women in treatment courts final - american university...5 owomen made up about 32% of participants...
TRANSCRIPT
Justice Programs OfficeNational Drug Court Resource Center
Women in Treatment CourtsWednesday, February 22, 2017
1:00pm-2:30pm EST
Panelists: Hon. William Schma
Valerie Moore
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• Terms• Gender in Drug Courts• Complex Women-Specific
Issues• First Women’s Treatment Court• Importance and Need• The “Right” Judge• Screening Instruments• Incentives and Sanctions
• Treatment Programming• Suggested Evidence-Based
Curricula• Fidelity to Models and
Oversight• Access to Services• Aftercare/Continuing Care• Strategies• Trauma-Informed Treatment
Court Tips
Agenda
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• Gender-Responsive Treatmento “Creating an environment through site selection, staff selection,
program development, content, and material that reflects an understanding of the realities of the lives of women and that addresses and responds to their strengths and challenges”
• Gender-Specific Programo These programs often employ and treat only women but they
do not necessarily provide gender-responsive treatment
Terms
Bloom, B., Owen, B., & Covington, S. (2004). Women offenders and gendered effects of public policy. Review of Policy Research, 21, 31-48.
Greenfield, S. F., & Grella, C. (2009). What is women-focused treatment for substance abuse? Psychiatric Services, 60, 880-882.
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• Gender-responsive principles:o Gendero Environmento Relationshipso Serviceso Socioeconomic Statuso Community
Terms
Covington, S. (2008). Women and addiction: a trauma-informed approach. Journal of Psychoactive Drugs, SARC Supplement 5, 377-385.
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o Women made up about 32% of participants in drug courts in 2014
o “Women graduated from some drug courts at rates substantially below those of male drug court participants.”
o “Best practice standards require drug courts to monitor access and outcomes for female participants and deliver evidence-based gender-specific services.”
Gender in Drug Courts
NDCI. June 2016. Painting the Current Picture: A National Report on Drug Courts and Other Problem-Solving Courts in the US.
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Complex Women-Specific IssuesMany studies have shown…
• “Women offenders are significantly more likely than men to have coexisting psychiatric disorders, parental stress, housing issues, and extensive histories of sexual and physical abuse.”
• “Men and women have different pathways to crime and addiction, continue to use drugs for different reasons, enter and remain in treatment for different reasons, and have a greater unmet need for treatment and therapy.”
• Very few services available specifically for womenD’Angelo, L., Wolf, R. V. (2002). Women and Addiction: Challenges for Drug Court Practitioners. The Justice System Journal, Vol. 23, No. 3, 385-400.
Messina, N., Calhoun, S., & Ward, U. (2012). Gender-responsive drug court treatment: a randomized controlled trial. Criminal Justice and Behavior, 39, 1539-1558.
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Complex Women-Specific Issues
o Treatment issues:• Lack of services for
women• Not understanding
treatment for women• Long waiting lists• Lack of childcare
services• Shame and stigma
o Relationship issues:• Fear of losing children• Fear of losing partner
o Systemic issues:• Lack of financial
resources• Lack of clean/sober
housing• Poorly coordinated
services
• Common Themes in the Lives of Addicted Women:
Covington, S. (2008). Women and addiction: a trauma-informed approach. Journal of Psychoactive Drugs, SARC Supplement 5, 377-385.
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Complex Women-Specific Issues
• Criminal Behavior:o Nonviolent crimeso Common crimes tend to be shoplifting, prostitution,
paper crimeso Drug use, possession, or small amounts of distribution
D’Angelo, L., Wolf, R. V. (2002). Women and Addiction: Challenges for Drug Court Practitioners. The Justice System Journal, Vol. 23, No. 3, 385-400.
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Complex Women-Specific Issues• Mental Health Issues:
o Traumao Higher prevalence among women
• Substance Use:o “When women enter treatment, they typically present with a more
severe clinical profile (e.g., more medical, behavioral, psychological and social problems) than men, despite having used less and for a shorter period of time.”
o Women are more susceptible to craving and relapse than men are
D’Angelo, L., Wolf, R. V. (2002). Women and Addiction: Challenges for Drug Court Practitioners. The Justice System Journal, Vol. 23, No. 3, 385-400.
Greenfield, S.F., Back, S.E., Lawson, K., & Brady, K.T. (2010). Substance Abuse in Women. Psychiatric Clinics of North America, Vol. 33(2), 339-355.
