Implementing Trauma-Informed Research-Supported Treatment: Fidelity, Feasibility, and Acceptability

Abstract

Evidence indicates the importance of integrating treatment of co-occurring traumatic stress and substance use disorders in adolescent populations. However, the effectiveness of trauma-informed research-supported treatments (TI-RSTs) depends on program fidelity, feasibility, and acceptability. This study assessed perceived fidelity, feasibility, and acceptability of two TI-RSTs, The Sanctuary Model and Seeking Safety, at one residential adolescent substance misuse treatment agency. Perceived fidelity was examined two years into implementation while feasibility and acceptability were examined over time from early in the implementation process (n = 25), to 1 year later (n = 31), and to 2 years later (n = 23) through a series of staff interviews. Findings suggest that implementation of The Sanctuary Model and Seeking Safety at adolescent residential substance misuse treatment agencies can be conducted with fidelity and is feasible and acceptable. However, findings indicate that not all TI-RSTs are responded to in the same way. Furthermore, findings suggest that additional efforts might be necessary to ensure improved and long-term feasibility and acceptability, and consequently, the success of the implementation of TI-RSTs.

This is a preview of subscription content, access via your institution.

References

  1. Aarons, G. A. (2004). Mental health provider attitudes toward adoption of evidence-based practice: The Evidence-based Practice Attitude Scale (EBPAS). Mental Health Service Research, 6, 61–74.

    Google Scholar 

  2. Aarons, G. A., Glisson, C., Hoagwood, K., Kelleher, K., Landsverk, J., Cafri, G., et al. (2010). Psychometric properties and U.S. National norms of the Evidence-Based Practice Attitude Scale (EBPAS). Psychological Assessment, 22(2), 356–365.

    PubMed  Google Scholar 

  3. Abt Associates. (2008). Characteristics of residential treatment for children and youth with serious emotional disturbances. Abt Associates Inc. Retrieved from https://www.nabh.org/wp-content/uploads/2018/06/Abt-FINAL-Report.8.4.08.pdf.

  4. Barnett, E. R., Yackley, C. R., & Licht, E. S. (2018). Developing, implementing, and evaluating a trauma-informed care program within a youth residential treatment center and special needs school. Residential Treatment for Children & Youth, 35, 95–113.

    Google Scholar 

  5. Barrett, E., Indig, D., Sunjic, S., Sannibale, C., Sindicich, N., Rosenfeld, J., … Mills, K. (2015). Treating comorbid substance use and traumatic stress among male prisoners: A pilot study of the acceptability, feasibility, and preliminary efficacy of seeking safety. International Journal of Forensic Mental Health, 14(1), 45–55.

  6. Berenz, E. C., & Coffey, S. F. (2012). Treatment of co-occurring post traumatic stress disorder and substance use disorders. Current Psychiatry Reports, 14, 469–477.

    PubMed  PubMed Central  Google Scholar 

  7. Bloom, S. L. (1994). The Sanctuary Model: Developing generic inpatient programs for the treatment of psychological trauma. In M. B. Williams & J. F. Sommer (Eds.), Handbook of post-traumatic therapy: A practical guide to intervention, treatment, and research (pp. 474–491). Westport, CN: Greenwood Publishing.

    Google Scholar 

  8. Bloom, S. (1997). Creating sanctuary: Toward an evolution of sane societies. New York, NY: Routledge.

    Google Scholar 

  9. Bloom, S. (2013). Restoring sanctuary: A new operating system for trauma-informed organizations and systems of care. New York, NY: Oxford University Press.

    Google Scholar 

  10. Bloom, S., & Farragher, B. (2011). Destroying sanctuary: The crisis in human service delivery systems. New York, NY: Oxford University Press.

    Google Scholar 

  11. Bougard, K., Laupola, T., Parker-Dias, J., Creekmore, J., & Stangland, S. (2016). Turning the tides: Coping with trauma and addiction through residential adolescent group therapy. Journal of Child and Adolescent Psychiatric Nursing, 29(4), 196–206.

    PubMed  Google Scholar 

  12. Brady, K. T., & Back, S. E. (2012). Childhood trauma, posttraumatic stress disorder, and alcohol dependence. Alcohol Research: Current Reviews, 34(4), 408–413.

