Sexual Abuse
Conditions
Brief summary
The study will conduct a randomized comparative effectiveness trial of peer-facilitated, online, 6-week group Motivational Interviewing (MI) vs. Motivational Interviewing (MI) with a trauma-informed Sexual and Gender Minority (SGM) affirmative care approach.
Detailed description
Through workshops and ongoing supervision/consultation, researchers will train MaleSurvivor peer leaders to competently deliver both versions of MI and conduct a randomized controlled trial comparing the two versions of MI to enhance treatment engagement in SGM male survivors with mental health problems. All SGM male survivors who meet inclusion criteria, including significant emotional distress, will complete pre-test measures and be randomized to 6-week MI delivered by peers in online groups or 6-week MI with trauma-informed, SGM affirmative care delivered by peers in online groups. Randomization will be counterbalanced by treatment status: treatment naive versus treatment-experienced (prior treatment but not within the past 60 days).
Interventions
All SGM male survivors who meet inclusion criteria, including significant emotional distress, will complete pre-test measures and be randomized to 6-week Motivational Interviewing (MI) delivered by peers in online groups or 6-week MI with trauma-informed, SGM affirmative care delivered by peers in online groups. Participants will complete pre-intervention (baseline), end of the 6-week intervention, 60- and 120-days follow-up assessments via an online survey platform, to determine if there was an increase in formal treatment engagement, and any significant changes in mental health symptomology (i.e., PTSD, depression, high-risk drinking, and illicit substance use).
Major principles and tenets of Motivational Interviewing (MI) group include: Non-confrontational nature of group; environment is one of respect, safety, and encouragement of all group members; purpose is to learn about members' personal thoughts and choices and not to push an agenda
Sponsors
Study design
Intervention model description
randomized comparative
Eligibility
Inclusion criteria
* 18 years or older * English-speaking; men who have sex with men or individuals identifying as SGM males * Individuals who report a history of sexual abuse and individuals who self-report a minimum cut-off score of 3.0 or higher on emotional distress, using a 4-question symptom inventory.
Exclusion criteria
* Individuals who endorse active psychosis * Individuals who have a cognitive dysfunction * SGM men who report that they are currently in formal mental health counseling
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Number of Participants Who Engage in Mental Health Treatment | Post-intervention (immediately following last online group), 60-day follow-up, and 120-day follow-up. | The number of participants who initiated mental health treatment/reinitiated mental health treatment versus those who did not. Mental health treatment engagement will be operationally defined as having ≥1 visit(s) or scheduled appointments to any mental health services within 120 days of the last online group. |
| Center for Epidemiological Studies Depression Scale | Baseline (pre-intervention), Post-intervention (immediately following last online group), 60-day follow-up, and 120-day follow-up. | This is a 20-item questionnaire that asks about experience and frequency of depressive symptoms over the past week. Possible range of scores is 0-60, with the higher scores indicating the presence of more symptomatology. A score of 16 or higher identifies those individuals who are at risk for major depression (which is equivalent to endorsing at least 6 out of 20 symptoms for depression. Researchers will be looking for scores to reduce to below 16, indicating a lack of criteria being met for major depressive disorder. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Post Traumatic Stress Disorder | Baseline (immediately pre-intervention), Post-intervention (immediately following last online group), 60-day follow-up, and 120-day follow-up. | PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) , DSM-5 (PCL-5; Weathers et al., 2013) is a 20-item instrument that corresponds to the current psychiatric diagnostic criteria for PTSD. Participants respond on a Likert scale ranging from 0 (not at all) to 4 (extremely). A provisional PTSD diagnosis can be made by treating each item rated as 2 (moderately) or higher as a symptom endorsed, then following the DSM-5 diagnostic rule which requires at least: 1 Criterion B item (Intrusion symptoms; questions 1-5), 1 Criterion C item (Avoidance symptoms; questions 6-7), 2 Criterion D items (Alternations in cognitions and mood; questions 8-14), 2 Criterion E items (Alterations in arousal and reactivity; questions 15-20). A PCL-5 cut-point of 33 appears to be a reasonable value to use for provisional PTSD diagnosis. Severity can be determined adding scores of each item together to determine a total score. The range is 0-80. |
