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 & 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 ddstoutrps@aol.com & sensiblerecovery@aol.com www.responsiblerecovery.org For training in: MI, CDOI, Case Management, Counselor Wellness,SUD’s/COD’s, Trauma & more Ontrack Program Services www.getontrack.org