    Google Scholar 

  13. Briggs, E., Greeson, J., Layne, C., Fairbank, J., Knoverek, A., & Pynoos, R. (2012). Trauma exposure, psychosocial functioning, and treatment needs of youth in residential care: Preliminary findings from the NCTSN Core Data Set. Journal of Child & Adolescent Trauma, 5, 1–15.

    Google Scholar 

  14. Bright, C. L., Raghavan, R., Kliethermes, M. D., Juedemann, D., & Dunn, J. (2010). Collaborative implementation of a sequenced trauma-focused intervention for youth in residential care. Residential Treatment for Children and Youth, 27, 69–79.

    PubMed  Google Scholar 

  15. Bruns, E. J., Kerns, S. E., Pullmann, M. D., Hensley, S. W., Lutterman, T., & Hoagwood, K. E. (2016). Research, data, and evidence-based treatment use in state behavioral health systems, 2001–2012. Psychiatric Services, 67(5), 496–503.

    PubMed  Google Scholar 

  16. Bryson, S. A., Gauvin, E., Jamieson, A., Rathgeber, M., Faulkner-Gibson, L., Bell, S., et al. (2017). What are effective strategies for implementing trauma-informed care in youth inpatient psychiatric and residential treatment settings? A realist systematic review. International Journal of Mental Health Systems, 11(36), 1–16.

    Google Scholar 

  17. Chen, C. Y., Storr, C. L., & Anthony, J. C. (2009). Early-onset drug use and risk for drug dependence problems. Addictive Behaviors, 34(3), 319–322.

    PubMed  Google Scholar 

  18. Colton, M., & Roberts, S. (2007). Factors that contribute to high turnover among residential child care staff. Child and Family Social Work, 12, 133–142.

    Google Scholar 

  19. Danielson, C., McCart, M., De Arellano, M., Macdonald, A., Doherty, L., & Resnick, H. (2010). Risk reduction for substance use and trauma-related psychopathology in adolescent sexual assault victims: Findings from an open trial. Child Maltreatment, 15(3), 261–268.

    PubMed Central  Google Scholar 

  20. Dennis, M. L., & Stevens, S. J. (2003). Maltreatment issues and outcomes of adolescent enrolled in substance abuse treatment. Child Maltreatment, 8, 3–6.

    PubMed  Google Scholar 

  21. Enoch, M. A. (2011). The role of early life stress as a predictor for alcohol and drug dependence. Psychopharmacology (Berlin), 214(1), 17–31.

    Google Scholar 

  22. Esaki, N. B., Benamati, J., Yanosy, S., Middleton, J. S., Hopson, L. M., Hummer, V. L., et al. (2013). The Sanctuary Model: Theoretical framework. Families in Society: The Journal of Contemporary Social Services, 94(2), 87–95.

    Google Scholar 

  23. Family First Prevention Services Act of 2018, H.R.1892 §§ 50701–50782 (2018).

  24. Farragher, B., & Yanosy, S. (2005). Creating a trauma-sensitive culture in residential treatment. Therapeutic Community: The International Journal for Therapeutic and Supportive Organizations, 26(1), 97–113.

    Google Scholar 

  25. Fixsen, D. L., Blase, K., Metz, A., & Van Dyke, M. (2013). Statewide implementation of evidence-based programs. Exceptional Children, 79(2), 213–230.

    Google Scholar 

  26. Fixsen, D. L., Naoom, S. F., Blase, K. A., Friedman, R. M., & Wallace, F. (2005). Implementation research: A synthesis of the literature. Tampa, FL: University of South Florida, Louis de la Parte Florida Mental Health Institute, The National Implementation Research Network (FMHI Publication #231).

  27. Garner, B. R., Hunter, B. D., Modisette, K. C., Ihnes, M. S., & Godley, S. H. (2011). Treatment staff turnover in organizations implementing evidence-based practices: Turnover rates and their association with client outcomes. Journal of Substance Abuse Treatment, 42(2), 134–142.

    PubMed  PubMed Central  Google Scholar 

  28. Gotham, H. J., Claus, R. E., Selig, K., & Homer, A. L. (2010). Increasing program capability to provide treatment for co-occurring substance use and mental disorders: Organizational characteristics. Journal of Substance Abuse Treatment, 38, 160–169.

    PubMed  Google Scholar 

  29. Greenhalgh, T., Robert, G., Macfarlane, F., Bate, P., & Kyriakidou, O. (2004). Diffusion of innovations in service organizations: Systematic review and recommendations. Milbank Quarterly, 82, 581–629.

