The Power of Gender-Informed Interventions

Transcription

1 The Power of Gender-Informed Interventions

2 Setting Context 1964 Interviewer: What would the world be like without men? Woman: There would be no crime and lot s of happy, fat women Nicole Hollander

3 We ve Come A Long Way META ANALYSIS: Programs that were designed for women and address the salient needs of women demonstrate more favorable outcomes than gender-neutral programs. Gobiel, Blanchette, Stewart (In Press)

4 Gender-Responsive Treatment Curriculum that target salient needs Parenting Substance abuse Trauma Violence Relationships and cognitive skills Collaborative case work and transition models OUTCOME STUDIES: Demonstrating reductions in symptoms and recidivism

5 Gender-Responsive Strategies 1: Trauma informed 2: Relationship oriented 3: Strengths based 4: Integrative and comprehensive

6 Presentation Overview

7 Advancing Our Work with Justice Involved Women Spotlight on trauma and some emerging research Highlight some innovative and promising practices when working with women who present with complex behaviors

8 Trauma Trauma

9 Trauma Refers to an EVENT that results in a REACTION or RESPONSE that can range from intense fear, helplessness, or horror (Briere & Scott, 2006)

10 Naturally Occurring Events Hurricanes, Earthquakes, Automobile accidents, Fires

11 Those We Create War, Poverty Exploitation Racial discrimination Child abuse Child neglect -

12 Understanding Trauma Trauma not identified as a causal or major contributing factor in early reviews of the research with men. Prevalence data for women is extraordinarily high (particularly for reports of childhood victimization) Ranges of 60 percent in probation samples to as high as 90 percent in prison

13 Adverse Childhood Events Study Collaborative research between Centers for Disease Control and Prevention in Atlanta, GA, and Kaiser Permanente in San Diego, CA. Over 17,000 Kaiser patients participating in routine health screening volunteered to participate Data continues to be analyzed: More than 50 scientific articles and 100 conferences Reveals staggering proof of the health, social, and economic risks that result from childhood trauma.

14 Factors Explored ABUSE: Emotional abuse Physical abuse Sexual abuse NEGLECT Emotional neglect Physical neglect HOUSEHOLD DYSFUNCTION Mother treated violently Household substance abuse Household mental illness Parental separation or divorce Incarcerated Household Member

15 As the Number of ACE s Increase The risk of medical, economic, social and behavioral issues also increases. Women 50% more likely to have a score higher than 5 than men. Messina & Grella (2012) women in prison average score of 6 10

16 What does early trauma predict? N = 1,206 Mental health issues ( r =.31 *** ) Poor stability (e.g., housing, financial issues, etc.) (r =.29 *** ) Family conflict (r =.21 *** ) Substance abuse (r =.19 *** ) Involvement with antisocial peers (r =.17 *** ) * P <.05. ** P <.01. *** P <.001.

17 Another critical finding Personal childhood solutions to deal with early adverse experiences seem to play a survival function Engaging in drinking, drug-use selfharm behavior However, these behaviors have longstanding negative consequences in adulthood

18 Brain Science Research

19 Stress - Influenced Response When we perceive danger or experience high levels of stress the amygdala sets off an alarm activates fight, flight or freeze. Stress response is activated and adrenaline and cortisol are released through the blood stream. Cortisol limits access to the prefrontal cortex and prevents us from thinking rationally. Once the threat has passed the body eliminates the stress hormones and we go back to normal.

20 We Need the Low Road

21 And We Need the High Road

22 Trauma-Influenced Response Individuals may struggle with or are unable to return to rest and relaxation. The limbic system stays on stuck on high alert and is chronically activated. Stress hormones are not broken down and become toxic to the brain, Impacts ability to learn and remember new things. Often the individual is easily startled, has trouble reading social cues, has difficulty sleeping, and tends to avoid situations that increase stress.

23 The Trauma-influenced Stress Response For survivors, the low road to fear can dominate

24 Everything is a Snake in the Sand

25 Traumatized people chronically feel unsafe inside their bodies. The past is alive in the form of gnawing interior discomfort. Their bodies are constantly bombarded by visceral warning signs -Bessel van der Kolk (2005)

26 Unconscious Responses: Instinct and Survival Mode Hyper-mobilized, or constantly scanning for danger Hypo-mobilized, or withdrawing and shutting down Vacillate between hyper- and hypo-mobilized *Many of the women we work with are functioning in one of these three states because their past experiences have taught them that doing so will keep them safe.

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28 Resilience

29 Why we Should Remain Optimistic There is another aspect of trauma and its impact that provides hope. Despite conventional wisdom that says trauma will and must have a powerful, devastating, and lasting impact on our life for the most part- the opposite is true. Bonanno (2004) one of the leading researchers in this area has found that the most commonly observed outcome following exposure to a traumatic event is RESILIENCE.

