trauma-informed care in mental health courts · trauma-informed care in mental health courts...
TRANSCRIPT
Trauma-Informed Care in Mental Health Courts
Wednesday,March30,2016NewYork,NY
©2016CouncilofStateGovernmentsJusDceCenter
Presenters
Hon.MarciaHirschPresidingJudge,QueensTreatmentCourts
AlyssaBenedict,MPHTheNaDonalResourceCenteronJusDceInvolvedWomen
2
3
CSG Justice Center Newsletters and Announcements; Facebook and Twitter
Subscribe at csgjusticecenter.org/subscribe/
Follow us on Twitter @CSGJC
ManagingaTrauma-InformedCourtRoom
Overview
Ques@onsandAnswers
MentalHealthCourts:TheEssen@alRoleofTrauma-InformedCare
4
MentalHealthCourts:TheEssen@alRoleofTrauma-InformedCare
5
SeEngtheContext
• Growthinthenumberofoffenderswithmentalillness• Personswithmentalillnessover-representedincriminal
jusDcepopulaDons• SupportforprogrammingandservicestargeDngoffenders
withmentalillness• ThecriDcalroleofmentalhealthcourts
6
Jus@ceandMentalHealth
• BalancingtradiDonalobjecDveswithinnovaDveresponses
• Thementalhealthcourtmodel–lookingbackandlookingforward
• TheSequenDalInterceptModelandtrauma-informedcare
7
EnhancingMHCourtProcessesandOutcomes:TheEssen@alRoleofTrauma-informedCare
• TraumaasauniversalexperienceamongpeoplewhoarejusDce-involved.(NCTIC)
• TraumaDcexperiencesconnectedtomentalhealthandsubstanceabusechallenges.
• Survivorsarenotlikelytoseektreatmentfortrauma-relatedsymptoms.(Schreiber,Renneberg,&Maercker,2009)
• Survivor’sexperiencesinthecriminaljusDcesystemcandeepentraumaDcwoundsandcreatenewtraumas.(SAMHSA)
8
MovingfromUnderstandingtoCollabora@on&Implementa@on
9
SomeBarriers…
• Traumacanget“lostintheweeds”
• Over-specializaDon• LackofintegraDon• Stakeholdersmaynotsharethesameawarenessoftraumaanditsimpacts
• OperaDonalizaDonishard!
10
MHCoordinators:ManagingtheInterfaceofCriminalJus@ceandMentalHealth
• Raisingawarenessabouttheimpactoftraumaandtheimportanceoftrauma-informedapproachesamongkeyplayers(judges,POs,providers,PDs)
• Awarenessoflocal,trauma-basedservicesandsupportsforclients/offenders
• CollaboraDngwithotheragenciestofacilitateclient/offenderaccesstotrauma-informedcare
• Addressingtraumaaspartofcourt-basedassessment
• FacilitaDngclient/offenderaccesstotrauma-basedservices/treatment
• FacilitaDngclient/offenderaccesstoadvocacy(e.g.,regardingvicDmrights,protecDveorders)
• ImplemenDngtrauma-informedpracDcesinthecourtroom(i.e.,aspartofcourtprocesses)
• ManagingthecomplexiDesofco-occurringissues/disorders
11
TheNeurobiology&EcologyofTrauma
Neurobiology Ecology• Traumaresponsesand
recoveryoccurinarelaDonal-socialcontexts
• InteracDonswithpartners,family&friends,community,insDtuDons&systemsandsocietyMATTER.
• PotenDalforhealingandgrowthbiggestinthecontextofrelaDonships
12
ThePrinciples
ofTrauma-informedCare(Harris&Fallot,2006)
• Safety• Trust• Choice• CollaboraDon• Empowerment
13
BringingStakeholdersTogethertoAddressTrauma
ImportantQues@ons
• *Whatistraumaanditsimpact?• *Whataretheprinciplesoftrauma-
informedcare?• Whatisthemissionofthiscourt?Goals?• Whereandhowdoestrauma-informed
carefit?• Howcanweimproveourrespec;veand
collec;veprac;ces?• Howcanweiden;fychallenges?
