Women, Co-occurring Disorders, And Violence Study Research Articles

Targeting Trauma-related Interventions and Improving Outcomes for Women with Co-occurring Disorders

National attention to the effects of interpersonal trauma has led mental health systems to adopt policies on trauma-related services; however, there is a lack of clarity regarding targeting of these services. Data from the Women, Co-occurring Disorders and Violence Study (WCDVS) were reanalyzed by grouping women on their baseline PTSD and substance abuse presentation and assessing the differential response to an integrated mental health/substance abuse intervention. Treatment effects were largest for subgroups characterized by high levels of PTSD, whereas the effects for those in the low symptom group were near zero. These findings underscore the need for clinicians to conduct careful assessments of trauma-related symptoms and to target the most intensive trauma-related interventions to individuals with PTSD symptoms.

Promoting resiliency in children of mothers with co‐occurring disorders and histories of trauma: Impact of a skills‐based intervention program on child outcomes

AbstractUsing a quasi‐experimental design, this study examined the effectiveness of a standardized intervention model designed to build resiliency in children of women with co‐occurring mental health and substance use disorders and histories of interpersonal abuse. The children and mothers who participated in this study were a subset of the sample used for the Women, Co‐occurring Disorders and Violence Study (WCDVS). The children's intervention model consisted of three components: clinical assessment, service coordination and advocacy, and a psychoeducational skills‐building group. Children in the comparison group received individual, group, and family services. Six‐month and 12‐month outcomes were examined among 253 children. Children in the intervention group improved significantly more than children in the comparison group. © 2007 Wiley Periodicals, Inc. J Comm Psychol 35: 823–843, 2007.

Service Use and Costs for Women With Co-occurring Mental and Substance Use Disorders and a History of Violence

This study examined the 12-month cost of the array of services used by women with co-occurring mental health and substance use disorders and a history of violence and trauma who participated in the Women, Co-occurring Disorders, and Violence Study (WCDVS). The study compared costs of the intervention and external services for women in the WCDVS intervention in outpatient and residential settings-which provided comprehensive, integrated, and trauma-informed services-with the costs for women in the usual-care comparison group. The study also compared costs with recorded clinical outcomes. Costs of service use were examined for 2,026 women who participated in the WCDVS (N=1,018) and in the comparison group (N=1,008). Women were interviewed three, six, nine, and 12 months after baseline about any service use in the past three months. Costs for these services, along with indirect costs (participants' time and transportation) were estimated by using a variety of sources. A number of cost estimates were analyzed by using either ordinary least squares regression or two-part models. The average participant had almost 43,000 dollars in costs related to their service use during the 12 months after baseline. Women in the intervention group had lower service costs and higher overall costs than those in the comparison group, but the null hypotheses of no difference in any cost measure between groups was not rejected. Also, the null hypothesis of no difference in the probability of accessing services external to the study intervention was not rejected. Because no differences were detected in costs but improvements were seen in clinical outcomes, the interventions offered in the WCDVS may be more efficient than usual care.

Design Strengths and Issues of SAMHSA's Women, Co-occurring Disorders, and Violence Study

In 1998 the Substance Abuse and Mental Health Services Administration launched the Women, Co-occurring Disorders, and Violence Study (WCDVS). The WCDVS developed, implemented, and evaluated the outcomes and costs of comprehensive, trauma-informed treatment programs for women with a history of violence and trauma who have substance use and mental health disorders. This article discusses the overall design features of the study, issues related to such a design, results of the outcomes and cost evaluations, and suggestions for future research. The nine WCDVS sites were located across the continental United States, with six sites on the East Coast, two on the West Coast, and one in Colorado. A total of 2,729 women (1,415 in the intervention condition and 1,314 in the comparison condition) were enrolled over the 13.5-month baseline accrual period (January 2001 through February 2002). Follow-up interviews were conducted with all participants at three, six, nine and 12 months post-baseline. Women in the intervention and the comparison groups showed improvement in outcomes in four areas: alcohol use, drug use, mental health, and trauma. At six months women in the intervention group scored modestly better than women in the usual-care group for outcome measures for drug use, trauma, and mental health. At 12 months women in the intervention group maintained their improvement in drug use outcomes and continued to improve in mental health and trauma outcomes. After a start-up period, costs for services were not significantly different between the intervention and comparison groups at both follow-up points. Despite their very modest nature, the WCDVS results are promising.