NIDA (2016). Substance Use in Women. Retrieved February 16, 2017, from https://www.drugabuse.gov/publications/research-reports/substance-use-in-women
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Complex Women-Specific Issues• Family:
o Economic dependence on an unhealthy partner/relationship
o Instability at homeo Single parento Women in treatment can be separated from children
(due to foster care or case in CPS)• Gender Socialization:
o Lack of self-esteem, self-respect, confidence• Social Issues:
o More likely to be unemployedD’Angelo, L., Wolf, R. V. (2002). Women and Addiction: Challenges for Drug Court Practitioners. The Justice System Journal, Vol. 23, No. 3, 385-400.
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Kalamazoo County Women’s Treatment Court
• 1st Women’s Drug Court in the US• Developed by Judge Schma
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• Gender-Responsive Drug Court Treatment:1. Participants in the gender-responsive group had better in-
treatment performance, more positive perceptions related to their treatment experience and reductions in PTSD symptomology
2. “The consistent literature outlining the extensive trauma histories of women as compared to men and the undeniable link between childhood trauma and adult addictive and criminal behaviors suggest that these issues need to be addressed safely and systematically for women to best meet their treatment needs.”
Importance and Need
US Department of Health and Human Services. (2016). www.womenshealth.govMessina, N., Calhoun, S., & Ward, U. (2012). Gender-responsive drug court treatment: a randomized controlled trial. Criminal Justice and Behavior, 39, 1539-1558.
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• Gender of the Judgeo Certain topics must be treated with more
delicacy• Personality
o Personal, but professionalo Boundarieso Know the children’s names• Leadership• Judicial Training
The “Right” Judge
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• Alcohol and Drugo Addictions Severity Index (ASI) o AUDIT (alcohol, drugs, adults, clinician administered)• Criminal History
o LSI-R, COMPAS, State-Specific• Trauma
o The Life Event Checklist (LEC): 17-item, self-report measureo Trauma History Screen (THS): 14-item, self-report measure
Screening Instruments
SAMHSA-HRSA Center for Integrated Health Solutions. Screening Tools. Retrieved from http://www.integration.samhsa.gov/clinical-practice/screening-tools
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• PTSDo Clinician Administered PTSD Scale (CAPS-5): 30-item
structured interviewo Posttraumatic Diagnostic Scale (PDS): 49-item, self-report
measure• Mental Health
o Mood Disorder Questionnaire (MDQ): 15-item, self-report questionnaire to identify bipolar disorder
o Patient Health Questionnaire (PHQ-9): 9-item instrument for screening, diagnosing, and measuring severity of depression
Screening Instruments
SAMHSA-HRSA Center for Integrated Health Solutions. Screening Tools. Retrieved from http://www.integration.samhsa.gov/clinical-practice/screening-tools
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• Incentiveso Visitation with child in foster careo Anything that helps build self-esteem
§ Talking in the court room about how well a participant is doing
§ Allowing participants to show pictures of their kids§ Bringing their kids to the court room
• Sanctionso Should not be punitiveo Should relate to course of treatmento Utilize therapeutic adjustments
Incentives and Sanctions
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Treatment Programming• Must meet
standards of care for treatment courts and ASAM criteria• Gender-
responsive clinicians
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Suggested Evidence-Based Curricula
• Seeking Safety, Lisa Najavits• Helping Women Recover, Stephanie Covington• Beyond Trauma, Stephanie Covington• Dialectical Behavioral Therapy (DBT), Marsha M.
Lenihan• Eye Movement-Desensitization and Reprocessing
(EMDR), Francine Shapiro
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Fidelity to Models and Oversight
• Delivered by female clinicians with background in trauma-informed care to female participants
• Imperative that experts monitor group processes
• Ensure both curricula and approach to delivery meets standards
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Access to Services• Provide onsite child care• Ensure initial and ongoing healthcare appointments• Safe housing• Pre-employment training• Job placement assistance• Psychiatric mental health and medication management• Parenting courses
o Adult drug courts that provided parenting classes had 65% greater reductions in criminal recidivism and 52% greater cost savings than those courts that did not provide parenting classes
Carey, S.M., J.R., & Finigan, M.W. (2012). What Works? The 10 Key Components of Drug Court: Research-based best practices. Drug Court Review.
