Women and Community Re-Entry: Examining Trauma and Readiness to Change with Latent Profile Analysis

Background and Purpose: Women constitute more than one-quarter of the adults arrested in the United States (FBI, 2012). Re-entry programs are designed to help parolees transition from corrections to the community, which is important as these women often face problems related to alcohol and drugs as well as other psychosocial challenges (e.g., behavioral health issues, PTSD) that act as barriers to reintegration. Community-based re-entry programs often meet the behavioral health needs of residents offering treatment for mental illness, substance use disorders, and relapse prevention.  While many programs subscribe to evidence-based milieus, limited knowledge exists related to characteristics of women who may benefit most from such programs. The purpose of this study was to: 1) use latent profile analysis (LPA) to identify classes of women based on trauma indicators and 2) examine the association between class membership and readiness to change substance use behaviors.

Methods: Participants in this study (N = 103) were residents of a re-entry program using Helping Women Recover([HWR], Covington, 1999), a program designed for women with substance use disorders and trauma history. These data were gathered prior to the intervention. Trauma was measured with the Trauma Symptoms Inventory (TSI; Briere, 1996). We focused on the following TSI subscales: Anxious Arousal, Depression, Anger/Irritability, Intrusive Experiences, Defensive Avoidance, Dissociation, Sexual Concerns, Dysfunctional Sexual Behavior, Impaired Self-reference, and Tension Reduction Behavior. Readiness to change was measured with the University of Rhode Island Change Assessment (URICA; McConnaughy, Prochaska, & Velicer, 1983) and is made up of the following subscales: Precontemplation, Contemplation, Action, and Maintenance.

Results: LPA resulted in a two-class solution (AIC = 6117.965, 6199.642, Entropy= .968; LMR=528.84, p<.001). Class 1 (57.3%; n=59) included women with high levels of trauma across all indicators. Class 2 (42.7%; n= 44) demonstrated notably lower levels of trauma indicators.  Demographics were not significantly different across subgroups of women. However, age trended toward significance (p=.06) demonstrating that younger women had lower levels of trauma (i.e., Class 2). There was a significant difference between classes with respect to the Precontemplation subscale of the URICA with Class 1 (i.e., higher trauma) demonstrating higher precontemplation than women in Class 2 (i.e., lower trauma) (p=.029).  Women with higher trauma in Class 1 also demonstrated a trend toward greater action than women in Class 2 (p=.071). URICA Readiness to change scores were slightly higher for women with more trauma in Class 1, but the difference was non-significant.

Implications: Findings illustrate a first step in demonstrating the link between trauma indicators and readiness to change; women in Class 1, who experienced more trauma, were both more ambivalent and more likely to address their problematic behaviors when compared to Class 2. These results point to a need to further delineate links between trauma and readiness to change, which has implications for administrators delivering evidence-based treatment. Findings that illustrate extremes of readiness among individuals with high trauma suggest a need to tailor interventions to include motivational components that are also trauma-informed.