addressing the mental health needs of children with ... · ‣parental incarceration as a primary...

Addressing the Mental Health Needs of Children with Incarcerated Parents

Anna Morgan-Mullane, DSW, LCSW-R Vice President of Mental Health Services

OVERVIEW

‣ Understanding Mass Incarceration - Historical and Current Context

‣ Children of Promise, NYC

‣ Parental Incarceration as a Primary Trauma

‣ Applications of Trauma-Informed Theories and Interventions: TI-CBT,

Narrative and Relational Therapy

‣ Trauma-Centered Care grounded in Critical Consciousness, Cultural

Humility, and Dismantling Anti-Blackness

‣ Social Work Education and Practice in the Mass Incarceration Era with

Children of Incarcerated Parents

© 2018 Dr. Anna Morgan-Mullane All Rights Reserved

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Mass Incarceration

Implications for Social Work Education and Clinical Practice

Credit: Close Rikers


WHY CRIMINAL JUSTICE IS RELEVANT TO ALL SOCIAL WORK

MULTITUDES IMPACTED BY INCARCERATION • 6.7 million adults currently under some form of correctional supervision (Source: Bureau of

Justice Statistics) • More than 2 million juveniles arrested yearly (Source: Office of Juvenile Justice and

Delinquency Prevention) • 11 million people cycle in and out of jail every year (Source: Prison Policy Initiative) • Nearly 2.7 million children with parents who are incarcerated (Source: Pew Charitable Trust)

DISPROPORTIONATE DISADVANTAGE • Individuals involved in the criminal justice system also commonly

experience disproportionately higher rates of: 1. Poverty 2. Low educational attainment 3. Substance abuse 4. Mental illness 5. Infectious diseases and poor healthcare


MASS INCARCERATION DEFINED: THE NEW CASTE SYSTEM

Mass incarceration is a system that locks people not only behind actual bars in actual prisons, but also behind virtual bars and virtual walls, walls that are invisible to the naked eye but function nearly as effectively as Jim Crow laws once did at locking people of color into a permanent second-class citizenship (Alexander, 2010)


US VIOLENT CRIME AND INCARCERATION RATE (1990-2011)

Credit: Wikipedia Source: Bureau of Justice Statistics


MASS INCARCERATION DISPROPORTIONATELY

IMPACTS PEOPLE OF COLOR

Credit: The Sentencing Project


MASS INCARCERATION INCREASES THE LIKELIHOOD OF INCARCERATION FOR

PERSONS OF COLOR

Credit: The Sentencing Project


CHILDREN OF PROMISE, NYC ADDRESSING THE INVISIBLE POPULATION IMPACTED

BY MASS INCARCERATION


THE NUMBERS BEHIND THE NEED

Credit: Children of Promise, NYC Source: US Bureau of Justice Statistics; NYS Division of Criminal Justice Services


Children of Promise, NYC

• Nonprofit located in Bedford-Stuyvesant, Brooklyn

• Children ages 5-17 with one or both parents incarcerated

• CPNYC Wellness Center – Article 31 (NYS) licensed outpatient community mental health clinic

• Clinical, Mitigation, Case Management, Mentoring Services, Psychiatric Services, Academic Interventions, After-School and Summer Programming


THE COLLATERAL CONSEQUENCES OF

INCARCERATION • Children with Incarcerated Parents - At least 2.7 million children (1 in

9) in the US have one or both parents incarcerated on a given day (Arditti, 2005)

• Incarcerating Caregiving Mothers - 75% of incarcerated women were

the primary caretakers of at least one child before their incarceration (Arditti, 2015)

• Single caregiver instability (i.e., incarcerating single mothers) increases a

child’s risk of experiencing financial and residential instability, as well as the traumatic effects of insecure attachment, including: • Depression • Anxiety • Trauma-related stress (Afifi et al., 2011)


