Twelve-Month Outcomes of Trauma-Informed Interventions for Women With Co-occurring Disorders

Harvard University, Cambridge, Massachusetts, United States
Psychiatric Services (Impact Factor: 2.41). 11/2005; 56(10):1213-22. DOI: 10.1176/
Source: PubMed


Women with co-occurring mental health and substance use disorders frequently have a history of interpersonal violence, and past research has suggested that they are not served effectively by the current service system. The goal of the Women, Co-occurring Disorders, and Violence Study was to develop and test the effectiveness of new service approaches specifically designed for these women.
A quasi-experimental treatment outcome study was conducted from 2001 to 2003 at nine sites. Although intervention specifics such as treatment length and modality varied across sites, each site used a comprehensive, integrated, trauma-informed, and consumer-involved approach to treatment. Substance use problem severity, mental health symptoms, and trauma symptoms were measured at baseline, and follow-up data were analyzed with prospective meta-analysis and hierarchical linear modeling.
A total of 2,026 women had data at the 12-month follow-up: 1,018 in the intervention group and 1,008 in the usual-care group. For substance use outcomes, no effect was found. The meta-analysis demonstrated small but statistically significant overall improvement in women's trauma and mental health symptoms in the intervention relative to the usual-care comparison condition. Analysis of key program elements demonstrated that integrating substance abuse, mental health, and trauma-related issues into counseling yielded greater improvement, whereas the delivery of numerous core services yielded less improvement relative to the comparison group. A few person-level characteristics were associated with increases or decreases in the intervention effect. These neither moderated nor supplanted the effects of integrated counseling.
Outcomes for women with co-occurring disorders and a history of violence and trauma may improve with integrated treatment.

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    • "tual thinking to the data - driven analysis of TIC and its effects . However , this forward movement is blocked by the absence of psycho - metrically strong instruments to evaluate TIC . Within the limited empirical work on TIC , the effects of TIC imple - mentation are typically measured via client - reported out - comes such as symptom indices ( Morrissey et al . , 2005 ) ; program - level metrics such as suspension and expulsion reduction ( Stevens , 2012 ) ; and organizational - level char - acteristics such as treatment environment ( Rivard et al . , 2005 ) . Though these are important outcomes , they are costly and time - consuming to collect and evaluate ."

    School Mental Health 10/2015; DOI:10.1007/s12310-015-9161-0
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    • "Promising effects of integrated treatments for PTSD and alcohol use have been found (Back, Brady, Sonne, & Verduin, 2006; Back et al., 2012; Hien, Campbell, Ruglass, Hu, & Killeen, 2010), although generalizability is limited by small sample sizes, high attrition, absence of control groups, or lack of standardization across protocols. Studies also have found that integrated treatments are not more effective than standard alcohol treatments or health education controls (Cohen & Hien, 2006; Hien et al., 2009; Morrissey et al., 2005). Combined treatments are lengthy and complex, which can create challenges when working in low-resource settings where session attendance may be more problematic. "
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    • "), longstanding and effective efforts to address IPV (Bair- Merritt et al., 2014; Garc ıa-Moreno et al., 2014; Ghandour, Campbell, & Lloyd, 2014; MacMillan et al., 2009; Miller et al., 2011; Ramsay, Rivas, & Feder, 2005); successful treatments for PTSD and complex PTSD (Cloitre et al., 2012; Engel et al., 2008; U.S. Department of Veterans Affairs National Center for PTSD, 2015; van der Kolk et al., 2014); interventions with adults to ameliorate the impact of adverse childhood experiences (Sikkema et al., 2007; Toussaint, VanDeMark, Bornemann, & Graeber, 2007), and models of trauma-informed care in other settings and with other populations (Gilbert et al., 2009; Morrissey et al., 2005). Based on a review of the literature and input by experts from the national strategy group, we developed an approach to TIPC that defines trauma broadly, addresses both recent and lifelong trauma, and includes an essential focus on provider support and well-being (Figure 1). "

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