Trauma Research Development Project

Investigators: Ruth O. Ralph, Ph.D. and Ann Jennings, Ph.D.

PROJECT GOALS

The overall goal of this project is to develop trauma-sensitive services for the Maine Department of Mental Health, Mental Retardation and Substance Abuse Services. With Center support, a Trauma Services Provider Survey was conducted which assessed the capacity of the system to provide trauma-sensitive services.

RESEARCH ACTIVITIES AND RESULTS

Following are results from the Trauma Services Provider Survey:

A total of 2180 surveys were mailed and 404 returned, 385 of which were usable. This represented 17.7% of the total mailing; there was no attempt to follow-up on those not received. Of the 385 respondents, 321 served clients directly, full time or with partial responsibility for administration/ management. Twenty-eight of these were professional members of a Trauma Advisory Group (TAG). An additional 64 responders were involved in administration/management. Because the professional TAG members were selected by trauma survivors as providers who have been helpful in their treatment, it was decided to separate the responses of TAG members from others who provide Direct Service (DS). It is assumed that the TAG members are knowledgeable in trauma services provision, and provides a comparison group for those in DS who have not been in a TAG group.

Of the TAG members, 43% are in private practice in mental health, 29% work in a private not-for-profit mental health agency, and 18% in a non-mental health service agency. In the DS group, 49% work in a private not-for-profit mental health agency, and 31% are employed in Public Mental Health (state operated) services. Only 3.4% work in private practice in mental health. The majority of TAG members (64%) work in outpatient counseling. The DS group is well distributed across most of the services, with the highest proportion (26%) working in inpatient settings followed by 20% who work in outpatient counseling.

The providers were also asked if they had ever been abused sexually or physically, and if so, how it affected their work with trauma survivors. About 39% of the TAG, and 33% of the Direct Service groups report having been abused. Of those reporting abuse, 82% of the TAG and 66% of the DS group said this was while they were children. When asked if they had ever received mental health services for their abuse related problems, 82% of the TAG and 62% of the DS groups indicated that they had. In terms of the effect of the abuse on their work with trauma survivors, 80% of the TAG and 74% of the DS group indicated that it helped in their ability to work with trauma survivors.

Seventy-five percent of the TAG, and 62% of the DS respondents report that more than fifty percent of their female clients report having been abused, and 75% of the TAG and 54% of DS respondents report that more than fifty percent of their male clients report having been abused. Because self-injury is one of the sequelae of trauma, a question was asked about the number of the clients who self-injure. While the largest proportion of respondents report that about 10% of both their female and male clients self-injure, an additional 24% in both groups indicate that 1/4 of their female clients self-injure, and 15% of TAG and 20% of DS report that 1/4 of their male clients self-injure.

Two thirds of the DS, and 78% of the TAG indicate that they ask every client during assessment about their trauma history. Most of the remainder say they ask only if the client's symptoms indicate there may have been abuse, but nearly 14% of the DS say they seldom or never ask about trauma history. Eighty-six percent of TAG and 69% of DS indicate they have developed a specific plan to help the trauma survivor to deal with the effects of trauma.

Providers were asked whether trauma sensitive services are available in their local service area, and to what extent these services are needed. In general, the TAG is more conservative than the DS group in their estimate as to whether a service is available in their local service area. Both groups indicate that the most available service is a crisis hot line and the least available services are support groups for male survivors, residential programs for trauma survivors, case management which helps to decrease "triggers" which re-traumatize, and use of expressive therapies. Generally, 50-60 percent of both groups agree that specific services are needed.

While TAG members felt that they have more extensive education and experience compared to those in the DS group, fifty to sixty percent of the DS group would like more education, and 35-50 % of the TAG members would also. In addition both groups felt that staff in their organizations need education in all of the surveyed subject areas.

INCLUSION OF GENDER AND MINORITY SUBJECTS

While nearly 86% of the TAG members are women, about 69% of the DS group are women. The ethnicity of the groups reflect the distribution in Maine, with 93% Caucasian; Native Americans represented 3.8% of the DS group.

SIGNIFICANCE OF FINDINGS/POLICY IMPLICATIONS

Results from the survivor/consumer and professional needs assessments have been presented to the governor and legislature of Maine and have guided the Department's development of services, educational interventions, standard operating procedure modifications and policy directions. The needs assessment made clear that in order to meet the needs of trauma victims, the mental health and substance abuses systems in Maine would require fundamental realignment and retooling of capacity and would require a number of years to effect. The Department is developing statewide training and supervision in trauma-based assessments and treatments; creating trauma curricula as part of the formal education and licensing of professionals; formulating a range of services and supports specifically designed for trauma survivors; modifying existing services; and adjusting reimbursement policies to expand coverage and complementing procedures to eliminate re-traumatization caused by seclusion and restraint and other practices.

Information from the Trauma Advisory Groups was published (In Their Own Words) and was the basis for discussions at the Trauma Advisory Groups Forums held in 1996 and 1997.

Publications:

Jennings, A. and Ralph, R (eds.), (1997). Trust Tell What Hurts, What Helps, and What is Needed for Trauma Services, In Their Own Words: Trauma Survivors and Professionals. Augusta ME: Maine Department of Mental Health, Mental Retardation and Substance Abuse Services.

Ralph, R. and Jennings, A. (1998). Trauma Services Provider Survey. Final Report. Augusta, ME. Maine Department of Mental Health, Mental Retardation and Substance Abuse Services.

Project completed.

[Top]