vicarious trauma in treatment courts: the increased ... · vicarious trauma in treatment courts:...
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Vicarious Trauma in Treatment Courts:
The Increased Challenge of the Rise in Opioid
Addiction and Overdose
NADCP
2019 Conference
7/17/19
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Moderator:
Chanson Noether, MA
Director
SAMHSA’s GAINS Center
Vice President for CJ Programs
Policy Research Associates
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Speakers:
Lisa Callahan, PhD
Senior Research Associate II
Policy Research Associates, Inc.
Hon. Wendy MortonCommissionerSuperior Court of Arizona in Maricopa County
Jennifer Johnson, J.D.J.K. Johnson AdvisorsSenior Consultant SAMHSA’s GAINS Center
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Vicarious Trauma in Treatment Courts
Lisa Callahan, PhD
Senior Research Associate II
Policy Research Associates, Inc.
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• 2000 Conference of Chief Justices cited well-functioning drug courts is example of therapeutic jurisprudence (TJ)
• How to use the law and legal processes to improve outcomes for individuals & society
• Old ways of dispensing justice weren’t working
• Underlying causes of problems -> justice contact
Background
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Setting the Stage for Vicarious Trauma
• Knowing participants, relationship building
• Extended time in program
• Collaborative, problem-solving approach
• Participant selection & program eligibility
• Focus on RNR
Core Characteristics of
Treatment Courts -> Changing Roles
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Definitions of Vicarious Trauma
• “Cost of caring” – Figley 1982
• “Compassion fatigue” – Perlman & Saakvitne, 1995
• “Sick with listening” – Rossner, 2017
• “Emotional residue” of exposure to traumatic stories & experiences of others through work (American Counseling Assn., 2016)
• “Secondary traumatization” – ACA, 2016
• “Trauma & stressor-related disorders” – DSM-6
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Vicarious Trauma among Treatment Court Professionals
• There are at least 20,000 treatment court professionals in the US
• Self-care is outside scope of training for justice professionals
• What risk factors do treatment court professionals have?
• What resilience factors do treatment court professionals have?
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Research on Vicarious Trauma
• Most VT research is with first responders, sexual assault counselors, or medical professionals
• Studies focus on the high incidence of burnout among attorneys and bench stress among judges
• No studies link evolving role of justice professionals to negative work outcomes (e.g. burnout, VT)
• Little research on criminal justice professionals
• What work conditions in the justice system are parallel to conditions in other work places that are known to be related to VT?
• Lack of training, awareness, understanding
• Lack of support, debriefing, supervision
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Raising Awareness• Expectation of resilience
• Need to mitigate the negative effects of work
• Organizational recognition of VT & provide resources
• 2003 – 63% of judges had at least one symptom of VT
• 2011 – need for “controlled empathy”
• Legal education & training
• Vicarious resilience – mitigate effects?
Molnar et al., 2017; Resnick et al., 2011; Chase & Hora, 2009
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Who is at Risk?
• Judges
• Attorneys
• Probation officers
• Peers
• Behavioral health providers
• Other professionals (e.g. bailiff, clerks, support staff)
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Bringing Awareness of Vicarious Trauma Within Your Treatment Court
Jennifer Johnson, J.D.
J.K. Johnson Advisors
Senior Consultant
SAMHSA’s GAINS Center
NADCP
2019 Conference
7/17/2019
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When We are Not OurselvesUnderstanding Vicarious Trauma and Compassion Fatigue
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We have not been directly exposed to the trauma scene, but we hear the story told with such intensity, or we hear similar stories so often, or we have the gift and curse of extreme empathy, and we suffer. We feel the feelings of our client. We experience their fears. We dream their dreams. Eventually, we lose a certain spark of optimism, humor and hope. We aren’t sick, but we are not ourselves.
Charles Figley, 1995
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Why Does This Matter?
