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Special Collection: Trauma-Informed Domestic Violence Services: Developing Collaborations and Increasing Access (Part 3 of 3)

This is PART 3 of a 3-part collection, which also includes Understanding the Framework and Approach (PART 1 of 3), and Building Program Capacity (PART 2 of 3). PART 3 provides resources for building collaboration to ensure that survivors and their children have access to culture-, DV- and trauma-informed mental health and substance abuse services.

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This Special Collection was developed by the National Center
on Domestic Violence, Trauma & Mental Health
(NCDVTMH) in
partnership with the National Resource Center on Domestic Violence.
Contact NCDVTMH for specialized technical assistance and training
on this and related topics.

Survivors of domestic violence come to us with a lifetime of experiences, all of which shape the person that we see before us. Trauma-informed responses consider the complexity of survivors' experiences and provide comprehensive services to address a variety of intersecting needs. When we reach out to gather all pieces of the puzzle, effective treatment approaches can begin to take shape.

Introduction | Back to top

Building on over 20 years of work in this area, the National Center on Domestic Violence, Trauma & Mental Health (NCDVTMH) have put into practice a framework that integrates a trauma-informed approach with a DV victim advocacy lens. The term trauma-informed is used to describe organizations and practices that reflect an understanding of the pervasiveness and impact of trauma and that are designed to reduce retraumatization, support healing and well-being and address the root causes of abuse and violence. The resources compiled in these collections reflect this integrated perspective (NCDVTMH 2013, adapted from Harris and Fallot 2001).

Resources on providing collaborative and comprehensive trauma-informed services and advocacy that have been developed by NCDVTMH specifically for DV settings. Also included throughout this collection are resources that have been developed for mental health or substance abuse settings that can also be useful to DV victim advocates.

The goals of this Special Collection series are to provide:

  • Basic information about the different ways in which trauma can affect individuals and to highlight current research on effective ways to respond to trauma;
  • Practical guidance on developing trauma-informed DV programs and services; and
  • Information that will help support collaboration between DV programs, and mental health, substance abuse, and other social services agencies and that will increase awareness about trauma treatment in the context of DV.

A Note About Gender: Intimate partner violence perpetrated by men against their female partners is epidemic. At the same time, whatever a person’s gender or their partner’s gender, they may experience intimate partner violence, and gendered language can minimize the experiences of many survivors. We have attempted to use language in this Special Collection that reflects our analysis of gender oppression and other forms of oppression, as well as our commitment to serving all survivors of domestic violence.

The mission of the National Center on Domestic Violence, Trauma & Mental Health is to develop and promote accessible, culturally relevant, and trauma-informed responses to domestic violence and other lifetime trauma so that survivors and their children can access the resources that are essential to their safety and well-being. NCDVTMH provides training, support, and consultation to advocates, mental health and substance abuse providers, legal professionals, and policymakers as they work to improve agency and systems-level responses to survivors and their children.

Collaborating with Mental Health and Substance Abuse settings | Back to top

For some survivors, the effects of trauma will be alleviated with increased safety and support; for others, professional mental health or substance abuse services may also be helpful. DV programs can play a key role in helping survivors connect with the services and supports that they want and need. However, accessing any kind of mental health or substance abuse services can be challenging, and even those providers who offer trauma-specific treatment are not necessarily trauma-informed. It may be especially difficult to find providers who also understand DV and the DV-related safety risks that survivors face, such as the risk that an abusive partner may interfere with treatment.

Building relationships with peer support specialists and mental health and substance abuse providers can help to fill these gaps. In a number of states and communities, collaborating to provide cross-training, cross-consultation and even co-located services has helped to create trusted cross-sector partnerships and a more robust safety net for survivors. These collaborations have also provided opportunities for DV programs and coalitions to play a critical role in influencing the development of behavioral health services that are both DV- and trauma-informed in their communities and their states.

This section includes resources that will be useful to DV victim advocates who have built or want to build partnerships with peer support specialists and mental health and substance abuse providers.

