Addressing Intergenerational Trauma through Two-Generation Interventions and Trauma-Responsive Systems of Care

Adverse childhood experiences and other potentially traumatic events are implicated in an array of mental health problems. Left unaddressed, these challenges undermine the well-being not only of adults but also their offspring. Despite the availability of evidence-based treatments for trauma-related mental health symptoms, access is limited and unequal. These disparities are compounded by passive systems of care that wait for clients to seek assistance.

To help redress the inequitable distribution of trauma-responsive mental health care, there is a need to integrate practices within service systems that routinely engage clients and connect them to therapeutic services. The trauma-informed care (TIC) movement has been successful in raising trauma awareness, but it has also drawn criticism for lacking clear and specific practice recommendations. Arguably, population mental health can be improved by translating TIC principles into trauma-responsive practices such as screening, psychoeducation, and motivational enhancement. Moreover, mental health equity will be increased to the extent these strategies are disseminated on a large scale to engage vulnerable populations.

One promising trauma-responsive model is the Trauma Screening, Brief Intervention, and Referral to Treatment (T-SBIRT) protocol, which aims to help trauma-exposed adults with mental health problems gain access to therapeutic services. Two feasibility studies of T-SBIRT have been conducted with low-income and predominantly racial/ethnic minority adults, one in federally qualified health centers and another in a workforce development program. Results from these studies indicated that it was feasible for non-clinical service providers to implement T-SBIRT, as denoted by high tolerability, provider adherence, and acceptance of referrals to treatment. This presentation will summarize those results along with preliminary findings from a third study where T-SBIRT is being implemented within a home visiting program called Family Connects.

Family Connects is a targeted universal intervention that enables all families with a newborn to receive a postpartum home visit. Following a comprehensive in-home assessment, home visitors allocate additional services and referrals in line with each family’s needs so that resources are allocated efficiently and equitably. Results from previous trials of Family Connects will be summarized, including evidence that has linked the program to improved postpartum mental health and reduced child protective service reports. In addition, preliminary findings from a new pilot study will be presented, including evidence that it was feasible for Family Connects home visitors to implement T-SBIRT with fidelity.

Closing recommendations will be offered for promoting mental health equity by disseminating and implementing T-SBIRT through large-scale interventions. Family Connects may be a particularly promising outlet because of its communitywide reach and triage model of care that allocates greater resources to disadvantaged families. Early returns from studies of Family Connects suggests that the model is a promising child maltreatment prevention strategy. Integrating T-SBIRT within this model may increase its capacity to interrupt the intergenerational transmission of trauma by strengthening community connections between frontline human services and backend mental health treatment.