Massachusetts' statewide initiative for trauma-informed treatment for substance use disorders

Because of the prevalence of histories of trauma among those with alcohol and other drug problems, it is vital that treatment for alcohol and drug use disorders be designed to work effectively with trauma survivors. SAMHSA's Women, Co-Occurring Disorders and Violence study demonstrated that trauma-informed, integrated services that included skill-building trauma recovery groups produced better outcomes for women with co-occurring substance abuse and mental health disorders and histories of physical and sexual abuse than did services as usual. Based on these findings, the Massachusetts Department of Public Health/Bureau of Substance Abuse Services developed an initiative to enhance the capacity of substance abuse treatment to provide trauma-informed care. Components of the initiative include: requirement for trauma-informed care in contract terms and conditions; trauma needs assessment; separate regional trainings for administrators/supervisors and for direct care workers; a three-session psycho-educational curriculum for use in short-term programs; trauma services included in an on-line resource directory; annual statewide training; and on-site training (including co-facilitation of trauma recovery groups in a train-the-trainer model) and technical assistance at programs. Although these strategies have been somewhat effective, there is currently no means to measure effectiveness. It has therefore been decided to enhance these efforts in the future to ensure that training translates into practice change. Programs will be required to select a person responsible for implementing trauma-informed services, conduct a trauma self-assessment, and develop a trauma strategic plan, in order to receive on-site training and technical assistance. The Trauma Self-Assessment will be re-administered to measure practice change.