Trauma-Informed Care in Mental Health Courts · Trauma-Informed Care in Mental Health Courts...
Transcript of Trauma-Informed Care in Mental Health Courts · Trauma-Informed Care in Mental Health Courts...
Trauma-Informed Care in Mental Health Courts
Wednesday,March30,2016NewYork,NY
©2016CouncilofStateGovernmentsJusDceCenter
Presenters
Hon.MarciaHirschPresidingJudge,QueensTreatmentCourts
AlyssaBenedict,MPHTheNaDonalResourceCenteronJusDceInvolvedWomen
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ManagingaTrauma-InformedCourtRoom
Overview
Ques@onsandAnswers
MentalHealthCourts:TheEssen@alRoleofTrauma-InformedCare
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MentalHealthCourts:TheEssen@alRoleofTrauma-InformedCare
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SeEngtheContext
• Growthinthenumberofoffenderswithmentalillness• Personswithmentalillnessover-representedincriminal
jusDcepopulaDons• SupportforprogrammingandservicestargeDngoffenders
withmentalillness• ThecriDcalroleofmentalhealthcourts
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Jus@ceandMentalHealth
• BalancingtradiDonalobjecDveswithinnovaDveresponses
• Thementalhealthcourtmodel–lookingbackandlookingforward
• TheSequenDalInterceptModelandtrauma-informedcare
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EnhancingMHCourtProcessesandOutcomes:TheEssen@alRoleofTrauma-informedCare
• TraumaasauniversalexperienceamongpeoplewhoarejusDce-involved.(NCTIC)
• TraumaDcexperiencesconnectedtomentalhealthandsubstanceabusechallenges.
• Survivorsarenotlikelytoseektreatmentfortrauma-relatedsymptoms.(Schreiber,Renneberg,&Maercker,2009)
• Survivor’sexperiencesinthecriminaljusDcesystemcandeepentraumaDcwoundsandcreatenewtraumas.(SAMHSA)
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MovingfromUnderstandingtoCollabora@on&Implementa@on
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SomeBarriers…
• Traumacanget“lostintheweeds”
• Over-specializaDon• LackofintegraDon• Stakeholdersmaynotsharethesameawarenessoftraumaanditsimpacts
• OperaDonalizaDonishard!
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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
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TheNeurobiology&EcologyofTrauma
Neurobiology Ecology• Traumaresponsesand
recoveryoccurinarelaDonal-socialcontexts
• InteracDonswithpartners,family&friends,community,insDtuDons&systemsandsocietyMATTER.
• PotenDalforhealingandgrowthbiggestinthecontextofrelaDonships
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ThePrinciples
ofTrauma-informedCare(Harris&Fallot,2006)
• Safety• Trust• Choice• CollaboraDon• Empowerment
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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
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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*
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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
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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
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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
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“Thiscourtsavedmylife.Myrapewasunderneath
everythingIwasdoing.Iwasinchains.Thosechainsarebrokennow.Iamfree.Icanbreatheagain.”
-Client
“Ineverrealizedhowthisworkwasaffec;ngme.Beingtrauma-informedisnotjustaboutthe[clients].It’saboutustoo.Weallhaveexperiencedsomekindoftrauma.
Thisapproachhelpsallofus.I’mbeReratmyjobandI’mbeReratlife.”
-CorrecDonsProfessional
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ManagingaTrauma-InformedCourtroom
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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
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TraumaProjectCollaborators• TreatmentAgencies
– SamaritanVillage,Inc– CounselingServicesoftheEasternDistrictofNewYork
– ElmcorYouthandAdultAcDviDes
• ProgramEvaluators– StonyBrookResearch&EvaluaDonConsulDng,LLC
*SpecialThankstoPolicyResearchAssociates
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QueensTraumaProject(QTP)• FundedbygrantfromtheCenterforSubstanceAbuseTreatment(CSAT)forthreeyears– fromOctober1,2010throughSeptember30,2013
• GoalsofQTP– ProvideenhancedscreeningandassessmentofallparDcipantsinthefivefelonytreatmentcourtsinQueensCounty,NY(approximately200/year)
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QueensTraumaProject(QTP)• GoalsofQTP(cont.)
