the path to a trauma informed juvenile probation department · presentation train the trainer...
TRANSCRIPT
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.
The Path to a Trauma Informed
Juvenile Probation
Department
Steve Bridger, Chief Crawford County Juvenile Probation
Audrey S. Smith, Director Parkside Psycholo0gical Associates
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Multiple Traumas and Losses
• Most youth involved with the juvenile justice system have
experienced multiple traumas, often beginning in early
childhood, and recurring over a long period of time.
• Many experienced trauma at the hands of those who were
supposed to protect them.
• This chronic trauma can derail physical, emotional, and social
development. Chronic trauma influences the way youth think,
feel, behave, and interact with others. It influences the way they
see the world.
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Juvenile Justice System Enhancement Strategy Four Stages of Implementation
.
PROFICIENCY
PROFICIENCY
Stage One
Readiness
Stage Two
Initiation
Stage Three
Behavioral
Change
Stage Four
Refinement
PROFICIENCY
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Stages of Implementation
Stage One: Readiness
Intro to EBP Training
Organizational Readiness
Cost-Benefit Analysis
Stakeholder Engagement
Stage Two: Initiation
Motivational Interviewing
Structured Decision Making
Detention Assessment
MAYSI-2 Screen
YLS Risk/Needs Assessment
Inter-Rater Reliability
Case Plan Development
Stage Three: Behavioral Change
Skill Building and Tools
Cognitive Behavioral Interventions
Responsivity
Evidence Based Programming and Interventions
Service Provider Alignment
Standardized Program Evaluation Protocol (SPEP)
Graduated
Responses
Stage Four: Refinement
Policy Alignment
Performance Measures
EBP Service Contracts
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Juvenile Justice System Enhancement Strategy Four Stages of Implementation
.
PROFICIENCY
PROFICIENCY
Stage One
Readiness
Stage Two
Initiation
Stage Three
Behavioral
Change
Stage Four
Refinement
PROFICIENCY
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2014
Formed Trauma Workgroup
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A juvenile justice organization is trauma-informed…
.
When it establishes—at every level in the organization—a culture that:
(1) recognizes the adverse effects of trauma on youth, families, and
staff;
(2) requires and supports operational practices that consistently
prevent further traumatization; and
(3) supports healing and recovery of all trauma-affected
individuals in the organization
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A Culture Shift: A Sweeping Scope of Change
The change involves all aspects of program activities, setting and atmosphere (more than adding new services
The change involves all groups: administrators, supervisors, line staff, consumers, families (more than direct service providers)
It involves changing to a new routine, a new way of thinking and a new way of acting (more than new information)
. 8
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Challenges to Implementation
Staff Buy-in
Perceived loss of power can be threatening
Change is difficult
Expenditures of agency resources: training costs,
administration and staff time
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Staff Trauma Training Highlights
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In a Group of 25 People:Kaiser Permenente Florida JJ
Household Dysfunction
•Substance Abuse 27% 27%
•Parental Separation /Divorce 23% 81%
•Mental Illness 19% 10%
•Battered Mother 13% 83%
•Incarcerated Household Member 5% 60%
Abuse
•Psychological Abuse 11% 35%
•Physical Abuse 28% 34%
•Sexual Abuse 21% 19%
Neglect
•Emotional Neglect 15% 35%
•Physical Neglect 10% 15%
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The Learning Brain
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The Survival Brain
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Fight, Flee, or Freeze (to protect)
Hypothalamus
Release of adrenaline
and cortisol
Heart rate and blood
pressure increase
Breathing rate
increases
Hippocampus
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(Restak, 1988)
AmygdalaBecomes “irritable”,Increasingly sensitive to triggers
Prefrontal
CortexFrontal lobes shut down or decrease activity to ensure instinctive responding
ThalamusAbility to perceive new information decreases
Triggering
Stimulus
The “Overactive Alarm”
16.
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Development’s Missing Stairs
When children endure
multiple traumatic events over
long periods of time they are
especially likely to have
multiple gaps in their
development.
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Impact of Abuse on Learning
•30% of abused children have some type of language or cognitive impairment
•over 50% of abused children struggle in school. Including poor attendance and misconduct
•Over 22% of abused children have a learning disorder
•Approximately 25% of abused children will require special education services
(National Child Traumatic Stress Network)
18.
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Trauma Triggers
Things, events, situations,
places, sensations, and
even people that a youth
consciously or
unconsciously connects
with a traumatic event
© 2011, Richard Ross. All Rights Reserved
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Potentially Traumatizing Events in JJ Settings
•Seclusion
• Restraint
• Routine room confinement
• Strip searches/pat downs
• Placement on suicide status
• Observing physical altercations
• Fear of being attacked by other youth
• Separation from caregivers/community
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Common Diagnoses Given to children/adults with histories of childhood trauma:
Attention deficit hyperactivity disorder
Oppositional defiant disorder
Conduct disorder
Bipolar disorder
Reactive attachment disorder
Major Depression
These diagnoses generally do not capture the full extent of the developmental impact of trauma.
.
.
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Coping Strategies
A coping strategy is a behavior individuals use consciously or unconsciously to tolerate
adversity, disadvantage, or disability without correcting or eliminating the underlying
condition
- Can be positive or negative- Are adaptive in a traumatic situation
- Can be maladaptive when the situation changes
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“Male child with an ACE score of 6 has a 4600% increase in likelihood of later becoming an IV drug user when compared to a male child with an ACE score of 0. “
Might drugs be used for the relief of profound anguish dating back to childhood experiences? Might it be the best coping device that an individual can find?”