    Google Scholar 

  30. Hamburger, M. E., Leeb, R. T., & Swahn, M. H. (2008). Childhood maltreatment and early alcohol use among high-risk adolescents. Journal of Studies on Alcohol and Drugs, 69, 291–295.

    PubMed  Google Scholar 

  31. Henggeler, S. W., Chapman, J. E., Rowland, M. D., Halliday-Boykins, C. A., Randall, J., Shackelford, J., et al. (2008). Statewide adoption and initial implementation of contingency management for substance abusing adolescents. Journal of Consulting and Clinical Psychology, 76, 556–567.

    PubMed  PubMed Central  Google Scholar 

  32. James, S. (2011). What works in group care? A structured review of treatment models for group homes and residential care. Children and Youth Services Review, 33(2), 308–321.

    PubMed  PubMed Central  Google Scholar 

  33. James, S., Alemi, Q., & Zepeda, V. (2013). Effectiveness and implementation of evidence-based practices in residential care settings. Children and Youth Service Review, 35, 642–656.

    Google Scholar 

  34. James, S., Thompson, R., & Ringle, J. (2017). The implementation of evidence-based practices in residential care: Outcomes, processes, and barriers. Journal of Emotional and Behavioral Disorders, 25(1), 4–18.

    Google Scholar 

  35. Joiner, V., & Buttell, F. (2018). Investigating the usefulness of trauma-focused cognitive behavioral therapy in adolescent residential care. Journal of Evidence-Informed Social Work, 15(4), 457–472.

    PubMed  Google Scholar 

  36. Kelly, P., Hegarty, J., Barry, J., Dyer, K. R., & Horgan, A. (2017). A systematic review of the relationship between staff perceptions of organizational readiness to change and the process of innovation adoption in substance misuse treatment programs. Journal of Substance Abuse Treatment, 80, 6–25.

    PubMed  Google Scholar 

  37. Knight, D. K., Becan, J. E., & Flynn, P. M. (2011). Organizational consequences of staff turnover in outpatient substance abuse treatment programs. Journal of Substance Abuse Treatment, 42(2), 143–150.

    PubMed  PubMed Central  Google Scholar 

  38. Kramer, M. (2016). Sanctuary in a residential treatment center: Creating a therapeutic community of hope countering violence. Therapeutic Communities, 37(2), 69–83.

    Google Scholar 

  39. Korchmaros, J. D., & Ruiz, B. (2008). Perceptions of organizational change. Tucson, AZ: The University of Arizona.

    Google Scholar 

  40. Lee, J. Y., Brook, J. S., Finch, S. J., & Brook, D. W. (2016). Pathways from victimization to substance use: Post traumatic stress disorder as a mediator. Psychiatry Research, 237, 153–158.

    PubMed  Google Scholar 

  41. Lehman, W. E. K., Simpson, D. D., Knight, D. K., & Flynn, P. M. (2011). Integration of treatment innovation planning and implementation: Strategic process models and organizational challenges. Psychology of Addictive Behaviors, 25, 252–261.

    PubMed  PubMed Central  Google Scholar 

  42. Leigh-Smith, C., Toth, K., Lehmann, J., & Sanders, R. (2014). The sanctuary model, creating safety for an out-of-home care community. Children Australia, 39(4), 232–236.

    Google Scholar 

  43. Lenz, A., Henesy, R., & Callender, K. (2016). Effectiveness of seeking safety for co-occurring posttraumatic stress disorder and substance use. Journal of Counseling & Development, 94(1), 51–61.

    Google Scholar 

  44. Little, L., Butler, L. S., & Fowler, J. (2010). Change from the ground up: Bringing informed-dialectical behavioral therapy to residential treatment. Residential Treatment of Children and Youth, 27, 80–91.

    Google Scholar 

  45. Lopez-Quintero, C., Pérez de los Cobos, J., Hasin, D. S., Okuda, M., Wang, S., Grant, B. F., et al. (2011). Probability and predictors of transition from first use to dependence on nicotine, alcohol, cannabis, and cocaine: Results of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Drug and Alcohol Dependence, 115(1–2), 120–130.

    PubMed  Google Scholar 

  46. Lundgren, L., Chassler, D., Amodeo, M., D’Ippolito, M., & Sullivan, L. (2012). Barriers to implementation of evidence-based addiction treatment: A national study. Journal of Substance Abuse Treatment, 42(3), 231–238.