| Psychosocial Functioning | Baseline (immediately pre-intervention), Post-intervention (immediately following last online group), 60-day follow-up, and 120-day | Inventory of Psychosocial Functioning (IPF-B; Rodriguez, Holowka, & Marx, 2012) is a brief 7-item scale that assesses functional impairment or quality of life related to trauma and PTSD. Questions assess for impairment in romantic relationships, family relationships, work, friendships and socializing, parenting, academic pursuits, and self-care. Higher scores indicate greater functional impairment. Respondents answer each item by using a 7-point scale ranging from 1 (never) to 7 (always). The IPF yields an overall functional impairment score. |
| Substance Abuse | Baseline (immediately pre-intervention) | The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) is an 8-item measure of use of alcohol, tobacco products, and other drugs across the lifespan and in the past 3 months. The test has been shown to be a valid indicator of active substance use with adequate construct validity. Scores are summed across for each drug category separately with a maximum score for tobacco = 31 and a maximum score for each of the other drug categories = 39. A Global Continuum of Risk Score can also be calculated by summing all items for all drug classes together with a maximum score of 414. Scores are categorized into Low (0 - 3), Moderate (4 - 26), and High (27+) risk. |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Motivational Interviewing Sexual and gender minority males who are sexual abuse survivors.
Motivational Interviewing: Major principles and tenets of Motivational Interviewing (MI) group include: Non-confrontational nature of group; environment is one of respect, safety, and encouragement of all group members; purpose is to learn about members' personal thoughts and choices and not to push an agenda | 178 |
| MI With Trauma-informed SGM Affirmative Care MI w/trauma-informed SGM affirmative care
Trauma-informed SGM affirmative care: All SGM male survivors who meet inclusion criteria, including significant emotional distress, will complete pre-test measures and be randomized to 6-week Motivational Interviewing (MI) delivered by peers in online groups or 6-week MI with trauma-informed, SGM affirmative care delivered by peers in online groups.
Participants will complete pre-intervention (baseline), end of the 6-week intervention, 60- and 120-days follow-up assessments via an online survey platform, to determine if there was an increase in formal treatment engagement, and any significant changes in mental health symptomology (i.e., PTSD, depression, high-risk drinking, and illicit substance use). | 178 |
| Total | 356 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | 0 Sessions Attended | 34 | 37 |
| Overall Study | Protocol Violation | 1 | 0 |
| Overall Study | Withdrawal by Subject | 4 | 6 |
Baseline characteristics
| Characteristic | Motivational Interviewing | MI With Trauma-informed SGM Affirmative Care | Total |
|---|---|---|---|
| Age, Continuous | 34.7 years STANDARD_DEVIATION 12.2 | 35 years STANDARD_DEVIATION 11.3 | 34.9 years STANDARD_DEVIATION 11.8 |
| Depression (CES-D) | 30.61 units on a scale STANDARD_DEVIATION 10.85 | 31.24 units on a scale STANDARD_DEVIATION 10.81 | 30.92 units on a scale STANDARD_DEVIATION 10.82 |
| Mental Health Treatment History Not treatment naive | 157 Participants | 159 Participants | 316 Participants |
| Mental Health Treatment History Treatment naive | 21 Participants | 19 Participants | 40 Participants |
| Race (NIH/OMB) American Indian or Alaska Native | 2 Participants | 2 Participants | 4 Participants |
| Race (NIH/OMB) Asian | 17 Participants | 11 Participants | 28 Participants |
| Race (NIH/OMB) Black or African American | 17 Participants | 16 Participants | 33 Participants |
| Race (NIH/OMB) More than one race | 12 Participants | 12 Participants | 24 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 1 Participants | 1 Participants | 2 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 0 Participants | 2 Participants | 2 Participants |
| Race (NIH/OMB) White | 129 Participants | 134 Participants | 263 Participants |
| Sex/Gender, Customized Gender Identity Male | 146 Participants | 153 Participants | 299 Participants |
| Sex/Gender, Customized Gender Identity Other | 6 Participants | 7 Participants | 13 Participants |
| Sex/Gender, Customized Gender Identity Trans male/Trans man | 26 Participants | 18 Participants | 44 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 0 / 178 | 0 / 178 |
| other Total, other adverse events | 5 / 178 | 12 / 178 |
| serious Total, serious adverse events | 2 / 178 | 0 / 178 |
Outcome results
Center for Epidemiological Studies Depression Scale
This is a 20-item questionnaire that asks about experience and frequency of depressive symptoms over the past week. Possible range of scores is 0-60, with the higher scores indicating the presence of more symptomatology. A score of 16 or higher identifies those individuals who are at risk for major depression (which is equivalent to endorsing at least 6 out of 20 symptoms for depression. Researchers will be looking for scores to reduce to below 16, indicating a lack of criteria being met for major depressive disorder.
