The document summarizes a substance use disorder treatment program for families that implements trauma-informed and evidence-based practices. It finds that participants have extensive trauma histories, including high Adverse Childhood Experience scores and trauma symptoms. The program uses therapies like Celebrating Families!, Family Behavior Therapy, and Seeking Safety to treat co-occurring substance use and trauma and improve family outcomes. Post-treatment, families reported improved housing stability, permanency for children, and mental well-being.

1. Intergenerational Trauma Prevalence in Substance Use Disorder
Will Giebert, MPA
Kiley Compton, MA
Overview
Evidence-Based Practices
and Interventions
Family Baselines Family Outcomes
Helen Ross McNabb Center (HRMC) offers New
Beginnings for Families, a substance use disorder
(SUD) treatment program for families funded through
the Department of Health and Human Services,
Children’s Bureau, Regional Partnership Grant.
Families are provided SUD treatment through either
in-home, intensive outpatient, or residential-based
modalities. Demographic, health, and family history
data along with psychometric assessments are
collected and traced at structured intervals during
families’ treatment and at 3-, 6-, 12-, and 18-months
post-discharge from treatment services. A rigorous
evaluation conducted by internal evaluators at HRMC
utilize these data to assess and compare processes
and outcomes across the separate modalities.
Intergenerational Trauma
Prevalence
Contributing Factors
References
Many participants have extensive acute and complex
trauma histories including cyclical and inter-
generational abuse. The average Adverse Childhood
Experience (ACE) score among participants in the
residential-based program is 5.6. Participants are at
high risk of continuing the cycle of intergenerational
violence, abuse and trauma with their children who
face substance exposure, NAS, parental incarceration
and foster care.
37.5% of clients scored in the elevated risk range of
the Trauma Symptoms Checklist (12 of 32) at
baseline.
New Beginnings for Families implements family-
focused and trauma-informed EBPs to address co-
occurring substance use disorder and trauma and
improve family functioning, stability, and cohesion.
Celebrating Families! (CF!) combines SUD recovery
concepts with healthy family living skills in a cognitive
behavioral support group model for families that
present with parental substance use disorder and high
risk for child abuse or neglect.
Family Behavior Therapy (FBT) addresses SUD
along with family/social relationships, employment and
education through a Community Reinforcement
Approach.
Hazelden Co-occurring Disorders Program (CDP)
addresses and treats co-occurring substance use and
non-severe mental health disorders through
combined, integrated therapies.
Nurturing Parenting reinforces positive parenting
behaviors through a family-centered, trauma-informed
approach focusing on reducing intergenerational child
abuse and substance use.
Seeking Safety addresses co-occurring substance
use and trauma through a highly flexible, present-
focused therapy model aimed at increasing safety and
safe coping skills.
Definitions:
“Family” refers to the family unit consisting of the
adult(s) receiving SUD treatment.
“Target Child” refers to the youngest child of the
adult(s) receiving SUD treatment.
Contributors: Erika Panek, MSSW; Sarah Long, LCSW
Data was collected from clients served through New Beginnings for
Families in-home and residential-based modalities from January 1, 2014 –
June 30, 2016.
187
144
135
84
64
63
104
120
171
190
0 50 100 150 200 250 300
Emotional Abuse as an adult
Sexual Abuse/rape as an adult
Domestic Violence as an adult
Sexual Abuse as a child
Physical Abuse as a child
TRAUMA HISTORY
Yes No
52
54
130
154
123
101
102
108
92
130
0 50 100 150 200 250 300
Other family member(s)
Step-parent(s)
Sibling(s)
Father
Mother
FAMILY HISTORY OF SUBSTANCE ABUSE
Yes No
At discharge, participating families reported the
following outcomes:
Housing
• 83.1% (206 of 248) were living in sober housing
(free of substance use).
• 89.6% (138 of 154) were living in safe housing
(free of violence or other danger).
• 86.3% (132 of 153) were living in stable
housing (no threat of eviction).
Permanency
• 67.4% of Target Children (153 of 227) resided
at home with their family (with or without open
child welfare cases).
• 61.8% of Target Children (123 of 199) resided
in their family’s physical custody.
• 50.8% of families that did not have custody of
their Target Child at the beginning of treatment
either began or increased visitation with their
Target Child (34 of 67).
• 18.7% of families that did not have custody of
their Target Child at the beginning of treatment
were reunified with their Target Child (12 of 65).
Well-being
• 75% (24 of 32) improved or scored the same
level on the Trauma Symptoms Checklist.
• 90.5% (19 of 21) improved or scored the same
level on the CES-D depression scale.
• 100% (6 of 6) improved on the Parental Stress
Index measure.
“I want people to know. We have no control over our
disease; it controls us. Until you’re ready to give up the
control, you’ll never get better.” – New Beginnings for
Families client
“I wanted a different life for my daughter. I have two other
kids that have had it rough and want things to be different
for her. This program saved my life and my relationship with
my daughter.” – New Beginnings for Families client
1. Family Development Resources. Nurturing Parenting.
2. Hazelden Betty Ford Foundation. Hazelden's Co-occurring Disorders Program (CDP).
3. JBS International, Inc. and The Center for Children and Family Futures. (2007).
Family-Centered Treatment for Women with Substance Use Disorders: History, Key
Elements, and Challenges. Substance Abuse and Mental Health Services
Administration Center for Substance Abuse Treatment.
4. Najavits, L. M. (2002). Seeking Safety: A Treatment Manual for PTSD and Substance
Abuse. New York: The Guilford Press.
5. Substance Abuse and Mental Health Services Administration. Family Behavior
Therapy. SAMHSA's National Registry of Evidence-based Programs and Practices.
6. The National Abandoned Infants Assistance Resource Center. (2005).Celebrating
Families: An Innovative Approach for Working with Substance Abusing Families. The
Source, 6-10.
Acute and
Chronic Abuse,
Assault,
Maltreatment,
Neglect, and
Separation
Persistent
Symptoms of
Trauma and
Substance Use
Disorder
Family History of
Substance Use
Disorder
“I keep remembering how good it felt to be clean… for
my family to trust me…to have a job …to buy whatever
I wanted. I want my kids to have things that I didn’t
have growing up. I have a sixteen year old daughter
and she watches and sees what I do and I don’t want
her doing the things I did. I just want to live life again
and be happy.” – New Beginnings for Families client
Opiates form the majority of both the primary
substance problem requiring treatment (56.4%) and
the drug of choice (60.2%) of 257 clients surveyed.
71%
47%
39% 41%
48%
0%
10%
20%
30%
40%
50%
60%
70%
80%
Incarceration Mental health
disorder
Child welfare
removal
Parental criminal
involvement
Parental mental
health disorder
FAMILY RISK FACTORS