    PubMed  Google Scholar 

  47. McCart, M., Zajac, K., Danielson, C., Strachan, M., Ruggiero, K., Smith, D., … Kilpatrick, D. (2011). Interpersonal victimization, posttraumatic stress disorder, and change in adolescent substance use prevalence over a ten-year period. Journal of Clinical Child & Adolescent Psychology, 40(1), 136–143.

  48. McHugh, R. K., & Barlow, D. H. (2010). The dissemination and implementation of evidence-based psychological treatments: A review of current efforts. American Psychologist, 65(2), 73–84.

    Google Scholar 

  49. McLellan, A. T., Carise, D., & Kleber, H. D. (2003). Can the national addiction treatment infrastructure support the public’s demand for quality care?. Journal of Substance Abuse Treatment, 25, 117–121.

    PubMed  Google Scholar 

  50. McSparren, W. (2007). Models of change and the impact on Organizational Culture: The Sanctuary Model®. Retrieved February 10, 2014, from https://sanctuaryweb.com/PDFs_new/McSparren%20Thesis%20Summary%20-%20McSparren%202007.pdf.

  51. Melnick, G., Wexler, H. K., Chaple, M., & Cleland, C. M. (2009). Constructive conflict and staff consensus in substance abuse treatment. Journal of Substance Abuse Treatment, 36(2), 174–182.

    PubMed  Google Scholar 

  52. Najavits, L. M. (1999). Seeking safety: A new cognitive-behavioral therapy for PTSD and substance abuse. National Center for Post-traumatic Stress Disorder Clinical Quarterly, 8, 42–45.

    Google Scholar 

  53. Najavits, L. M. (2007). Seeking Safety: An evidence-based model for substance abuse and trauma/PTSD. In K. A. Witkiewitz & G. A. Marlatt (Eds.), Therapists’ guide to evidence-based relapse prevention: Practical Resources for the mental health professional (pp. 141–167). San Diego: Elsevier Press.

    Google Scholar 

  54. Najavits, L. M., Gallop, R. J., & Weiss, R. D. (2006). Seeking Safety therapy for adolescent girls with PTSD and substance use disorder: A randomized controlled trial. Journal of Behavioral Health Services Research, 33, 453–463.

    PubMed  Google Scholar 

  55. Najavits, L. M., Liese, B. S., & Heath, N. (2007). Adapted version of the Seeking Safety Adherence Scale, based on the original version: Najavits, L. M., & Liese, B. S. (1996). Seeking Safety Adherence Scale. Unpublished scale. McLean Hospital/Harvard Medical School.

  56. Najavits, L. M., & Hien, D. (2013). Helping vulnerable populations: A comprehensive review of the treatment outcome literature on substance use disorder and PTSD. Journal of Clinical Psychology, 69, 433–479.

    PubMed  Google Scholar 

  57. Najavits, L. M., Weiss, R. D., Shaw, S. R., & Muenz, L. R. (1998). “Seeking safety”: Outcome of a new cognitive-behavioral psychotherapy for women with posttraumatic stress disorder and substance dependence. Journal of Trauma and Stress, 11, 437–456.

    Google Scholar 

  58. Nooner, K. B., Linares, L. O., Batinjane, J., Kramer, R. A., Silva, R., & Cloitre, M. (2012). Factors related to posttraumatic stress disorder in adolescence. Trauma Violence Abuse, 13(3), 153–166.

    PubMed  Google Scholar 

  59. Olin, S. S., Nadeem, E., Gleacher, A., Weaver, J., Weiss, D., Hoagwood, K. E., et al. (2016). What predicts clinician dropout from state-sponsored managing and adapting practice training. Administration & Policy in Mental Health, 43(6), 945–956.

    Google Scholar 

  60. Palinkas, L. A., Um, M. Y., Jeong, C. H., Chor, K. H., Olin, S., Horwitz, S. M., et al. (2017). Adoption of innovative and evidence-based practices for children and adolescents in state-supported mental health clinics: A qualitative study. Health Res Policy Syst, 15(1), 27.

    PubMed  PubMed Central  Google Scholar 

  61. Powell, B. J., Beidas, R. S., Lewis, C. C., Aarons, G. A., McMillen, J. C., Proctor, E. K., et al. (2017). Methods to improve the selection and tailoring of implementation strategies. Journal of Behavioral Health Services & Research, 44(2), 177–194.