– ProvidetraumaspecifictreatmentservicestoparDcipantsthatareidenDfiedaspotenDallybenefilngfromtheseservices(approximately40/year)
– ConductevaluaDonoffidelityofimplementaDonofprogramacDviDesandsuccessofacDviDesinachievingintendedoutcomes
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Trauma-InformedCare
• WHY?• WHO?
• WHAT?
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WhyDoWeLearnAboutTrauma?
• Developunderstanding• Increaseawareness• Recognizesigns• Learnhowtorespond• ImprovecourtroominteracDons• Createsuccessfuloutcomes
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Goal:Trauma-InformedResponses
• Increasesafety• Reducerecidivism• Promoterecovery• Acknowledgethepresenceandimpactoftrauma
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Goal:Trauma-InformedResponses
• Beawareofpossible“triggers”—smells,sounds,orsensaDons—thatprovokememoriesofpasttraumaDcexperiences
• ResponsesmaybemoreeffecDveifthey:– Arespecifictotheindividual’sgender– Integratetrauma-specifictreatmentwithmentalhealthandsubstanceabusetreatments
– UDlizegroupenvironmentstobuildtrustandenhancehealing
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Trauma-InformedJudicialPrac@ces• Trauma-informedjudicialinteracDonsbeginwithdignityandrespect
• EffecDvecommunicaDonisessenDalandtakesintoaccountthepercepDonofthetraumasurvivor
• ExpressconcernandgiveposiDvefeedback,ratherthanusenegaDveorpuniDvelanguage
• ThecourtroomenvironmentcanbeinDmidaDng–makesurethatparDcipantisnotre-traumaDzed
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Trauma@cEvents
• Physicalabuse• Loss• CombatorvicDmofwar• Communitytrauma• Sexualabuse
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Trauma@cEvents
• DomesDcviolence• WitnessviolenceorothertraumaDcevent• Historicaltrauma• Terrorism• Naturaldisaster• BetrayaloftrustbyapersonorinsDtuDon
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TraumaIs…
• Apsychologicalresponseto:– EventsthatarephysicallyoremoDonallyharmful– ExperiencesthathavenegaDvelong-termeffectsonanindividual’sphysicalandmentalwell-being
• Causesfeelingsofconstantpowerlessness,fear,hopelessness,andastateofalert
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TraumaIs…
• Impactispervasive• ItshapestheworldviewoftheparDcipant• Individualizedexperiences• Manypeoplecopeorhealwhileothersgetstuck
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ImpactofTrauma
• Short-termeffectsoftraumacanincludesubstanceabuse,interpersonalviolence,gambling,andotherriskybehavior
• Long-termeffectscanincludearrest,incarceraDon,andrecidivism
• HighACE(AdverseChildhoodExperiences)scoresareassociatedwithdepression,suicideaqempts,hallucinaDons,andvariousdiseases(i.e.liverdisease,heartdisease,autoimmunedisease,etc.)