30 What is Resilience? The concept of resilience is not new 1955, 698 infants part of a 30 year study Vulnerable But Invincible: A Longitudinal Study of Resilient Children and Youth. -Werner and Smith

31 Resilience Resilience is the ability of an individual to adjust and thrive after exposure to a highly disruptive event or events. It does not mean that life s major hardships are not difficult and upsetting but rather they are surmountable. We confuse events with the people who experience them. Never underestimate the resilience of people who have experienced trauma if you want to build resilience don t go after the trauma but the imprint it has left.

32 Approach Matters Trauma informed Strengths based Relationally oriented- (healing power of relationships) If we respond in a respectful, empathic and supportive manner she feels safe. When she feels safe she is more likely to remain regulated or to return to a state of regulation more quickly. She is also more likely to communicate her concerns which opens the way for problem-solving (build resilience).

33 Recognize the value of relationships and that all are not healthy. Learn to engage with others in a fundamentally different way Trauma

34 Strengths Based Demonstrate how her current feelings and coping strategies can be understood within the context of abuse history and then move forward to build resiliency. What I am hearing is that using drugs helped you to cope with the abuse you used to survive. And at the same time I am also hearing you that using drugs has really cost you- you are having problems with your children, you have tested dirty and you are worried may lose your freedom Would you consider trying some other ways that people have found helpful to feel safer?

35 After you master approach more GOOD News Neurogenesis and neuroplasticity We can teach an old dog new tricks Brain can continue to develop new neural pathways and this occurs when we engage in new behaviors

36 Working with Women Who Present with Complex Behaviors

37 Potential for Negative Outcomes is Cumulative More likely to be have disciplinary reports, to be denied parole Women- often placed in the most restrictive settings (segregation or behavior management units) Less likely to engage with staff, to have visits, to have opportunities for personal, social and vocational development WHO ARE THESE WOMEN? Greatest need for healthy contact Invariably report a history of complex trauma- (prolonged, repeated, childhood abuse). \

38 Trauma- Informed Universal Precautions

39 Trauma Informed Care All women should be treated with RESPECT, humanity and dignity. Knowledge about trauma and the guiding principles should be integrated into all policies, procedures, and practices.

40 Principles of Trauma-Informed Care Safety (respectful always, provide explanations, de-escalation policies) Trust (clarify rules, roles, responsibilities, consistency, accountability) Choice (give her choices whenever possible; options limited but little things pick appointment time or day of visit, etc.) Collaboration (give her autonomy and decision-making; she is in control of what will happend) Empowerment (strengths based; What do you need to be successful?) Principles of Trauma-informed Care, Harris & Fallot, 2006 Adults Surviving Child Abuse (ASCA)

41 The Importance of Self-Care 911 first responders We as professionals need to feel safe so it is important that we are regulated, that we have sufficient resilience and that we are supported in our work.

42 When Trauma-Informed Lise Bisonnette: MCI- Framingham, MA BENEFITS- Reductions in: Inmate-on-staff assaults Inmate-on-inmate assaults and fights Segregation placements Disciplinary reports Suicide attempts 15% reduction in all selfinjurious behaviors 20% reduction in transfers to inpatient psychiatric hospitalization 33% reduction in days on constant mental health watch 46% decrease in total crisis contacts

43 Dilemma: Translating the Model to Practice I am not going to show her respect when she: Is verbally abusive Engaging in self-harm behavior Noncompliant Oppositional We need to build staff competence so that they can manage complex and difficult behaviors in the moment.

44 Core Associates & Orbis Partners, Inc.

45 Part 1: Regulation Hold On and Anticipate Explore Acknowledge & Reflect Review

46 Part 2: Resiliency Reflect Her/Your Position Explore Options Plan Affirm Individual Strengths Review

47 The power of integrated models Integration of: Neuroscience and trauma research Evidence-based interventions designed to build emotionalregulation skills (DBT; CBT; MI; etc.) Promising interventions (mindfulness, yoga, somatic experiencing, etc.) Delivered using a relational and strengths-based approach

48 Living Safely and Without Violence Living Safely and Without Violence

49 Four Core Practices Brain Research Woven into every session and anchored to the Living Safely Plan Mindfulness Emotional Regulation Relationship Skills

50 Mindfulness

51 Wrap Up and Some Unsolicited Advice

52 Unsolicited Advice Learn more about trauma an do not be afraid to explore and integrate the neuroscience, attachment and resilience research. How we communicate and work with women directly impacts outcomes safety, respect, humanity, dignity. Start with her strengths. Rather than focus on what she is doing wrong- anticipate why she might be behaving the way she is, validate this and then within agency parameters generate options. Provide a nutritious and diverse menu of choices and opportunities and invite her to try them. Don t be surprised if she doesn t like everything you serve.

53 Listen Remember women hold up half the sky -Mao Zedong

54 For further information about this presentation please contact: Marilyn Van Dieten, Ph.D. Orbis Partners Inc.

55 Resources Resources: National Resource Center on Justice Involved Women Technical Assistance National Institute of Corrections Technical Assistance Training in Trauma Informed Care Substance Abuse and Mental Health Services Administration (SAMHSA) National Center for Trauma-Informed Care