    Google Scholar 

  62. Proctor, E., Silmere, H., Raghavan, R., Hovmand, P., Aarons, G., Bunger, A., … Hensley, M. (2011). Outcomes for implementation research: conceptual distinctions, measurement challenges, and research agenda. Administration and Policy in Mental Health and Mental Health Services Research, 38(2), 65–76.

  63. Rivard, J. (2006). Trauma-focused intervention targeting risk for violence. Retrieved January 4, 2014, from https://www.sanctuaryweb.com/PDFs/A6q.%20Rivard%20JBFCS%20Powerpoint.pdf.

  64. Rivard, J. C., Bloom, S. L., McCorkle, D., & Abramovitz, R. (2005). Preliminary results of a study examining the implementation and effects of trauma recovery framework for youths in residential treatment. Therapeutic Community: The International Journal for Therapeutic and Supportive Organizations, 26, 83–96.

    Google Scholar 

  65. Roberts, N. P., Roberts, P. A., Jones, N., & Bisson, J. (2016). Psychological therapies for post-traumatic stress disorder and comorbid substance use disorder. Cochrane Database of Systematic Reviews, 4(4), CD010204.

    Google Scholar 

  66. Smith, B. D., & Manfredo, I. T. (2011). Frontline counselors in organizational contexts: A study of treatment practices in community settings. Journal of Substance Abuse Treatment, 41, 124–136.

    PubMed  Google Scholar 

  67. Stevens, S. J., Hasler, J., Murphy, B. S., Taylor, R., Senior, M., Barron, M., et al. (2003). La Cañada adolescent treatment program: Addressing issues of drug use, gender and trauma. In S. J. Stevens & A. Morral (Eds.), Adolescent substance abuse treatment in the United States: Exemplary models from a National Evaluation Study (pp. 183–209). Binghampton, NY: The Haworth Press.

    Google Scholar 

  68. Suarez, L. M., Belcher, H. M. E., Briggs, E. C., & Titus, J. C. (2012). Supporting the need for an integrated system of care for youth with co-occurring traumatic stress and substance abuse problems. American Journal of Community Psychology, 49, 430–440.

    PubMed  Google Scholar 

  69. Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. (2014). The TEDS report: Age of substance use initiation among treatment admissions aged 18 to 30. Rockville, MD. Retrieved from https://www.samhsa.gov/data/sites/default/files/WebFiles_TEDS_SR142_AgeatInit_07-10-14/TEDS-SR142-AgeatInit-2014.htm.

  70. Substance Abuse and Mental Health Services Administration. (2018). Key substance use and mental health indicators in the United States: Results from the 2017 National Survey on Drug Use and Health. HHS Publication No. SMA 18-5068, NSDUH Series H-53. Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. Retrieved from https://www.samhsa.gov/data/sites/default/files/cbhsq-reports/NSDUHFFR2017/NSDUHFFR2017.

  71. Thyer, B., & Myers, L. (2011). The quest for evidence-based practice: A view from the United States. Journal of Social Work, 11(1), 8–25.

    Google Scholar 

  72. Wolff, N., Frueh, B., Shi, J., & Schumann, B. (2012). Effectiveness of cognitive–behavioral trauma treatment for incarcerated women with mental illnesses and substance abuse disorders. Journal of Anxiety Disorders, 26(7), 703–710.

    PubMed  Google Scholar 

  73. Wolitzky-Taylor, K., Sewart, A., Vrshek-Schallhorn, S., Zinbarg, R., Mineka, S., Hammen, C … Craske, M. G. (2017). The effects of childhood and adolescent adversity on substance use disorders and poor health in early adulthood. Journal of Youth and Adolescence, 46(1), 15–27.

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Josephine D. Korchmaros.

Ethics declarations

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical Approval

All ethical standards for protecting human subjects have been followed in accordance with standards of the institution’s internal review board for protection of human subjects.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Korchmaros, J.D., Greene, A. & Murphy, S. Implementing Trauma-Informed Research-Supported Treatment: Fidelity, Feasibility, and Acceptability. Child Adolesc Soc Work J 38, 101–113 (2021). https://doi.org/10.1007/s10560-020-00671-7

Download citation

Keywords

  • Trauma-informed research-supported treatment
  • Adolescents
  • Substance use disorder
  • Residential treatment