Trauma Recovery and Empowerment Model (TREM)

Scientific Rating:
3
Promising Research Evidence
See scale of 1-5
Child Welfare System Relevance Level:
Medium
See descriptions of 3 levels

About This Program

The information in this program outline is provided by the program representative and edited by the CEBC staff. Trauma Recovery and Empowerment Model (TREM) has been rated by the CEBC in the area of: Trauma Treatment (Adult).

Target Population: Women who have a history of sexual, physical, and/or emotional abuse and can have severe mental health problems and frequent co-occurring substance abuse issues

Brief Description

TREM is a fully manualized 24- to 29-session group intervention for women who survived trauma and have substance use and/or mental health conditions. This model draws on cognitive–behavioral, skills training, and psychoeducational techniques to address recovery and healing from sexual, physical, and emotional abuse. TREM consists of three major parts. The first section, on empowerment, helps group members learn strategies for self-comfort and accurate self-monitoring as well as ways to establish safe physical and emotional boundaries. The second component of TREM focuses more directly on trauma experience and its consequences. In the third section, focus shifts explicitly to skills building. These sessions include emphases on communication style, decision-making, regulating overwhelming feelings, and establishing safer, more reciprocal relationships.

Program Goals:

The overall goals of the Trauma Recovery and Empowerment Model (TREM) are:

  • Increased trauma recovery skills
    • Increased self-esteem
    • Increased boundary-setting
    • Increased emotional regulation
    • Increased judgment and decision-making
  • Decreased mental health symptoms
    • Decreased anxiety
    • Decreased depression
    • Decreased hostility
    • Decreased posttraumatic stress disorder (PTSD) symptoms
  • Decreased substance abuse

Essential Components

The essential components of the Trauma Recovery and Empowerment Model (TREM) include:

  • 24 to 29 sessions offered in the prescribed order
  • Ten topics in first section that address empowerment:
    • What It Means To Be a Woman
    • What Do You Know and How Do You Feel About Your Body?
    • Physical Boundaries
    • Emotional Boundaries: Setting Limits and Asking for What You Want
    • Self-Esteem
    • Developing Ways To Feel Better: Self-Soothing
    • Intimacy and Trust
    • Female Sexuality
    • Sex With a Partner
    • A transition section from the first to the second sections
  • At least ten topics in second section that address trauma:
    • Gaining an Understanding of Trauma
    • The Body Remembers What the Mind Forgets
    • What Is Physical Abuse?
    • What Is Sexual Abuse?
    • Physical Safety
    • What Is Emotional Abuse?
    • Institutional Abuse
    • Abuse and Psychological or Emotional Symptoms
    • Trauma and Addictive or Compulsive Behavior
    • Abuse and Relationships
  • Section three includes the following topics:
    • Family—Myths and Distortions
    • Family Life: Current
    • Decision-making: Trusting Your Judgment
    • Communication: Making Yourself Understood
    • Self-Destructive Behaviors
    • Blame, Acceptance, and Forgiveness
    • Feeling out of Control
    • Relationships
    • Personal Healing
  • Two or three co-leaders and three to ten group members for each session
  • Group leaders who are able to engage effectively with the members
  • The ability to meet weekly (at least) for 75 minutes per session
  • The Trauma Recovery and Empowerment Profile (TREP) to measure outcomes

Adult Services

Trauma Recovery and Empowerment Model (TREM) directly provides services to adults (regardless of whether they are parents or caregivers) and addresses the following:

  • Disrupted life coping skills; mental health symptoms such as anxiety, depression, hostility, and posttraumatic stress disorder (PTSD); substance abuse

Delivery Settings

This program is typically conducted in a(n):

  • Community Agency
  • Hospital
  • Outpatient Clinic
  • Prison or pre-release center
  • Residential Care Facility
  • Domestic Violence Shelter

Homework

This program does not include a homework component.

Languages

Trauma Recovery and Empowerment Model (TREM) does not have materials available in a language other than English.

Resources Needed to Run Program

The typical resources for implementing the program are:

A group room, two or three co-leaders, and the treatment manual (Harris, M., & The Community Connections Working Group. (1998). Trauma Recovery and Empowerment: A clinician’s guide to working with women in groups. New York: The Free Press.)

Minimum Provider Qualifications

General background in running group interventions; specific training in TREM is strongly recommended, though not mandatory.

Education and Training Resources

There is a manual that describes how to implement this program, and there is training available for this program.

Training Contacts:
  • Rebecca Wolfson Berley, MSW, Director of Trauma Education, Community Connections

    phone: (202) 608-4735
  • Lori Beyer, LICSW, Lead Trainer, Community Connections
Training is obtained:

Training is usually provided either onsite at an agency requesting this training or at a regional training institute in behavioral health.

