Trauma-Informed Care in a Substance Abuse Treatment Setting: A Mixed Methods Process Evaluation Open Access

Acker, Carolyn Jayne (2014)

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Trauma affects between 75% and 95% of clients in substance abuse treatment settings (Rosenberg, 2011; Wu, Schairer, Dellor, & Grella, 2010). Trauma-informed care (TIC) seeks to treat clients in a way that acknowledges and addresses clients' trauma and empowers them to recover. Evaluations have typically addressed outcomes related to substance abuse and trauma symptoms, but this study sought to evaluate the fidelity to TIC in a process evaluation and learn about client and staff experiences of TIC. Mixed-method interviews with 23 clients and in-depth interviews with 4 staff members were conducted in order to show what aspects of TIC are being implemented well and which aspects could be improved. The program had positive results, with a vast majority of the clients reporting that the program helped them feel empowered, hopeful, and safe. Although most clients felt the program was trustworthy, one client reported a possible breath of confidentiality. While clients felt that their goals were treated as the most important aspect of their treatment plan, some clients also felt that they did not have much choice and control over services offered. While women were familiar with trauma and its effects, 5 men reported not knowing the symptoms related to trauma. Staff were educated or trained in TIC, but not all of the staff reported feeling comfortable and competent with TIC. Recommendations were created with staff members based on the literature review, results of the study, and staff perceptions of feasibility and importance. These include conducting a follow-up TIC training, conducting a confidentiality training, optional client-run classes for the clients, continuing to improve clients' self-determination, improving male clients' knowledge of trauma and its effects, including a PTSD symptom scale during assessments, adding a comprehensive and sensitive trauma scale to the intake assessment.

Table of Contents

Chapter 1: Introduction 1

Defining the Problem: Substance Abuse and Trauma 1

Explanation of Program 2 Justification 4 Research Questions 5 Chapter 2: Literature Review 6

Substance Use Disorders 6

Trauma 8

Trauma and Substance Use Disorder 13

Trauma-Informed Care 15

Evaluations of Trauma-Integrated Substance Abuse Interventions 17

Evaluations of Trauma-Informed Care Systems 19

Conclusion 21 Evaluation Questions 22 Chapter 3: Methods 23 Evaluation Methods 23

Formative Key Informant Interview Methods 24

Data Collection Methods 24

Triangulation 29

Ethical Considerations and Confidentiality 31

Chapter 4: Results 33 Chapter 5: Discussion 61 Conclusions 61 Recommendations 62 Limitations 65 Strengths 66

Dissemination Plans 67

Further Evaluation Plans 67

References 68 Appendix A: CCTIC Scale 72

Appendix B: CCTIC Self-Assessment and Planning Protocol 87

Appendix C: Staff Interview Guide 105 Appendix D: Client Interview Guide 107

Appendix E: Client and Staff Combined Codebook 111

Appendix F: IRB Exemption 113 Appendix G: Staff Consent Form 114 Appendix H: Client Consent Form 117

Appendix I: Client Survey Reasons for Less than Agreement 120

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