The_Intersection_of_Violence_Violent_Victimization
- 1. The Intersection of Violence, Violent Victimization, and Trauma Cassondra (Cassie) Branderhorst, MS Patricia (Pat) Tucker, MA, MBA
- 2. PAGE 2 Agenda • About trauma • Trauma and children • Trauma Informed Care (TIC) • Victimization • “Code of the Street” • Traumatic victimization and violence • TIC in the juvenile justice system • What’s next? • Q & A • Activities throughout
- 3. PAGE 3 Activity • Create an Emergency Self-Care plan – Take a 3X5 card and write down 3 to 5 things that you can do for yourself when things get tough. Examples are breathe, listen to a particular song, yoga, meditate, call a friend, take photographs, sing, cook, or watch reality television.
- 4. PAGE 4 What is Trauma? • Traumatic Event – When a person experiences (witnesses or is confronted with): • Actual or threatened death • Serious Injury • Threat to the physical integrity of self or another
- 5. PAGE 5 Examples of Trauma • Sexual Abuse • Physical Abuse • Severe Neglect • Loss • Domestic Violence • Witnessing of Violence • Terrorism • Disasters • War • Community Violence
- 6. PAGE 6 Trauma Definitions • Acute Trauma – Typically involves a one- time experience (e.g., natural disaster or car accident. (NASMHPD, 2006) • Complex Trauma: – Involves prolonged or multiple traumatic events. Complex trauma typically occurs within a caregiving relationship by neglect, physical, sexual or verbal abuse.
- 7. PAGE 7 Prevalence • Trauma histories are pervasive among youth in America (especially youth from diverse cultural backgrounds). (Marcenich, 2009) • A report of child abuse is made every ten seconds in the United States. (Childhelp, 2013) • Children who experience child abuse and neglect are 59% more likely to be arrested as a juvenile, 28% more likely to be arrested as an adult, and 30% more likely to commit violent crime. (Child Welfare Information Gateway, 2006) • Children with disabilities are more likely to experience neglect than children without disabilities. (Child Welfare Information Gateway, 2006)
- 8. PAGE 8 Trauma Facts • Being abused or neglected as a child increases the likelihood of arrest as a juvenile by 59% (Widom, CS, 1995). • 70% - 92% of incarcerated girls reported sexual, physical, or severe emotional abuse in childhood (DOC, 1998; Chesney & Shelden, • Trauma is almost universal for boys (93%) and girls (87%) in the Juvenile Justice system • Trauma increases the risk of further trauma (most survivors have at least two distinct traumatic incidents)
- 9. PAGE 9 Gender and Trauma Females • Sexual assault/abuse • Domestic violence • Childhood neglect Males • Physical assault • Physical abuse • Military violence • Accidents
- 10. PAGE 10 Adverse Childhood Experiences (ACE) Study • Research study of 17,000 participants. • Adverse Childhood Experiences (ACEs) can affect an individual’s physical and emotional health throughout the life span. • Trauma/traumatic experiences are far more prevalent than previously recognized
- 11. PAGE 11 ACE Conceptual Framework
- 12. PAGE 12 Major Findings of ACE Study • Alcoholism and alcohol abuse • Chronic obstructive pulmonary disease (COPD) • Depression • Fetal death • Health-related quality of life • Illicit drug use • Ischemic heart disease (IHD) • Liver disease • Risk for intimate partner violence • Multiple sexual partners • Sexually transmitted diseases (STDs) • Smoking • Suicide attempts • Unintended pregnancies • Early initiation of smoking • Early initiation of sexual activity • Adolescent pregnancy
- 13. PAGE 13 Impact of Trauma Activation of survival responses: • Fight • Flight • Freeze • Submit • Shutting down of non-essential tasks. • Rational thought is less possible at this time. (Hopper, 2009)
- 14. PAGE 14 Impact on Child Development • Violence teaches withdrawal, anxiety, distrust, over- reaction and/or aggression as coping behaviors; and • Extreme behaviors are rooted in dysregulated emotional states (NF Commission, 2003; SG Report, 1999; Hodas, 2004; Saxe et al, 2003).
- 15. PAGE 15 Traumatized Children • Appear guarded and anxious; • Are difficult to re-direct, reject support; • Are highly emotionally reactive; • Have difficulty “settling” after outbursts; • Hold onto grievances; • Do not take responsibility for behavior; • Make the same mistakes over and over; • World is threatening and bewildering;
- 16. PAGE 16 Traumatized Children • World is punitive, judgmental, humiliating and blaming; • Control is external, not internalized; • People are unpredictable and untrustworthy; • Defend themselves above all else; and • Believe that admitting mistakes is worse than telling truth.
