10/2/2016 Ste e ring Yo ur Co urt to Suc c e ssful Outc o me s: - - PDF document

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Ste e ring Yo ur Co urt to Suc c e ssful Outc o me s: Unde rsta nding Yo ur L itig a nts

PRE SE NT E D BY: K RI ST YN S. CARVE R, PH.D., L PC-S

 70% o f a dults in the US ha ve e xpe rie nc e d a tra uma tic e ve nt a t le a st

• nc e in the ir live s.

 At le a st 75% o f yo uth invo lve d in the juve nile de linq ue nc y syste m

ha ve e xpe rie nc e d tra uma tic vic timiza tio n (Na tio na l Child T ra uma tic Stre ss Ne two rk)

Pre se nta tio n Ove rvie w

T

ra uma

T

ra uma & T he Bra in

Adve rse Childho o d E

xpe rie nc e s Study

Applic a tio n fo r Suc c e ssful Outc o me s

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Wha t is a tra uma info rme d a ppro a c h?

 Ac kno wle dg ing the pre va le nc e a nd impa c t o f tra uma a nd

a tte mpting to c re a te a se nse o f sa fe ty fo r a ll pa rtic ipa nts, whe thr o r no t the y ha ve a tra uma -re la te d dia g no sis.

 T

ra uma a wa re ne ss is a n o ppo rtunity to ma ke sma ll a djustme nts tha t impro ve judic ia l o utc o me s while minimizing a vo ida b le c ha lle ng e s a nd c o nflic t during a nd a fte r he a ring s.

 Re q uire s re -e xa mining po lic ie s a nd pro c e dure s tha t ma y re sult in

pa rtic ipa nts fe e ling lo ss o f c o ntro l, tra ining sta ff to b e we lc o ming .

 Minimizing pe rc e ive d thre a ts, a vo iding re -tra uma tiza tio n, a nd

suppo rting re c o ve ry.

T ra uma & T he Bra in T he Huma n Bra in

 Bo rn with o ve r 100 b illio n ne uro ns

in o ur b ra in

 Unde r o ptima l c o nditio ns whe n

• ur ne e ds a re c o nsiste ntly me t

b y lo ving c a re g ive rs o ur b ra ins thrive .

 T

he se ne uro ns c o nne c t in c o mple x a nd va st ne two rks.

 Ba b ie s a re b o rn with a ll this

wiring , b ut it is huma n inte ra c tio ns tha t ma ke the b ra in de ve lo p.

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Huma n I nte ra c tio n…

 E

ve ry e xpe rie nc e a nd inte ra c tio n sc ulpts the b ra in.

 T

he huma n b ra in flo urishe s whe n e xpo se d to po sitive o r nurturing e xpe rie nc e s.

 E

a rly c hildho o d e xpe rie nc e s impa c t the de ve lo pme nt a nd wiring o f the b ra in

 I

nfa nts who a re nurture d a nd c o nsiste ntly c a re d fo r b y a n a ttune d c a re g ive r will de ve lo p a fo unda tio n o f trust.

Do wnsta irs Bra in

 Hig hly de ve lo pe d a t b irth.  Allo ws b a b ie s to e a t,

sle e p, b re a the , he a r…

 Surviva l func tio ns a re

ro o te d he re

 Primitive , re a c tive ,

re spo nsib le fo r ke e ping us a live

Upsta irs Bra in

 Mo re so phistic a te d re g io ns o f the

b ra in

 Go ve rns hig he r func tio ns  c o mple x tho ug ht  re a so ning  e mo tio na l re g ula tio n  info rma tio n pro c e ssing  spe e c h,  se lf-re g ula tio n

As this pa rt de ve lo ps it a llo ws us to re g ula te e mo tio ns, c a lm o ur o wn b o die s, unde rsta nd

• urse lve s a nd o the rs, ma ke g o o d c ho ic e s,

b e fle xib le a nd a da ptive .

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Wha t we kno w…

 A de ve lo ping b ra in is ne g a tive ly

impa c te d b y e xpo sure to stre ss, fe a r, a nd tra uma .

 E

xpo sure to the se e xpe rie nc e s unde rmine s the struc ture , wiring , a nd c he mistry o f the b ra in.

 T

his puts a c hild a t risk fo r a life time o f diffic ulty with so c ia l, le a rning , a nd b e ha vio ra l pro b le ms.