  • Creating Trauma-Informed Services Tipsheet Series | HTML HTML
    by the National Center on Domestic Violence, Trauma & Mental Health (2012)
    These tipsheets provide practical advice on creating trauma-informed services at domestic violence programs and working with survivors who are experiencing trauma symptoms and/or mental health conditions.
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  • Locating Mental Health & Substance Abuse Supports for Survivors: A Reference Sheet for Domestic Violence Advocates | PDF PDF (2 p.)
    by the National Center on Domestic Violence, Trauma & Mental Health (February 2012)
    This document contains resources that you can use to locate additional supports for survivors who are experiencing mental health or substance abuse conditions.
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  • Collaboration Charter | PDF PDF (22 p.)
    by the Domestic Violence & Mental Health Collaboration Project (Revised September 2010)
    This charter represents the collaborative agreement among partners of the Domestic Violence and Mental Health Collaboration Project. The charter includes agreements on mission and values, roles and responsibilities, decision-making, conflict resolution, communications, and confidentiality.
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  • Fragmented Services, Unmet Needs: Building Collaboration Between The Mental Health And Domestic Violence Communities | HTML HTML
    by Carole Warshaw, Ada Mary Gugenheim, Gabriela Moroney and Holly Barnes for Health Affairs (2003)
    This report describes the initial focus and work of the Domestic Violence & Mental Health Policy Initiative (DVMHPI), a Chicago-based project that was founded in 1999 to build the capacity of Chicago-area service systems to provide accessible, culturally relevant, and DV- and trauma-informed services.
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  • Meeting Survivors' Needs: A Multi-State Study of Domestic Violence Shelter Experiences (Full Report) | PDF PDF (145 p.)
    by Eleanor Lyon, Shannon Lane, and Anne Menard for the National Institute of Justice (October 2008)
    This study highlights the importance of providing services to meet survivors’ emotional and mental health needs and for developing strategies to assist with conflict resolution in shelters – both areas in which a trauma-informed approach could be of benefit.
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  • Meeting Survivors’ Needs through Non-Residential Domestic Violence Services & Supports: Results of a Multi-State Study (Full Report) | PDF PDF (322 p.)
    by Eleanor Lyon, Jill Bradshaw, and Anne Menard for the National Resource Center on Domestic Violence (NRCDV) (November 2011)
    This report demonstrates that DV programs are now meeting a broader range of survivors’ needs than ever before (whether directly or in collaboration with other community agencies), including needs related to physical and mental health, economic security, legal and immigration issues, and transportation. The study highlights the importance of ensuring that survivors have access to an array of resources including mental health and substance abuse services.
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  • Mental Health and Domestic Violence: Collaborative Initiatives, Service Models, and Curricula | PDF PDF (77 p.)
    by Carole Warshaw and Gabriela Moroney for the Domestic Violence and Mental Health Policy Initiative (September 2002)
    This report describes concerns of state domestic violence coalitions and mental health providers and/or agencies and provides model initiatives and programs that have begun the work of responding to the mental health needs of battered women and their children.
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  • Screening for Domestic Violence in Mental Health Settings | HTML HTML
    by the NYS Office for the Prevention of Domestic Violence (2010)
    This page is designed for mental health professionals who don’t work in specialized domestic violence services, but need to know about their clients’ experiences of victimization in order to provide them with the best possible services.
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  • Women and Trauma: Report of the Federal Partners Committee on Women and Trauma, A Federal Intergovernmental Partnership on Mental Health Transformation | PDF PDF (79 p.)
    by the Women and Trauma Federal Partners Committee (June 2011)
    This report, or call to action, provides background on women and trauma, describes a Roundtable held on April 29, 2010, and presents an outline of what the Committee plans for the coming year.
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  • Domestic Violence and Health Care | HTML HTML
    by the Minnesota Center Against Violence and Abuse for VAWnet, the National Resource Center on Domestic Violence (October 2008)
    This collection organizes resources into the following five areas: 1) the impact of domestic violence on health; 2) public health approaches to domestic violence prevention; 3) guidelines and issues concerning identification and intervention by health care providers; 4) information about collaboration between health care providers and domestic violence advocates; and 5) training.
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Trauma-SPECIFIC Treatment MODELS | Back to top

While awareness of trauma has grown considerably in both the mental health and substance abuse fields, access to mental health or substance abuse services of any kind is often limited, much less services that are gender responsive, culturally relevant, trauma-informed, and trauma specific. Additional barriers to services exist for survivors who do not speak English or are undocumented, or for whom accessing behavioral health services carries a high level of stigma.

