Helping Women Recover & Beyond Trauma (HWR/BT)

2  — Supported by Research Evidence
Medium
NR  — Not able to be Rated
Medium

About This Program

Target Population: Adult women with addictive disorders and a trauma history (e.g., abuse, domestic violence, community violence, etc.)

Program Overview

HWR/BT is a combined intervention of 32 sessions that integrates three theories: a theory of addiction, a theory of women’s psychological development, and a theory of trauma; and then adds a psychoeducational component that teaches women what trauma is, its process, and its impact. The program model is organized into seven modules. The first four: Self, Relationships, Sexuality, and Spirituality are areas that recovering women have identified as triggers for relapse and as necessary for growth and healing. The last three: Violence, Abuse, and Trauma; The Impact of Trauma on Women’s Lives; and Healing from Trauma; focus on the trauma with a major emphasis on coping skills, with specific exercises for developing emotional wellness. The program comes with facilitator’s manuals, two participant workbooks (A Women’s Journal and A Healing Journey), and 3 DVDs. The materials are designed to be user-friendly and self-instructive. A special edition for criminal justice settings has also been developed.

Note: The Beyond Trauma materials were expanded and revised in 2017. The changes include an additional session, expanded sessions, inclusion of information from neuroscience, updated statistics, and resources. These changes have not been reviewed by the CEBC and are not included in the program’s Scientific Rating. The Helping Women Recover materials were expanded and revised in 2019. The changes include adding trauma-sensitive yoga exercises, updated gender information, expanded mindfulness information, new brain research as it relates to addiction and trauma, updated statistics, Adverse Childhood Experiences (ACEs) information, and the process of trauma and its effects on the mind and body. These changes have not been reviewed by the CEBC and are not included in the program’s Scientific Rating.

Program Goals

The overall goals of Helping Women Recover & Beyond Trauma (HWR/BT) are:

  • Decrease substance use disorders
  • Decrease depression
  • Increase understanding of trauma
  • Decrease trauma symptoms
  • Increase self-efficacy
  • Stabilize recovery

Logic Model

The program representative did not provide information about a Logic Model for Helping Women Recover & Beyond Trauma (HWR/BT).

Essential Components

The essential components of Helping Women Recover & Beyond Trauma (HWR/BT) include:

  • The Helping Women Recover part of the combined curriculum with four modules with specific topic areas for each of the 20 sessions (there is also a self-administered recovery scale for each module):
    • Opening Session: Introduction to the Program with total of 3 activities
    • Module A: Self - 4 sessions with a total of 11 activities:
      • Defining Self
      • Sense of Self
      • Self-Esteem
      • Sexism, Stereotyping, and Power
    • Module B: Relationships - 7 sessions with a total of 17 activities:
      • Family of Origin
      • Mothers
      • Mother Myths
      • Fathers
      • Understanding Abuse and Trauma
      • Interpersonal Violence
      • Creating Supportive and Loving Relationships
    • Module C: Sexuality - 5 sessions with a total of 15 activities:
      • Sexuality and Addiction
      • Body Image
      • Gender Identity and Sexual Orientation
      • Challenges to Healthy Sexuality
      • Healthy Sexuality
    • Module D: Spirituality - 3 sessions with a total of 11 activities:
      • What is Spirituality?
      • Mindfulness, Prayer, and Meditation
      • Creating a Vision
  • The Beyond Trauma part of the combined curriculum with three modules with specific topic areas for each of the 12 sessions.
    • Module A: Violence, Abuse and Trauma - 4 sessions with a total of 11 activities:
      • Introduction to the Program
      • The Connections between Violence, Abuse and Trauma
      • Power and Abuse
      • The Process of Trauma and Reactions to Trauma
    • Module B: The Impact of Trauma on Women’s Lives - 2 sessions with a total of 8 activities:
      • How Trauma Impacts our Lives
      • Abuse and the Family
    • Module C: Healing from Trauma - 6 sessions with a total of 21 activities:
      • The Connection between Trauma and Addiction: Spirals of Recovery and Healing
      • Grounding and Self-Soothing
      • The Mind and Body Connection
      • Our Feelings
      • Healthy Relationships
      • Endings and Beginnings
    • Recommended group size: 6-12 women with one facilitator
    • Each session also has an adaptation option for girls ages 13-18

Program Delivery

Adult Services

Helping Women Recover & Beyond Trauma (HWR/BT) directly provides services to adults (regardless of whether they are parents or caregivers) and addresses the following:

  • Substance abuse, interpersonal violence, symptoms from experiencing trauma

Recommended Intensity:

One or two 2-hour sessions of Helping Women Recover each week. One or two 2-hour sessions of Beyond Trauma each week.

