Facilitators of, Barriers to, and Innovations in the Implementation of the Trauma Recovery Center Model for Underserved Victims of Violent Crime in Los Angeles County.

Abstract

Policy Points California government codes 13963.1 and 13963.2 guide the funding and implementation of the Trauma Recovery Center model to provide mental health treatment and case management to underserved victims of violent crime. In Los Angeles County, Trauma Recovery Centers successfully engage underserved victims of crime and improve posttraumatic stress disorder (PTSD) symptoms, quality of life, and social needs for those who receive care. The sustainability of the Trauma Recovery Center model is threatened by current funding policies, including a 2-year grant cycle. California legislators should consider greater flexibility in spending and alternatives to the current model of funding, including integrating the model into continuous care systems CONTEXT: Victimization is widespread in the United States. Marginalized communities are at higher risk of violence and are less likely to receive victim services despite dedicated funding through policies such as the Victims of Crime Act. In California, legislation supports the Trauma Recovery Center (TRC) model, which provides comprehensive mental health and case management services to underserved victims of violent crime. The objective of this study is to describe the implementation of the TRC model in Los Angeles (LA) County.

Methods: We used an explanatory sequential mixed methods approach to assess implementation of five TRCs in LA County between 2021 and 2023. Descriptive analyses included process and outcome metrics. A Wilcoxon signed-rank test was used to assess the difference between pre- and postassessment measures, including change in the Posttraumatic Stress Disorder (PTSD) Checklist for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), World Health Organization Quality of Life (WHOQOL), and social needs. Subsequent qualitative interviews of TRC staff were conducted to identify drivers of process and outcome metrics. Interviews were guided and analyzed using the Consolidated Framework for Implementation Research.

Findings: There were 1,662 victims who received care at the TRCs; they were predominantly female (78.6%, n = 1,174) and Latinx (68.1%, n = 970) and had less than a high school education (41.7%, n = 561). Mean PTSD Checklist for the DSM-5 scores improved from 42.3 to 27.6 (p < 0.001), and WHOQOL scores improved by at least 0.8 points across each domain (p < 0.001). A total of 36 TRC staff members participated in interviews that revealed four themes: 1) clients have complex mental health needs, 2) social needs are compounded by a limited safety net, 3) implementation varies by existing infrastructure and leadership, and 4) funding restrictions limit care.

Conclusions: The TRC model brings comprehensive care to underserved victims of crime, with improvements in PTSD symptoms and quality of life. Funding concerns were the central limitation in model implementation according to TRC staff.