Trauma-informed care is moving toward the forefront of mental health treatment today, but often those most at risk for trauma — people of color, those with lower socioeconomic status, immigration status issues and other marginalized groups — experience the most difficulty in accessing this focused care. The Trauma Recovery Center at USC (TRC) at the Suzanne Dworak-Peck School of Social Work is changing this, with a particular focus on helping survivors of intimate partner violence (IPV) recover from their resulting trauma. 

Marginalized communities experience more of the socioeconomic and behavioral societal stressors that place them at greater risk for IPV, which is borne out in higher rates of this type of abuse among Black and Latinx women but may not be immediately clear when they first seek help. For example, while the crime that brings mental health clients to TRC ranges widely, 58% of clients indicate that they have been victims of domestic violence.

“Intimate partner violence is still often a hidden crime,” said Sarah Caliboso-Soto, clinical director of TRC.  “There's a lot of shame and guilt involved in it. In fact, many of our clients come to us because they have been victims of another crime and only when talking with them do we discover that there has been domestic violence.” 

TRC is the only trauma-informed care center for victims of crime housed within a school of social work, and the first such clinic within USC. Caliboso-Soto says applying a social work lens makes a difference in the scope of care they are able to provide to survivors of IPV, most notably the ability to provide wraparound case management services that are at the core of social work practice and can include financial and social support in addition to mental health treatment.

“As social workers, we're legally and ethically mandated to pay attention to the client's mental health needs, but also their case management,” said  Debra Waters-Roman, associate teaching professor who also serves as TRC’s licensed clinical psychologist and has worked with survivors of IPV for over 30 years. “If you are depressed, but you’re also being evicted at the end of the month, how are you going to concentrate on your mental health when you don't know where you’re going to be living next week or have no food? It's not happening.”

TRC treats chronically underserved and marginalized populations, offering clinical and cost-effective care through an array of services including assertive outreach, trauma- informed case management, and evidence-based psychotherapy to help survivors heal from the wounds left by violent crime. Funded by the California Victims Compensation Board, the clinic offers a course of 16 therapy sessions to any victim of crime in the state of California, with all services available whether in-person or online in English and Spanish. 

Treating invisible scars of IPV helps to heal families

Often, IPV victims either witnessed or experienced domestic violence as children. One of the goals of trauma treatment is to help interrupt these repeating family cycles to offer the current generation an option for healing and change. 

According to Waters-Roman, she always begins with assessing the client’s safety, which includes more than safety from physical violence. Do they need referrals for housing? Do they need referrals for immigration problems? Do they need referrals to food banks? 

“I was in a relationship where there was domestic violence, but for me, at that time, it seemed normal,” said “Jessica,” a client who felt trapped in a cycle of family violence since childhood and whose name has been changed to protect her privacy. “The way he treated me, the way I lived, I looked at it as normal. Until one day things went to the extreme. That’s when I realized I had to protect my children from that violence. I had to get away.” 

Jessica eventually left her abusive partner, but she was not able to leave the emotional impact behind. It still felt normal to her if someone raised their voice or hit her. Although she was not able to care for herself physically, she initially did not see the connection to her experience with IPV. 

“I never thought that the problems, the screaming, the beatings were a trauma or would affect me later emotionally,” Jessica said. 

At TRC, Jessica was able to receive care designed to address her traumas, with culturally sensitive services delivered in Spanish. She became motivated to heal herself, and has implemented many of the trauma-based tools provided by her therapist into her life. 

“It helped me tremendously,” Jessica said. “I was able to understand what I had been experiencing since I was a child until now.” 

Waters-Roman has noticed a shift over the last decade among the Latinx women she counsels. There is a greater acceptance of the importance of therapy and a decrease in stigma. 

“I’m not hearing that therapy is for crazy people, or this isn’t going to help, or this should just be kept in the family,” Waters-Roman said. “These women are telling me exactly what happened, and they’re telling me how they felt and even telling me if sometimes they want to go back to the offender.” 

Another TRC client, who exemplifies how mental health care and case management go hand in hand to help relieve the impacts of trauma, is “Elena,” whose name has been changed to protect her privacy. A sexual abuse survivor as a child, Elena also experienced IPV at the hands of a former partner. After escaping from her most recent abusive situation, Elena continued to struggle with emotional trauma, feeling unsafe and unable to trust anyone. At the same time, she was dealing with unemployment, care for her two young children — both of whom are disabled — and a pending case for custody. 

In addition to providing the trauma-informed mental health care that was critical in her present situation, TRC’s case management services also supported her in registering for English as a second language classes, connecting her with employment agencies, and providing her with two small grants — one to start a home-based business and another to support her son’s special needs. 

Relieving some of her immediate stressors allowed Elena to focus on her own trauma recovery in counseling sessions, allowing her to be a more effective parent and move forward on long-term goals. 

“For the first time I feel relieved,” Elena said. “I don’t want to be one more number, one more statistic. It’s been over 12 years that I was attached to my aggressor, but I’ve been able to finally feel released from him. It was different than previous therapy. I felt empowered, and able to adjust to a new life.” 

Both Jessica and Elena are grateful for the help they received from TRC and hope that by sharing their experiences of IPV and resulting trauma — and how they were able to significantly heal from them — they may be able to help other women like themselves. 

Trauma-informed care through telehealth increases access

Clients at TRC have the option of either in-person or online therapy, but Caliboso-Soto says that over 80% choose telehealth. 

“Being able to offer a Trauma Recovery Center that could deliver services purely online was one of the things we wanted to lean into,” Caliboso-Soto said. “We had been running our Telebehavioral Health Clinic for nearly a decade, so we had the infrastructure and knowledge in place. We know that we are effective in this area, so we decided to really focus on trauma in a dedicated way with a new clinic.” 

TRC launched in 2022 following a marked increase in clients of the Telebehavioral Health Clinic (TBHC) seeking mental health services specifically related to various trauma-related experiences. TBHC was established at USC Social Work in 2012 and developed substantial expertise in the telehealth space well before the pandemic increased that practice. 

Telehealth can make all the difference in having access to services, particularly for women with low income who may not have access to transportation or safe and reliable child care. For those with limited English proficiency, finding services available in Spanish and a culturally sensitive context is also an important consideration. 

“It is particularly helpful for survivors of domestic violence to be able to access trauma services remotely because many are afraid to leave their home,” Caliboso-Soto said. “Instead of having to retraumatize themselves in order to get services, they can receive treatment from home where they feel safe and secure.”

At a time when many other Trauma Recovery Centers funded by the California Victim Compensation Board have had their funding reduced or eliminated due to lower tax revenues, TRC had its funding renewed for a third year at nearly the same amount. Additional grant funding received from the California Youth and Behavioral Health Initiative will allow TRC to expand trauma-informed and culturally responsive services for low socioeconomic status and BIPOC youth aged 12 to25, increasing early intervention for youth at high risk for behavioral health conditions before they escalate. This new grant will provide training for TRC therapists in evidence-based practices specifically designed to treat trauma, including Eye Movement Desensitization and Reprocessing (EMDR) and Trauma-Focused Cognitive Behavioral Therapy (TFCBT). 

“EMDR and TFCBT are very effective practices that usually only people with means can access,” Caliboso-Soto said. “But we're bringing these great evidence-based interventions to populations who need them but are uninsured, and otherwise have no options to receive these services.”