Time frame: Baseline (pre-intervention), Post-intervention (immediately following last online group), 60-day follow-up, and 120-day follow-up.
Population: For outcome analyses, linear mixed models (LMM) of mental health symptoms were modeled as a repeated measures outcome variable, nested within participants, and nested within cohorts. Baseline values of the dependent variable, along with any baseline characteristics that differentiated the two groups, were included as time-invariant covariates (between participants), as was treatment group.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Motivational Interviewing | Center for Epidemiological Studies Depression Scale | Baseline | 30.50 score on a scale | Standard Error 0.67 |
| Motivational Interviewing | Center for Epidemiological Studies Depression Scale | Post-intervention | 24.04 score on a scale | Standard Error 0.75 |
| Motivational Interviewing | Center for Epidemiological Studies Depression Scale | 60-day follow-up | 27.33 score on a scale | Standard Error 0.77 |
| Motivational Interviewing | Center for Epidemiological Studies Depression Scale | 120-day follow-up | 24.01 score on a scale | Standard Error 0.79 |
| MI With Trauma-informed SGM Affirmative Care | Center for Epidemiological Studies Depression Scale | 120-day follow-up | 23.74 score on a scale | Standard Error 0.77 |
| MI With Trauma-informed SGM Affirmative Care | Center for Epidemiological Studies Depression Scale | Baseline | 30.70 score on a scale | Standard Error 0.67 |
| MI With Trauma-informed SGM Affirmative Care | Center for Epidemiological Studies Depression Scale | 60-day follow-up | 25.46 score on a scale | Standard Error 0.75 |
| MI With Trauma-informed SGM Affirmative Care | Center for Epidemiological Studies Depression Scale | Post-intervention | 22.87 score on a scale | Standard Error 0.73 |
Number of Participants Who Engage in Mental Health Treatment
The number of participants who initiated mental health treatment/reinitiated mental health treatment versus those who did not. Mental health treatment engagement will be operationally defined as having ≥1 visit(s) or scheduled appointments to any mental health services within 120 days of the last online group.
Time frame: Post-intervention (immediately following last online group), 60-day follow-up, and 120-day follow-up.
| Arm | Measure | Group | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| Motivational Interviewing | Number of Participants Who Engage in Mental Health Treatment | Post-Intervention | 23 Participants |
| Motivational Interviewing | Number of Participants Who Engage in Mental Health Treatment | 60-day follow-up | 31 Participants |
| Motivational Interviewing | Number of Participants Who Engage in Mental Health Treatment | 120-day follow-up | 28 Participants |
| MI With Trauma-informed SGM Affirmative Care | Number of Participants Who Engage in Mental Health Treatment | Post-Intervention | 18 Participants |
| MI With Trauma-informed SGM Affirmative Care | Number of Participants Who Engage in Mental Health Treatment | 60-day follow-up | 26 Participants |
| MI With Trauma-informed SGM Affirmative Care | Number of Participants Who Engage in Mental Health Treatment | 120-day follow-up | 31 Participants |
Post Traumatic Stress Disorder
PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) , DSM-5 (PCL-5; Weathers et al., 2013) is a 20-item instrument that corresponds to the current psychiatric diagnostic criteria for PTSD. Participants respond on a Likert scale ranging from 0 (not at all) to 4 (extremely). A provisional PTSD diagnosis can be made by treating each item rated as 2 (moderately) or higher as a symptom endorsed, then following the DSM-5 diagnostic rule which requires at least: 1 Criterion B item (Intrusion symptoms; questions 1-5), 1 Criterion C item (Avoidance symptoms; questions 6-7), 2 Criterion D items (Alternations in cognitions and mood; questions 8-14), 2 Criterion E items (Alterations in arousal and reactivity; questions 15-20). A PCL-5 cut-point of 33 appears to be a reasonable value to use for provisional PTSD diagnosis. Severity can be determined adding scores of each item together to determine a total score. The range is 0-80.