There are currently a handful of trauma treatment models that have been developed specifically for survivors of domestic violence. Most have adapted some form of Cognitive Behavioral Therapy (CBT), one of the common evidence-based treatments for posttraumatic stress disorder (PTSD), by including issues of particular concern to DV survivors and/or by modifying the length of treatment to increase accessibility. Several of these models have shown promise for improving the mental health and well-being of DV survivors, depending on their circumstances. To learn more about these models, see A Systematic Review of Trauma-Focused Interventions for Domestic Violence Survivors, by Carole Warshaw MD, Cris Sullivan, PhD, and Echo Rivera.

OTHER PROMISING APPROACHES: COMPLEX TRAUMA TREATMENT MODELS
While evidence-based trauma treatment designed specifically survivors of DV is currently limited, there are a number of other trauma treatments that may prove helpful for DV survivors if they are adapted to incorporate DV-specific concerns and studied to assess their safety and efficacy for DV survivors. The most promising of these are complex trauma treatment models.

Based originally on the work of Judith Herman, MD, in her 1992 book, Trauma and Recovery, complex trauma models offer a more comprehensive framework for understanding and responding to the various effects of chronic abuse as well as a more flexible multi-modal treatment approach. To date, none have been specifically tailored to or studied for survivors of domestic violence. In the long run, however, these models may ultimately prove to be especially useful to DV survivors, particularly those whose experiences of abuse have been more prolonged and severe. Complex trauma treatment models also tend to be consistent with many elements of trauma-informed practice, including addressing safety as a priority, recognizing that symptoms may be coping strategies, and stressing the importance of respectful, collaborative relationships in supporting healing and recovery (Harris, 1998; Saakvitne, Gamble, Pearlman, & Lev, 2000, Courtois and Ford, 2012). Treating Complex Traumatic Stress Disorders (Adults) An Evidence-Based Guide Edited by Christine A. Courtois and Julian D. Ford. Guilford Press, New York 2009.

SAMHSA’S NATIONAL REGISTRY OF EVIDENCE-BASED PROGRAMS AND PRACTICES
While it is beyond the scope of this Special Collection to provide a comprehensive review of trauma-specific treatments, this supplementary resource references a handful of trauma treatment approaches that are available in published form and take a broader approach, are relevant to women, and could potentially be adapted for survivors of domestic violence.

In addition, the National Registry of Evidence Based Programs and Practices, maintained by the Substance Abuse and Mental Health Services Administration (SAMSHA), currently lists 27 trauma-specific treatment techniques that have met stringent criteria for research evidence, and new techniques are being added on a regular basis. However, the treatments listed have not been designed specifically for DV survivors.

Trauma Treatment in the Context of Domestic Violence
For an in-depth review of mental health treatment in the context of DV, see the forthcoming eBook based on Warshaw, C., Brashler P. Mental Health Treatment for Survivors of Domestic Violence. In C. Mitchell and D. Anglin (Eds. ), Intimate partner violence: A health based perspective. New York: Oxford University Press (2009) (chapter is available on request from info@ncdvtmh.org).
  • A Systematic Review of Trauma-Focused Interventions for Domestic Violence Survivors | PDF PDF (27 p.)
    by Carole Warshaw, Cris Sullivan, and Echo Rivera for the National Center on Domestic Violence, Trauma & Mental Health (February 2013)
    This literature review provides an analysis of nine trauma-based treatments specifically designed or modified for survivors of domestic violence, along with caveats and recommendations for research and practice going forward.
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  • Models for Developing Trauma-Informed Behavioral Health Systems and Trauma-Specific Services | PDF PDF (117 p.)
    by Ann Jennings for the National Center for Trauma-Informed Care (2008)
    This extensive report includes descriptions of trauma service models and evidence-based and promising practice models. All models are designed for persons receiving public mental health and/or substance abuse services who have been traumatized by interpersonal violence and abuse.
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  • Models from Mental Health and Substance Abuse Settings: Trauma-Informed Domestic Violence Services | PDF PDF (3 p.)
    by the National Center on Domestic Violence, Trauma, and Mental Health for the National Resource Center on Domestic Violence (April 2013)
    This resource includes a list of domestic violence specific trauma treatment approaches that exist in published form as well as trauma program models that take a broader approach, are relevant to women, and could potentially be adapted for survivors of domestic violence.
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Women, Trauma & Addiction | Back to top

