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: Pretest–posttest study with a nonequivalent control group (Quasi-experimental)
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)
The purpose of the study was to report outcomes for the Trauma Recovery and Empowerment Model (TREM) which was modified for use in an existing residential substance abuse program. Participants were assigned to either a modified version of TREM or services as usual. Measures utilized include the 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 indicate significantly better outcomes for participants in the TREM group than those who received treatment-as-usual on trauma related symptoms, although not on alcohol or drug use. Limitations include non-randomization, lack of generalizability due to population, modifications to the intervention length, modifications from closed meeting sessions to open meeting sessions, 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: Pretest–posttest study with a nonequivalent control group (Quasi-experimental)
Number of Participants: 251

Population:

• Age — Mean=42 years
• Race/Ethnicity — 82% African American and 15% 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)
The purpose of the study was to test the effectiveness of the Trauma Recovery and Empowerment Model (TREM), a group intervention for women trauma survivors, in comparison to services as usual. Participants were assigned to either TREM or to services as usual. 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 indicate that 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 mental health and residential differences between the two groups at baseline.

Length of controlled postintervention follow-up: Approximately 4 months.

The following studies were not included in rating TREM on the Scientific Rating Scale...

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

The purpose of the study was to report the results of a study that examined nine-sites that provided comprehensive, integrated, trauma-informed, and consumer-involved services for women with mental health problems, substance use disorders, and who experienced interpersonal violence. Participants in three sites were assigned to Trauma Recovery and Empowerment Model (TREM) or to other program services. Measures utilized include the Global Severity Index (GSI) from the Brief Symptom Inventory, the Addiction Severity Index (ASI), and the Symptom Scale. Results indicate 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 and comparison conditions were not uniform and static. Note: This article was not used in the rating process due to the results not being reported separately for TREM participants.

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

The purpose of the study was to test the effectiveness of new service approaches specifically designed for women that were survivors of trauma with co-occurring mental health and substance use disorders. Trauma Recovery and Empowerment Model (TREM) was used at 3 of the 9 sites. Participants in three sites were assigned to TREM or to other program services. Measures utilized include the Global Severity Index (GSI) from the Brief Symptom Inventory, the Addiction Severity Index (ASI), and the Symptom Scale. Results indicate that 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 sites and conditions, reporting bias, and non-randomization. Note: This article was not used in the rating process due to the results not being reported separately for TREM participants.