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Exploring Trauma+: A Brief Intervention for Men and Gender-Diverse People (ET+)

Topic Areas
Scientific Rating
Child Welfare Relevance
Trauma Treatment (Adult)
3  — Promising Research Evidence
Medium

About This Program

Target Population: Adults who experience the world from a male perspective and have experienced trauma

Program Overview

Exploring Trauma+: A Brief Intervention for Men and Gender-Diverse People is the 2nd edition of the Exploring Trauma curriculum. This edition reflects the expanded definition of gender responsive to include the experiences of transgender and nonbinary people. This new material has inclusive pronouns, as well as examples of traumatic events and focus questions specific to this group. The facilitator guide and participant workbook are on a flash drive which allows for easy duplication. There are introductory materials for the facilitator and then detailed instructions (specific lesson plans) for the sessions. The session topics include: the process of trauma, the Adverse Childhood Experiences (ACE) questionnaire, power and abuse, grounding and self-soothing, the risk of victims becoming victimizers, understanding shame, and healthy relationships. There is a strong emphasis on grounding skills. This material can also be used for training staff on the gender-responsive issues related to trauma.

Program Goals

The goals of Exploring Trauma+: A Brief Intervention for Men and Gender-Diverse People (ET+) are:

  • Increase understanding of trauma
  • Increase in psychological well-being (mental health)
  • Decrease in trauma symptoms
  • Decrease in depression and anxiety
  • Decrease in anger and aggression
  • Decrease posttraumatic stress disorder (PTSD)

Logic Model

The program representative did not provide information about a Logic Model for Exploring Trauma+: A Brief Intervention for Men and Gender-Diverse People (ET+).

Essential Components

The essential components of Exploring Trauma+: A Brief Intervention for Men and Gender-Diverse People (ET+) include:

  • This can be conducted as a group intervention with 6-10 people who experience the world from a male perspective with one facilitator per group or can be used in individual work.
    • Specific topics for each of the 6 sessions:
      • Session 1: Welcome and Introduction (3 activities)
      • Session 2: Exploring Trauma (3 activities)
      • Session 3: Thinking, Feeling, and Acting (3 activities)
      • Session 4: Beyond Guilt, Shame, and Anger (5 activities)
      • Session 5: Healthy Relationships (4 activities)
      • Session 6: Love, Endings, and Certificates (5 activities)
    • Content includes:
      • Educating participants on the process of trauma
      • Education on typical responses to trauma including PTSD
      • Helping them to identify both maladaptive beliefs and behaviors
      • Teaching coping skills and grounding activities
      • Providing between session activities to reinforce information from group and to be able to practice skills
      • Workbook in English and Spanish
      • Materials are on a flash drive for ease of duplication

Program Delivery

Adult Services

Exploring Trauma+: A Brief Intervention for Men and Gender-Diverse People (ET+) directly provides services to adults (regardless of whether they are parents or caregivers) and addresses the following:

  • Symptoms of abuse including anxiety, depression, PTSD, and emotional dysregulation) and risk of perpetration

Recommended Intensity:

One or two 2-hour long sessions per week

Recommended Duration:

6 sessions – approximately 3-6 weeks

Delivery Settings

This program is typically conducted in a(n):

  • Outpatient Clinic
  • Community-based Agency / Organization / Provider
  • Group or Residential Care
  • Justice Setting (Juvenile Detention, Jail, Prison, Courtroom, etc.)
  • Shelter (Domestic Violence, Homeless, etc.)

Homework

Exploring Trauma+: A Brief Intervention for Men and Gender-Diverse People (ET+) includes a homework component:

Participants have a workbook to process their group experience and practice skills.

Languages

Exploring Trauma+: A Brief Intervention for Men and Gender-Diverse People (ET+) has materials available in a language other than English:

Spanish

For information on which materials are available in this language, please check on the program's website or contact the program representative (contact information is listed at the bottom of this page).