Successes?• Whatisourplanforself-reflec;on,
qualityassuranceandongoingimprovementandinnova;on?
Forums
ü DedicatedmeeDng(s)ü Summitsü Brownbaglunchesü Conferencesü Workshops
14
TheTeam
Judge Dee Anna Farnell and the Pinellas County Drug Court 15
KeyElementsSafety–Trust–Choice
Collabora@on–Empowerment
• TheteamasthefoundaDon• Whoandhow• Sharedphilosophy• HonoringrolesandperspecDves• Clearteamprocess• Managingcomplexity• Frequentcheck-ins• Self-care*
16
SelfCare–TheThreeR’s(Benedict,King,&VanDieten,2014)
• Whatishappenoingwithmerightnow?• NoDcesomaDc(body)experinces,feelings,thoughts
• Acknowledge
Recognize
• Whatcanhelpmefeelmoreanchored?• Breathe• Orient• Ground• CreateCalm
Regulate • HowcanIrespondeffec8vely?• CulDvatenon-judgment• Proceedwithpurpose
Respond
17
TheCourtroom
Judge Dee Anna Farnell and the Pinellas County Drug Court 18
KeyElementsSafety–Trust–Choice
Collabora@on–Empowerment
• Thecourtroomasanextensionofthetreatmentspace-selngthecondiDons
• Theteambringsitsphilosophyintothecourtroom• AdapDngtowhatarises• Everyoneintheroomcounts• Physical&emoDonalsafetyare
essenDal• Trauma-informedcommunicaDonand
procedures 19
Crea@ngRegula@onandResilience(Benedict,King&VanDieten,2014)
Regula@onÒ Tolerate difficult thoughts,
feelings, and sensations Ò Connect with self and others Ò Engage in effective action.
ResilienceÒ Access and utilize our skills and
strengths Ò Cope with day-to-day stresses
and burdens Ò Explore solutions to problems Ò Set and achieve goals
20
Examples• Increasingregula@onandresilience
– Reducecrowdingthroughdedicateddays– Selngatone
• Visualspace– Bringinglifeintothecourtroom– OfferinghopeandcelebraDngsuccess
• Rela@onalspace– Whoispresent– Wherekeyspersonssit
• Communica@on– Nonverbalmessages– Trauma-informedlanguageandmicroskills
• Empathy,reflecDvelistening,affirmaDons– Balancingsupportandaccountability
Judge Dee Anna Farnell and the Pinellas County Drug Court 21
TheTreatmentSafety–Trust–Choice
Collabora@on–Empowerment• Philosophy• Facility/Space• ManagementandOperaDons• StaffingandTraining• Culture• Offender/ClientManagement• AssessmentandClassificaDon• Programs,treatment• CaseandTransiDonalPlanning
22
“Thiscourtsavedmylife.Myrapewasunderneath
everythingIwasdoing.Iwasinchains.Thosechainsarebrokennow.Iamfree.Icanbreatheagain.”
-Client
“Ineverrealizedhowthisworkwasaffec;ngme.Beingtrauma-informedisnotjustaboutthe[clients].It’saboutustoo.Weallhaveexperiencedsomekindoftrauma.
Thisapproachhelpsallofus.I’mbeReratmyjobandI’mbeReratlife.”
