Effects of a trauma-informed curriculum on depression, self-efficacy, economic security, and substance use among TANF participants: Evidence from the Building Health and Wealth Network Phase II

Rationale: Integrating trauma-informed peer support curriculum into the Temporary Assistance for Needy Families (TANF) program can help address caregiver trauma symptoms (e.g., depression, low self-efficacy, economic hardship) caused by exposures to violence and adversity that negatively impact one's ability to maintain employment and improve earnings; yet, it is unclear if trauma-informed peer support interventions designed for TANF impact co-occurring disorders, such as depression and substance use, that inhibit resiliency in the labor market. Objective: The aim of this study is to examine whether integrating trauma-informed peer support curriculum into the TANF program is associated with reductions in co-occurring depression and substance use, and improvements in self-efficacy and economic security. Method: From October 2015 to May 2018, 369 caregivers were enrolled in the 16-week Building Wealth and Health Network Phase II single-group cohort study. Participants responded to questions regarding their socio-demographic characteristics, mental health, economic security, and use of drugs and alcohol at baseline and four three-month follow-up surveys. Associations between the trauma-informed peer support curriculum and health outcomes were assessed using maximum likelihood estimation. Results: Using class attendance records, participants were separated into a low-exposure group (= four classes; n = 213). Maximum likelihood analysis revealed that the high-exposure group reported a lower Center for Epidemiologic Studies Depression Scale (CES-D) score (-1.245; p = 0.027) and lower economic Hardship Index score (-0.499; p < 0.001) than the low-exposure group. The analysis also revealed that for the high-exposure group, attending an additional class was associated with declines in CES-D score (-1.024; p = 0.016) and 12-point Alcohol Use Disorders Identification Test score (-0.557; p = 0.012). Conclusions: These findings suggest that trauma-informed peer support programming improves economic security and self-efficacy and reduces the co-occurrence of depressive symptoms and alcohol use.