Transcript Changing Systems, Changing Lives

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
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 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
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%)
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)
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 selfesteem, 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 pop
LA County Jail is the world’s largest MH
facility
12 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 versa
 Families 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 abuse
 New Age system of slavery?
 Contributes to confusion re: SUD’s/COD’s status
as moral issue or disease
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
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
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
Safety
Mourning and Remembrance
Reconnection
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
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!
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
Special Needs/
Wrap-Around Services
Literacy, education, employment
Health
Parenting
Relationships
Integrated treatment
Transitional support
Aftercare
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
A Taste of MI Demo
Ask-Tell-Ask

Recommended Reading
 The Body Remembers: The Psychophysiology of Trauma &
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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, 22:449466.
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 TraumaInformed 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
[email protected] &
[email protected]
www.responsiblerecovery.org
For training in: MI, CDOI, Case Management,
Counselor Wellness,SUD’s/COD’s, Trauma & more

Ontrack Program Services
www.getontrack.org