Time frame: Baseline (immediately pre-intervention), Post-intervention (immediately following last online group), 60-day follow-up, and 120-day follow-up.
Population: For outcome analyses, linear mixed models (LMM) of mental health symptoms were modeled as a repeated measures outcome variable, nested within participants, and nested within cohorts. Baseline values of the dependent variable, along with any baseline characteristics that differentiated the two groups, were included as time-invariant covariates (between participants), as was treatment group.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Motivational Interviewing | Post Traumatic Stress Disorder | Baseline | 36.26 score on a scale | Standard Error 0.97 |
| Motivational Interviewing | Post Traumatic Stress Disorder | Post-intervention | 29.30 score on a scale | Standard Error 1.1 |
| Motivational Interviewing | Post Traumatic Stress Disorder | 60-day follow-up | 32.22 score on a scale | Standard Error 1.12 |
| Motivational Interviewing | Post Traumatic Stress Disorder | 120-day follow-up | 27.47 score on a scale | Standard Error 1.14 |
| MI With Trauma-informed SGM Affirmative Care | Post Traumatic Stress Disorder | 120-day follow-up | 25.57 score on a scale | Standard Error 1.12 |
| MI With Trauma-informed SGM Affirmative Care | Post Traumatic Stress Disorder | Baseline | 36.45 score on a scale | Standard Error 0.97 |
| MI With Trauma-informed SGM Affirmative Care | Post Traumatic Stress Disorder | 60-day follow-up | 29.21 score on a scale | Standard Error 1.1 |
| MI With Trauma-informed SGM Affirmative Care | Post Traumatic Stress Disorder | Post-intervention | 27.84 score on a scale | Standard Error 1.06 |
Psychosocial Functioning
Inventory of Psychosocial Functioning (IPF-B; Rodriguez, Holowka, & Marx, 2012) is a brief 7-item scale that assesses functional impairment or quality of life related to trauma and PTSD. Questions assess for impairment in romantic relationships, family relationships, work, friendships and socializing, parenting, academic pursuits, and self-care. Higher scores indicate greater functional impairment. Respondents answer each item by using a 7-point scale ranging from 1 (never) to 7 (always). The IPF yields an overall functional impairment score.
Time frame: Baseline (immediately pre-intervention), Post-intervention (immediately following last online group), 60-day follow-up, and 120-day
Population: For outcome analyses, linear mixed models (LMM) of mental health symptoms were modeled as a repeated measures outcome variable, nested within participants, and nested within cohorts. Baseline values of the dependent variable, along with any baseline characteristics that differentiated the two groups, were included as time-invariant covariates (between participants), as was treatment group.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Motivational Interviewing | Psychosocial Functioning | Baseline | 45.64 score on a scale | Standard Error 1.36 |
| Motivational Interviewing | Psychosocial Functioning | Post-intervention | 39.88 score on a scale | Standard Error 1.56 |
| Motivational Interviewing | Psychosocial Functioning | 60-day follow-up | 39.97 score on a scale | Standard Error 1.58 |
| Motivational Interviewing | Psychosocial Functioning | 120-day follow-up | 39.69 score on a scale | Standard Error 1.62 |
| MI With Trauma-informed SGM Affirmative Care | Psychosocial Functioning | 120-day follow-up | 38.72 score on a scale | Standard Error 1.6 |
| MI With Trauma-informed SGM Affirmative Care | Psychosocial Functioning | Baseline | 44.71 score on a scale | Standard Error 1.37 |
| MI With Trauma-informed SGM Affirmative Care | Psychosocial Functioning | 60-day follow-up | 34.05 score on a scale | Standard Error 1.56 |
| MI With Trauma-informed SGM Affirmative Care | Psychosocial Functioning | Post-intervention | 38.51 score on a scale | Standard Error 1.52 |
Substance Abuse
The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) is an 8-item measure of use of alcohol, tobacco products, and other drugs across the lifespan and in the past 3 months. The test has been shown to be a valid indicator of active substance use with adequate construct validity. Scores are summed across for each drug category separately with a maximum score for tobacco = 31 and a maximum score for each of the other drug categories = 39. A Global Continuum of Risk Score can also be calculated by summing all items for all drug classes together with a maximum score of 414. Scores are categorized into Low (0 - 3), Moderate (4 - 26), and High (27+) risk.