Number of days/hours:

2 days

Implementation Information

Since Trauma Recovery and Empowerment Model (TREM) is rated on the Scientific Rating Scale, information was requested from the program representative on available pre-implementation assessments, implementation tools, and/or fidelity measures.

Show implementation information...

Pre-Implementation Materials

There are no pre-implementation materials to measure organizational or provider readiness for Trauma Recovery and Empowerment Model (TREM).

Formal Support for Implementation

There is formal support available for implementation of Trauma Recovery and Empowerment Model (TREM) as listed below:

Support is offered by supervision or consultation, usually at a distance (requires the capacity to audiotape group sessions and to forward the audio files to Community Connections). Supervision and consultation vary widely in the frequency and duration of the arrangement, depending on the needs of the trainees.

Fidelity Measures

There are fidelity measures for Trauma Recovery and Empowerment Model (TREM) as listed below:

The TREM Fidelity Scale has been used in a number of studies of TREM’s effectiveness. It includes a set of items addressing the context of the groups (addressing such domains as the training of the other professionals working with the TREM clients, the screening and referral process, etc.). A second section addresses the specifics of each group’s implementation (number of sessions covered in order, e g.), And the third section provides a look at the details of each session’s implementation (number of comments made by the leaders; types of comments, leaders’ style, and extent to which session goals were met). The TREM Fidelity Scale is available through the program representative, whose information can be found at the bottom of the page.

Implementation Guides or Manuals

There are implementation guides or manuals for Trauma Recovery and Empowerment Model (TREM) as listed below:

The implementation guide is included in the training offered by Community Connections and reflects the training manual to a significant degree.

Research on How to Implement the Program

Research has not been conducted on how to implement Trauma Recovery and Empowerment Model (TREM).

Relevant Published, Peer-Reviewed Research

This program is rated a "3 - Promising Research Evidence" on the Scientific Rating Scale based on the published, peer-reviewed research available. The practice must have at least one study utilizing some form of control (e.g., untreated group, placebo group, matched wait list study) establishing the practice's benefit over the placebo, or found it to be comparable to or better than an appropriate comparison practice. Please see the Scientific Rating Scale for more information.

Child Welfare Outcome: Child/Family Well-Being

Show relevant research...

Cocozza, J. J., Jackson, E. W., Hennigan, K., Morrissey, J. P., Reed, B. G., Fallot, R., & Banks, S. (2005). Outcomes for women with co-occurring disorders and trauma: Program-level effects. Journal of Substance Abuse Treatment, 28(2), 109-119.

Type of Study: 9-site controlled before-and-after study
Number of Participants: 2,006

Population:

  • Age — Mean=36 year
  • Race/Ethnicity — 49% Non-Hispanic White, 26% Non-Hispanic Black, and 17% Hispanic
  • Gender — 100% Female
  • Status — Participants were women who have experienced interpersonal violence.

Location/Institution: Multi-site, National

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study reported results of a study that examined nine-sites (Trauma Recovery and Empowerment Model [TREM] was used at three sites) that provided comprehensive, integrated, trauma-informed, and consumer-involved services for women who have mental health problems, substance use disorders, and who have experienced interpersonal violence. Women participated in interviews at baseline, 3, 6, 9, and 12 months. Measures utilized include the Global Severity Index (GSI) from the Brief Symptom Inventory, the Addiction Severity Index (ASI), and the Symptom Scale was used to measure Posttraumatic Symptom Severity. Results indicated that sites which provided significantly more integrated counseling produced more favorable results in mental health symptoms and both alcohol and drug use problem severity. The same trend is observable for reductions in post-traumatic stress symptoms, although the difference does not attain statistical significance. Limitations include selection bias, comparison conditions were also not uniform and static. Note: Results are not reported separately for TREM clients.

Length of postintervention follow-up: 6 months.

Morrissey, J. P., Jackson, E. W., Ellis, A. R., Amaro, H., Brown, V. B., & Najavits, L. M. (2005). Twelve-month outcomes of trauma-informed interventions for women with co-occurring disorders. Psychiatric Services, 56, 1213-1222.

Type of Study: 9-site controlled before-and-after study
Number of Participants: 2,026 total across all sites (Trauma Recovery and Empowerment Model[TREM] was used at three of the nine study sites)

Population:

  • Age — 18 years and older
  • Race/Ethnicity — 50% Caucasian, 25% African-American, 17% Hispanic, and 7% Other or Mixed
  • Gender — 100% Female
  • Status — Participants were women in community treatment with co-occurring mental health and substance use disorders.

