SPECTRM The Clinical Impact of Doing Time Risk Trauma Informed Cultural Competence Needs Treatment Responsivity
S ENSITIZING P ROVIDERS to the E FFECTS of C ORRECTIONAL INCARCERATION on T REATMENT and R ISK M ANAGEMENT
About SPECTRM The Challenge: Clinical Impact of Doing Time The Approach: Cultural Competence The Technology: Cognitive Behavioral The Objective: Therapeutic Engagement
Why focus on engagement? Treatment outcome and premature termination predicted by engagement Treatment outcome related to patient effort Manner of therapist related to engagement and effort
SPECTRM The Clinical Impact of Doing Time Risk Trauma Informed Cultural Competence Needs Treatment Responsivity
R isk Match treatment intensity to level of risk N eeds Treat the offender, not the offense R esponsivity Modality must be one to which offender is responsive CBT Engagement
SPECTRM The Clinical Impact of Doing Time Risk Trauma Informed Cultural Competence Needs Treatment Responsivity
Trauma Table 1. Percentage Reporting Specific Traumatic Events by Gender Men Women p Serious disaster 41.1 28.8 .000 Life-threatening accident 33.1 27.9 .009 Death of intimate 59.7 53.4 .001 Child died 12.7 16.0 .036 Witnessed someone dying 57.2 49.9 .001 Physical violence by family member 49.8 73.0 .000 Violence by stranger 58.0 43.8 .000 Strip searched, held against will 68.6 63.6 .018 Had unwanted sex for money, etc. 11.1 30.6 .000 Sexually abused by family member 17.8 51.2 .000 Sexually abused by stranger 8.7 32.7 .000 Drug addiction 79.1 81.3 ns Alcohol addiction 67.0 55.0 .000 Homelessness 47.9 50.4 ns Diagnosed mental illness 36.1 30.6 .007 Carlson, 2010 α
Trauma Mass Incarceration Overcrowding Staffing shortages Disregard for disturbances Punitive Approach Incarceration experience Verbal and physical victimization Witness violence Fear of violence Haney, 2002
Trauma PTSD vs. PTS PTSD 10 X general Population 6.2% men 21.1% women PTS Normal Adaptive Reaction Vets Discrimination Racial Equity Haney 2014, Baryani 2018, Berger 2015
Trauma Consequences Isolation Hypervigilance Emotional reactivity Intervention principles Safe environment Processing of Trauma Identification of coping strategies
SPECTRM The Clinical Impact of Doing Time Risk Trauma Informed Cultural Competence Needs Treatment Responsivity
Cultural Competence Cultural Awareness Similarities and differences between groups Cultural Sensitivity Emotional expression Problems, struggles and joys Cultural Competence Beliefs, norms and values Knowledge and skills to incorporate
Cultural Competence Cultural Proficiency Meaning of symptoms, illness, stressors Meaning of treatment Relationship with professionals Overcoming mistrust Communication Rapport Disclosure Using “natural” community support
Structural Competence
Incarceration as Cultural Adaptation These walls are kind of funny. First you hate 'em, then you get used to 'em. Enough time passes, gets so you depend on them. That's institutionalized.
“Those of us who do assessment research in correctional settings must continually remember that we are dealing with atypical, highly biased samples of people exposed to massive situational influences specifically designed to alter their attitudes, personality and behavior. Incarceration is a massive intervention that affects every aspect of a person’s life for extended periods of time.” Megargee, 1995
Cultural Sensitivity The Environment: Problems, Struggles (and Joys?) Psychological Environment Constant threat of danger – of violence Social Environment Racial/Ethnic associations Urban/Rural differences Gangs/Organizations DOC’s rules/ Inmate Code Physical Environment Jail vs. Prison Gen Pop vs. MH Housing vs. SHU
Cultural Competence Values Attitudes Beliefs Language Behavior Meaning
Cultural Competence Prison and jail populations typically value strength in all its manifestations - from physical strength to self reliance. Projecting an image of being tough and menacing as an example is highly adaptive in these environments. Meaning?
Cultural Competence Prison and jail populations typically are characterized by presumptive distrust – distrust of staff – distrust of peers. Guardedness and secretiveness are adaptive attitudes within correctional environments. Meaning?
Cultural Competence “Snitches get stitches” is a prison and jail belief shared by everyone. While snitching goes on all the time in prison and jail – because information is a commodity that can be traded for gain – everyone is aware of the consequences of being caught – of being identified as a snitch. Meaning?