There are a number of issues to keep in mind when working with survivors who are dealing with substance abuse and when considering referrals for substance abuse treatment in the context of ongoing domestic violence. Understanding the role of abuse and trauma in initiating and sustaining a survivor’s use of substances as well as the role substance use plays in a survivor’s life are important for ensuring that treatment is tailored to her or his needs. Regardless of origin, substance use provides additional opportunities for control by abusers and additional safety risks for survivors. By partnering with substance abuse providers in their communities, advocates can play an important role in ensuring that services are attentive to these concerns. For more information on these issues, see the NCDVTMH Tipsheet on Mental Health and Substance Abuse Coercion.

  • Real Tools: Responding to Multi-Abuse Trauma—A Tool Kit to Help Advocates and Community Partners Better Serve People With Multiple Issues | PDF PDF (352 p.)
    by Debi S. Edmund & Patricia J. Bland for the Alaska Network on Domestic Violence & Sexual Assault (2011)
    This manual provides comprehensive guidance on how advocates and communities can respond to multi-abuse trauma often experienced by survivors of domestic violence.
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  • Seeking Safety: A Treatment Manual for PTSD and Substance Abuse | HTML HTML
    by Lisa Najavits
    Seeking Safety is an empirically studied, integrative treatment approach developed to help people attain safety from trauma/PTSD and substance abuse. This website provides implementation tools, sample topics, research summaries, articles, and assessment tools related to the program.
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In this video, Dr. Stephanie Covington, author of Helping Women Recover—A Program for Treating Addiction Facilitator's Guide & A Woman’s Journal shares her story and reviews the goals of her work to integrate theories of women’s psychological development, trauma, and addiction to meet the needs of women with substance-use disorders.

Helping Women Recover is a comprehensive, integrated curriculum for treating women with histories of addiction and trauma. It is based on the Women’s Integrated Treatment model (WIT) and is grounded in research, theory, and clinical practice. The foundation of the WIT treatment model is the integration of three theories: a theory of addiction, a theory of women’s psychological development, and a theory of trauma. The therapeutic strategies include psycho-educational, cognitive-behavioral, expressive art, and relational. The philosophy of the evidence-based program materials is consistent with the elements of a women-centered treatment model. The facilitator’s manual for the seventeen-session program is a step-by-step guide containing the theory, structure, and content needed for running groups. A Woman’s Journey, the participant’s workbook, allows women to process and record the therapeutic experience. The program model is organized into four modules that reflect the areas that recovering women have identified as triggers for relapse and as necessary for growth and healing. The materials are designed to be user-friendly and self-instructive. This allows the HWR program to be implemented by a staff with a wide range of training and experience. Helping Women Recover is a good resource for domestic violence agencies that want to include more comprehensive services. It is best facilitated by an experienced advocate with group skills or by someone with clinical experience.

Peer Support and Peer Involvement | Back to top

Domestic violence services emerged from a peer-based movement — a movement of people who had experienced abuse. Similarly, the substance abuse field was strongly influenced by the 12-step movement, which was peer-driven, and many people in the field are also in recovery. In both arenas, practice evolved from the stories of people with lived experiences and their allies. Within the peer movement in mental health (also referred to as the consumer, ex-patient, or survivor movement) there is a long tradition of people diagnosed with mental illnesses advocating for their rights.

The trauma-informed approach in mental health owes a debt of gratitude to the peer movement. The struggle of the activists who built this movement for the right to name their experience and control their lives was the foundation on which trauma-informed care was built. Many of the early mental health reformers were women who were abused twice—first at home by their abusers, and then by the mental health system (often after being committed by the people who were abusing them). Their experiences serve as a reminder that trauma-informed services are as much about social justice as they are about healing. Confronting the misuse of power, unearthing the roots of violence and coercion, and advocating for social change are as important as (and interdependent with) healing the personal consequences of abuse.