Credit: Children of Promise, NYC



Psychosocial Needs of Children of Incarcerated Parents

• Mood • Anxiety • Dissociation • Adjustment • Cognition • Substance use • Disruptions in eating and sleeping • Self-harming behaviors and

suicidality • Antisocial behavior • Problematic clinical conditions

associated with identity, spirituality, interpersonal relations

• Decrease in academic functioning

INTERGENERATIONAL CYCLES OF JUSTICE-INVOLVEMENT

According to the US Department of Justice, 70% of children who experience familial incarceration will enter into criminal justice system


(Boss, 2007) (Parke & Clarke Stewart, 2001)


Guiding Theories

Examples of Silence and Ambiguity


EXAMPLES OF SILENCE AND AMBIGUITY “…At first when I knew that my dad was in jail, I cried, then I thought,

‘Maybe he'll come home today’ but he

didn’t, so then I cried some more. I felt like daddy would never

come back, so I felt mad and sad at the same

time. But actually, one day he will. But

sometimes I think, ‘Did daddy leave you on

purpose?’ I was worried and confused then.”


Historical Trauma Theory

• Addresses the life course of populations exposed to trauma

• Examines the legacies of trauma passed down through generations

• Considers accumulated loss over time and the impacts of longitudinal violence and systemic trauma

• Community-based practice must address historical trauma as it relates to structural oppression, mass incarceration and the legacy of social work itself

(Whitbeck et al, 2004; Sotero, 2006; DeGruy, 2005)

GUIDING THEORIES

Psychotherapeutic Theories & Interventions

Applications of Trauma-Centered CBT, Narrative Therapy & Relational Therapy


Key Points-Child Traumatic Stress

•Two-thirds of children and adolescents in the US report experiencing at least one trauma event over their lifetimes (Bradley et al., 2005) •One-third of children experience multiple traumas before reaching adulthood (Brady et al., 2015) •Trauma experiences teach children the world is dangerous and adults may not protect them (APA, 2000) •Trauma exposure is associated with increased risk for medical and mental health problems (Cohen & Manning, 2015) • Early identification and treatment is key


Psychosocial Disturbances Connected to Secondary Incarceration

•Mood instability •Behavioral changes - anger, dissociation •Academic challenges •Problems related to identity spirituality, interpersonal relationships


Assessing the Effects of Secondary Incarceration Trauma

• Culturally appropriate assessment tools to identify trauma symptoms

• THQ • CPSS • SDQ • CFIQ

• Begin to formulate intervention plan towards: • secure attachment style • meaningful personal narrative • healthy coping strategies


Guiding Theories

Attachment Theory •Likely to develop a “secure” attachment, positive internal working model of self and others when raised by emotionally responsive caregivers (Bowlby, 1969) •Lends perspective into affect regulate abilities and interpersonal relationships •Adaptive/maladaptive coping strategies

•Functional/dysfunctional strategies to meet basic psychological needs- connection, competence, autonomy

Trauma Theory • Children are traumatized whenever they fear for their lives or for the lives of someone they love.

• A traumatic experience impacts the entire person-

• Thinking • Learning • Memory • Self-concept/esteem • View of others • Our sense-making and meaning-making

• …are all profoundly altered by traumatic experience. -Sandra Bloom, MD


Attachment Theory & Relational Therapy

• Addresses significance of developmental history in the emergence of psychosocial programs and the content of human behavior in the social environment

• John Bowlby- deprivation of the caregiver-child relationship contributes to psychopathology

• This can be reversed through the process of psychotherapy therapist becomes a secure

base and fulfills position of attachment figure

• Promotes changes in individual’s feeling and thinking, with increased sense of security


5 Components of TC-CBT 1. Psychoeducation

• information, validation, normalization

2. Coping Strategies • relaxation, cognitive

tools 3. Affect Regulation

• express feelings, manage emotional states

4. Trauma Narrative • uncover distortions • reframing • meaning-making

5. Enhancing Safety • Physical safety • Internal sense of security

and trust (Cohen et al., 2015)


Family Involvement & Gradual Exposure Infused throughout TC-CBT

● Reduce parental distress related to their own and child’s trauma

● Provide parenting support

● Enhancing family

communication about trauma

● Increasing exposure to trauma reminders while encouraging utilization of coping tools to master anxiety


Narrative Therapy

• Alternative stories about the nature of individuals and society can be revealed through a helping process in which new ideas can be developed, new voices heard...Possibilities emerge when one stands back from the usual way of doing things and considers new ways of responding.

