SPECTRM The Clinical Impact of Doing Time Risk Trauma Informed - - PowerPoint PPT Presentation

SPECTRM

The Clinical Impact of Doing Time

Risk Needs Responsivity Trauma Informed Treatment Cultural Competence

SENSITIZING PROVIDERS to the EFFECTS of CORRECTIONAL INCARCERATION on TREATMENT and RISK MANAGEMENT

The Challenge: Clinical Impact of Doing Time The Approach: Cultural Competence The Technology: Cognitive Behavioral The Objective: Therapeutic Engagement

About SPECTRM

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 Needs Responsivity Trauma Informed Treatment Cultural Competence

 Risk

 Match treatment intensity to level of risk

 Needs

 Treat the offender, not the offense

 Responsivity

 Modality must be one to which offender is responsive

 CBT  Engagement

SPECTRM

The Clinical Impact of Doing Time

Risk Needs Responsivity Trauma Informed Treatment Cultural Competence

Trauma

α

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

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 Needs Responsivity Trauma Informed Treatment Cultural Competence

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

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.

Incarceration as Cultural Adaptation

“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

Attitudes Beliefs Language Behavior Meaning Values

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.

Cultural Competence

Meaning?

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.

Cultural Competence

Meaning?

“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.

Cultural Competence

Meaning?

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.

Cultural Competence

Meaning?

“Punk City” - “Push up on” - “Kite” - “Boomerang” - “Newjack”- “Hang up” – “Juice” - “Box” – “Bing” – “Hole” – “SHU” – “Shank” – “Gun” – “Bug” – “MO” – “Skittle” – “703” – “Jailin”

Cultural Competence

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

VALUE Do Your Own Time Trust No One Don’t Snitch Don’t Show Weakness MEANING Isolate Manipulate Don’t share information Look aggressive

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

SNITCHING

Trading in information about others for personal gain

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 group of patients. INTIMIDATION 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 36 Uses jail/prison language about C. O.=s, inmates, lockdowns, and release dates. 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 Trust Isolation Manipulation Stonewalling Vigilance Bid Mentality Posturing Wolfing Cliquing Medication Concerns Doing Your Own Time Stigma of Mental Illness

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 Jail) .28* Disciplinary Tickets .31* Working Alliance - Bond

• .27*

PCL - Total Score .49* BPRS Total Score .23*

Rotter 2008

Responsivity

 Readiness of the program for the population  Readiness of the person for the program

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.

Client Readiness: RAP

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

Re-entry Themes

 Do Your Own Time  Respect  Snitches Get Stitches  Intimidation  Trust  Vigilance  Bid Mentality

CONCLUSIONS Three Principles

 CONNECTING

 Be willing to listen and learn: Where were you and what was it

like?

 EXPLORING

 Be aware of differences and similarities in the two cultures: What are the

cues?  CHANGING

 Be neutral: Is it working for you here?

The first night's the toughest, no doubt about it. They march you in naked as the day you were born, skin burning and half blind from that delousing shit they throw on you, and when they put you in that cell...and those bars slam home... that's when you know it's for real. A whole life blown away in the blink of an eye. Nothing left but all the time in the world to think about it.

Free!

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