Validation of a Trauma Screening Scale for Women with Substance Use Disorders

Background and Purpose: The goal of the services provided to homeless individuals is to successfully transition from homelessness to independent living (Fisk, Rowe, Laub, Calvocoressi & De Mino, 2005). Often the Problem Solving Approach is used as it focuses on teaching coping skills to enhance the individual/family relationships and eliminates deficiencies in problem solving due to a lack of motivation, capacity, or opportunity to solve problems in an appropriate way. Social workers also assess if recovery work is needed for mental illness or addiction problems. Additionally, housing, medical, dental, legal, and vocational skills may be needed.

Rates of trauma in women with co-occurring disorders and who are homeless range from 59% to 99% (Markoff, Reed, Fallot, Elliott, & Bjelajac, 2005). Trauma can be difficult to assess due to stigma and shame and women are sensitive to the language used in exploring it (McHugo et al., 2005). A measure of motivation to address trauma contained within a larger assessment tool may be more palatable to clients. The purpose of this study was to validate a subscale of the 69-item “What I Want from Treatment” (Miller & Brown, 1994). We wanted to determine if a subset of items could be combined to provide a more subtle indication of trauma and motivation to address trauma.

Methods: The “What I Want From Treatment” is a needs assessment/motivational measure given to clients at admission to residential treatment as part of the evaluation process. On this measure, which uses a Likert scale that ranges from 0=No to 3=YES! clients rate a range of problems for which they might want help. Counselors also utilize this measure in treatment planning. Data were gathered from all clients who were admitted December 2004-December 2007 to two SAMHSA-funded residential programs located at the same agency for women who were either (1) homeless with co-occurring disorders or (2) pregnant or parenting substance misusers (N=333). Twenty-two items from the “What I Want from Treatment” that were similar to those of the Trauma Symptom Checklist (Briere, 1996) were selected and entered into an exploratory factor analysis using a rotated component matrix.

Results: Results indicated the scale had 17 items that loaded above .55 and measured three factors: trauma symptoms (alpha=.87), trauma experiences (alpha=.77), and a factor regarding anxiety and confusion (alpha=.69). Good reliability was established as well for the overall subscale (alpha=. 69). T-tests analyses indicated that the homeless women scored significantly higher on motivation to address trauma symptoms and anxiety and confusion (Homeless: M=2.27, S.D.= .71; Pregnant/Parenting: M=2.06, S.D.= .73). Both groups however rated motivation to discuss actual trauma exposure as low.

Conclusion and Implications: The What I Want From Treatment contains a valid subscale that can be utilized by social workers screening for trauma symptoms and motivation to address these problems. Clients may be more willing to admit to trauma symptoms and willingness to address them but be less motivated to address trauma experiences at initial assessment. Having a measure to determine more subtle signs of trauma may be helpful to clinicians.