• In a treatment court we:
• work under stressful conditions
• with limited resources• witness the aftermath of human induced violence
• may experience the untimely death of participants
• We are at risk of burn out, compassion fatigue and vicarious trauma that may lead to:
• substance use
• relationship problems• poor work performance
• mental and physical health problems
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Definitions
• Burnout: physical and emotional exhaustion that workers can experience when they have low job satisfaction, perceived demands are greater than perceived resources, gap between expectations and outcomes
• Compassion Fatigue (CF): the cumulative physical, emotional and psychological effect of exposure to traumatic stories when working in a helping capacity
• Vicarious Trauma (VT): profound shift in world view that occurs in helping professionals when they work with clients who have experienced trauma
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How do They Differ?
• CF, VT and burn out can occur independently or together
• CF and VT have a greater relationship to the content of
the work rather than a lack of resources
• CF and VT tend to develop more slowly than burnout and
are harder to treat
• Burnout is more easily cured by a job change, support,
increase in resources
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Signs and Symptoms of CF and VT
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The Sympathetic Nervous System
• Acts as the nervous system “gas pedal”
• Increased heart rate, pulse, respiration
• Constriction of vagus nerve, gut, bladder
• Dilation of pupils
• Fight, flight or freeze response
• Rise in blood sugar
• Release of adrenaline and cortisol
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The Parasympathetic Nervous System
• Acts as the nervous system “brake”
• Lower heart rate, pulse, respiration
• Release of vagus nerve, gut, bladder
• Conservation of sugars and energy
• Relative relaxation
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Cognitive Symptoms of CF and VT
• Rigid black and white thinking
• Difficulty concentrating
• Confusion and memory loss
• Loss of sense of direction and purpose
• Inability to recognize cause and effect
• Minimization of problems, consequences
• Preoccupation with stressors that cannot be controlled
• Dissociation
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Emotional Symptoms of CF and VT
• Chronic fear and anxiety
• Inexplicable guilt and shame
• Self-doubt
• Withdrawal and isolation
• Feeling overwhelmed by small challenges
• Irritability and anger
• Powerlessness
• Intrusive thoughts and concerns
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Physical Symptoms of CF and VT
• Changes in breathing, heart rate, circulation
• Difficulty falling or staying asleep
• Problems with appetite and digestion
• Headaches
• Decreased libido
• Chronic musculoskeletal pain
• Immune problems
• High cholesterol, high blood pressure, diabetes
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Risk Factors for CF and VT
• Overly conscientious, unrealistic
expectations
• Self-giving personality traits
• Low levels of social support, stress in
personal life
• Previous history of trauma
• Poor coping strategies
• Lack of proper training
• Legal system does not acknowledge the
stressfulness of the work, tragic nature of
cases
• The adversarial system contributes to
denial and minimization of stress
• Little training for employees
• Little training for management
• Few mental health resources for
individuals working in the courts
Individual Risk Factors Institutional Risk Factors
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Resilience Factors for CF and VT
• Supportive social network
• Non-work related hobbies
• Reasonable expectations
• Time away from work
• Good self-care
• Interests that use different skills
• Activities to increase self-awareness and interpersonal skills
• Adequate training from the top down
• Reasonable and flexible expectations of workers
• Collaborative work environment
• Adequate resources
• Activities that foster connection, understanding, appreciation
• Retreats for recurrent training and education
Individual Resilience Factors Institutional Resilience Factors
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Your New Responsibility
• Hold your agencies accountable
• Hold yourselves accountable
• Create a culture of collaboration in the office
• Take your mental health seriously
• Seek balance in your life
• Know your strengths and accept your weaknesses
• Know when to ask for help
• Accept that THIS IS A HARD JOB!
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There is a cost to caring.
Charles Figley
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Vicarious Trauma
Among Judges
Hon. Wendy S. Morton
Commissioner
Superior Court of Arizona in Maricopa County
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USA TODAY
“Just seven hours before the killings, Michael and Carol Sanders appeared at an order-of-protection hearing in a Maricopa County courtroom at 9 a.m. Tuesday.”
“The judge declined to lift the order…After the judge entered the order, there was nothing to indicate that he would react in this way. He did not blow up. He did not storm out. There was no indication that this was coming."
