Changing Systems, Changing Lives

Arrested Development: A New Direction for Incarcerated

WomenDee-Dee Stout, MA, CADC-II;

Member of MINT; Advisor/Trainer, ICCEFor Ontrack Program Services

In the beginning…

Female Offenders

Background

From 1990 to 2002, women in federal/state prisons increased by 121% (to nearly 100,000) while men rose by 84% (to 1.34M)

Violent crimes convictions for women increased 49%; property felonies rose 44% (forgery, fraud, embezzlement)*

More Background

2000, most offenses were drug related (40%) and property crimes (34%), 18% for violent crimesWomen more likely to arrested for dx crimes

than for violent crimesWomen are now 7% of total prison

population; 11% of jail3.2M women were arrested (1998) which

accounts for 22% of all arrestsFemale drug offense arrests up 13%

Due to more punitive anti-dx laws and targeting women (mothers) of color

Drug Use & Women

50-60% of women in CJ have experienced child/sex/adult abuseAssociated w/incarceration for violent crimes,

higher risk sex , PTSD sx1980’s women’s dx use shifted to crack

leading to increased sex work and selling crack

Of these women 80% are est. to have SUD’s

Women in prison report higher rates of dx use than men (40% v 32%)

More Drug Use & Women

Men use more alcohol; women use more other substancesCocaine, MJ,Methamphetamines

Women use more often and use harder dx (see above)

Of incarcerated women who report dx use, 56% had dx tx prior to incarceration (41% of men)

Women’s Pathways to SUD’s

SUD’s and delinquency occurred earlier for incarcerated women than those in SUD’s tx (men, no difference)

Women have greater lifestyle problems related to: MH, childhood family environment, lack of education, adult social environment & physical health

Female Offenders

Lack of research re: COD’s/SUD’s and treatment

Report more depression, anxiety, low self-esteem, use medications more than male counterparts

Are more likely to be ID’d with mental illness (anti-social, 45%)

Entering prison, 59% diagnosed w/at least 1 MH d/o not including SUD’s

Summary of Differences

Female incarceration rate increase can be attributed to their SUD’s and changes in sentencing laws/guidelines

Women have different rates of dx use and different patterns of use, early pathways into SUD’s & criminal behavior, COD’s, and lifestyle problems

Definitions & More

COD: mental health disorder (MH) and substance use disorder (SUD’s)

AOD: alcohol and other drugs (dx)MH disorder rates are higher in

prison systems than in general popLA County Jail is the world’s largest

MH facility12 FT pharmacists

“Denial”

An adaptive reaction that protects survivors of trauma from the full force of the tragedy

A coping mechanism A gradual & graceful way to deal with

trauma by allowing one the time needed to make the transition from ‘shock and denial’ to grief

Much SUD’s in women happens DUE TO trauma not vice versaFamilies are torn up before the drug use begins

not just after

Brief Case Example?

Female

Cultural Sensitivity

Incarceration has a strong negative effect on women of color

Correctional policies contribute to disparities in health btw white and women of color

Policies of CJ & Tx can be oppressive & mimic perpetrators of abuseNew Age system of slavery?Contributes to confusion re: SUD’s/COD’s

status as moral issue or disease

Physical Reactions to Trauma

Faintness, dizzinessHot or cold sensations in body Tightness in throat, stomach, or chest Agitation, nervousness, hyper-arousal Fatigue and exhaustion Gastrointestinal distress and nausea Appetite decrease or increase Headaches Exacerbation of preexisting health conditions

Behavioral Reactions

Jumpiness, easily startled Sleep disturbances and nightmaresHyper-vigilance, scanning for danger Crying and tearfulness for no apparent reason Conflicts with family and coworkers Avoidance of reminders of trauma Inability to express feelings Isolation or withdrawal from others Increased use of alcohol or drugs

