Research
Triad Project
The original Triad Women's Group was developed as part of the Substance Abuse and Mental Health Services Agency's Women, Co-occurring Disorders & Violence Study. The group was designed to meet a need for an intervention for women that addresses issues of substance use disorders, mental illnesses and trauma in an evidence-based and empowering manner. The Triad Project involved collaboration among community treatment providers, researchers, and consumers to develop and evaluate innovative services for women with histories of trauma and abuse who have co-occurring psychiatric and substance abuse disorders and who are high utilizers of mental health and substance abuse treatment services. Interventions developed for the project included integrated case management services, a curriculum-based women's treatment group focused on substance abuse, mental health, and trauma issues, and a peer support group. These interventions were provided in jails, homeless shelters and domestic violence centers. Products resulting from this project included the Triad Women's Group Treatment Manual, Triad Girls' Group Treatment manual, and the Integrated Biopsychosocial Assessment. Each is described and can be downloaded below:
The Triad Girls' Group is an 18 session comprehensive group model for adolescent females with functioning difficulties due to substance use / abuse, emotional problems, and histories of violence, abuse or trauma. The groups aim to improve self-concept, self-control and coping / social skills. The model was developed in collaboration with FMHI, the Children's Board and Pace Centers for Girls. The group has been offered in outpatient, residential and school-based settings with the objective of reducing/ preventing the girls' likelihood of involvement in the juvenile justice system, building mental health and preventing substance use disorders.
Triad women's trauma model, developed by and implemented at one of the WCDVS sites,
is based on the perspective that complex disorders arise from trauma and that particular
fundamental issues must be addressed for long-term recovery to occur (Herman, 1992a;
1992b). As its name implies, Triad is targeted for women who experience challenges
around the three issues of trauma, mental health and substance abuse and is designed
to promote survival, recovery, and empowerment (Clark and Fearday, 2003). This cognitive
behavioral model is based, in part, on Linehan's (1993) Cognitive-Behavioral Treatment
model, Evans and Sullivan's (1995) work on substance abuse and trauma and Harris'
(1998) work on trauma and serious mental illness.
Triad's primary treatment goals are to reduce psychiatric and trauma-related symptoms
associated with histories of violence/abuse and substance use for those with substance
abuse disorders. Additional model goals are to increase abstinence or reduce harm
for those with substance dependence and to support women in maintaining their personal
safety. This 16-week group model is structured into four phases (four sessions per
phase), with each weekly group lasting two hours. Each session includes specific goals
and objectives to facilitate short-term treatment planning. Triad groups fit easily
within outpatient or residential community mental health centers and substance abuse
treatment facilities and are currently being offered in jails (with modifications).
Practical considerations frequently dictate, in given environments, whether groups
are closed or open to new members joining as the groups are progressing. Triad groups
are designed so that women can join at the beginning of each of the four phases for
a "modified open" format.
Triad groups are best facilitated by behavioral healthcare professionals or paraprofessionals
who are both knowledgeable of group process and who have either mental health or substance
abuse training. The model's authors strongly recommend that group facilitators receive
special training in treating co-occurring disorders and in working with people who
have trauma-related disorders. Ongoing supervision by a trauma specialist is also
recommended. Clinicians with strong backgrounds in treating trauma survivors are desirable
to co-facilitate the groups until the primary facilitator has adequate skills to run
the groups independently. When groups are larger than 8 – 10 women, a co-facilitator
is highly recommended (Clark and Fearday, 2003).
Clark, C. & Fearday, F (Eds.) (2003). Triad Women's Project: Group Facilitator's Manual.
Louis de la Parte Florida Mental Health Institute. ±«Óãtv, Tampa,
Florida.
Evans, K., & Sullivan, J. M. (1995). Treating addicted survivors of trauma. New York:
Guilford Press.
Harris, M. (1998). Trauma recovery and empowerment. New York: The Free Press.
Herman, J. (1992a). Complex PTSD: A syndrome in survivors of prolonged and repeated
trauma. Journal of Traumatic Stress, 5, 377-391.
Herman J. (1992b). Trauma and recovery. New York: Basic Books.
Linehan, M.M. (1993). Cognitive-behavioral treatment of borderline personality disorder.
New York: The Guilford Press.
The integrated biopsychosocial assessment tool was created by members of substance abuse programs, mental health programs, consumers and researchers from FMHI as a means of intake assessment that would apply for persons seeking behavioral healthcare services through diverse gateways. It was also developed to incorporate histories of abuse/ trauma/ violence as well as trauma related symptoms. Another important aspect of the assessment was to be gender sensitive (including for example, more issues of parenting than the standard assessment) and to be culturally competent both as to race/ ethnicity and to spiritual beliefs. Questions are included to assess the consumers' most culturally comfortable treatment environment. For the consumer, the instrument can be shared among agencies as the person served moves through the service system, to spare the client the strain of repeating the assessment process whenever he or she enters another program. For the provider the assessment addresses accreditation, certification issues and funding issues by meeting standards for, e.g. JCAHO, CARF, and DCF. It was recommended in TIP44 "Substance abuse treatment for adults in the criminal justice system." The instrument is designed to be filled out first by the consumer and then followed up by discussion with an intake worker.