Recommended Duration:

32 sessions – approximately 4-7 months

Delivery Settings

This program is typically conducted in a(n):

  • Outpatient Clinic
  • Community-based Agency / Organization / Provider
  • Group or Residential Care
  • Justice Setting (Juvenile Detention, Jail, Prison, Courtroom, etc.)
  • Other

Homework

Helping Women Recover & Beyond Trauma (HWR/BT) includes a homework component:

Women have two journals used consecutively to process their group experience and practice skills.

Resources Needed to Run Program

The typical resources for implementing the program are:

  • Facilitator’s guides
  • Flip chart
  • Workbooks
  • Room with chairs in a circle
  • A group facilitator
  • Art supplies for collage work

Manuals and Training

Prerequisite/Minimum Provider Qualifications

Counselor with experience in the field and with group work or a college graduate

Manual Information

There is a manual that describes how to deliver this program.

Training Information

There is training available for this program.

Training Contact:
Training Type/Location:

Training can be provided onsite. There are also trainings available at various sites in California and other parts of the U.S. Once the program is implemented, fidelity scales are available to assist with implementation.

For more information see, www.stephaniecovington.com and www.centerforgenderandjustice.org.

Number of days/hours:

Generally 2 days

Additional Resources:

There currently are additional qualified resources for training:

Please contact the Training Contact above for a list of certified trainers.

Implementation Information

Pre-Implementation Materials

There are no pre-implementation materials to measure organizational or provider readiness for Helping Women Recover & Beyond Trauma (HWR/BT).

Formal Support for Implementation

There is formal support available for implementation of Helping Women Recover & Beyond Trauma (HWR/BT) as listed below:

Certified trainers can provide additional training and ongoing support as requested.

Fidelity Measures

There are fidelity measures for Helping Women Recover & Beyond Trauma (HWR/BT) as listed below:

A standard fidelity measurement scale is available upon request through the Office of Stephanie Covington, PhD, LCSW, either via phone: 858-454-8528 or email:sc@stephaniecovington.com

Implementation Guides or Manuals

There are implementation guides or manuals for Helping Women Recover & Beyond Trauma (HWR/BT) as listed below:

The Facilitator Guide provides complete directions and implementation guidelines. The guide is available upon request through the Office of Stephanie Covington, PhD, LCSW, either via phone: 858-454-8528 or email:sc@stephaniecovington.com

Research on How to Implement the Program

Research has not been conducted on how to implement Helping Women Recover & Beyond Trauma (HWR/BT).

Relevant Published, Peer-Reviewed Research

Covington, S., Burke, C., Keaton, S., & Norcott, C. (2008). Evaluation of a trauma-informed and gender-responsive intervention for women in drug treatment. Journal of Psychoactive Drugs, SARC Supplement 5, 387-398. doi:10.1080/02791072.2008.10400666

Type of Study: One group pretest-posttest study
Number of Participants: 202

Population:

  • Age — 18-54 years
  • Race/Ethnicity — White 41%, Hispanic 31%, Black/African American 18%, and Other 10%
  • Gender — 100% Female
  • Status — Participants were from a twelve-month residential drug and alcohol treatment program for women.

Location/Institution: California

Summary: (To include basic study design, measures, results, and notable limitations)
This study examined the use of the Helping Women Recover and Beyond Trauma (HWR/BT) curricula in a residential drug and alcohol treatment facility for women. Women who successfully completed the HWR/BT programs were assessed at several points in time. Measures included the Trauma Symptom Checklist, Beck Depression Inventory, and Addiction Severity Index for females. The findings indicated less substance use, less depression, and fewer trauma symptoms —including anxiety, sleep disturbances, and dissociation—after participation in the HWR/BT curricula. Limitations included the lack of a comparison or control group and a high rate of attrition between intake and exit.

Length of postintervention follow-up: None.

Messina, N., Grella, C. E., Cartier, J., & Torres, S. (2010). A randomized experimental study of gender-responsive substance abuse treatment for women in prison. Journal of Substance Abuse Treatment, 38(2), 97–107. doi:10.1016/j.jsat.2009.09.004

Type of Study: Randomized controlled trial
Number of Participants: 115

Population:

  • Age — Mean=36 years
  • Race/Ethnicity — 48% White, 17% Black, 26% Hispanic, and 9% Other
  • Gender — 100% Female
  • Status — Participants were women who participated in prison based substance abuse treatment program.

Location/Institution: California

Summary: (To include basic study design, measures, results, and notable limitations)
This study compared post-release outcomes for women who participated in prison-based substance abuse treatment. Women were randomized to a gender-responsive treatment program using the manualized Helping Women Recover and Beyond Trauma (HWR/BT) curricula or a standard prison-based therapeutic community. Data were collected from the participants at prison program entry and 6 and 12 months after release. Measures included the Addiction Severity Index (ASI) Lite and the Posttraumatic Stress Diagnostic Scale, along with administrative records from the prison and treatment providers. Results indicate that both groups improved in psychological well-being, but data from the Posttraumatic Stress Diagnostic Scale was not reported at the follow-up time point. HWR/BT participants had greater reductions in drug use, were more likely to remain in residential aftercare longer, and were less likely to have been re-incarcerated within 12 months after parole. Limitations included a lack of fidelity measures during the active treatment phase, the relatively small sample size, and limited power in the study.