- 17. PAGE 17 Trauma Informed Care • We might unintentionally cause harm by practices, policies and activities that are insensitive to the needs of our clients • Re-traumatizing someone unintentionally is a real possibility • Understanding trauma also means recognizing that our personal traumatic experiences or the stress associated with working in human services may impact our emotional and physical well being as well as our work success and satisfaction
- 18. PAGE 18 What Is Trauma-Informed Care? • An appreciation for the high prevalence of traumatic experiences in persons who receive mental health (physical health and substance abuse) services • A thorough understanding of the profound neurological, biological, psychological and social effects of trauma and violence on the individual (Jennings, 2004)
- 19. PAGE 19 Principles of a Trauma-Informed Care Organization Include? • Safe, calm, and secure environment with supportive care • System wide understanding of trauma prevalence, impact and trauma-informed care • Cultural Competence • Consumer voice, choice and advocacy • Recovery, consumer-driven and trauma specific services • Healing, hopeful, honest and trusting relationships
- 20. PAGE 20 Trauma Informed Care: Relationships WHAT HURTS? Interactions that are humiliating, harsh, impersonal, disrespectful critical, demanding, and judgmental WHAT HELPS? • Interactions that express kindness, patience, reassurance, calm and acceptance and listening • Frequent use of words like PLEASE and THANK YOU
- 21. PAGE 21 Trauma Informed Care: Physical Environment WHAT HURTS? • Congested areas that are noisy • Poor signage that is confusing • Uncomfortable furniture • Separate bathrooms • Cold non-inviting colors and paintings/posters on the wall WHAT HELPS? • Treatment and waiting rooms that are comfortable, calming and offers privacy • Furniture is clean and comfortable • No wrong door philosophy: we are all here to help • Integrated bathrooms (clients and staff) • Wall coverings, posters/pictures are pleasant and conveys a hopeful positive message
- 22. PAGE 22 Trauma Informed Care: Policies and Procedures WHAT HURTS? • Rules that always seem to be broken (time to take a second look at these rules) • Policies and Procedures that focus on organizational needs rather than on client needs • Documentation with minimal involvement of clients • Many hoops to go through before a client’s needs are met • Language and cultural barriers WHAT HELPS? • Sensible and fair rules that are clearly explained (focus more on what you CAN DO rather than what you CAN’T DO) • Transparency in documentation and service planning • Materials and communication in the person’s language • Continually seeking feedback from clients about their experience in the program
- 23. PAGE 23 Trauma Informed Care: Attitudes and Beliefs WHAT HURTS? • Asking questions that convey the idea that “there is something wrong with the person” • Regarding a person’s difficulties only as symptoms of a mental health, substance use or medical problem WHAT HELPS? • Asking questions for the purpose of understanding what harmful events may contribute to current problems • Recognizing that symptoms may be a persons way of coping with trauma or are adaptations
- 24. PAGE 24 Activity • Watch the following TEDTalk – https://www.youtube.com/watch?v=svX3fEdVTLQ • Discussion
- 25. PAGE 25 Switching Gears • Adolescent Violence, Victimization, and Trauma • How to use a trauma-informed approach in the juvenile justice setting
- 26. PAGE 26 Activity • What do you think of when you think of the “typical” victim of crime? • Write down your idea, including specific demographic information, on one of your index cards.
- 27. PAGE 27 “Victim Offender Overlap” • What does the research say? – Past victimization leads to future perpetration of violence among youth (Baron 2003; Coleman & Jensen, 2000; Loeber, Kalb &Huizenga, 2001; Welte et al., 2001) – In youths, victimization and offending are mutually stimulating (Loeber et al.) – 49% of youths who were serious, violent offenders had previously been violently victimized vs. 12% of non- offending youth (Loeber et al.)
- 28. PAGE 28 Risk Factors for Victimization (Loeber et al. 2001) • Gang membership or participation – Gang member victimization rates vs. non-gang member victimization rates • Fighting in a group • Carrying weapons • Serious assault • Selling drugs • Having delinquent peers – Social learning context – Not a protection factor
- 29. PAGE 29 Anderson’s “Code of the Street” (1999) • “Don’t be punked, protect yourself, someone gets you- retaliate, watch your back.” – Violence prevents victimization – Victims are a result of showing weakness – Code of street eliminates the threat of violence – Violence is a way of life – Death is an acceptable risk to maintain respect – Violence is essential to self-preservation
- 30. PAGE 30 Anderson’s Contributors to “Code of the Street” • Poverty • Lack of jobs • Violence as the norm • Alienation • Distrust of police/justice system • Hopelessness • Structural inequality • Institutionalized racism • Stigma of race
- 31. PAGE 31 Pathways to Recurrence (Rich & Grey, 2005) • Loss of sense of safety after victimization – Don’t want to be a “sucker” – Intensifies feelings of distrust for police – Causes traumatic stress
- 32. PAGE 32 PTSD and Victimization (Rich & Grey, 2005) • Almost 2/3 of study participants met criteria within a month of their injury • Symptoms of hypervigilance especially high – Blunting normal fear responses – Nightmares – Flashbacks • Exaggerated sense of vulnerability leading to obtaining weapons and other undesirable responses
- 33. PAGE 33 Most Justice Involved Youth are Survivors of Traumatic Violence (Ajmani, 2015) • At first entry, the vast majority of juvenile justice- involved youth have witnessed and/or have been victim to some type of violence • Community violence in impoverished, urban areas cause continual traumatic violence • Almost 80% of adolescents sentenced to life in prison without the possibility of parole (LWOP) witnessed violence in their homes during childhood – 80% of girls and almost half of all youth who are serving LWOP sentences have been physically abused.
