Changing Systems, Changing Lives

1. Changing Systems, Changing Lives Arrested Development: A New Direction for Incarcerated Women Dee-Dee Stout, MA, CADC-II; Member of MINT; Advisor/Trainer, ICCE For Ontrack Program Services

2. In the beginning… Female Offenders

3. 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)*

4. More Background • 2000, most offenses were drug related (40%) and property crimes (34%), 18% for violent crimes • Women more likely to arrested for dx crimes than for violent crimes • Women are now 7% of total prison population; 11% of jail • 3.2M women were arrested (1998) which accounts for 22% of all arrests • Female drug offense arrests up 13% • Due to more punitive anti-dx laws and targeting women (mothers) of color

5. Drug Use & Women • 50-60% of women in CJ have experienced child/sex/adult abuse • Associated w/incarceration for violent crimes, higher risk sex , PTSD sx • 1980’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%)

6. More Drug Use & Women • Men use more alcohol; women use more other substances • Cocaine, 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)

7. 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

8. 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

9. 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

10. 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 pop • LA County Jail is the world’s largest MH facility • 12 FT pharmacists

11. “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 versa • Families are torn up before the drug use begins not just after

12. Brief Case Example? Female

13. 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 abuse • New Age system of slavery? • Contributes to confusion re: SUD’s/COD’s status as moral issue or disease

14. Physical Reactions to Trauma • Faintness, dizziness • Hot 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

15. Behavioral Reactions • Jumpiness, easily startled • Sleep disturbances and nightmares • Hyper-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

16. 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

17. 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

18. 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

19. 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

20. Stages of Trauma Treatment • Safety • Mourning and Remembrance • Reconnection

21. Compassion Fatigue (CF) • Occurs when caregivers focus on others without practicing self-care • And when helpers don’t feel supported or fully competent • Symptoms include: apathy, isolation, bottled up emotions, and misuse of substances

22. What Works with Trauma? • Motivational Interviewing (MI)* • Seeking Safety (present focus) • Cognitive Behavioral Therapy (CBT) • Dialectical Behavioral Therapy (DBT) • Meditation • Somatic Experiencing • EMDR?? • CDOI* *Also works on CF!

23. While Incarcerated • Needs of women are greater & more complex • Need to develop trust with CJ staff/other incarcerated women to work on trauma • May be increase in violent behaviors inc. self harm due to trauma

24. Special Needs/Wrap-Around Services • Literacy, education, employment • Health • Parenting • Relationships • Integrated treatment • Transitional support • Aftercare

25. Some Possibilities… • Systems Change: • Involve inmates in all areas of care • Allow for some choice • Treatment Change: • Save autobiographies until Safety is established • Staff Change: • Ask-Tell-Ask

26. A Taste of MI Demo Ask-Tell-Ask 

27. 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.

28. 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.

29. THANK YOUfor spending time with me!! Contact us at… Dee-Dee Stout ddstoutrps@aol.com & sensiblerecovery@aol.comwww.responsiblerecovery.org For training in: MI, CDOI, Case Management, Counselor Wellness,SUD’s/COD’s, Trauma & more  Ontrack Program Services www.getontrack.org