Time frame: Baseline (immediately pre-intervention)
Population: For outcome analyses, linear mixed models (LMM) of mental health symptoms were modeled as a repeated measures outcome variable, nested within participants, and nested within cohorts. Baseline values of the dependent variable, along with any baseline characteristics that differentiated the two groups, were included as time-invariant covariates (between participants), as was treatment group.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Motivational Interviewing | Substance Abuse | Cocaine | 1.58 score on a scale | Standard Error 0.17 |
| Motivational Interviewing | Substance Abuse | Sedatives | 2.00 score on a scale | Standard Error 0.23 |
| Motivational Interviewing | Substance Abuse | Marijuana | 6.44 score on a scale | Standard Error 0.33 |
| Motivational Interviewing | Substance Abuse | Hallucinogens | .98 score on a scale | Standard Error 0.15 |
| Motivational Interviewing | Substance Abuse | Amphetamine/ Stimulant | 2.51 score on a scale | Standard Error 0.23 |
| Motivational Interviewing | Substance Abuse | Opioids | 1.02 score on a scale | Standard Error 0.17 |
| Motivational Interviewing | Substance Abuse | Alcohol | 8.83 score on a scale | Standard Error 0.35 |
| Motivational Interviewing | Substance Abuse | Other | 8.83 score on a scale | Standard Error 0.35 |
| Motivational Interviewing | Substance Abuse | Inhalants | .96 score on a scale | Standard Error 0.15 |
| Motivational Interviewing | Substance Abuse | Medical Marijuana | 1.68 score on a scale | Standard Error 0.3 |
| Motivational Interviewing | Substance Abuse | Tobacco | 5.77 score on a scale | Standard Error 0.28 |
| MI With Trauma-informed SGM Affirmative Care | Substance Abuse | Medical Marijuana | 1.65 score on a scale | Standard Error 0.3 |
| MI With Trauma-informed SGM Affirmative Care | Substance Abuse | Tobacco | 5.83 score on a scale | Standard Error 0.28 |
| MI With Trauma-informed SGM Affirmative Care | Substance Abuse | Alcohol | 8.93 score on a scale | Standard Error 0.35 |
| MI With Trauma-informed SGM Affirmative Care | Substance Abuse | Marijuana | 6.53 score on a scale | Standard Error 0.33 |
| MI With Trauma-informed SGM Affirmative Care | Substance Abuse | Cocaine | 1.69 score on a scale | Standard Error 0.17 |
| MI With Trauma-informed SGM Affirmative Care | Substance Abuse | Amphetamine/ Stimulant | 2.55 score on a scale | Standard Error 0.23 |
| MI With Trauma-informed SGM Affirmative Care | Substance Abuse | Inhalants | 1.06 score on a scale | Standard Error 0.15 |
| MI With Trauma-informed SGM Affirmative Care | Substance Abuse | Sedatives | 1.84 score on a scale | Standard Error 0.23 |
| MI With Trauma-informed SGM Affirmative Care | Substance Abuse | Hallucinogens | .98 score on a scale | Standard Error 0.15 |
| MI With Trauma-informed SGM Affirmative Care | Substance Abuse | Opioids | 1.03 score on a scale | Standard Error 0.17 |
| MI With Trauma-informed SGM Affirmative Care | Substance Abuse | Other | 8.93 score on a scale | Standard Error 0.35 |
Substance Abuse
The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) is an 8-item measure of use of alcohol, tobacco products, and other drugs across the lifespan and in the past 3 months. The test has been shown to be a valid indicator of active substance use with adequate construct validity. Scores are summed across for each drug category separately with a maximum score for tobacco = 31 and a maximum score for each of the other drug categories = 39. A Global Continuum of Risk Score can also be calculated by summing all items for all drug classes together with a maximum score of 414. Scores are categorized into Low (0 - 3), Moderate (4 - 26), and High (27+) risk.
