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. https://doi.org/10.1016/j.jsat.2004.08.010

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 basic study design, measures, results, and 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 controlled 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(10), 1213-1222. https://doi.org/10.1176/appi.ps.56.10.1213

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 basic study design, measures, results, and 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 controlled 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. https://doi.org/10.1002/jcop.20187

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 basic study design, measures, results, and 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 controlled 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. https://doi.org/10.1080/15504263.2011.566056

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 basic study design, measures, results, and 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 controlled postintervention follow-up: Approximately 4 months.