Trauma-Responsive Employment Services: Support for Socio-Economically Disadvantaged Adults

Background and purpose: Low-income adults residing in central city neighborhoods face multiple barriers to economic stability, including arrest patterns, job migration and systematic discrimination. The scope of the problem is alarming; rates of joblessness in some urban centers is as high as 50%. Various solutions have been advanced including innovative employment programs. While attractive in theory, the programs have produced mixed results to date. Emerging data suggest that employment programs might improve their performance if they expand beyond traditional job services. Studies indicate that low-income job seekers experience a high prevalence of violence exposure and mental health problems; meanwhile, employment service programs that address these issues through trauma-responsive models of care have shown promise.

The current study examines data from one such initiative: Healthy Workers, Healthy Wisconsin (HWHW). Through HWHW, employment service programs in Milwaukee are piloting an innovative trauma screening, brief intervention, and referral to service protocol (T-SBIRT). T-SBIRT assesses trauma exposure and symptoms and refers participants to mental health treatment when indicated. Using HWHW data, this investigation explores the following research questions:

1. What are the rates of trauma exposure, PTSD, depression and anxiety;
2. What are the rates of acceptance for mental health service referrals; and
3. Does acceptance of mental health service referrals vary by gender, race, socioeconomic status (SES), and mental health status?

Methods: The sample (N=148) was predominately Black (69%) and male (60%), with an average age of 37. Most participants (66%) earned less than $5,000 annually.

Participants provided cross-sectional, self-report data on trauma exposure (Trauma History Screen), post-traumatic stress disorder or PTSD (Primary Care Post-Traumatic Stress Disorder), depression (Patient Health Questionnaire-9), and anxiety (Generalized Anxiety Disorder-7). T-SBIRT providers reported on mental health service referrals.

Results for the first and second research questions emerged from descriptive analyses. Simple bivariate chi-square analyses generated results for the third research question

Results: Of the full sample: 86% reported exposure to three or more types of significant lifetime trauma, 53% met criterion for PTSD, 61% met criterion for depression, and 59% met criterion for generalized anxiety. Fully 55% of participants accepted a mental health referral. Notably, males were as likely to accept referrals as females; Blacks were as likely as whites; and adults of low SES were as likely as adults with higher SES. Referral acceptance rates did not vary by mental health status with one exception. Participants with positive versus negative anxiety screening scores were more likely to accept mental health referrals (59% vs 39%, p=.048).

Implications and conclusion: Findings reinforce the assertion that low-income, central city job seekers endure high levels of trauma exposure and high rates of mental health problems. However, the study suggests that the majority accept mental health referrals when offered through employment services. Finally, it is noteworthy that referral acceptance did not vary by personal characteristic, suggesting that groups suffering significant disparities in access to mental health care, such as Black Americans and very low-income adults, can potentially benefit from trauma-responsive employment services that include referral to mental health services.