- 34. PAGE 34 Practical Recommendations for Addressing the Impact of Traumatic Victimization on Youths (Ford, Chapman, Mack & Pearson, 2006) • Social history assessment for every youth • Determine motivation: protection or harm • Orders for programs that teach emotion management and clear thinking • Assess intellectual, emotional, and social strengths • Involve family in rehabilitation • Increase services for prevention of delinquency • Provide safe places to develop healthy skills
- 35. PAGE 35 Trauma-Informed Assessment and Intervention in Juvenile Justice Systems (Kerig, 2013) • When? – First referral • Who? – Probation officers, legal guardians, child welfare workers – Detention staff at intake – Attorneys • Goal: A fully trauma-informed juvenile justice system where all mental health professionals are specially trained in trauma assessment
- 36. PAGE 36 Challenges to Trauma-Informed Assessment (Kerig, 2013) • Need for delineation of complex PTSD and developmental trauma disorder • Youth unwillingness to fully divulge traumatic life events • Poor staff attitudes toward assessments
- 37. PAGE 37 Challenges to Trauma-Informed Treatment Kerig, 2013 • Girls in juvenile justice care present unique issues – High prevalence of “close to home” trauma • Need for additional strategies to treat complex trauma • Low parental involvement in effective interventions
- 38. PAGE 38 Trauma and the Environment of Care in Juvenile Institutions (Burrell, 2013) • Incarceration is a traumatic event – Try to limit detention appropriately • Efforts to focus on: – Preventing and reducing institutional trauma – Organizational change – See: Dr. Sandra Bloom’s Sanctuary Model
- 39. PAGE 39 Trauma and the Environment of Care in Juvenile Institutions (Burrell, 2013) • Issues to consider: – Staff are trained to recognize distress and respond appropriately – Youth are kept informed of non-discrimination and needs recognition – Youth are educated on safety protocols – Searches at intake are conducted according to Prison Rape Elimination Act standards – Youth are screened for trauma – Youth are informed of their rights and the rules in written form – Youth know how to get help when needed and who to best contact
- 40. PAGE 40 Avoiding Re-Traumatization (Burrell, 2013) • Use of force and Solitary Confinement • Behavior Management and Disciplinary Confinement • Physical Environment
- 41. PAGE 41 What’s next for Trauma-Informed Care in the Juvenile Setting? • Trauma-Informed Juvenile Justice Roundtable (2013) – Necessary elements of trauma-informed care • “Utilize trauma screening and assessment and evidence-based trauma treatments designed for justice settings” • “Partner with families to reduce the potential traumatic experience of justice involvement” • “Create a trauma-responsive environment of care” • “Reduce disproportionate minority contact and address disparate treatment of minority youth”
- 42. PAGE 42 What’s next for Trauma-Informed Care in the Juvenile Setting? • Evidence-based practices for traumatized youth involved in juvenile justice (Ford, Kerig & Olafson, 2014) – Trauma Affect Regulation: Guide for Education and Therapy (TARGET) – Trauma and Grief Components Therapy for Adolescents (TGCT-A) – Cognitive Processing Therapy (CPT) • Evidence-based interventions for traumatized adolescents (Ford, Kerig & Olafson, 2014) – Trauma Focused Cognitive Behavioral Therapy (TF-CBT) – Prolonged Exposure Therapy (PE)
- 43. PAGE 43 What’s next for Trauma-Informed Care in the Juvenile Setting? • President Obama’s “My Brother’s Keeper” Campaign – “All youth and young adults should be safe from violent crime; and individuals who are confined should receive the education, training, and treatment they need for a second chance.”
- 44. PAGE 44 Question and Answer
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- 46. PAGE 46 Contact Us • Cassondra (Cassie) Branderhorst, MS – Research Associate, Advocates for Human Potential – cbranderhorst@ahpnet. com • Patricia (Pat) Tucker, MA MBA – Senior Program Manager, Advocates for Human Potential – ptucker@ahpnet.com