Trauma-Informed Treatment Decreases Posttraumatic Stress Disorder Among Women Offenders

Abstract

Traumatic experiences among women offenders can impact their psychological well-being and patterns of substance use and offending. However, rigorous research in this area for women offenders with a history of trauma is sparse. This study combined data from 2 previous studies of women offenders in order to provide greater statistical power in examining the psychological trends found in the individual studies. Specifically, women in gender-responsive treatment (GRT; n = 135) were compared to women in non-GRT (n = 142) in regard to their change in posttraumatic stress disorder (PTSD) and related symptomatology from baseline to follow-up. The pooled sample of women were predominantly White (58%) or Hispanic (22%), and many had never been married (47%); their mean age was 36 years (SD = 8.9), and, on average, they had 12 years (SD = 1.8) of education. Methamphetamine was their primary drug (71%). Moreover, 55% of the women reported histories of sexual abuse and 37% physical abuse. Finally, 31% had a diagnosis of PTSD. Using generalized estimation equations, we detected significant Group × Time interactions in PTSD (odds ratio [OR] = 0.17) and some related symptomatology (reexperiencing: OR = 0.42; and avoidance: OR = 0.24). Given the aggregate impact of trauma in the lives of women offenders, these women, their families, and their communities could benefit from research on how trauma influences their lives and on services that mitigate the negative impact of such histories.

Keywords:

• posttraumatic stress disorder
• substance abuse
• women offenders
• trauma-informed and gender-responsive treatment

Acknowledgments

This study was funded by the National Institute on Drug Abuse (Grant No. R01 DA22149-01), the California Department of Corrections and Rehabilitation (Contract No. C06.441), and the California Endowment (Grant No. 20081206). The findings and conclusions of this article are those of the authors and do not necessarily represent the official policies of the San Diego County Adult Drug Court Programs or the Los Angeles County Second Chance Women's Re-Entry Court Program.

The authors would like to thank Kris Langabeer for editorial support as well as Kira Jeter, Stephanie Taube, Brittany Horth, Stephanie Torres, Claudia Gonzales, Robert Veliz, Yvette Almeida, and Dave Bennett for their help with study coordination, data collection, data entry, and data building. They would also like to thank the staff of Mental Health Systems, Inc., including Kim Bond, president and chief executive office; Alison Ordille; Patricia Lazalde; and the program directors and counseling staff for their cooperation with training, implementation, recruitment, randomization, and support of program data collection. They are grateful to the San Diego County Drug Court System judges and staff for their support and assistance on this project. They are also grateful to Dr. Stephanie Covington for her many hours of training and program site visits and Penny Philpot for her onsite facilitation of the implementation of the curricula and clinical supervision. For the Second Chance Women's Re-Entry Court study, the authors are very thankful to Judge Michael Tynan, Nancy Chand, Mark Delgado, and the rest of the Countywide Criminal Justice Coordination Center staff for their support and assistance with this project. They are also extremely appreciative of the cooperation and support provided by Cassandra Loch, April Wilson, and the rest of the Prototypes treatment staff with implementation, recruitment, and data collection. Finally, they wish to thank the participants who volunteered to be interviewed and to share their life experiences.

Notes

1. The GRT programs used program components designed specifically for women, including gender-specific staff, health and wellness care, education/employment training and placement, and transportation and child care.

2. Recruitment for Study 1 took place from January 19, 2009, through February 3, 2010. Baseline interviews were conducted with participants within 30 days of entry into the program and with the prison comparison participants 6 months prior to their release from prison. By the time of the final follow-up interview, one subject was found to be deceased and six subjects had been deported. Thus, they were removed from the potential follow-up sample. Out of the 120 remaining participants, 83 were located and completed the posttreatment follow-up interview (88% of the GRT group and 56% of the prison group), which was conducted 12 months after their baseline assessment. Participants lost to follow-up were compared to those who were located and interviewed on their baseline characteristics. There were no significant differences in age, race, education, or marital status between those interviewed and those not interviewed at the 12-month follow-up. There were also no significant differences in criminal offense history or drug use history.

3. Recruitment for Study 2 began in February 2007 and ended in March 2009. All participants were interviewed within the first 30 days of entry into drug court programs (baseline) by UCLA research assistants. Baseline interviews focused on capturing behaviors 30 days and also 4 months prior to the arrest that led to court-mandated drug court treatment. By the time of the final follow-up interview, 1 subject was found to be deceased and 23 subjects remained in treatment. Thus, they were removed from the potential follow-up sample. Out of the 126 remaining participants, 94 were located and completed the posttreatment follow-up interview (77% of the GRT group and 71% of the MG group), which was conducted 4 months after they left treatment. Participants lost to follow-up were compared to those who were located and interviewed on their baseline characteristics. There were no significant differences in age, race, education, or marital status between those interviewed and those not interviewed 4 months after leaving treatment. There were also no significant differences in criminal history or drug use history.

4. Scoring for a PDS diagnosis of PTSD was done by NCS Pearson, Inc.^© Reported inventories (profile reports) included presence of PTSD diagnosis, symptom severity score, symptom severity rating, total number of symptoms endorsed, and level of functioning impairment. Profile reports also included whether specific Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 1994) symptom criteria were met.

5. These results are available upon request.

6. Autoregressive is a term derived from times series analysis that assumes that observations are related to their own past values through one, two, or a higher order autoregressive process. An autoregressive correlation structure indicates that two observations taken close in time (or space) within an individual tend to be more highly correlated than two observations taken far apart in time from the same individual.

7. This includes those who were married, remarried, divorced, separated, or widowed.