Development and implementation of a multisite evaluation for the Women, Co‐Occurring Disorders and Violence Study

AbstractIn this article we describe the development and implementation of the Substance Abuse and Mental Health Services Administration's (SAMHSA's) multisite Women, Co‐Occurring Disorders and Violence Study (WCDVS), highlighting some of the challenges encountered, decisions made, and lessons learned. Four themes are discussed. First, the unique contributions of the consumer/survivor/recovering (C/S/R) women to the research process are described through instances where their knowledge and advocacy were clearly influential. Second, the solutions chosen to address research design challenges are recounted, as are the ways in which these choices played out. Third, the procedures for standardizing recruitment, data collection, and data management across sites are described. Finally, the strategies employed by the nine sites to retain contact with this challenging population are reviewed and successful techniques are highlighted. © 2005 Wiley Periodicals, Inc. J Comm Psychol 33: 411–427, 2005.

Trauma‐informed or trauma‐denied: Principles and implementation of trauma‐informed services for women

AbstractIn this article, we attempt to bridge the gap between practice (service delivery) and philosophy (trauma theory, empowerment, and relational theory). Specifically, we identify 10 principles that define trauma‐informed service, discuss the need for this type of service, and give some characteristics of trauma‐informed services in eight different human service areas. The areas include outreach and engagement, screening and assessment, resource coordination and advocacy, crisis intervention, mental health and substance abuse services, trauma‐specific services, parenting support, and healthcare. We draw upon the experiences of the nine sites involved in the Substance Abuse and Mental Health Service Administration's (SAMHSA) 5‐year grant project, Women, Co‐occurring Disorders and Violence Study (WCDVS), and include the recommendation that consumers be integrated into the design and evaluation of services. © 2005 Wiley Periodicals, Inc. J Comm Psychol 33: 461–477, 2005.

Characteristics of women engaged in treatment for trauma and co‐occurring disorders: Findings from a national multisite study

AbstractUsing data from a common cross‐site protocol administered at study enrollment, in this article we examine key characteristics of 2,729 participants in the Women, Co‐Occurring Disorders and Violence Study (WCDVS), including demographics, physical health, mental health, substance abuse, trauma experiences, parenting status, and past history of service use. These data are important because they represent the first federal initiative that addresses the significant lack of appropriate services for women with co‐occurring substance use and mental health disorders who have experienced trauma. Study findings reveal a very vulnerable population with extensive histories of abuse and substantial physical and mental health service needs. Data suggest a pressing need for increased availability of physical and mental health services capable of serving the complex needs of women with co‐occurring disorders and histories of interpersonal violence (physical and/or sexual abuse). Equally important are funding strategies to support needed services. © 2005 Wiley Periodicals, Inc. J Comm Psychol 33: 429–443, 2005.

The assessment of trauma history in women with Co-occurring substance abuse and mental Disorders and a history of interpersonal Violence

The Women, Co-occurring Disorders, and Violence Study (WCDVS) was a large (N = 2729) multisite study of the effectiveness of integrated and trauma-informed services for women with substance use and mental health disorders and a history of interpersonal violence (physical or sexual abuse). Study participants' exposure to lifetime and current traumatic events was assessed at baseline and follow-up via in-person interviews. This article describes the choice of the Life Stressor Checklist-Revised (LSC-R) to assess trauma history to meet the WCDVS's research aims and to respond to consumer input. Quantitative data address the breadth and prevalence of potentially traumatic events in the past and current lives of study participants, the formation and properties of summary measures, and test-retest reliability. Qualitative data address tolerance of the instrument by interviewers and respondents and the generalizability of quantitative findings about trauma prevalence. Finally, recommendations are offered for improvements to the WCDVS version of the LSC-R for use in future research.