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Judicial Peer Support Team98 judges
63 Commissioners
7 on Peer Support Team
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Peer Support Team
High Profile cases
General Peer
Support
On-Boarding new
Judicial Officers
Rotations
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Disputed Divorce Led Dwight Jones to Commit Mass Murder, Cops Say
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Trauma Exposure
in Court StaffJudges, Attorneys, JA’s, Bailiffs,
Court Reporters and Interpreters.
By Kirsten Lewis, M.Ed.KSL Research, Training, & Consultation, LLC
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86%
11%3%
Yes No Unsure
Do you believe that working in your profession has changed the way you view the world?
N=1,141
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• Direct exposure to an extreme or life-threatening event
• Being assaulted
• Receiving threats
• Dealing with hostile/aggressive conduct
• Witnessing unstable and/or unpredictable behavior
• Observing medical emergencies
• Performing job duties that cause pain and suffering to others
Primary Traumatic Stress
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47%
11%13% 14% 15%
4 or more 3 2 1 None
How many primary traumatic events have you experienced in your career?
N=1,264
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Working in the CourtEmployees are exposed to disturbing aspects of human behavior
• Animosity between parties
• People who are suffering
• Evidence
• Testimony
• Abusers / Victims
• Collateral interactions
• Dealing with the public
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28%
31%
17%15%
10%
Always Frequently Often Occassionally Rarely
In the course of your day, how often are you exposed to traumatic material?
N=801
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Secondary Trauma Indirect exposure to an extreme or life-threatening
event
◦ Drug overdoses / Suicide
◦ The family’s suffering / helplessness
◦ Parents’ behavior impacting children
◦ Victimizations
◦ Reoffending / Relapses
◦ Trauma histories of drug user
◦ Graphic accounts of abuse/neglect
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64%
9% 8%12%
6%
4 or more 3 2 1 None
How many secondary traumatic events have you experienced in your career?
N=1,239
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1. Increased anger, disgust, sadness, and/or distress (55%)
2. Sleep disturbances (54%)
3. Loss of trust (49%)
4. Lower concentration (49%)
5. Feeling detached or numb (44%)
6. Avoidant behavior(s) (41%)
7. Chronic exhaustion (39%)
8. Hyper-vigilance (36%)
9. Loss of innocence (33%)
10. Preoccupation with trauma (29%)
N= 314
COMMON REACTIONS TO SECONDARY TRAUMA
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• Exposure to the trauma of someone else can cause people to
vicariously experience a change in their own world view
• Beliefs about humanity
• Views of the world (safety)
• Chronic suspicion
• Cynicism
• Loss of empathy
• Occurs when secondary traumatic stress becomes global
• Instead of just being angry or disappointment in the perpetrator, all of mankind
is viewed with distain and cynicism(Ludick & Figley, 2017;
McCann & Pearlman, 1995)
VICARIOUS TRAUMA
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N = 504
COMMON REACTIONS TO VICARIOUS
TRAUMA1. Increased cynicism (69%)
2. Less tolerant (61%)
4. Feeling desensitized (59%)
5. Loss of empathy (57%)
6. Chronic suspicion of others (53%)
7. Distorted world view (37%)
8. Intrusive thoughts (35%)
9. Intrusive imagery (34%)
10. Question spirituality (34%)
11. Interpersonal problems (33%)
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CONTACT INFORMATION
Hon. Wendy S. Morton
Commissioner, Superior Court of Arizona in Maricopa County
Email: [email protected]
602-506-0959
Kirsten Lewis, M.Ed.
KSL Research, Training, & Consultation, LLC
Email: [email protected]
Website: www.kslresearch.org
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Questions?
GAINS Center for Behavioral Health and Justice TransformationThe GAINS Center focuses on expanding access to services for
people with mental and/or substance use disorders who come into contact with the justice system.
https://www.samhsa.gov/gains-center1-800-311-4246
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Policy Research Associates, Inc.
345 Delaware Avenue
Delmar, NY 12054
http://www.prainc.com/
p. 518-439-7415 • e. [email protected]
Creating positive social change through technical assistance,
research, and training for people who are disadvantaged.