Date of Award

Fall 2024

Language

english

Embargo Period

11-26-2024

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

College/School/Department

School of Social Welfare

Program

Social Welfare

First Advisor

Heather Horton

Committee Members

Lani Jones, Jiang Yu

Keywords

trauma-informed care, addiction, women, substance use disorder treatment

Subject Categories

Social Welfare | Social Work

Abstract

Aims: Regardless of literature citing the effectiveness of trauma-informed care (TIC) (e.g., Capezza & Najavits, 2012; Covington, 2008; Morgan et al., 2020), implementation is lacking in settings that serve women with substance use disorders (SUD) (Bartholow & Huffman, 2023; Capezza & Najavits, 2012; Terplan et al., 2015). Not implementing TIC often results in methods that are trauma-inducing, may prevent the achievement desired outcomes, and lead to negative outcomes such as drop-out and relapse (Brown et al., 2013; Capezza & Najavits, 2012; Claus & Kindleberger, 2002; Hales et al., 2019; SAMHSA, 2014). This study aims to provide a theoretically driven empirical model that can measure and explain clinicians’ behavioral intentions surrounding the use of trauma-informed care in women’s substance use disorder treatment. This exploratory, quantitative, correlational, nonexperimental study seeks to determine which factors predict an intention to use a trauma-informed approach with women in SUD treatment. The Theory of Planned Behavior (TPB) is a psychological theory that explains how a person’s beliefs and intentions influence their behavior. The TPB posits that one’s attitude towards the behavior, subjective norms, and perceived behavioral control influence behavioral intention. The researcher examined how well TPB predicts clinicians’ intention to use a trauma-informed approach to care. One goal of the research is to advance the understanding of what leads an SUD treatment provider to use a trauma-informed approach, which in turn may influence the development of additional training and policies that will increase the use of TIC in women’s SUD treatment (an empirically supported intervention). Methodology: The sample consisted of 490 current professional members/affiliates of The Association for Addiction Professionals (NAADAC), who responded to a recruitment email by completing an online survey through Qualtrics. The study used multiple linear regression to examine the relationships between TPB variables (IVs) and intention to use TIC (DV). An additional multiple linear regression model was used to determine which demographic variables were associated with clinicians’ intention to use TIC. Findings: The TPB was supported by the data. The TPB alone (not controlling for demographic influences) explained 69.1% of the variance in clinicians’ intention to use TIC in women’s SUD treatment. The final multiple linear regression model that included TPB variables and demographic controls explained 74.0% variance in clinicians’ intention to use TIC. Male clinicians and those who completed some college were significantly less likely to use TIC with women in SUD treatment. An individual’s perceived behavioral control was found to be the strongest predictor of intention in both models. Conclusions: The findings cast light on the multiple factors that impact a clinician’s use of TIC with women in SUD treatment. First, a clinician’s perspective about their control over, or ability to use the intervention in a given service setting significantly predicted whether they intended to use (or were already using) a trauma-informed approach to treatment. Second, the perceived social pressure to engage or not to engage in using TIC in one’s agency similarly predicted the use of TIC (revealing the power of an organization and colleagues to influence clinician behavior). Third, the degree to which using TIC is positively or negatively valued by the clinician (significantly) matters in terms of its use. Thus, model standardization for clinicians working with women who have SUDs, broader adoption of trauma-informed care education among women’s SUD treatment agencies, and providing more supportive work environments for the use of TIC may increase clinician’s intention to use TIC in these agencies. Due to the struggles women have endured regarding receiving appropriate treatment for SUD (e.g., criminalization, lack of beds, inappropriate treatment methods, etc.) it is necessary to take steps forward in meeting the needs of these women. Systematic implementation of TIC in women’s SUD treatment by clinicians, although only one piece of the puzzle, is necessary to ensure women have the best chance of recovery.

License

This work is licensed under the University at Albany Standard Author Agreement.

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