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ChildhoodTrauma
• TraumaDcexperiencesduringchildhoodaffectbehaviorduringadulthoodintwoways:– Increaselikelihoodofsmoking,drinkingexcessively,overeaDng,self-injury,andengaginginriskysex—behaviorsknownascopingmechanisms
– Adverselyaffectbraindevelopment,hinderingitsabilitytorespondtostress
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ProcessofTrauma
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TraumaInstruments
AdverseChildhoodExperiences(ACE)N=270
• 74%reportedscoreof0-2• 13%reportedscoreof3-4• 13%reportedscoreof5ormore
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TraumaInstruments
TraumaSymptomChecklist-40(TSC-40)N=249
• 63%reportedscoreof0-30• 20%reportedscoreof16-30• 18%reportedscoreof31-97
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TraumaInstruments
PTSDChecklist-CivilianVersion(PCL-C)N=50
• 32%reportedscoreof17-22(noclinicalconcern)
• 28%reportedscoreof23-31(symptomsofsomeclinicalconcern)
• 40%reportedscoreof32-57(likelypresenceofPTSD)
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TraumaInstruments
TraumaHistoryScreen(THS)• Notformallyscored,butusedtogathermoredetailsabouttraumaDcevents
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AdverseChildhoodExperiences(n=25)– 36%ACEscoreof5ormoreitemsendorsed– 20%ACEscoreof3-4itemsendorsed– 44%ACEscoreof0-2itemsendorsed
TraumainVeterans(N=36)
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TraumainVeterans(N=36)
CurrentTraumaSymptoms– 100%indicatelikelypresenceofPTSDonPCL-C(n=5)
– 50%score31+onTSC-40(n=24)
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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
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136
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129
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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
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TAMAR
• TheTAMARProgramisdesignedtoeducateandtreatthosewhohaveahistoryofphysicaland/orsexualabuseandarecenttreatmenthistoryforamentalhealthcondiDonaswellasanalcoholordruguseorabusedisorder.
• Structured,manualized15-weekintervenDoncombiningpsycho-educaDonalapproacheswithexpressivetherapies
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SeekingSafety
• Offerscopingskillstohelpclientsaqaingreatersafetyintheirlives
• Highlyflexibleandcanbeusedforgrouporindividualformat;women,men,andadolescents;alllevelsofcare(e.g.,outpaDent,inpaDent,residenDal);alltypesoftraumaandsubstances;andanyclinician.
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SeekingSafety
• 25treatmenttopics,eachrepresenDngasafecopingskillrelevanttobothPTSDandSUD.
• Usedbroadlywithclientswhoneedimprovedcopingskills;theydonothavetomeetcriteriaforPTSDandsubstanceabuseastheskillscanbegeneralized.
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HelpingMenRecover
• HelpingMenRecoverintegratesatheoryofaddicDon,atheoryoftrauma,andatheoryofmalepsychosocialdevelopment.
• ProgrammaterialsconsistofafacilitatormanualandaparDcipantworkbook
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HelpingMenRecover
• 18sessionsinfourmodules: ModuleA:Self ModuleB:RelaDonships ModuleC:Sexuality ModuleD:Spirituality
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Par@cipantFeedback
“Traumaservicessavedmylife.”“Iamverygratefulforthisexperience.Thoughithasbeendifficultat;mes,IknowitwillbeRermylifeandmyfuture.”
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Par@cipantFeedback“Iwaslostbeforeandallthisexperiencehelpedmeimprovemylifeandemo;onalissuesthathasledmetothewrongpaths.”“Irecommendittothosewhoreallyneeditandwouldbenefitfromit.Ienjoyedit.”
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Recovery
• Aprocessofchangethroughwhichindividualsimprovetheirhealthandwellness,liveaself-directedlifeandstrivetoreachtheirfullpotenDal.
• DependsontheempowermentoftheindividualandthecreaDonofhealthyrelaDonships
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Resilience
• Recoveringfromtraumarequiresresiliency• The10FactorsofResiliency:
1. OpDmism-maintainingaposiDvealtudewhilebeingawareofthechallengesyouface
2. Flexibility3. Corevaluesystem-stayingtruetostrong
personalmoralsandbeliefs
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Resilience
• The10FactorsofResiliency(cont.):4. Faith-bothdependentand
independentofreligion5. PosiDverolemodels6. Socialsupport-asafetynetforsupportandcommunicaDon
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Resilience
• The10FactorsofResiliency(cont.):7. Physicalfitness8. CogniDvestrength9. Facingfears-fearisnormalandcan
beusedasaguideinovercominglife’schallenges
10. Findingmeaninginstruggles
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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.
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Ques@ons?
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PresenterContactInformaDon
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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.
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