-CorrecDonsProfessional
23
ManagingaTrauma-InformedCourtroom
24
ManagingaTrauma-InformedCourtroom
Hon.MarciaHirsch,PresidingJudge,QueensTreatmentCourts
ResearchProvidedby;Dr.PamelaLinden,AssistantProfessor,StonyBrookUniversityand
Dr.ShellyCohen,StonyBrookResearch&Evalua;onConsul;ng
TraumaProjectCollaborators• TreatmentCourtTeams
– CourtstafffromfivefelonytreatmentcourtsinQueens(QTC,QDWI,QMHC,QVTC,QDDC)
– QueensDistrictAqorney’sOffice– DefenseBar(LegalAid,QLA,PrivateAqorneys)– QueensTASC– NYSDepartmentsofProbaDonandEducaDon&USDepartmentofVeteransAffairs
*SpecialThankstoPolicyResearchAssociates
26
TraumaProjectCollaborators• TreatmentAgencies
– SamaritanVillage,Inc– CounselingServicesoftheEasternDistrictofNewYork
– ElmcorYouthandAdultAcDviDes
• ProgramEvaluators– StonyBrookResearch&EvaluaDonConsulDng,LLC
*SpecialThankstoPolicyResearchAssociates
27
QueensTraumaProject(QTP)• FundedbygrantfromtheCenterforSubstanceAbuseTreatment(CSAT)forthreeyears– fromOctober1,2010throughSeptember30,2013
• GoalsofQTP– ProvideenhancedscreeningandassessmentofallparDcipantsinthefivefelonytreatmentcourtsinQueensCounty,NY(approximately200/year)
28
QueensTraumaProject(QTP)• GoalsofQTP(cont.)
– ProvidetraumaspecifictreatmentservicestoparDcipantsthatareidenDfiedaspotenDallybenefilngfromtheseservices(approximately40/year)
– ConductevaluaDonoffidelityofimplementaDonofprogramacDviDesandsuccessofacDviDesinachievingintendedoutcomes
29
Trauma-InformedCare
• WHY?• WHO?
• WHAT?
30
WhyDoWeLearnAboutTrauma?
• Developunderstanding• Increaseawareness• Recognizesigns• Learnhowtorespond• ImprovecourtroominteracDons• Createsuccessfuloutcomes
31
Goal:Trauma-InformedResponses
• Increasesafety• Reducerecidivism• Promoterecovery• Acknowledgethepresenceandimpactoftrauma
32
Goal:Trauma-InformedResponses
• Beawareofpossible“triggers”—smells,sounds,orsensaDons—thatprovokememoriesofpasttraumaDcexperiences
• ResponsesmaybemoreeffecDveifthey:– Arespecifictotheindividual’sgender– Integratetrauma-specifictreatmentwithmentalhealthandsubstanceabusetreatments
– UDlizegroupenvironmentstobuildtrustandenhancehealing
33
Trauma-InformedJudicialPrac@ces• Trauma-informedjudicialinteracDonsbeginwithdignityandrespect
• EffecDvecommunicaDonisessenDalandtakesintoaccountthepercepDonofthetraumasurvivor
• ExpressconcernandgiveposiDvefeedback,ratherthanusenegaDveorpuniDvelanguage
• ThecourtroomenvironmentcanbeinDmidaDng–makesurethatparDcipantisnotre-traumaDzed
34
Trauma@cEvents
• Physicalabuse• Loss• CombatorvicDmofwar• Communitytrauma• Sexualabuse
35
Trauma@cEvents
• DomesDcviolence• WitnessviolenceorothertraumaDcevent• Historicaltrauma• Terrorism• Naturaldisaster• BetrayaloftrustbyapersonorinsDtuDon
36
TraumaIs…
• Apsychologicalresponseto:– EventsthatarephysicallyoremoDonallyharmful– ExperiencesthathavenegaDvelong-termeffectsonanindividual’sphysicalandmentalwell-being
• Causesfeelingsofconstantpowerlessness,fear,hopelessness,andastateofalert
37
TraumaIs…
• Impactispervasive• ItshapestheworldviewoftheparDcipant• Individualizedexperiences• Manypeoplecopeorhealwhileothersgetstuck
38
ImpactofTrauma
• Short-termeffectsoftraumacanincludesubstanceabuse,interpersonalviolence,gambling,andotherriskybehavior
• Long-termeffectscanincludearrest,incarceraDon,andrecidivism
• HighACE(AdverseChildhoodExperiences)scoresareassociatedwithdepression,suicideaqempts,hallucinaDons,andvariousdiseases(i.e.liverdisease,heartdisease,autoimmunedisease,etc.)