Length of postintervention follow-up: 1 year.

Messina, N., Calhoun, S., & Warda, U. (2012). Gender responsive drug court treatment: A randomized controlled trial. Criminal Justice and Behavior, 9(12), 1539-1558. doi:10.1177/0093854812453913

Type of Study: Randomized controlled trial
Number of Participants: 94

Population:

  • Age — Mean=36 years
  • Race/Ethnicity — 58% White and 22% Hispanic
  • Gender — 100% Female
  • Status — Participants were women offenders admitted into participating drug court programs.

Location/Institution: San Diego, CA

Summary: (To include basic study design, measures, results, and notable limitations)
This study compared outcomes for women offenders who participated in four drug court programs. Participants were randomly assigned to either Helping Women Recover and Beyond Trauma (HWR/BT) or standard mixed-gender treatment. Measures utilized include the Posttraumatic Stress Diagnostic Scale (PDS) and the Addiction Severity Index–Lite (ASI). Results showed that there were no significant differences between the HWR/BT and standard groups on drug use or PTSD symptoms at follow-up. HWR/BT participants had better in-treatment performance and more positive perceptions related to their treatment experience. Limitations include the small sample size and concerns regarding treatment fidelity across the sites.

Length of postintervention follow-up: Unclear – approximately 22 months after treatment entry with treatment lasting 15 to 24 months. Subjects still in treatment at follow-up were excluded from the analyses.

Saxena, P., Messina, N., & Grella, C. E., (2014). Who benefits from gender responsive treatment. Accounting for abuse history on longitudinal outcomes for women in prison. Criminal Justice and Behavior, 41(4), 417-432. doi:10.1177/0093854813514405

Type of Study: Randomized controlled trial
Number of Participants: 115

Population:

  • Age — Mean=35.7- 36.1 years
  • Race/Ethnicity — 48% White, 26% Latina, 17% Black, and 9% Other
  • Gender — 100% Female
  • Status — Participants were women in the California State Prison System.

Location/Institution: Valley State Prison for Women (VSPW) in California

Summary: (To include basic study design, measures, results, and notable limitations)
Study uses the same sample as Messina, Grella, Cartier, & Torres (2010). This study reports on psychological and substance use outcomes for incarcerated women with prior experience with physical/sexual abuse receiving gender response treatment (GRT). The two treatment groups involved were in the Integrity Program (GRT [now called Helping Women Recover and Beyond Trauma (HWR/BT)]) or the Destiny Program (using a standard TC group). Measure utilized was the Posttraumatic Stress Diagnostic Scale (PDS). Random assignment was primarily performed by the assignment lieutenant, who placed all treatment-eligible women with an even California Department of Corrections and Rehabilitation (CDCR) identification number into the Integrity Program and all women with an odd CDCR identification number into the Destiny Program. Results indicate that HWR/BT has shown potential for mitigating negative outcomes (i.e., depression and substance use) associated with histories of abuse for incarcerated women. Women offenders who had experienced prior traumatic events (i.e., physical/sexual abuse) improved their psychological status and decreased the number of substances they used in the trauma-informed gender-responsive substance abuse treatment group. Even when controlling for the presence of clinical level trauma distress (i.e., posttraumatic stress disorder [PTSD]), HWR/BT successfully moderated the associations between abuse and depression and abuse and substance use. Limitations include generalizability to other populations, reliability of self-reported measures; the study did not have a systematic procedure to evaluate the fidelity of the intervention to HWR/BT's principles and specific components.

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

Additional References

Research Articles

Covington, S. (December 2013). “Chapter IV: Understanding and applying gender differences in recovery.” In United Nations Interregional Crime and Justice Research Institute (UNICRI) (Eds.), Dawn Drug Alcohol Woman Network: Promoting a gender-responsive approach to drug addiction (a collection of good practices). Turin, Italy: Author.

Poole, N., & Greaves, L. (Eds). (2012). Becoming trauma informed. Toronto, Ontario, Canada: Centre for Addiction and Mental Health (CAMH).

Descriptive Articles

Covington, S. (2008). Women and addiction: A Trauma-informed approach. Journal of Psychoactive Drugs, November (Suppl. 5), 377-385. Retrieved from https://www.stephaniecovington.com/site/assets/files/1338/covington_sarc.pdf

Contact Information

Stephanie S. Covington, PhD, LCSW
Agency/Affiliation: Center for Gender and Justice
Website: www.stephaniecovington.com
Email:
Phone: (858) 454-8528
Fax: (858) 454-8598

Date Research Evidence Last Reviewed by CEBC: April 2020

Date Program Content Last Reviewed by Program Staff: December 2019

Date Program Originally Loaded onto CEBC: June 2013