Translating Trauma-Responsive Practices into TANF Programming: Preliminary Results from an Outcome Field Trial

Background: Adults facing significant socioeconomic disadvantage experience joblessness at rates much higher than the national average. Unfortunately, employment service programs designed to promote job development and placement for such adults typically produce mixed long-term results. Program participants often face multiple barriers to sustainable employment beyond structural forces, including mental health impairments. Research suggests that exposure to cumulative trauma helps explain linkages between mental health problems and long-term unemployment.

Consequently, the Healthy Workers, Healthy Wisconsin program integrated a trauma screening, brief intervention and referral to treatment (T-SBIRT) protocol within employment service programs in southeastern Wisconsin. Based on SBIRT for substance misuse, T-SBIRT requires 30 minutes to complete and educates participants about trauma exposure and symptoms, elicits insight into stress coping, and enhances motivation for mental healthcare. Previous research indicated that it is feasible to implement T-SBIRT within employment services. This study assessed whether T-SBIRT is associated with improvements in mental health, employment and income among participants of a Temporary Assistance to Needy Families (TANF) program.

Methods: Participants in this quasi-experimental study (N=147) were recruited from TANF orientation sessions. Upon completing an initial baseline assessment, participants either selected into the T-SBIRT plus TANF service condition or the TANF service condition only. Those who chose the former completed the T-SBIRT protocol anywhere from one to six weeks post-baseline. A follow-up assessment was administered to all participants approximately eight weeks post-baseline. Mental health outcome measures included well-validated self-report scales of depression, anxiety, post-traumatic stress disorder (PTSD), and anger, while single survey items informed employment and income outcomes. To assess changes in outcomes over time and across conditions, mixed linear models or marginal generalized estimating equations were used, controlling for age, race and gender.

Results: Fully 93.9% of the participants identified as female; 88.4% reported earning less than $10,000 annually at baseline. Analyses revealed that the T-SBIRT group reported significantly poorer results than the comparison group in five of the six outcome domains: anxiety, PTSD, anger, employment and income. However, time was a significant variable in each model, indicating that improvements in pooled means from baseline to follow-up were statistically significant. Additionally, the rate of change for the T-SBIRT group was significantly more pronounced, as demonstrated via condition by time interactions for PTSD, employment and income outcomes.

Conclusion: Results suggest that T-SBIRT attracted participants experiencing comparatively severe mental health and employment problems. These selection effects, while highlighting a limitation of quasi-experimental designs, support the authors’ intention to draw high-risk adults to T-SBIRT services. Findings also show that both study groups improved over a short period of time across all outcome measures. While attributing changes to TANF services would be premature, detection of TANF program effects cannot be ruled out. Finally, results indicated that T-SBIRT appeared to be associated with improvements in specific mental health and employment-related outcomes. Preliminary findings contribute to a growing body of literature highlighting the significant benefits of conducting motivationally-based trauma interviews within social or health services. Future research will confirm initial results, explore mechanisms of effect, and support dissemination efforts.