Colleen Clark

Consumer Perceptions of Integrated Trauma-Informed Services among Women with Co-Occurring Disorders

As part of a national, multi-site treatment outcome study, an instrument was designed to assess consumers’ perceptions of key services integrating trauma, mental health, and substance abuse issues, the Consumer Perceptions of Care (CPC). This study evaluates the psychometric properties of this instrument and analyzes consumers’ perceptions of the services they received. The results suggest that the measure has four factors: services integration, choice in services, trauma-informed assessment, and respect for cultural identity. These factors demonstrated adequate reliability, and the overall results suggested that the measure is a reliable, sensitive, and valid reflection of consumers’ perceptions of their services and their providers for diverse racial and ethnic groups. Women in the intervention programs perceived their services as more highly integrated for trauma, mental health, and substance use than women in the services as usual or comparison programs, supporting its utility as a measure of programs designed to provide integrated services.

Adolescent Girls’ Use of Avoidant and Approach Coping as Moderators Between Trauma Exposure and Trauma Symptoms

High rates of child maltreatment demand attention, as exposure to child maltreatment substantially increases the risk of developing PTSD. Some evidence exists that the presence of coping skills may reduce the likelihood that victims of childhood maltreatment will develop PTSD (Agaibi & Wilson, Trauma Violence Abuse 6:195–216, 2005). This study examined whether avoidant and/or approach coping skills moderated the relationship between childhood trauma exposure and trauma symptoms among adolescent females with a history of complex trauma. Results suggest that the use of avoidant coping moderates the relationship between trauma exposure and trauma symptoms. More specifically, girls with higher levels of trauma exposure demonstrated lower levels of trauma symptoms if they reported using higher levels of avoidant coping. Clinical implications for these results are discussed.

Outcomes of mandated treatment for women with histories of abuse and co-occurring disorders

Although there is much momentum for behavioral health policies supporting mandated treatment, there is little evidence supporting its safety and effectiveness for individuals with complex issues. The authors used a national study of women with co-occurring psychiatric, substance use disorders and histories of trauma to compare mandated and voluntary treatment by examining psychiatric, substance use, and trauma-related outcomes following treatment. This quasi-experimental study included 2,726 women, with measures completed at baseline, 6-month, and 12-month follow-up. Two-way analyses of covariance examined the main and interactive effects of coercive status (mandated vs. voluntary) and condition (integrated treatment vs. services as usual) on psychiatric distress, trauma-related symptoms, and substance use outcomes. Women did better with integrated treatment and with mandated treatment regardless of treatment condition for psychiatric, trauma, and substance use outcomes at both follow-ups. Further research clarifying unintended side effects and change mechanisms of mandated treatment is needed to inform policy decisions.

Mental health services expenditures among children placed in out-of-home care.

This study examined Florida Medicaid mental health expenditures for children in out-of-home care. Child welfare and Medicaid administrative databases were analyzed using two-part models to identify characteristics associated with expenditures. Mental health expenditures were higher for older children, boys, children who were abused or lost their caregivers, or with a longer length of stay in out-of-home care. In contrast, African American children were less likely to have positive expenditures than White children, but among youth with positive expenditures, African Americans had higher expenditures. In addition, among youth with positive expenditures, substance use and affective disorders were associated with higher expenditures.

Challenges of Diverting Veterans to Trauma Informed Care: The Heterogeneity of Intercept 2

The challenges of diverting veterans from the criminal justice system and into appropriate trauma informed mental health and substance abuse services at Intercept 2 of the Sequential Intercept Model (initial detention and initial first appearance court hearing) are discussed. Six challenges are considered, including identification of veterans and determining veteran status; navigating complex partnerships among stakeholders in the community and within the VA that are essential for a successful program, particularly in terms of a mutual understanding of the functions, resources, and philosophies of each in order to allow for cross-system collaboration; difficulties in defining and operationalizing jail diversion; the timing and logistics of diversion; and screening for trauma-related disorders in a sensitive and client-centered manner within the confines of the criminal justice system. A brief overview of the funding, policy, and program landscape related to diversion of veterans is related to the challenges of diversion generally, and specific to intercept 2, with examples from Florida’s SAMHSA-funded Jail Diversion Trauma Recovery initiative.

