offered me ways to deal with those feelings.”

Peer Support

Steps to Safety has also been noteworthy in its engagement and support of its clients through the Peer Housing Educator (PHE) program, which grew from the clients’ need for more housing support and the need to incorporate more peer support. PHE graduates, using the knowledge they learn through their recovery and under the supervision of the Steps to Safety staff members, assist their peers in the housing process through scheduled presentations, office hours, and the creation of a housing library. PHEs believe in the program’s ability to provide a sense of empowerment, both for the staff and for the clients with whom they work. One PHE stated, “I’m just like them…I’m in the same situation they are. By them being able to trust me and see the transitions that I made throughout the program, it gives them hope and a sense of direction that they can do this and find housing.”

The work of the PHEs has led to more buy-in from current clients and has also helped the PHE mentors maintain a sense of purpose, while enforcing the knowledge that they have learned along the way. Due to the success of the PHE program, Palladia has hired a former PHE graduate to help co-facilitate Seeking Housing and provide peer support. Other Palladia staff consists of a counselor, social worker, intake and engagement specialist, and peer housing educator. The program is overseen by the chief program officer, a project coordinator, a research coordinator, and a consultant, all of whom assist in the creation of a trauma-informed system of care.

Steps to Safety’s extensive research, analysis, and unique program development is a result of their partnership with the New York Academy of Medicine, whose staff also serve as Principal Investigator, Project Director, and Outreach Coordinator. This partnership also assists Steps to Safety in their evaluation of the program and to provide follow-up to their clients. In addition, Palladia has numerous linkages with other community-based providers, including primary health care, mental health, and housing providers who contribute to the success of Steps to Safety.

Learn about SAMHSA's six key principles of a trauma-informed approach. Visit SAMHSA's National Registry of Evidence-based Programs and Practices (NREPP) to learn more about scientifically established behavioral health interventions.

Access more behavioral health and homelessness resources.

Publication Year

Connie Campos
Last Updated: 07/10/2019