Cultural Competence Prison and jail are environments of constant danger and threat of violence. They require a level of alertness which anywhere else would be characterized as hypervigilence . Meaning?
Cultural Competence “Punk City” - “Push up on” - “Kite” - “Boomerang” - “Newjack” - “Hang up” – “Juice” - “Box” – “Bing” – “Hole” – “SHU” – “Shank” – “Gun” – “Bug” – “MO” – “Skittle” – “703” – “Jailin” Meaning?
Inmate Code Do Your Own Time Mind Your Own Business Trust No One Show Respect Ignore Others’ Infractions Don’t Steal Don’t Snitch Don’t Show Weakness Don’t Stare
Inmate Code MEANING VALUE Isolate Do Your Own Time Manipulate Trust No One Don’t share information Don’t Snitch Look aggressive Don’t Show Weakness
Prison & Jail Behavioral Categories INTIMIDATION Wolfing – use of verbal threats Posing – use of nonverbal threats Cliquing – gangs, crews or posses DOING TIME Hospital = Lockup Privileges and levels = more or less lockup Medication = trade merchandise Staff = correction officers CLINNICAL SCAMMING Presenting through report or behavior what the client thinks staff want to hear in order to get desired changes CONNING Misrepresentation and dishonesty to trick both patients and staff for personal gain Trading in information about others for personal gain SNITCHING STONEWALLING Prison code of silence
SPECTRM Behavioral Observation Scale DISCRIMINATING ITEMS ITEM DESCRIPTION 21 Makes general threats about the consequences if denied something. INTIMIDATION 40 Speaks to other patients with implied threats if denied something. INTIMIDATION 17 Lets people know they are dangerous. INTIMIDATION 9 Makes threatening facial expressions and gestures. INTIMIDATION 53 Wears chosen colors, particularly scarves, bandannas, and beads, that match those worn by a specific INTIMIDATION group of patients. 6 Directs specific other patients to reward and punish staff and non-member patients. INTIMIDATION 23 Organizes group pressure among patients to get favors paid back INTIMIDATION 24 Recruits other patients into an on-going group relationship. INTIMIDATION 16 Advises other patients to keep things calm and quiet to keep staff involvement at a minimum. DOING TIME Uses jail/prison language about C. O. = s, inmates, lockdowns, and release dates. 36 DOING TIME 18 Lets staff know how brave they are for sharing information. SNITCHING 50 Tries to use staff to punish people he/she dislikes or competitors. SNITCHING 14 Implies or threatens that patients who give information to staff will face retaliation. STONEWALLING 35 Shows distaste for patients who are open with staff. STONEWALLING 55 Expresses concern that taking medication gives the impression of being vulnerable to attack. UNCLASSIFIED p<0.05 for full cohort p<0.10 or better with gender as covariate Rotter 2005
Structured Assessment of Correctional Adaptation Items and Scoring Respect Posturing Trust Wolfing Isolation Cliquing Manipulation Medication Concerns Stonewalling Doing Your Own Time Vigilance Stigma of Mental Illness Bid Mentality
Structured Assessment of Correctional Adaptation Jail (n=123) No Jail (n=25) Total (n=149) Mean Age 38.7 26.6 38.4 Race African American 79 13 92 Hispanic 32 7 39 Caucasian 11 5 16 Diagnosis Schiz. Spectrum 111 (90.2%) 24 (96.0%) 135 (97.1%) Affective Disorder 11 (8.9%) 1 (4.0%) 12 (8.1%) Substance Abuse 70 (56.9%) 8 (33.3%) 78 (52.3%) Rotter 2008
Structured Assessment of Correctional Adaptation SACA 13 Age .04 Jail (vs. no .28* Jail) Disciplinary .31* Tickets Working -.27* Alliance - Bond PCL - Total .49* Score BPRS Total .23* Score Rotter 2008
Responsivity Readiness of the program for the population Readiness of the person for the program
Client Readiness: RAP I have trouble sleepin' at night. I have bad dreams like I'm falling. I wake up scared. Sometimes it takes me a while to remember where I am.
Purpose Promote Cultural Re-adaptation by Developing trust through shared experience Challenging prison and jail attitudes Introducing new problem solving skills
RAP: Group Processes CONNECTING War stories EXPLORING Psycho-Education: Setting Differences and Similarities: Scripts CHANGING Cognitive Behavioral Technology: ABCD analysis
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