Probation-medical partnership using a gender, trauma, and motivational intervention to improve justice and health outcomes for women

Transcription

1 Probation-medical partnership using a gender, trauma, and motivational intervention to improve justice and health outcomes for women Diane Morse, MD Associate Professor of Psychiatry and Medicine University of Rochester School of Medicine Women s Initiative Supporting Health

2 Acknowledgements Monroe County Probation, Rochester, NY Julia Wagner, senior probation officer Angela Ruffier, probation officer Department of Justice Second Chance Act Smart Probation: Reducing Prison Populations, Saving Money, and Creating Safer Communities 2013-SM-BX-0005

3 Background Justice-involved women have many unmet legal, health, and social needs Histories of trauma and other genderbased barriers hinder women s legal and health success

4 Background Project FOCUS (Female Offenders Can Ultimately Succeed) Novel partnership: mid-sized urban county probation and Women s Initiative Supporting Health (WISH) Part of Transitions Clinic Network-unique Women-only Combines Self-determination Theory of motivation &Trauma Recovery and Empowerment model

5 Process aims of Project Focus Trauma, gender-specific, motivationbased Trained peer community health workers using above as well as re-entry strategies Trained probation officers use above as well as supervision strategies according to a social work model

6 Content aims of Project FOCUS Decrease recidivism Increase linkage to healthcare and social resources Improve women s corresponding outcomes Impact public health

7 Research aims of Project FOCUS Examine high-risk women s probation violations and healthcare uptake in the context of their elevated risks Qualitative Describe processes, barriers, facilitators of collaboration Describe content and fidelity of PO-client interactions

8 Current exploratory study Methods Examines interactions between two trained self-selected probation officers and their FOCUS clients One day training & monthly supervision Audio-taped encounters between 20 FOCUS clients and their probation officers A qualitative thematic framework analysis

9 Framework analysis Uses theoretical framework as foundation of thematic coding Develop coding document, revised iteratively Apply to transcribed documents Find emerging themes within the frameworks and map onto matrix

10 Theoretical frameworks Self-determination Theory of human motivation Autonomous regulation/motivation Competence Relatedness Socio-ecological model Intrapersonal Interpersonal Community Institutional Systemic

11 Supporting autonomy Intrapersonal issues-navigating sobriety Client: I know better than to drink, but other people don t get it. They re just like, J, let me get you a drink. Let s get a drink. Next time you re out here, drinks are on me. PO: Why is it better not to drink? Client: Well, if I never drank I probably wouldn t have ever tried to kill myself, and I probably would never have gotten arrested ever, because all my arrests are alcohol related, and pretty much every time I ve been in the hospital is because of drinking. PO: Okay. It sounds like good reasons to me.

12 Supporting autonomy & competence Institutional barriers to treatment Client: But the thing is, I m not trying to get violated for smoking [marijuana]... I mean, I have support in my fiancé and I have the support of his family, but having that support of going to [SUD treatment] group... knowing that if I have the cravings, I m able to talk to somebody and get the support back. PO: Right. Have you thought of maybe any other strategies that you can incorporate into the whole thing, other than going back into group?

13 Supporting competence Interpersonal-IPV & intergenerational violence Community-housing barriers PO: I m not going to tell you that it will all work out in the end, even though I believe it will. I also know you re too smart to make really bad decisions that are going to hurt you in the end. I think you re pissed right now, and I would be pissed too. Client: Yeah, I am. PO: Yup. You re in a tough spot having to make some decisions. Client: What I m gonna do probably is just stay at Dave s house [supportive friend]

14 Supporting autonomy & competence Motivation expressed-future job PO: So where do you see yourself five years from now? What would you like to be doing? Do you see yourself at Wal-Mart and what would you like to be doing there? Client: I like my job. I ve been working there for a long time. Hopefully I can somehow move up in the company. So I wouldn t mind doing something like that, but honestly, my true passion... I really want to be a lawyer. PO: Really? Wow. Client: That s really what I want to do is be an attorney...before all of this happened. That s what I was going to school for.

15 Process findings Process POs implemented motivational strategies Responded to feedback Clients responded positively

16 Trauma-specific Content findings IPV>barriers w/housing, manipulate wrt child custody SEM POs provide instrumental support to address daily living needs for women & their children Intrapersonal, interpersonal, community, institutional, systemic barriers

17 Summary PO s substitute specific strategies for violations PO s using motivation, trauma specific, help overcome barriers at multiple levels Women responded with change talk

18 Limitations One community Probation officers self-selected, not punitively-oriented Not randomized and no comparison group 015

19 Implications Pilot study-need RCT POs can be trained to utilize evidencebased approaches POs did not need a lot of supervision Clients responded Quantitative data to follow re violations, incarcerations, healthcare utilization, substance use, and mental health