Relationship between Trauma and Risky Behavior in Substance-Abusing Parents Involved in a Family Dependency Treatment Court

This exploratory study examined participants in a Family Dependency Treatment Court (FDTC), designed for substance-abusing parents whose children were removed from the home. Twenty-five participants were interviewed one year after FDTC enrollment to assess retrospectively the relationship between trauma history and risky behaviors. Treatment compliance rates were found to be high, and most participants had negative urinalysis results. Qualitative analyses revealed that approximately half of the participants attributed decreases in risky behaviors to the FDTC program. This study increases understanding of the effect of substance abuse and trauma on high-risk behaviors and might help to improve services for substance-abusing parents involved in the child welfare system. Finally, the future success of reducing child abuse and neglect and parental substance use could hinge on the partnership between judicial and substance abuse treatment through FDTCs. Findings from this exploratory pilot study should be replicated with more representative and larger samples.

Comparing Two Service Delivery Models for Homeless Individuals With Complex Behavioral Health Needs: Preliminary Data From Two SAMHSA Treatment for Homeless Studies

Assertive Community Treatment (ACT) and the Comprehensive, Continuous, Integrated System of Care (CCISC) are two models for delivering services to homeless persons with complex behavioral health needs. This quasi-experimental study presents preliminary data comparing these two programs. The first program was based out of a community mental health center and utilized the ACT model of care with supported housing (ACT-SH), and the second program was based out of a substance abuse treatment agency and used the CCISC model of care in a residential treatment facility (CCISC-RT). Participants completed clinical assessment interviews at baseline before being admitted to the programs and then 6 months later. Measures included the Brief Symptom Inventory (BSI) to measure mental health symptoms; the Treatment Services Needed and Received (TSNR) to assess service needs, utilization, and levels of unmet needs; and a tool assessing employment, housing, and past-month substance use. Results indicated that participants in both interventions reported significant reductions in substance use and mental health symptoms, although the CCISC-RT program was associated with slightly greater reductions in mental health symptoms. Both programs were also associated with significant improvements in residential stability, although participants in the ACT-SH program were more likely to own or rent their own residence 6 months following program enrollment. This study indicates that both the ACT and CCISC models of care can be successfully implemented to serve homeless individuals with behavioral health needs. Although the CCISC-RT program was based in a residential treatment facility and delivered a greater intensity of behavioral health services than the ACT-SH program, results indicate that either approach can successfully be used to assist homeless individuals in obtaining a variety of needed services, reducing their substance use and mental health symptoms, and attaining a stable residence.

Assessing Trauma-Informed Care Readiness in Behavioral Health: An Organizational Case Study

Objective: In this organizational case study the authors pilot a new protocol for evaluating and developing trauma-informed care in behavioral health settings. Methods: A mixed methods design was used to collect data with three instruments: the Adverse Childhood Experiences, the Consumer Perceptions of Care, and the Community Readiness Model key informant interview. Adults (N = 138) in a behavioral health residential treatment program provided a consumer perspective on trauma and integrated services. Providing the staff perspective, key informant interviews of staff (N = 7) were conducted and the overall protocols utility was assessed. Results: Results indicate the protocol is an efficient, strength-based, and culturally sensitive assessment approach that provided valuable data about the agencys prevalence of consumer trauma, level of integrated trauma-informed services, and readiness to advance a trauma-informed organizational culture. The piloted protocol also fostered understanding of trauma-informed care principles among staff and improved awareness of how to enhance the level of trauma-informed services at their agency. Conclusions: In addition to providing assessment data, the protocol helped agency staff and leadership to fully engage and mobilize toward change. Further application of this tool and future research are discussed.

The role of coercion in the treatment of women with co-occurring disorders and histories of abuse

Debate continues on issues of involuntary treatment for individuals with behavioral healthcare problems. Women with co-occurring disorders and histories of abuse are an especially vulnerable population. This study seeks to increase our knowledge about the experiences of coercion for women in the behavioral healthcare system. Patterns of coercion are explored. This study did not find the predicted relationship between high levels of interpersonal violence and frequent involuntary treatment experiences. The results do offer support for the hypothesis that women are more likely to be currently mandated to treatment if they have been recently arrested, and that being mandated to treatment does not appear to be related to clinical issues such as recidivism and acute symptoms. As expected, women currently required to be in treatment report having less choice in other aspects of their care. Implications for future research in the current climate of increasingly coercive policies are presented.

Creating Alcohol and Other Drug, Trauma, And Mental Health Services For Women in Rural Florida: The Triad Women's Project

SUMMARY Located in central Florida, the Triad Womens Project is a comprehensive system of care developed to respond to the needs of women and children living in a three-county semi-rural area. The women have histories of abuse or violence, co-occurring alcoholism and other drug (AOD) and mental health disorders, and have been high utililizers of behavioral healthcare services. This paper will describe the efforts of collaborating providers, the women themselves, services researchers, and concerned community members to develop services to assist these women in their AOD recovery, their healing from abuse, and their empowerment in dealing with mental illnesses. Practical information on establishing consensus, dealing with barriers and filling service gaps will be presented.