The relationship between mothers' child abuse potential and current Mental Health symptoms

This analysis examined data from mothers at 2 of the 9 sites participating in Substance Abuse and Mental Health Services Administration's (SAMHSA's) national Women Co-occurring Disorders and Violence Study (WCDVS). According to previous literature, it was hypothesized that women in the WCDVS would be at high risk of perpetrating child abuse. This research examined mothers' potential for physical child abuse and assessed the association between child abuse potential, current mental health symptoms, alcohol and drug use severity, and trauma. Results revealed that participants had significant potential for child abuse. Hierarchical regression analyses revealed that current mental health symptoms were the strongest predictor of mothers' scores on the Child Abuse Potential (CAP) Inventory. This study highlights the important relationships between commonly used instruments across the mental health, substance, and child welfare fields and the potential dual use of these instruments. Implications for policy and practice are discussed.

Building resilience in children of mothers who have Co-occurring Disorders and histories of Violence

Historically, children of parents with co-occurring substance abuse and mental health disorders and histories of violence/trauma have been overlooked in behavioral health treatment systems. The Women, Co-occurring Disorders and Violence Study (WCDVS) was a 5-year initiative funded by the United States Substance Abuse and Mental Health Services Administration (SAMHSA) that included a Children's Study that explored the treatment needs of children of women with these multiple disorders. This article describes the development of the Children's Study intervention that included clinical assessment, group intervention, and resource coordination/advocacy for children aged 5-10 to build resilience through increasing coping skills, improving interpersonal relationships, and helping coalesce positive identity and self-esteem. Innovative procedures, including the participation of consumer/survivor/recovering women and mothers, in the planning, implementation, and administrative applications of this intervention and study are also highlighted. It is recommended that programs begin to implement family-focused integrated treatment approaches that can potentially increase protective factors for children affected by parental mental illness, substance abuse, and violence.

Women, Co-occurring Disorders, and Violence Study: Evaluation design and study population

The Women, Co-occurring Disorders, and Violence Study (WCDVS) was a multi-site cooperative study to evaluate new service models for women with co-occurring mental health and substance use disorders and a history of physical and/or sexual abuse. Despite common features in the service interventions and evaluation procedures, diversity across the nine sites plus differences introduced by non-random assignment led to numerous methodological challenges. This article describes the design, measurement, and analysis decisions behind the WCDVS and lays the foundation for understanding participant-level outcomes and service costs. This article also describes the study population, as recruited and following attrition at the 6-month follow-up, in order to address the threat of selection bias to inferences drawn from this multi-site study.

Improving the quality of demonstration research: Integrating those with personal experience

The 6-month outcomes presented in this issue begin to demonstrate what those with personal experience have believed for some time: that attention to trauma during substance abuse and/or mental health treatment is not only possible, but critical, and that integrated counseling (i.e., trauma, mental health, and substance abuse) facilitates healing and recovery. In addition, the depth of integration of Consumer/Survivor/Recovering (CSR) women into the Women, Co-Occurring Disorders and Violence Study (WCDVS) was an unprecedented and fruitful aspect of the project. Although the journey toward authentic collaboration has been arduous, service and research design, implementation, and data analyses and interpretations were greatly enhanced by the involvement of those with the lived experience of healing from the impact of violence.

Scholarship, collaboration, struggle, and learning in the Women, Co-occurring Disorders, and Violence Study: Introduction to the 6-month outcome papers

The four papers featured in this special section of the Journal of Substance Abuse Treatment describe the design, population, and 6-month outcomes (focused on symptom reduction) from the Women, Co-occurring Disorders and Violence Study (WCDVS). As described more fully in all the papers, previous research has demonstrated that interpersonal violence is pervasive in the lives of women and is related to a wide range of physical, mental health, and substance abuse struggles. Interventions that address all of these in an integrated way, however, are infrequently available.