E a rly T ra uma & Stre ss

 Sig nific a ntly a lte r b ra in de ve lo pme nt a nd

c he mistry

 Ca use de la ys in so c ia l c o mpe te nc e  L

e a d to de ve lo pme nt o f dysfunc tio na l c o ping me c ha nisms

 Cre a te b a rrie rs to de ve lo ping he a lthy

re la tio nships in a ne w e nviro nme nt

 Witho ut inte rve ntio n – the se will pe rsist a nd

inte nsify

Chro nic Stre ss

 Whe n a c hild sta ys in a c hro nic sta te o f stre ss, the b ra in is

b a the d in c o rtiso l.

 T

• xic stre ss in c hildho o d is a sso c ia te d with a dult o b e sity,

dia b e te s, c a rdio va sc ula r dise a se , a ddic tio n, a nd de pre ssio n

 E

xc e ssive le ve ls o f c o rtiso l ta ke s a to ll o n pre fro nta l c o rte x whic h c o ntro ls:

 I

mpulsivity

 a g g re ssio n  Mo o d  Se lf-re g ula tio n

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Be ha vio r is the o utwa rd sig n o f inne r turmo il – the re sult o f a dysre g ula te d b ra in c a use d b y e a rly tra uma – ta ke time to try a nd unde rsta nd wha t is b e hind the b e ha vio r.

Atta c hme nt & T ra uma

Wha t is Atta c hme nt?

 Jo hn Bo wlb y – I

de a tha t infa nts c re a te a spe c ia l b o nd with the ir c a re g ive rs. I n a n ide a l situa tio n, infa nts use c a re g ive rs a s a secur e base fro m whic h to e xplo re the ir physic a l a nd so c ia l wo rlds.

 I

nfa nts ne e d to fe e l safe a nd kno w the ir c a re g ive r will me e t the ir needs

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 I

nfa nts use a tta c hme nts with c a re g ive rs a s models fo r future re la tio nships.

 Histo rie s with c a re g ive rs

influe nc e pa tte rns o f a tta c hme nt a nd ho w infa nts re spo nd whe n the y a re upse t.

 Atta c hme nt style s pe rsist

into a dultho o d

Atta c hme nt Style s & Outc o me s

Adult Attac hme nt Style Assoc iate d Be havior s Se c ure Atta c hme nt

• Ab le to g ive & re c e ive c a re (nurture )
• Ab le to ne g o tia te ne e ds
• Ab le to b e a uto no mo us
• Co mpe te nt le a de r
• Ab le to se lf-re g ula te

Dismissive Atta c hme nt

• Clo se d o ff e mo tio na lly
• Diffic ulty with a ffe c tio n & e mo tio n
• I

nve sts e ne rg y in thing s ra the r tha n pe o ple E nta ng le d Atta c hme nt

• I

ntrusive in re la tio nships

• L

ike ly c o ntro lling

• Ma y strug g le with a ng e r & re se ntme nt
• Po o r b o unda rie s

Unre so lve d Atta c hme nt

• Ma y e ng a g e in “c he c king o ut” b e ha vio rs
• Be ha vio ra l & e mo tio na l diso rde rs like ly
• Cha o tic / c o nfusing re la tio nships

T ra uma & Atta c hme nt in the Bra in

Bra in c he mistry pre dic ts me nta l he a lth / me nta l

illne ss

K

ids fro m ha rd pla c e s o fte n do no t ha ve b a la nc e b e twe e n e xc ita to ry a nd inhib ito ry ne uro tra nsmitte rs b e c a use whe n the y c rie d, no o ne c a me .

T

he se kids g ro w into a do le sc e nts a nd a dults who displa y e ffe c ts o f inse c ure a tta c hme nt a nd tra uma .

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F e a r, stre ss, a nd tra uma c a use the do wnsta irs b ra in to o ve r de ve lo p while the upsta irs b ra in unde r de ve lo ps.

T he Bra ins Surviva l Re spo nse

 Whe n c hildre n fe e l

thre a te d o r o ve rwhe lme d with fe a r – b ra in trig g e rs fig ht, flig ht, o r fre e ze re spo nse .

 I

f the b ra in sta ys he re to o lo ng it re o rg a nize s a ro und surviving the tra uma a t the e xpe nse o f de ve lo pme nt o f o the r pa rts o f the b ra in.

Re pe a te d fe a rful e xpe rie nc e s

 De trime nta l whe n c hild is le ft to

ma na g e fe a r a lo ne o r whe n the c a re g ive r is frig hte ning .