39
ChildhoodTrauma
• TraumaDcexperiencesduringchildhoodaffectbehaviorduringadulthoodintwoways:– Increaselikelihoodofsmoking,drinkingexcessively,overeaDng,self-injury,andengaginginriskysex—behaviorsknownascopingmechanisms
– Adverselyaffectbraindevelopment,hinderingitsabilitytorespondtostress
40
ProcessofTrauma
41
TraumaInstruments
AdverseChildhoodExperiences(ACE)N=270
• 74%reportedscoreof0-2• 13%reportedscoreof3-4• 13%reportedscoreof5ormore
42
TraumaInstruments
TraumaSymptomChecklist-40(TSC-40)N=249
• 63%reportedscoreof0-30• 20%reportedscoreof16-30• 18%reportedscoreof31-97
43
TraumaInstruments
PTSDChecklist-CivilianVersion(PCL-C)N=50
• 32%reportedscoreof17-22(noclinicalconcern)
• 28%reportedscoreof23-31(symptomsofsomeclinicalconcern)
• 40%reportedscoreof32-57(likelypresenceofPTSD)
44
TraumaInstruments
TraumaHistoryScreen(THS)• Notformallyscored,butusedtogathermoredetailsabouttraumaDcevents
45
AdverseChildhoodExperiences(n=25)– 36%ACEscoreof5ormoreitemsendorsed– 20%ACEscoreof3-4itemsendorsed– 44%ACEscoreof0-2itemsendorsed
TraumainVeterans(N=36)
46
TraumainVeterans(N=36)
CurrentTraumaSymptoms– 100%indicatelikelypresenceofPTSDonPCL-C(n=5)
– 50%score31+onTSC-40(n=24)
47
ProgramStatusandTraumaAdverseChildhoodExperiences(ACE)
0%
5%
10%
15%
20%
25%
%graduate %fail
21%
3%
17%
0
17%
11%
LowACE Moderate High 48
PhaseAdvancementandTrauma(MedianNumberofDays)
AdverseChildhoodExperiences(ACE)
110115120125130135140
Phase1 Phase2
129
122
136
122
129
121
LowACE Moderate High 49
TypesofReportedTrauma(n=39)
• Lossofclosefamilymemberthroughdeath(16)orseparaDon(2)
• MilitaryCombatexperience(3)• Sexualabuseasachildoradult(5)• Autoaccident(4)• Workaccidentwithinjury(1)• Witnessfamilyviolence(4)• NaturalDisaster/Hurricane(1)• Witnessstranger’sdeath(1)• Assault(2) 50
TreatmentInterven@ons
Three(3)TraumaCaseManagershiredinthreeQueensCountytreatmentagenciesandtrainedinthreetraumatreatmentgroupmodels:• Trauma,AddicDons,MentalHealthandRecovery(TAMAR)
• SeekingSafety• HelpingMenRecover
51
TAMAR
• TheTAMARProgramisdesignedtoeducateandtreatthosewhohaveahistoryofphysicaland/orsexualabuseandarecenttreatmenthistoryforamentalhealthcondiDonaswellasanalcoholordruguseorabusedisorder.
• Structured,manualized15-weekintervenDoncombiningpsycho-educaDonalapproacheswithexpressivetherapies
52
SeekingSafety
• Offerscopingskillstohelpclientsaqaingreatersafetyintheirlives
• Highlyflexibleandcanbeusedforgrouporindividualformat;women,men,andadolescents;alllevelsofcare(e.g.,outpaDent,inpaDent,residenDal);alltypesoftraumaandsubstances;andanyclinician.
53
SeekingSafety
• 25treatmenttopics,eachrepresenDngasafecopingskillrelevanttobothPTSDandSUD.
• Usedbroadlywithclientswhoneedimprovedcopingskills;theydonothavetomeetcriteriaforPTSDandsubstanceabuseastheskillscanbegeneralized.