(Felitti, 1998)
23.
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Childhood Experiences
Underlie Suicide
0
5
10
15
20
25
% A
ttem
pti
ng
Su
icid
e
ACE Score
1
2
0
3
4+
24.
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Juvenile Justice System Enhancement Strategy Four Stages of Implementation
.
PROFICIENCY
PROFICIENCY
Stage One
Readiness
Stage Two
Initiation
Stage Three
Behavioral
Change
Stage Four
Refinement
PROFICIENCY
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The Attorney General’s Task Force on Children Exposed to Violence Recommendation for
Juvenile Justice Systems:
Make trauma-informed screening,
assessment, and care the standard in
juvenile justice services.
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Why Screen for Traumatic Stress?
.
• Identifies youth who have traumatic stress
symptoms that may have contributed to
their offending and may interfere with their
success in court-ordered programming
• Assists in identifying youth who would
benefit from referral for a comprehensive
trauma assessment
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Considerations for Traumatic Stress Screening
.
Tools need to be reliable and valid
Timing is tricky… should take place
as early as possible but trust may
improve accuracy of results
Mandated Reporting obligations
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Examples of Trauma Screening .
Youth Level of Service (YLS) Section 3
MAYSI-2
TE scale: 5 questions to identify whether a youth has had greater exposure to traumatic events compared to other youths. Scores of 4 or 5 often lead to referral
Adverse Childhood Experiences (ACES)
Questionnaire
Total Scores range from 0-10. Scores of 3-4 often
lead to referral
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Trauma Assessment
Domains covered include:
• Basic demographics
• Family history
• Trauma history (comprehensive, including events experienced or witnessed)
• Developmental history
• Overview of child’s problems/symptoms
Includes trauma-specific standardized clinical
measures to assist in identifying the types and
severity of symptoms the child is experiencing
May include assessment of caregiver stress and/or trauma and parent-child relationship
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Motivational Interviewing is ….
“A collaborative, person-centered form of guiding to elicit and strengthen motivation for change.”
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The “Spirit” of MI is Based on 3 Key
Elements: .
Collaboration (vs. Confrontation)
Evocation ( Drawing out, Rather than imposing ideas)
Autonomy (vs, Authority)
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Juvenile Justice System Enhancement Strategy Four Stages of Implementation
.
PROFICIENCY
PROFICIENCY
Stage One
Readiness
Stage Two
Initiation
Stage Three
Behavioral
Change
Stage Four
Refinement
PROFICIENCY
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2015
Juvenile Probation Staff Trained on Skills for Building Resilience
with JJ Youth
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Building the Seven Cs of Resilience
Confidence
Competence
Connection
Character
Contribution
Coping
Control
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The Cornerstone of Resilience…
The surest single predictor
of resilience on a child
is whether they have at least one…
Attentive, Protective, Guiding and Nurturing
relationship with a reasonably healthy adult!
.
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Trauma Specific Treatment
There are a number of treatment models that have been
shown to be effective in reducing trauma symptoms in
children and youth.
When making referrals, look for therapists with
specialized training/expertise in evidence based trauma
treatment models.
Instead of asking, “Can you treat traumatized youth?”
Ask, “What models of trauma treatment are you trained
in?”
1
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Where to find lists of evidence-based trauma treatment models:
National Registry of Evidence-based Programs and Practices (NREPP)http://www.samhsa.gov/nrepp
National Child Traumatic Stress Network (NCTSN)
http://nctsn.org/training-guidelines
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Examples of Evidence-Based Trauma Treatment for Youth
.
TARGET (Trauma Affect Regulation: Guide for Education and Therapy )
SPARCS (Structured Psychotherapy for Adolescents Responding to Chronic Stress) Group treatment for teens in chronically stressful life circumstances
SEEKING SAFETY co-occurring PTSD and substance abuse.
TF-CBT (Trauma Focused-Cognitive Behavioral Therapy) trauma processing and resolution
EMDR (Eye Movement Desensitization and Reprocessing) resolution of traumatic memories
ARC (Attachment Self-Regulation and Competency) youth and families who have experienced
multiple and/or prolonged traumatic stress developed.
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Trauma’s Impact on Responsivity to Interventions
.
Cognitive Behavioral Interventions typically require the ability
to sit still, focus attention, concentrate, understand
spoken/written language, remember information, generalize
learning to new situations…All of these activities are
performed by the “Learning Brain”
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Responsivity continued…
.
If “ Learning Brain” is frequently going off-line, the
youth’s ability to benefit from these interventions will be
limited
Trauma treatment specific to getting the “ Learning
Brain” back on-line may enhance responsivity to other
interventions
Example: Aggression Replacement Treatment
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A Work in Progress:
.
Sustainability: 2 Juvenile Probation Staff completed a 6 hour ACES Community Presentation Train the Trainer program
Trainings planned: Developmental Relationships and Engaging Families by Search Institute
Still to Come: training to recognize and respond to secondary traumatic stress/ vicarious trauma in the workplace
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Imagine…
. .
A place where people ask…..
“What happened to you?” instead of
“What’s wrong with you?”
A place that understands that
trauma can be re-triggered.
A place committed to supporting the
healing process while ensuring no more harm is done.