Resources Needed to Run Program

The typical resources for implementing the program are:

  • Flash drive which contains the facilitator’s guide and participant workbook
  • Flip chart
  • Room with chairs in a circle or at a table
  • A group facilitator
  • Art supplies for collage work

Manuals and Training

Prerequisite/Minimum Provider Qualifications

Counselor with experience in the field or an experienced group facilitator are the typical qualifications. It can be used with peer facilitation, as well as for individual work.

Manual Information

There is a manual that describes how to deliver this program.

Program Manual(s)

Manual information:

  • Covington. S., Pugh, S., & Rodriguez, R. (2021). Exploring Trauma+: A Brief Intervention for Men and Gender-Diverse People. Hazelden.

The flash drive with facilitator guides and workbooks can be purchased online, please contact kim@stephaniecovington.com or go to https://www.stephaniecovington.com and select “Bookstore.”

Training Information

There is training available for this program.

Training Contact:
Training Type/Location:

Training can be provided onsite or virtually. There are also trainings available at various sites in California and other parts of the U.S.

For more information see, https://www.stephaniecovington.com (select “Training”) and https://www.centerforgenderandjustice.org

Number of days/hours:

Generally 1 day onsite, or 2 days (4 hours per day) virtually

Implementation Information

Pre-Implementation Materials

There are no pre-implementation materials to measure organizational or provider readiness for Exploring Trauma+: A Brief Intervention for Men and Gender-Diverse People (ET+).

Formal Support for Implementation

There is formal support available for implementation of Exploring Trauma+: A Brief Intervention for Men and Gender-Diverse People (ET+) as listed below:

Formal support for implementation in addition to the written facilitator guide can be provided via consultation to include onsite observations, Zoom meetings, email communication, and telephone calls.  Consultation and TA are optional and can be contracted for a specific period of time depending on the needs of the agency. Formal support can include implementation issues, facilitator refresher courses, use of fidelity measures (see below), leadership coaching, and trouble-shooting any challenges the agency is having regarding implementation. Information on consultation is provided upon request. Please contact the program representative listed at the bottom of this page for more information.

Fidelity Measures

There are fidelity measures for Exploring Trauma+: A Brief Intervention for Men and Gender-Diverse People (ET+) as listed below:

The Fidelity Instrument and Implementation Guidelines can be used in a variety of ways: a self-report checklist; a self-report checklist to compare with a checklist completed by an observer; checklist used with video recordings. Fidelity Instrument and Implementation Guidelines are available upon request. Please contact the program representative listed at the bottom of this page for more information.

Implementation Guides or Manuals

There are implementation guides or manuals for Exploring Trauma+: A Brief Intervention for Men and Gender-Diverse People (ET+) as listed below:

The Facilitator Guide provides complete directions and implementation guidelines.

Implementation Cost

There are no studies of the costs of Exploring Trauma+: A Brief Intervention for Men and Gender-Diverse People (ET+).

Research on How to Implement the Program

Research has not been conducted on how to implement Exploring Trauma+: A Brief Intervention for Men and Gender-Diverse People (ET+).

Relevant Published, Peer-Reviewed Research

Child Welfare Outcome: Child/Family Well-Being

Messina, N. (2023) An experimental study of the effectiveness of a trauma- specific intervention for incarcerated men. Journal of Interpersonal Violence, 38(3-4), 3088–3112. https://doi.org/10.1177/08862605221104526

Type of Study: Randomized controlled trial
Number of Participants: 221

Population:

  • Age — Mean=37.1 years (approximately)
  • Race/Ethnicity — 44% Latino/Hispanic and 22% Black
  • Gender — 100% Male
  • Status — Participants were men incarcerated in a prison housed on a security classification risk Level III yard.

