Additional information
by Women and Trauma Committee (Author), Substance Abuse and Ment Administration (Author)
In the early 1990s, the Substance Abuse and Mental Health Services Administration (SAMHSA) began a series of initiatives to raise awareness regarding the increasing numbers of women seeking services from public mental health and substance abuse programs who had experienced personal histories of violence and trauma, frequently beginning in childhood. Initially, attention focused on the pervasiveness of the problem, with experiences of violence leading to traumatic stress in more than 80-90% of women seeking services. Troubling manifestations of traumatic stress included physical health consequences and precipitous spiritual questioning as well as commonly labeled psychiatric and substance use disorders. For women survivors, addressing the full range of impacts of trauma often required involvement of the entire spectrum of public health services in ongoing trauma resolution and recovery efforts, typically involving the need for supported "safe" housing, supported education and employment assistance, family welfare supports, and possible contact with criminal justice and/or victim assistance programs. Due to the spiraling number of people impacted and the wide range of consequences, trauma is now believed to be a "public health crisis." Existing providers lacked the capacity to effectively assist women with histories of abuse and trauma. A number of troubling service delivery breakdowns were identified, including widespread lack of screening or assessment for trauma; lack of training in clinical and community-based trauma treatment; and misdiagnosis, under-diagnosis or failure to diagnose trauma as the issue underlying a wide range of problems. Compounding problems further, providers typically offered only the standard regimen of services-as-usual for these women, which often led to a revolving door of treatment and discharge. Even when correctly diagnosed, trauma was typically viewed as one episode or event in the lives of these women, rather than an ongoing series of violent events woven throughout the life cycle. Little or no attention was paid to the inter-generational cycle of trauma that kept recurring within trauma-impacted families. To address the lack of capacity to effectively serve women who had experienced trauma, SAMHSA sponsored a five-year "Women and Violence" Study (1998-2003) to develop and evaluate new trauma service paradigms. This research study demonstrated that trauma requires a central focus in treatment and needs to be integrated into the provision of related public health and social services. This approach, called "trauma-integrated counseling," has demonstrated efficacy and practicality. New gender-specific group psychosocial empowerment and education counseling models introduced in the "Women and Violence" study are now evidence-based interventions that have been widely applied with significant impact on the recovery of women trauma survivors. In 2004 SAMHSA's National Center for Trauma-Informed Care (NCTIC) was funded to provide technical assistance to public health programs interested in adopting a "trauma-informed" 5 organizational and services delivery paradigm that focuses on trauma as the key issue to be addressed in facilitating recovery. Currently, more than 45 State Mental Health Authorities are in the process of implementing trauma-informed systems and services, and trauma-informed care is spreading rapidly to all segments of the public health system. The Women and Trauma Committee will be instrumental in leading and supporting these new movements.