 Re pe a te d e xpo sure a c tiva te s

g ro wth a nd c o nne c tio n in the do wnsta irs b ra in

 Child ha s lo ts o f e xpe rie nc e s

whe re do wnsta irs b ra in is a c tive a nd o ve rde ve lo pe d – b ut ve ry fe w e xpe rie nc e s to de ve lo p se lf so o thing skills in upsta irs b ra in.

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I mpa c t o f tra uma g o e s b e yo nd upsta irs a nd do wnsta irs b ra in – F e a r a lso impa c ts the he misphe re s

 Whe n ne e ds a nd

e mo tio ns a re no t re spo nde d to c o nsiste ntly a nd in a n a ttune d wa y, the rig ht he misphe re do e s no t de ve lo p o ptima lly.

 Whe n o ne

he misphe re o ve r de ve lo ps, the c hild e ithe r b e c o me s c ut

• ff fro m his e mo tio ns,
• r flo o de d b y the m.

Re pe a te d e xpo sure sha pe s the b ra in. Bra ins c ha ng e d b y fe a r a nd unme t ne e ds c a n b e re sha pe d thro ug h re pe a te d, nurturing , po sitive e xpe rie nc e s.

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Adve rse Childho o d E xpe rie nc e s Study

 Ong o ing c o lla b o ra tive

re se a rc h b e twe e n the Ce nte rs fo r Dise a se Co ntro l a nd Pre ve ntio n a nd K a ise r Pe rma ne nte

 Ove r 17,000 pa rtic ipa nts –

ma jo rity white , o ve r a g e o f 50, e duc a te d, e mplo ye d, g o o d he a lth insura nc e

 De sig ne d to a sse ss a sso c ia tio ns

b e twe e n c hildho o d ma ltre a tme nt a nd la te r he a lth a nd we ll-b e ing

“ ”

Child a b use is the g ra ve st a nd mo st c o stly pub lic he a lth issue in the Unite d Sta te s

ROBE

RTANDA, MD

ACE

S RE SE ARCHE R

 T

he o ve ra ll c o st o f c hild a b use e xc e e ds tha t o f c a nc e r

• r he a rt dise a se .

 E

ra dic a ting c hild a b use in Ame ric a wo uld re duc e the

• ve ra ll ra te o f de pre ssio n b y mo re tha n ha lf, a lc o ho lism

b y 2/ 3 a nd suic ide , I V drug use , a nd do me stic vio le nc e b y 3/ 4.

 I

t wo uld ha ve a dra ma tic e ffe c t o n wo rkpla c e pe rfo rma nc e a nd va stly de c re a se the ne e d fo r inc a rc e ra tio n

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F inding s…



63% o f re spo nde nts re po rte d a t le a st

• ne c a te g o ry o f c hildho o d tra uma .



Of tho se , 87% sc o re d 2 o r mo re



Ove r 20% e xpe rie nc e d 3 o r mo re c a te g o rie s o f tra uma

E mo tio na l, physic a l, o r se xua l a b use

E mo tio na l o r physic a l ne g le c t

Do me stic vio le nc e

So me o ne in ho me using d rug s/ a lc o ho l

Me nta l illne ss in ho me

L

• ss o f pa re nt d ue to se pa ra tio n o r

d ivo rc e

I nc a rc e ra tio n o f fa mily me mb e r

T he mo re c a te g o rie s o f tra uma e xpe rie nc e d, the g re a te r the like liho o d o f e xpe rie nc ing…

 Alc o ho lism  Chro nic o b struc tive pulmo na ry

dise a se (COPD)

 Chro nic De pre ssio n  F

e ta l de a th

 Po o r he a lth-re la te d q ua lity o f life  I

llic it drug use

 L

ive r dise a se

 Risk fo r intima te pa rtne r vio le nc e  Multiple se xua l pa rtne rs  Se xua lly tra nsmitte d infe c tio ns  Smo king  Ob e sity  Suic ide a tte mpts  Uninte nde d pre g na nc ie s  Ca nc e r  E

mphyse ma

 Isc he mic he a rt dise a se  Wo rkpla c e a b se nte e ism  F

ina nc ia l pro b le ms

 L

• we r life -time inc o me

We c a n’ t c ha ng e pe o ple ’ s c hildho o ds a nd tra uma s, b ut we c a n inc re a se o ur se nsitivity to ho w pe o ple func tio n due to the impa c t

• f e a rlie r e xpe rie nc e s.