Peer support can be an important resource for DV agencies, whether it takes the form of independent peer-run programs, self-help and mutual support groups, or services delivered by peers working within mental health organizations. Through the establishment of collaborative relationships with peer support providers, DV advocates can increase their own understanding of mental health and psychiatric disability and develop their skills for supporting survivors who are experiencing a mental health crisis or who need emotional support, while also sharing their knowledge about trauma and domestic violence.

In this video, residents and staff describe the programs and structure of the Peer Support and Wellness Center in the Metro Atlanta Area.


Healing Self-Injury
This website describes how self-inflicted violence (SIV) is a common means of managing the after-effects of traumatic experiences, serving to temporarily manage many of the emotional struggles that stem from unhealed trauma. Most people living with self-injury have experienced abuse. Once understood in context, SIV can be healed by acknowledging the needs it serves and addressing the trauma from which it springs. The website includes resources, FAQs, survivor expressions, and a blog.
  • Engaging Women in Trauma-Informed Peer Support: A Guidebook | PDF PDF (96 p.)
    by Andrea Blanch, Beth Filson, and Darby Penney for the National Center for Trauma-Informed Care (April 2012)
    This guide is designed as a resource for peer supporters in behavioral health or other settings who want to learn how to integrate trauma-informed principles into their relationships with the women they support or into the peer support groups of which they are members.
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  • The Essence of Being Real: Relational Peer Support for Men and Women who have Experienced Trauma | PDF PDF (76 p.)
    by Jennifer L. Wilkerson for Sidran Press (2002)
    This manual offers trauma survivors a way to explore their experiences, receive support, and work through the stigma often associated with needing help to heal.
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  • Dealing with the Effects of Trauma: A Self-Help Guide | PDF PDF (10 p.)
    by Mary Ellen Copeland for the Substance Abuse and Mental Health Services Administration (SAMHSA) (2002)
    This booklet is designed to help determine if traumatic experiences may be causing some or all of the symptoms an individual is experiencing. It provides guidance in working to relieve these symptoms and includes suggestions for healing from the effects of trauma.
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  • In Their Own Words: Trauma survivors and professionals they trust tell what hurts, what helps, and what is needed for trauma services | PDF PDF (81 p.)
    by Ann Jenings and Ruth O. Ralph for The Department of Mental Health, Mental Retardation and Substance Abuse Services (June 1997)
    Both survivors of abuse and the professionals they trust give voice in this book to their experiences with individuals, organizations, and systems that have been shaped and influenced in such a way that they frequently harm, rather than help, the individuals they serve. Readers will be moved by their accounts of what hurts, what helps, and what is needed from our service systems for healing and recovery.
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  • In Our Own Voice: African American Stories of Oppression, Survival and Recovery in Mental Health Systems | PDF PDF (32 p.)
    by Vanessa Jackson for the Substance Abuse Mental Health Services Administration (SAMHSA)
    This guide provides historical highlights regarding African American survivors and mental health treatment in America; explores the themes shared in the collected oral histories; provides strategies for using history projects as a tool for personal and community healing and social change; and includes resources to assist you in starting your own history project.
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  • The Politics of Memory: Part II. The Voice of the Oppressed | HTML HTML
    by Patricia Deegan (December 2010)
    This video (embedded below) highlights the historical roots of the mental health consumer/survivor/ex-patient movement in the fight for women’s rights. It graphically but eloquently describes the abuses women and men experienced at the hands of the mental health system. *Trigger Warning*
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  • On Being Invisible in the Mental Health System | PDF PDF (14 p.)
    by Ann Jennings for The Journal of Mental health Administration 21(4): 374-387. (1994)
    The author provides a case study of her daughter’s sexual abuse as a child and subsequent experiences as a "chronically mentally ill" client in the mental health system. Information from 17 years of mental health records and anecdotal accounts are used to illustrate the effects of the abuse, her attempts to reach out for help, and the system’s failure to respond.
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Recommended Reading | Back to top

  • Recommended Reading: Trauma-Informed Domestic Violence Services | PDF PDF (7 p.)
    by the National Center on Domestic Violence, Trauma, and Mental Health for the National Resource Center on Domestic Violence (April 2013)
    This list provides recommended supplementary reading for the 3-part VAWnet Special Collection series, Trauma-Informed Domestic Violence Services.
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