The CARE Health Advocacy Intervention Improves Trauma-Informed Practices at Domestic Violence Service Organizations to Address Brain Injury, Mental Health, and Substance Use

Abstract

Objective: The aim of this study was to evaluate the impact that domestic violence (DV) service organizations' (SO) agency-wide adoption of CARE had on improving DVSO trauma-informed care (TIC) practices, overall, and in relation to addressing brain injury and mental health. CARE is an advocacy intervention designed to raise DVSOs' capacity to CONNECT with survivors; ACKNOWLEDGE that head trauma, strangulation, and mental health challenges are common; RESPOND by accommodating needs in services and providing targeted referrals; and EVALUATE effectiveness of response to meet survivors' stated concerns. We hypothesized that TIC would significantly improve among DVSO staff with the agency's use of CARE. Setting/Participants/Design: Pre- (n = 53) and 1-year post-CARE (n = 60) implementation online surveys were completed by staff at 5 DVSOs in Ohio from 2017 to 2019. Main Measures: Trauma-Informed Practice Scales (TIPS) were used to assess agency support and overall staff impression of implementing TIC; scales were modified to assess the use of TIC-practices related to head trauma, strangulation, mental health, suicide, and substance use. Attitudes Regarding Trauma-Informed Care (ARTIC-45) subscales assessed DVSO staff's endorsement of personal and organizational support in implementing TIC practices. Response options on the Survivor Defined Practice Scale (SDPS) were modified to gain staff insight into DVSO's ability to facilitate survivor empowerment. Differences in endorsement of TIC practices between pre- and post-CARE implementation were evaluated using regression models. Results: DVSO agency environment (P < .01) and overall staff impression (P < .001) regarding implementing TIC practices, and in respect to head trauma (P < .01), strangulation (P < .01), mental health (P < .01), suicide (P = .04), and substance use (P < .01), significantly improved with the agency's use of CARE. CARE increased DVSO staff's belief in personal and organizational support to implement TIC (P < .01 and P = .02, respectively) and in their agency's ability to foster survivor empowerment (P < .01). Conclusion: CARE improved TIC practices of DVSOs, overall, and to address brain injury and mental health.