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6 K e y Risk F a c to rs F

• r E

a rly T ra uma

Diffic ult / Stre ssful Pre g na nc y Diffic ult Birth E

a rly Ho spita liza tio n

Ab use Ne g le c t T

ra uma

T he I mpa c t o f T ra uma o n Be ha vio r

T HE ST RE SS OF T HE COURT ROOM E NVIRONME NT MAY AF F E CT T HE ABIL I T Y OF T RAUMA SURVIVORS T O COMMUNI CAT E E F F E CT IVE L Y WIT H YOU AND COURT PE RSONNE L

T ra uma a nd Be ha vio r



Diffic ulty with mo tiva tio n & fo llo w thro ug h (tre a tme nt, visits, e duc a tio n, jo b tra ining )



“All o r No thing ” thinking



F la t o r ina ppro pria te e mo tio na l e xpre ssio n



I mpulsive / Re a c tive / Po o r se lf- re g ula tio n



Re fusa l to e ng a g e in se rvic e s



I nte rpe rso na l c o nflic ts with a utho rity fig ure s (a tto rne ys, judg e s, pro b a tio n o ffic e rs)



I rrita b le , e a sily a g ita te d, a ng ry



Hype rvig ila nc e

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A T ra uma Info rme d Judg e a sks, “Wha t ha ppe ne d to yo u? ” ra the r tha n, “Wha t’ s wro ng with yo u? ”

T he re is ho pe …

Just a s tra uma hurts the b ra in, lo ving re la tio nships c a n he a l the b ra in.

I nc re a sing Suc c e ssful Outc o me s

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T rust Ba se d Re la tio na l I nte rve ntio n

DE VE L OPE D BY DRS. K ARYN PURVIS & DAVID CROSS INST I T UT E OF CHIL D DE VE L OPME NT AT T E XAS CHRIST I AN UNIVE RSI T Y

Ho listic a ppro a c h tha t is multi-disc iplina ry, fle xib le , a tta c hme nt-c e nte re d , a nd c ha lle ng ing . A tra uma -info rme d inte rve ntio n tha t is spe c ific a lly de sig ne d fo r c hildre n who c o me fro m “ha rd pla c e s”, suc h a s ma ltre a tme nt, a b use , ne g le c t, multiple ho me pla c e me nts, a nd vio le nc e . Wo rks b e c a use it is fo unde d in re se a rc h a nd the o ry o n ho w

• ptima l de ve lo pme nt sho uld

ha ve o c c urre d . He lps a c hild o r te e n re turn to the na tura l de ve lo pme nta l tra je c to ry

T BRI

T hre e Se ts o f Princ iple s

• Co nne c ting
• E

mpo we ring

• Co rre c ting

Co nne c ting Princ iple s

 Goal: to b uild trusting re la tio nship

tha t he lp a pe rso n fe e l va lue d, c a re d fo r, sa fe , a nd c o nne c te d.

 Disa rming fe a r a nd b uilding trust

g re a tly inc re a se s the c a pa c ity fo r c o nne c tio n, g ro wth, a nd le a rning

 T

re a ting individua ls who c o me b e fo re the c o urt with dig nity a nd re spe c t

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Co nne c ting Stra te g ie s

E

ng a g e me nt

 Giving vo ic e  Cho ic e s  Co mpro mise  Sha ring Po we r  T

• uc h

 E

ye c o nta c t

 Vo ic e Qua lity  Be ha vio r Ma tc hing  Pla yful Inte ra c tio n  T

ra nspa re nc y

 F

inding Stre ng ths / re silie nc e (Pe rse ve ra nc e , pa tie nc e , a sse rtive ne ss,

• rg a niza tio n, c re a tivity, e mpa thy)

 Mindfulne ss

 Be a wa re o f litig a nt’ s

ne e ds

 Be a wa re o f yo urse lf &

yo ur histo ry – Pe rso na l trig g e rs (ta tto o s, b a d

pa re nts, a ddic ts, do me stic vio le nc e , une duc a te d pe o ple )  Be c a lm, a tte ntive , fully

pre se nt, re spe c tful

“ ”

T we nty ye a rs o f a dult drug c o urt re se a rc h indic a te s tha t the # 1 inc e ntive fo r pe o ple in the ir re la tio nship with the ir judg e o r pro b a tio n o ffic e r.”