Location/Institution: National, multisite

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This article reported results of a study that was developed to test the effectiveness of new service approaches specifically designed for these women survivors of trauma with co-occurring mental health and substance use disorders. Nine sites utilized a comprehensive, integrated, trauma-informed, and consumer-involved approach to treatment. TREM was used at 3 of the 9 sites. Women participated in interviews at baseline, 3, 6, 9, and 12 months. Measures utilized include the Global Severity Index (GSI) from the Brief Symptom Inventory, the Addiction Severity Index (ASI), and the Symptom Scale was used to measure Posttraumatic Symptom Severity. Results indicate for substance use outcomes, no effect was found and 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. Results also 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. Limitations include selection bias, inability to compare across site and conditions, reporting bias, and non-randomization. Note: Results are not reported separately for TREM clients.

Length of postintervention follow-up: 12 months.

Toussaint, D. W., VanDeMark, N. R., Bornemann, A., & Graeber, C. J. (2007). Modifications to the Trauma Recovery and Empowerment Model (TREM) for substance-abusing women with histories of violence: Outcomes and lessons learned at a Colorado substance abuse treatment center. Journal of Community Psychology, 35(7), 879-894.

Type of Study: Non-equivalent control groups design
Number of Participants: 170

Population:

  • Age — 29–33 years
  • Race/Ethnicity — Not specified
  • Gender — Not specified
  • Status — Participants were women in residential treatment with co-occurring mental health and substance use disorders.

Location/Institution: Arapaho House - Colorado

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This article reported outcomes for the Trauma Recovery and Empowerment Model (TREM) which was modified for use in an existing residential substance abuse program. Measures utilized include Life Stressors Checklist (LSC-R), the Global Severity Index (GSI), the Social Role Functioning Index, the Addiction Severity Index (ASI), the Current Exposure to Interpersonal Abuse (CEIA) Scale, the Current Exposure to Other Stressors (CEOS) Scale, the PTSD Symptom Scale (PSS), the Brief Symptom Inventory (BSI), a six item safety scale, a three-item feeling Response – Dissociation Scale, and a nine item-Feeling Response-Trauma Coping Index. Results demonstrated significantly better outcomes than those who received treatment-as-usual on trauma related symptoms, although not on alcohol or drug use. Limitations include non-randomization, generalizability due to population and sample bias.

Length of postintervention follow-up: 6 and 12 months.

Fallot, R. D., McHugo, G. J., Harris, M., & Xie, H. (2011). The trauma recovery and empowerment model: A quasi-experimental effectiveness study. Journal of Dual Diagnosis, 7(1-2), 74-89.

Type of Study: One group pretest/posttest study, with non-equivalent comparison group
Number of Participants: 251

Population:

  • Age — Mean=42 years
  • Race/Ethnicity — 82.1% African American and 14.7% White
  • Gender — 100% Female
  • Status — Participants were women with histories of physical and/or sexual abuse and co-occurring serious mental illnesses and substance use disorders.

Location/Institution: Washington, DC and Baltimore, MD

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study tested the effectiveness of the Trauma Recovery and Empowerment Model (TREM), a group intervention for women trauma survivors, in comparison to services as usual. TREM groups were added to standard services at two community mental health agencies in Washington, DC, while comparison group participants received usual services at two agencies in Baltimore, MD. Measures utilized include the Life Stressor Checklist–Revised [LSC-R], Global Severity Index (GSI) from the Brief Symptom Inventory, the Addiction Severity Index (ASI), and the Posttraumatic Symptom Scale. Results indicated TREM participants showed greater reductions in alcohol and drug abuse severity, anxiety symptoms, and current stressful events, and they showed greater increases in perceived personal safety. There were no group differences in change for posttraumatic stress disorder and global mental health symptoms, physical and mental health–related quality of life, and exposure to interpersonal abuse. Changes in trauma recovery skills were associated positively with gains in study outcomes for TREM group participants. Limitations include non-randomization of participants and differences between the two groups at baseline.

Length of postintervention follow-up: Approximately 4 months.

References

Fallot, R. D., & Harris, M. (2002). Trauma Recovery and Empowerment Model (TREM): Conceptual and practical issues in a group intervention for women. Community Mental Health Journal, 38(6), 475-485.

Contact Information

Name: Rebecca Wolfson Berley, MSW
Agency/Affiliation: Community Connections
Website: www.ccdc1.org
Email:
Phone: (202) 608-4735
Fax: (202) 544-5365

Date Research Evidence Last Reviewed by CEBC: September 2016

Date Program Content Last Reviewed by Program Staff: October 2014

Date Program Originally Loaded onto CEBC: July 2013