Trauma Informed Organizational Dynamics and Client Outcomes in Concurrent Disorder Treatment

Background and Purpose: Recent research and practice in human service program delivery has focused on the efficacy of trauma informed practice in contributing to service user positive outcomes in a variety of contexts. As knowledge is developed in this field, researchers and practitioners alike can begin to develop frameworks for organizations that apply a trauma informed lens to the provision of services aimed at supporting groups with histories of trauma. This study provides an empirical model that can be implemented and support organizational development within current disorder treatment programs. The research highlights the importance of adapting and developing organizations as an important intervention tool to enhance service user outcomes.

Methods: A cross-sectional quantitative design is employed to validate a model of trauma informed organizational experiences before using it to test for service user outcomes in a concurrent disorder treatment program. Service users (n=172) were surveyed while in treatment to determine the effects of trauma informed organizational dynamics (i.e., experiences with safety, trust, choice, collaboration, and empowerment) on service user intrapersonal development outcomes (i.e., self-awareness, outlook, coping ability, self-worth, and self-determination) and improvements with concurrent disorder behaviors. After testing for validity and reliability of latent factors, data were analyzed using multivariate analysis. Service user demographics were collected as control variables.

Results: Latent factor variables for trauma informed organizational dynamics and service user outcomes performed well on psychometric assessment tests, showing strong construct validity and reliability. Empowerment was found to significantly positively predict all intrapersonal social outcome variables at the p< 0.01 level, while trust also significantly positively predicted all intrapersonal outcome variables with the exception of self-worth, and these relationships were slightly weaker at the p< 0.05 level. The latent construct of safety was the only factor to share a significant relationship with improvement on symptomology of concurrent disorder behaviors assessed by the GAINs-SS total score at the p< 0.05 level. Finally, the results show that each of the social and behavioral outcomes is positively predicted by increased overall experiences with a Trauma Informed Organizational Environment (the higher order factor) in treatment.

Conclusions and Implications: Findings from this research present a model of trauma informed organizational dynamics that can be adopted to support service user outcomes in concurrent disorder treatment. Specifically, the roles of empowerment and trust were found to be highly important, supporting the efficacy of specific techniques, such as strengths-based approaches and the formation of trusting bonds with program staff, as powerful strategies for developing a strong sense of self in service users. This study was conducted in partnership with a community-based treatment program as part of a multi-year client-focused evaluation project. Findings have directly contributed to the chosen methods of client engagement, as well as intervention strategies, by informing decisions and adjustments at all levels of the organization in an effort to adopt trauma-sensitive and client-centered programming.