VI

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Sa mple Co urtro o m Co mmunic a tio n

Judge ’s Comme nt Pe r c e ption of T r auma Sur vivor T r auma-Infor me d Appr

• ac h

“Yo ur drug sc re e n is dirty.” “I ’ m dirty. T he re is so me thing wro ng with me .” “Yo ur drug sc re e n sho ws the pre se nc e o f drug s.” “Did yo u ta ke yo ur me ds to da y? ” “I ’ m a fa ilure . I ’ m a b a d pe rso n. No o ne c a re s ho w the drug s ma ke me fe e l.” “Are the me dic a tio ns yo ur do c to r pre sc rib e d wo rking we ll fo r yo u? ” “”Yo u didn’ t fo llo w the c o ntra c t, yo u’ re g o ing to ja il; we ’ re do ne with yo u. T he re is no thing mo re we c a n do .” “I ’ m ho pe le ss. Why sho uld I c a re ho w I b e ha ve ? T he y e xpe c t tro ub le a nywa y.” “Ma yb e wha t we ha ve b e e n do ing isn’ t’ the b e st wa y fo r us to suppo rt yo u. I ’ m g o ing to a sk yo u no t to g ive up o n re c o ve ry. We ’ re no t g o ing to g ive up o n yo u.” “I ’ m se nding yo u fo r a me nta l he a lth e va lua tio n.” “I must b e c ra zy. T he re is so me thing wro ng with me tha t c a n’ t b e fixe d.” “I ’ d like to re fe r yo u to a do c to r who c a n he lp us b e tte r unde rsta nd ho w to suppo rt yo u.”

T ra uma -I nfo rme d L a ng ua g e

 “I wo nde r if…”  “I no tic e tha t…”  “Be c a use I kno w it is ha rd to re me mb e r info rma tio n in time s o f stre ss,

c a n yo u re pe a t…”

 “Ac c e ssing se rvic e s c a n so me time s fe e l sc a ry…”  “T

he ne xt ste p is…”

 “Wha t yo u c a n e xpe c t is…”

E mpo we ring Princ iple s

 Goal: He lp litig a nts le a rn impo rta nt skills suc h a s se lf-re g ula tio n.

 Physio lo g ic a l Stra te g ie s  Hyd ra tio n  Blo o d sug a r  Physic a l a c tivity  F e lt sa fe ty  E

c o lo g ic a l (e nviro nme nta l) Stra te g ie s

 Ritua ls / Ro utine s / pre dic ta b le  T

ra nsitio ns – c le a r e xpla na tio ns o f wha t is g o ing to ha ppe n

 Se nso ry Ne e ds (fidg e ts)  Co urtro o m e nviro nme nt (po sitio n o f judg e , re stric tio n sig ns, impa c t o f o the rs pre se nt,

no nve rb a l intimida tio n)

 Re duc e wa it time s whe n po ssib le & sc he dule inte ntio na lly

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Co rre c ting Princ iple s

Go a ls: to he lp individua ls le a rn

a ppro pria te stra te g ie s fo r g e tting the ir ne e ds me t a nd to le a rn to na vig a te suc c e ssful inte ra c tio ns da y-to -da y.

Co rre c ting Princ iple s

Pro a c tive Stra te g ie s

 T

e a c h so c ia l skills during c a lm / a le rt time s

 Pla yful E

ng a g e me nt

 Pro a c tive stra te g ie s

g re a tly re duc e ne e d fo r re spo nsive stra te g ie s

Re spo nsive Stra te g ie s

 Guide line s fo r re spo nding

to c ha lle ng ing b e ha vio r.

 Suc c e ssful a s a re sult o f

the c o nne c tio n a nd e mpo we rme nt

Disrupte d de ve lo pme nt lo o ks like b a d b e ha vio r if yo u a re n’ t tra ine d to lo o k fo r it.

• DR. K

ARYN PURVIS

10/2/2016 17

Whe n a pe rso n’ s ne e ds a re c o nsiste ntly me t b y a nurturing a nd re spo nsive pe rso n – the y le a rn to trust. Ove r time , with lo ts o f e xpe rie nc e s ha ving fe a rs c a lme d a nd so o the d a nd ne e ds me t – individua ls de ve lo p the c a pa c ity to so o the the mse lve s in time s o f stre ss a nd to se lf re g ula te .

“ ”

Altho ug h the wo rld is full o f suffe ring , it is a lso full o f o ve rc o ming it

HE

L L E N K E L L E R