Emotional Reactions

Anxiety, fear, worry about safety Shock, disbelief Numbness Sadness, grief Longing and pining for the deceased Helplessness, powerlessness, and

vulnerability Disassociation (disconnected, dream-like) Anger, rage, desire for revenge

Cognitive Reactions

Confusion and disorientation Poor concentration and memory problems Impaired thinking and decision making Complete or partial amnesia Repeated flashbacks, intrusive thoughts and

images Obsessive self-criticism and self-doubts Preoccupation with protecting loved ones Questioning of spiritual or religious beliefs

Emotional Reactions-2

Irritability, short temper Hopelessness and despair Blame of self and/or others Survivor guilt Unpredictable mood swings Re-experiencing pain associated with

previous trauma

Screening & Assessment Checklist Trauma and loss exposure Presence of risk and resiliency

factors Current psychological distress Prior coping with major stressors Availability of social support Current pressing concerns

Stages of Trauma Treatment

SafetyMourning and RemembranceReconnection

Compassion Fatigue (CF)

Occurs when caregivers focus on others without practicing self-care And when helpers don’t feel

supported or fully competentSymptoms include: apathy,

isolation, bottled up emotions, and misuse of substances

What Works with Trauma?

Motivational Interviewing (MI)*Seeking Safety (present focus)Cognitive Behavioral Therapy (CBT)Dialectical Behavioral Therapy (DBT)MeditationSomatic ExperiencingEMDR??CDOI*

*Also works on CF!

While Incarcerated

Needs of women are greater & more complex

Need to develop trust with CJ staff/other incarcerated women to work on traumaMay be increase in violent

behaviors inc. self harm due to trauma

Special Needs/Wrap-Around ServicesLiteracy, education, employmentHealthParentingRelationshipsIntegrated treatmentTransitional supportAftercare

Some Possibilities…

Systems Change:Involve inmates in all areas of careAllow for some choice

Treatment Change:Save autobiographies until Safety is

establishedStaff Change:

Ask-Tell-Ask

A Taste of MI Demo

Ask-Tell-Ask

Recommended Reading

The Body Remembers: The Psychophysiology of Trauma & Trauma Treatment. Babette Rothschild, 2000. WW Norton.

Trauma & Recovery. Judith Herman, MD. 1992. Basic Books.

Many Roads, One Journey: Moving Beyond the 12-Steps. Charlotte Kasl, Ph.D. 1992. HarperCollins.

Seeking Safety: A Treatment Manual for PTSD and Substance Abuse. Lisa Najavits, Ph.D. 2002. Guilford Press.

Sacks, J.Y. (2004). Women with co-occuring substance use and mental disorders (COD) in the criminal justice system: a research review. Behavioral Sciences and the Law, 22:449-466.

Recommended Reading

Motivational Interviewing, (2nd Ed), Preparing People for Change. William R. Miller & Stephen R. Rollnick, Guilford Press. 2002.

Waking the Tiger : Healing Trauma : The Innate Capacity to Transform Overwhelming Experiences by Peter Levine & Ann Frederick. North Atlantic Books. 1997.

The Change Book Workbook.: A Blueprint for Technology Transfer. www.nattc.org/thechangebook), 2004.

New Directions for Mental Health Services Using Trauma Theory to Design Service Systems, No. 89, Spring 2001. Maxine Farris and Roger Fallot. Jossey-Bass, 2001.

“Guiding as Practice: Motivational Interviewing and Trauma-Informed Work With Survivors of Intimate Partner Violence.” Motivational Interviewing and Intimate Partner Violence Workgroup. Partner Abuse, Vol 1, #1, 2010 , pp. 92-104(13). Springer Publishing.

THANK YOU for spending time with me!!

Contact us at…Dee-Dee Stout

ddstoutrps@aol.com & sensiblerecovery@aol.com

www.responsiblerecovery.orgFor training in: MI, CDOI, Case Management,

Counselor Wellness,SUD’s/COD’s, Trauma & more

Ontrack Program Services

www.getontrack.org