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June 2, 2025
Quarterly Article
Annette M. Dekker
Adrian Yen
Andrea Larco Canizalez
Yesenia Perez
David Salazar
Bita Ghafoori
Dorit Saberi
Breena R. Taira
Jun 2, 2025
Apr 7, 2025
Back to The Milbank Quarterly
Policy Points:
See all articles in the special issue, Mental Health and Substance Use Challenges Facing the United States: What Can State Policymakers Do?
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.
