What Are the Outcomes of Trauma-Informed Interventions for Incarcerated Women? a Review

Background and Purpose: Female offenders are the fastest growing population in U.S. prisons; however, they are a relatively small percentage of the overall prison population, which may explain the lack of gender-specific treatment for women in prison. Compared to men, incarcerated women report higher rates of prior victimization, mental illness, and high rates of substance abuse, all of which appear to be connected. Approximately half of incarcerated women report a history of trauma in addition to high rates of substance abuse and mental health symptomatology. The purpose of this review was to conduct a review of experimental and quasi-experimental studies evaluating manualized trauma-informed interventions.

Methods: Studies for this review were identified using the following electronic databases: PsycINFO, Social Sciences Full-Text, Academic Search Complete, ISI Web of Science, and PubMed. The reviewer completed a manual search of reference lists of all primary outcome studies implemented with incarcerated women. Initially, all located outcome studies of trauma-informed interventions for incarcerated women were reviewed and screened to ensure that they met the inclusion and exclusion criteria for this review. Studies were selected for review if they met the following criteria: (a) a randomized controlled study or quasi-experimental study, (b) participants were incarcerated women over the age of 18, (c) the intervention was manualized and its primary focus was trauma, (d) the outcome measures included a mental health and/or substance abuse measure, (e) the article was written in English and involved women incarcerated in U.S. prisons, and (f) the article was published in a peer-reviewed journal.

Results: Using the specified inclusion/exclusion criteria, 414 articles were retrieved using the search terms and methodological filters listed above. After a removal of duplicates, 255 articles remained. Of the 255 articles, 233 were excluded after a review of the title and/or abstract. After a full review of the remaining 22 articles, 8 met the specified inclusion and exclusion criteria. Three studies used random assignment and five used a comparison or waitlist group. Interventions identified included Seeking Safety, Helping Women Recover/Beyond Trauma, and Esuba. Results of the studies indicate a decrease in PTSD symptomatology and an additive effect to treatment as usual.

Conclusion and Implications: Initial evidence for trauma-informed interventions for incarcerated women appears positive, however, replication using more rigorous research designs and inclusion of effect sizes is recommended. The number of women incarcerated continues to grow, significantly impacting the women incarcerated, their families, and their communities. The costs of this trend are infinite. Incarcerated women often have histories of trauma, mental health diagnoses, and substance abuse issues that are interrelated. The need for gender-responsive and trauma-informed programs has been established. Future intervention research with this population should take into account women’s complex histories of trauma in addition to addressing other mental health and substance abuse needs.