Twelve-month outcomes of trauma-informed interventions for women with co-occurring disorders.
OBJECTIVE
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.


METHODS
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.


RESULTS
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.


CONCLUSIONS
Outcomes for women with co-occurring disorders and a history of violence and trauma may improve with integrated treatment.
Morrissey
Joseph P
JP
Department of health policy and administration and the Cecil G. Sheps Center for Health Services Research at the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, USA. joe_morrissey@unc.edu
Jackson
Elizabeth W
EW
Ellis
Alan R
AR
Amaro
Hortensia
H
Brown
Vivian B
VB
Najavits
Lisa M
LM
D000328:Adult; D003191:Comprehensive Health Care; D003376:Counseling / Q000379:methods*; D003710:Demography; D017831:Diagnosis, Dual (Psychiatry); D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007398:Interpersonal Relations; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D011613:Psychotherapy / Q000379:methods*; D012720:Severity of Illness Index; D013179:Spouse Abuse / Q000706:statistics & numerical data*; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D019966:Substance-Related Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D013997:Time Factors