Building a trauma-informed system of care within treatment for alcohol, tobacco and other drug disorders

Research indicates that the vast majority of individuals with substance use disorders (SUDs) have experiences of victimization, and that incorporating an understanding of the impact of trauma into treatment improves outcomes. The Massachusetts Department of Public Health/Bureau of Substance Abuse Services (BSAS) contracts with the Institute for Health and Recovery (IHR) to apply principles of organizational change to enhance the ability of the treatment system to provide trauma-informed care. Initially, training was provided for staff, but one lesson learned was that training alone did not lead to practice change. IHR then began working with individual SUD programs to conduct needs assessments, train staff, create trauma integration teams, and develop and implement trauma integration strategic plans. While this strategy was effective (as measured by change scores on self-assessments), it affected a small number of programs. To impact a larger number of programs, IHR is now training groups of programs at the same level of care and convening learning communities that meet by teleconference to develop and implement trauma integration strategic plans. IHR also assists with implementation of trauma-specific groups for adults (Seeking Safety, Helping Men Recover) and for children of parents in residential SUD treatment (Child Parent Psychotherapy) along with child-focused trauma consultation. IHR is using similar strategies in a women's prison and in a re-entry program in a county jail. It is recommended that agencies that wish to implement trauma informed care use a collaborative and flexible approach, but build on strategies with demonstrated effectiveness.