3429.1 TREM is a structured group therapy intervention designed for individuals who have survived trauma and have substance use disorders and/or mental health conditions. TREM draws on cognitive restructuring, skills training, and psychoeducational and peer support to address recovery and healing from sexual, physical, and emotional abuse. A curriculum for each model outlines the topic of discussion, a rationale, a set of goals, and a series of questions to be posed to the group in addition to an experiential exercise for each session.

The components are:

1. (a) Therapy sessions focused on empowerment, self-comfort, and accurate self-monitoring, as well as ways to establish safe physical and emotional boundaries;
2. (b) Therapy sessions focused on the trauma experience and its consequences; and
3. (c) Therapy sessions focused on skills building, including emphases on communication style, decision-making, regulating overwhelming feelings, and establishing safer, more reciprocal relationships.

3429.2 Each TREM group is population specific and on average consists of eighteen (18) to twenty-four (24) sessions, with each session at least seventy-five (75) minutes in duration. Population-specific groups include:

1. (a) TREM for women;
2. (b) TREM for men;
3. (c) TREM for girls twelve (12) to seventeen (17) years of age;
4. (d) TREM for boys twelve (12) to seventeen (17) years of age;
5. (e) TREM for individuals who are lesbian, gay, bisexual, transgender, questioning, intersex, or asexual (groups for either individuals under eighteen (18) or individuals eighteen (18) and over);
6. (f) TREM for male Transition Aged Youth (TAY) ages sixteen (16) to twenty-five (25) years of age; and
7. (g) TREM for female TAY sixteen (16) to twenty-five (25) years of age.

3429.3 Due to the sensitive nature of the discussions, TREM requires at least two (2) facilitators to be assigned to every group to ensure the safety and continuity of the group. At least one (1) facilitator shall be an independently licensed qualified practitioner. A team approach is required to: address situations that may arise within the group; decrease burnout; provide continuity if one facilitator is absent; and to lend additional therapeutic support to the group. Qualified practitioners staff working as facilitators shall have completed Department-approved, population-specific TREM training.

3429.4 TREM may be provided without prior authorization from the Department.

3429.5 TREM shall not be billed on the same day as:

(a) Rehabilitation Day Services;

(b) Intensive Day Treatment;

(c) CBI Level II and III; or

(d) ACT.

3429.6 TREM shall be provided:

(a) At the MHRS provider's service site; or

(b) In a residential facility of sixteen (16) beds or less unless otherwise stated by the Department.

3429.7 Qualified Practitioners of TREM are:

(a) Psychiatrists;

(b) Psychologists;

(c) LICSWs;

(d) APRNs with psychiatry as a specialty area of practice;

(e) LMFTs;

(f) LPCs;

(g) LISWs;

(h) LGSWs;

(i) LGPCs; and

(j) Psychology Associates.

3429.8 Certified Recovery Coaches, Certified Peer Specialists, and Certified Addiction Counselors I and II who have successfully completed a TREM group and Department-approved TREM training shall be authorized to support TREM services under the supervision of the two (2) group facilitators.

SOURCE: Final Rulemaking published at 67 DCR 10674 (September 4, 2020); as amended by Final Rulemaking published at 70 DCR 003050 (March 10, 2023); as corrected by Errata Notice published at 71 DCR 004474 (April 19, 2024).