54
HelpingMenRecover
• HelpingMenRecoverintegratesatheoryofaddicDon,atheoryoftrauma,andatheoryofmalepsychosocialdevelopment.
• ProgrammaterialsconsistofafacilitatormanualandaparDcipantworkbook
55
HelpingMenRecover
• 18sessionsinfourmodules: ModuleA:Self ModuleB:RelaDonships ModuleC:Sexuality ModuleD:Spirituality
56
Par@cipantFeedback
“Traumaservicessavedmylife.”“Iamverygratefulforthisexperience.Thoughithasbeendifficultat;mes,IknowitwillbeRermylifeandmyfuture.”
57
Par@cipantFeedback“Iwaslostbeforeandallthisexperiencehelpedmeimprovemylifeandemo;onalissuesthathasledmetothewrongpaths.”“Irecommendittothosewhoreallyneeditandwouldbenefitfromit.Ienjoyedit.”
58
Recovery
• Aprocessofchangethroughwhichindividualsimprovetheirhealthandwellness,liveaself-directedlifeandstrivetoreachtheirfullpotenDal.
• DependsontheempowermentoftheindividualandthecreaDonofhealthyrelaDonships
59
Resilience
• Recoveringfromtraumarequiresresiliency• The10FactorsofResiliency:
1. OpDmism-maintainingaposiDvealtudewhilebeingawareofthechallengesyouface
2. Flexibility3. Corevaluesystem-stayingtruetostrong
personalmoralsandbeliefs
60
Resilience
• The10FactorsofResiliency(cont.):4. Faith-bothdependentand
independentofreligion5. PosiDverolemodels6. Socialsupport-asafetynetforsupportandcommunicaDon
61
Resilience
• The10FactorsofResiliency(cont.):7. Physicalfitness8. CogniDvestrength9. Facingfears-fearisnormalandcan
beusedasaguideinovercominglife’schallenges
10. Findingmeaninginstruggles
62
Ques@ons?Pleasecontact:
• Hon.MarciaHirsch,PresidingJudge– [email protected]
• Dr.ShellyCohen,ProgramEvaluator,StonyBrookResearch&EvaluaDonConsulDng,LLC
• Dr.PamelaLinden,EvaluaDonConsultant,StonyBrookResearch&EvaluaDonConsulDng,LLC
– [email protected] 63
References1. AdministraDonforChildrenandFamilies.(2009).Understandingtheeffectsof
maltreatmentonbraindevelopment.Retrievedfromhqps://www.childwelfare.gov/pubPDFs/brain_development.pdf
2. DennisCharney,StevenSouthwick,Resilience:TheScienceofMasteringLife’sGreatestChallenges(NewYork:CambridgeUniversityPress,2012)
3. WhatEveryJudgeNeedstoKnowAboutTrauma.Essen;alComponentsofTrauma-InformedJudicialPrac;ce,SAMHSA,1-9.Retrievedfromhqp://gainscenter.samhsa.gov/cms-assets/documents/128389-391390.essenDalDjudges.pdf
4. Covington,S.S.(2008).WomenandaddicDon:Atrauma-informedapproach.Journalofpsychoac;vedrugs,5,377-385.
64
Ques@ons?
65
PresenterContactInformaDon
66
Hon.MarciaHirsch,PresidingJudge,[email protected]
AlyssaBenedict,MPHExecuDveDirector,COREAssociatesFederalpartner,NaDonalResearchCenteronJusDceInvolvedWomencoreassociatesllc@comcast.net401-837-CORE
http://cjinvolvedwomen.org/
Thank You
The presentation was developed by members of the Council of State Governments Justice Center staff. The statements made reflect the views of the authors, and should not be considered the official position of the Justice Center, the members of the
Council of State Governments, or the funding agency supporting the work. Citations available for statistics presented in preceding slides available on CSG Justice Center web site.
JoinourdistribuDonlisttoreceiveCSGJusDceCenterprojectupdates!
www.csgjusDcecenter.org/subscribe
FormoreinformaDon,[email protected]:hqps://csgjusDcecenter.org/courts/
67