“...after trauma, the narrative process is urgent. The act of

writing about the trauma is an act against trauma.” • Narrative memory replaces traumatic memory (Cohen et al.,

2006)


Transactional Partnership The worker's understanding of a shared humanity is a

prerequisite for the helping relationship

• Narrative knowledge and practice saturate the lives of social workers and their clients, narrative acts alone can bridge the divides between social workers and their clients toward a therapeutic universal recognition of the human condition

• Client's stories reveal that they have the same needs, desires, and emotions as those who listen to them (Unterhitzenberger & Rosner, 2015)

• Additionally, the therapeutic alliance and working partnership between social worker and client serves as a paramount intervention in itself with significant positive outcomes


Therapeutic Change Process After treatment, most children identify experiencing change - described as an absence of symptoms, and changes in how they thought, acted and felt about themselves. (Simonich et al., 2015) • “Before, I was a crying mess. So much was happening at once- all the different

investigators, therapy, the loss of my mom, knowing that she was gone. I was scared. I feel that I am stronger as a person. I’m doing okay; I’ve gotten better.”-Age 11

• “At first I described my life as bad. Bad times were in school when I got in trouble, and I wouldn’t think before I did something, that was a year ago. Now I describe my life as….good…I don't need to space-out any more, nothing bad is happening no more. I feel confident that I’m just letting everything go”-Age 13

• “There has been a big change because before I thought a lot about the arrest of my dad and then I had stomach aches all the time…but when I came to the center they helped me talk about it so now I feel much better”-Age 8


IMPLICATIONS FOR SOCIAL WORK EDUCATION, SUPERVISION, AND TRAINING


POSITIVE MODELING AND TRAINING AS SUPERVISORS


GUIDING THEORIES FOR SUPERVISION

Critical Consciousness

• Challenges social workers to be aware

of the power they have and how this power is experienced in relation to those they work with

• Requires intentional and ongoing self-

reflection of one’s perception of self and others throughout treatment grounded in construct of social justice (Sakamoto & Pitner, 2005)

Cross Cultural Supervision

• Understanding the role of one’s own

social identities across race, gender, class, sexual orientation, abilities, age, and all other relevant clinical variables

• Observe and discuss one’s own racism, biases, power-privilege, and assumptions in action (Danso, 2017)


Anti-Racist Supervisory Framework


LIMITATIONS WITH EXISTING SOCIAL WORK EDUCATION

• The marginalization of criminal justice coursework within the field of social work during an era of mass incarceration overlooks the role that social workers can play both within and adjunct to the criminal justice system.

• Less than 5% of MSW programs offer a concentration in

a justice-related field. (Epperson et al., 2013)


EFFECTIVE SOCIAL WORK REQUIRES A HISTORIC UNDERSTANDING OF MASS INCARCERATION

When social work programs fail to include the historical context of contemporary issues such as mass incarceration in their curriculum or clinical practice, students enter the field without adequate knowledge of the historically racial, social, psychological, and economic factors that have propelled mass incarceration in the US. (James & Smyth, 2014)


Social Work Policy in Practice

Applications of Legal Mitigation in Criminal and Juvenile Cases


(Phillips, 2011)


Mitigating Factor – Harsh Prison Conditions and Lack of Re-Entry Support

MITIGATING FACTOR - MENTAL ILLNESS

Disproportionate Health Composition • In 2014 More than half of all children and adults who were

incarcerated had a mental health diagnosis

• 1.2 million incarcerated people have been diagnosed mental health conditions • 56% of those in state prisons • 45% of those in federal prisons • 64% of those in jails