Location/Institution: California

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to assess the effectiveness of a trauma-specific intervention among men incarcerated for violent offenses Exploring Trauma: A Brief Intervention [now called Exploring Trauma+: A Brief Intervention for Men and Gender-Diverse People (ET+)]. Participants were randomized into Exploring Trauma or a waitlist control group. Measures utilized include a modified index of perpetration and victimization history from the Conflict Tactics Scales, a modified index of perpetration and victimization history of the Abuse Behavior Inventory, the Patient Health Questionnaire Depression Subscale, the Patient Health Questionnaire Anxiety Subscale, The Trauma Symptom Checklist – 40 (TSC40), the Kessler Psychological Distress Scale (K6), the State-Trait Anger Expression Inventory—2 (STAXI-2), and the Revised Instrumental and Expressive Representation Scales. Results indicate that significant improvement was found for Exploring Trauma compared with the control group on 11 of the 13 trauma-related outcome measures. The largest effect sizes ranged from .46 for mental health functioning, .42 for trait anger measures, and .40 for anxiety. Limitations include study sample may not be representative of male prison populations nationally; potential for a biased estimation resulting from sample attrition; not able compare the two groups on outcomes from official records data, as the control group was offered the program immediately after completing the final survey and post-release outcomes were not obtained due to the lengthy sentences of the incarcerated populations in California for serious violent crimes.

Length of controlled postintervention follow-up: None.

Messina, N. (2022) Evaluation of a peer-facilitated trauma intervention for incarcerated men. Criminal Justice and Behavior, 49(1), 1399–1417. https://doi.org/10.1177/00938548221093280

Type of Study: One-group pretest–posttest study
Number of Participants: 624

Population:

  • Age — Mean=40 years
  • Race/Ethnicity — 46% Latin, 22% Black, 20% White, 8% Multiracial, and 5% Other
  • Gender — 100% Male
  • Status —  Participants were incarcerated men in the Exploring Trauma program from varying levels of security classification (i.e., Level II, III, IV).

Location/Institution: Two California prisons

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to assess the feasibility and effectiveness of Exploring Trauma, a peer-facilitated trauma-specific intervention [now called Exploring Trauma+: A Brief Intervention for Men and Gender-Diverse People (ET+)] among incarcerated men. Measures utilized include the Patient Health Questionnaire Depression Subscale, the Patient Health Questionnaire Anxiety Subscale, the Kessler Psychological Distress Scale (K6), the modified version of the Short Screening Scale for DSM-IV Posttraumatic Stress Disorder, the Trauma Symptom Checklist–40 (TSC-40), the Buss-Warren Aggression Questionnaire (AQ), the State-Trait Anger Expression Inventory–2 (STAXI-2), and the Revised Instrumental and Expressive Representation Scales. Results indicate that there was statistically significant improvement in trauma-related symptoms relative to pretreatment functioning and demonstrated support for the feasibility of peer-facilitation. Effect sizes were small to moderate, with the largest impact on current traumatic distress, depression, and anxiety. The mixed-effects regression results show that the impact of ACEs on outcomes is strong and cumulative (i.e., greater exposure to ACEs increased the likelihood of participant program gain on mental health and aggression outcomes, ranging from .15 to .77). Limitations include lack of randomization, reliance on self-reported measures, and questions on the ACE survey were also limited.

Length of controlled postintervention follow-up: None.

Additional References

Gajewski-Nemes, J., & Messina, N. (2021). Exploring and healing invisible wounds: Perceptions of trauma-specific treatment from incarcerated men and women. Journal of Trauma & Treatment, 10, Article 5. https://www.hilarispublisher.com/open-access/exploring-and-healing-invisible-wounds-perceptions-of-traumaspecific-treatment-from-incarcerated-men-and-women.pdf

Messina, N. P., & Burdon, W. B. (2021, Winter). Evaluation of a violence- and trauma-prevention program in secure housing units. Journal of Community Justice, 30(2), 7–12(6). https://www.civicresearchinstitute.com/online/article_abstract.php?pid=9&iid=1565&aid=9775

Messina, N., & Schepps, M. (2021). Opening the proverbial 'can of worms' on trauma‐specific treatment in prison: The association of ACEs to treatment outcomes. Clinical Psychology & Psychotherapy, 28(5), 1210–1221. https://doi.org/10.1002/cpp.2568

Contact Information

Stephanie S. Covington, PhD
Title: LCSW
Agency/Affiliation: Center for Gender and Justice
Website: www.stephaniecovington.com
Email:
Phone: (858) 454-8528

Date Research Evidence Last Reviewed by CEBC: April 2023

Date Program Content Last Reviewed by Program Staff: September 2023

Date Program Originally Loaded onto CEBC: September 2023