Time frame: Post-intervention (immediately following last online group)
Population: For outcome analyses, linear mixed models (LMM) of mental health symptoms were modeled as a repeated measures outcome variable, nested within participants, and nested within cohorts. Baseline values of the dependent variable, along with any baseline characteristics that differentiated the two groups, were included as time-invariant covariates (between participants), as was treatment group.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Motivational Interviewing | Substance Abuse | Cocaine | 1.39 score on a scale | Standard Error 0.2 |
| Motivational Interviewing | Substance Abuse | Sedatives | 1.67 score on a scale | Standard Error 0.26 |
| Motivational Interviewing | Substance Abuse | Marijuana | 5.89 score on a scale | Standard Error 0.38 |
| Motivational Interviewing | Substance Abuse | Hallucinogens | .88 score on a scale | Standard Error 0.17 |
| Motivational Interviewing | Substance Abuse | Amphetamine/ Stimulant | 2.16 score on a scale | Standard Error 0.26 |
| Motivational Interviewing | Substance Abuse | Opioids | .83 score on a scale | Standard Error 0.19 |
| Motivational Interviewing | Substance Abuse | Alcohol | 7.71 score on a scale | Standard Error 0.4 |
| Motivational Interviewing | Substance Abuse | Other | 4.92 score on a scale | Standard Error 0.32 |
| Motivational Interviewing | Substance Abuse | Inhalants | 1.06 score on a scale | Standard Error 0.16 |
| Motivational Interviewing | Substance Abuse | Medical Marijuana | 1.55 score on a scale | Standard Error 0.39 |
| Motivational Interviewing | Substance Abuse | Tobacco | 4.92 score on a scale | Standard Error 0.32 |
| MI With Trauma-informed SGM Affirmative Care | Substance Abuse | Medical Marijuana | 2.74 score on a scale | Standard Error 0.36 |
| MI With Trauma-informed SGM Affirmative Care | Substance Abuse | Tobacco | 4.75 score on a scale | Standard Error 0.31 |
| MI With Trauma-informed SGM Affirmative Care | Substance Abuse | Alcohol | 8.26 score on a scale | Standard Error 0.39 |
| MI With Trauma-informed SGM Affirmative Care | Substance Abuse | Marijuana | 5.69 score on a scale | Standard Error 0.36 |
| MI With Trauma-informed SGM Affirmative Care | Substance Abuse | Cocaine | 1.04 score on a scale | Standard Error 0.19 |
| MI With Trauma-informed SGM Affirmative Care | Substance Abuse | Amphetamine/ Stimulant | 2.11 score on a scale | Standard Error 0.27 |
| MI With Trauma-informed SGM Affirmative Care | Substance Abuse | Inhalants | .90 score on a scale | Standard Error 0.17 |
| MI With Trauma-informed SGM Affirmative Care | Substance Abuse | Sedatives | 2.21 score on a scale | Standard Error 0.25 |
| MI With Trauma-informed SGM Affirmative Care | Substance Abuse | Hallucinogens | .98 score on a scale | Standard Error 0.17 |
| MI With Trauma-informed SGM Affirmative Care | Substance Abuse | Opioids | .99 score on a scale | Standard Error 0.19 |
| MI With Trauma-informed SGM Affirmative Care | Substance Abuse | Other | 4.75 score on a scale | Standard Error 0.31 |