• Individuals incarcerated had greater predispositions to posttraumatic stress disorder than the general public (Source: National Resource Council)


AREAS FOR FURTHER TRAINING

• Expand existing research on the effects of incarceration to children and adolescents

• Infuse mass incarceration specific content to all social work curricula and clinical supervision regarding:

• Mass Incarceration • Complex Trauma and child development • Culturally responsive trauma assessments • Trauma informed-practice • Dismantling of anti-black practices in

◦ Clinical social work practice ◦ Policy practice ◦ MSW education ◦ Criminal justice research


QUESTIONS


Anna Morgan-Mullane, DSW, LCSW-R Vice President of Mental Health Services

Children of Promise, NYC [email protected]

718-475-9417 Adjunct Lecturer

NYU Silver School of Social Work

CONTACT INFORMATION


CTAC Questions: [email protected]

Social Workers and LMHCs: How to Obtain Your Continuing Education Contact Hour for this Webinar ‣ Create a Username & Password at the NYU Silver CE Online

Portal : • https://sswforms.es.its.nyu.edu/

‣ Log on to the “Continuing Education Online Portal for the NYU Silver School of Social Work” page, click on “All Events & Programs” tab

‣ Scroll down & select today’s webinar under “Online Learning” ‣ Click “Register” ‣ Fill in the billing information, click register, and pay the CE

registration fee Remember: Our system works best with Google Chrome or Mozilla Firefox

https://sswforms.es.its.nyu.edu/

Social Workers and LMHCs: How to Obtain Your Continuing Education Contact Hour for this Webinar, cont. ‣ After registering, you will receive a confirmation email with

a link to complete an evaluation ‣ Once the evaluation is submitted, within 24 - 48 hours, log

back on to NYU Silver CE Online Portal, go to “Your Registrations” and you will see “Take Assessment” in red next to the name of the program

‣ Complete assessment ‣ Once done, you will be directed how to download your CE

certificate ‣ For Questions: Call 212-998-5973 or email

[email protected]

mailto:[email protected]

Upcoming Webinar

Understanding Adolescent Self-Injury Thursday, July 26, 2018

1:00 - 2:00PM Janis Whitlock, PhD, MPH

www.ctacny.org

http://www.ctacny.org/

References • Afifi, T., Mather, A., Boman, J., Fleisher, W., Enns, M., MacMillan, H., and Sareen, J. (2011) Childhood Adversity and Personality Disorders: Results

from a Nationally Representative Population-based Study. Journal of Psychiatric Research. 814-822.

• Alexander, M. (2010). The new Jim Crow: Mass incarceration in the age of colorblindness. New York.

• Arditti, J., (2005) Families and Incarceration: An Ecological Approach. Families in Society: The Journal of Contemporary Social Services. 86:2 251 – 260.

• Arditti, J., and Savla, J. (2015) Parental Incarceration and Child Trauma Symptoms in Single Caregiver Homes. Journal of Child and Family Studies.

24:3 551-561.

• American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders • (4th ed. Text Revised), Author, Washington, DC.

• Boss, P. (2007) Ambiguous Loss Theory: Challenges for Scholars and Practitioners. Family Relations, 56(2)105-111.

• Bowlby, J. (1969) Attachment and Loss. New York: Basic Books.

• Bradley, R., Greene, J., Russ, E., Dutra, L., and Western, D. (2005) A Multidimensional Meta-Analysis of Psychotherapy for PTSD. American Journal of Psychiatry. 162: 214 – 227

• Brady, F., Warnock-Parkes, E., Barker, C., and Ehlers, A. (2015). Early in Session Predictors of Response to Trauma-Focused Cognitive Therapy for

Posttraumatic Stress Disorder. Behavior Research and Therapy, 75: 40-47.

• Cohen, J., Mannarino, A., and Deblinger, E. (2004). Trauma Focused Cognitive Behavioral Therapy for Sexually Abused Children. Psychiatric Times, Volume XXII issue 10.

• Cohen, J., Mannarino, A., and Deblinger, E. (2006). Treating Trauma and Traumatic Grief in Children and Adolescents. New York: The Guildford

Press.

• Cohen, J., Mannarino, A., and Deblinger, E. (2015). Trauma-Focused Cognitive Behavior Therapy for Traumatized Children and Families. Child and Adolescent Psychiatric Clinics of North America, 24: 557-570.

• Cohen, J., Mannarino, A., Iyengar, S. (2011) Community Treatment of Posttraumatic Stress Disorder for Children Exposed to Intimate Partner Violence:

A Randomized Controlled Trial. Archives of Pediatric Adolescent Medicine. 165(1): 16 -21.


References Continued ‣ Danso, R. (2015) An Integrated Framework of Critical Cultural Competence and Antioppressive Practice for Social Justice Social Work Research.

Qualitative Social Work, 14(4):572-588

‣ Epperson, M., Roberts, L., Ivanoff, A., Tripodi, S., and Gilmer, C. (2013) To What Extent is Criminal Justice Content Specifically Addressed in MSW Programs? Journal of Social Work Education, 49(1):96-107

‣ Glaze, L and Maruschak, L. (2008). Parents in Prison and Their Minor Children. Washington, DC: Bureau of Justice Statistics

‣ James, K., & Smyth, J. (2014). Deconstructing mass incarceration in the United States through a human rights lens: Implications of social work education and practice. In M. Bethold, L. Healey, K. Liba

• National Research Council. (2014). The Growth of Incarceration in the United States: Exploring Causes and Consequences. Committee on Causes and Consequences of High Rates of Incarceration, J. Travis, B. Western, and S. Redburn, Editors. Committee on Law and Justice, Division of Behavioral and Social Sciences and Education. Washington, DC: The National Academies Press.

• Philips, S. D. and Gates, T. (2011) A Conceptual Framework for Understanding the Stigmatization of Children of Incarcerated Parents. Journal of Child and Family

Studies, 20: 286-294.

• Phillips, S.D., Erkanki, A., Keeler, G.P., Costello, E.J., and Angold, A. (2006) Disentangling the Risks: Parents Criminal Justice Involvement and Children's Exposure to Family Risks. Criminology and Public Policy, 5(4): 677 – 702.

• Roettger, M.E. and Swisher, R.R. (2011) Associations of Fathers' History of Incarceration with Sons' Delinquency and Arrest Among Black, White, and Hispanic

Males in the United States. Criminology, 49(4): 1109-1147.

• Simonich, H. K., Wonderlich, S. A., Erickson, A. L., Myers, T., Hoesel, J., Wagner, S., Engel, K. (2015). A Statewide Trauma-Focused Cognitive Behavioral Therapy Network: Creating an Integrated Community Response. Journal of Contemporary Psychotherapy, 45: 265-274.

• Turanovic, J. J., Rodriguez, N., and Pratt, T.C. (2012). The Collateral Consequences of Incarceration Revisited: A Qualitative Analysis of the Effects on Caregivers

of Children of Incarcerated Parents. Criminology 50(4): 913 – 959.

• Unterhitzenberger, J. and Rosner, R. (2016). Case Report: Manualized Trauma-Focused Cognitive Behavioral Therapy with an Unaccompanied Refugee Minor Girl. European Journal of Pychotraumatology. 7: 1 – 5.

• Western, B. and Wildeman, C. (2009). The Black Family and Mass Incarceration. Annals of American Academy of Political and Social Science. 621: 221 – 242.

• Western, B. and Wildeman, C. (2010). Incarceration in Fragile Families. The Future of Children. 20 (2): 157 – 177.


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