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Aftercare/Continuing Care• Ensure women can come back to treatment/court
when needed• Ensure access to safe housing for women
o Halfway houseo Oxford Housingo Transitional housing• Identify potential women-only housing opportunities in
community• Develop relapse prevention plan• Ensure continued access to health care and
medications
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Strategies for Developing a Gender-Responsive Program
• Relationships are key to a woman’s recoveryo Relationship with family dependency courtso Child Protective Services
§ Include case worker on mother’s status§ Reunion with children is not an initial motivator, but is important later
in the recovery processo Assign trained peer mentor or peer support early on in program
• Trauma training for drug court teamo Develop trauma-informed programo Languageo Approach
National Association of Drug Court Professionals. (2013). Adult Drug Court Best Practice Standards, Vol. 1.
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• Respond quickly at time of arresto Opportunity at crisis pointo Intake – Screening – Treatmento Up-front identification of:
§ Substance Use§ Mental Illness§ Trauma§ Criminogenic Needs
• Build in programmatic flexibilityo Meet changing dynamics and needs of
participants
Strategies (cont’d).
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• Unified written case plan or status reporto Include data and narrative from all direct services
persons
• Counties without resources for separate courto Consider separate court docket
Strategies (cont’d).
D’Angelo, L., Wolf, R. V. (2002). Women and Addiction: Challenges for Drug Court Practitioners. The Justice System Journal, Vol. 23, No. 3, 385-400.
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Trauma-Informed Treatment Court Tips
Judge • Demonstrate a commitment to providing trauma-informed care
• Consider the language used in the courtroom and by the team
Coordinator/Case Manager
• Conduct trauma screen• Compile list of trauma resources
and programs for participants• Plan trainings on trauma• Reexamine policies and
procedures
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Trauma-Informed Treatment Court TipsTreatment Provider
• Conduct a validated trauma assessment
• Provide or refer the individual to appropriate trauma-informed treatment services
Defense Counsel
• Receive training on trauma; learn grounding techniques to help your client feel safe
• Communicate with your client in a respectful manner
Prosecutor • Receive training on trauma• Be transparent in interactions with
participants
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Bloom, B., Owen, B., & Covington, S. (2004). Women offenders and gendered effects of public policy. Review of Policy Research, 21, 31-48.
Carey, S.M., J.R., & Finigan, M.W. (2012). What Works? The 10 Key Components of Drug Court: Research-based best practices. Drug Court Review.
Covington, S. (2008). Women and addiction: a trauma-informed approach. Journal of Psychoactive Drugs, SARC Supplement 5, 377-385.
D’Angelo, L., Wolf, R. V. (2002). Women and Addiction: Challenges for Drug Court Practitioners. The Justice System Journal, Vol. 23, No. 3, 385-400. Retrieved from http://www.jstor.org/stable/27977122
Fallot, Ph.D., Roger D, Harris, Ph.D., Maxine. (July 2009). Creating Cultures of Trauma Informed Care (CCTIC): A Self-Assessment and Planning Protocol. Community Connections. Version 2.2-7-09.
Greenfield, S.F., Back, S.E., Lawson, K., & Brady, K.T. (2010). Substance Abuse in Women. Psychiatric Clinics of North America, Vol. 33(2), 339-355.
Greenfield, S. F., & Grella, C. (2009). What is women-focused treatment for substance abuse? Psychiatric Services, 60, 880-882.
Messina, N., Calhoun, S., & Ward, U. (2012). Gender-responsive drug court treatment: a randomized controlled trial. Criminal Justice and Behavior, 39, 1539-1558.
National Association of Drug Court Professionals. (2013). Adult Drug Court Best Practice Standards, Vol.1.Retrieved:http://www.allrise.org/sites/default/files/nadcp/AdultDrugCourtBestPracticeStandards.pdf
National Center on Domestic Violence, Trauma and Mental Health. (2005) Responding to Domestic Violence: Tools for Mental Health Providers.Residential Domestic Violence: Sample Forms for Mental Health.Creating Accessible, Culturally Relevant Domestic Violence and Trauma Informed Agencies. A Self-Reflection Tool”. Retrieved from http://nationalcenter.dvtaumamh.org
NIDA (2016). Substance Use in Women. Retrieved February 16, 2017, from https://www.drugabuse.gov/publications/research-reports/substance-use-in-women
SAMHSA-HRSA Center for Integrated Health Solutions. Screening Tools. Retrieved from http://www.integration.samhsa.gov/clinical-practice/screening-tools
Substance Abuse and Mental Health Services Administration, SAMHSA’s National Center on Trauma-Informed Care and SAMSHA’s National GAINS Center for Behavioral Health and Justice: Essential Components of Trauma-Informed Judicial Practice. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2013.
References
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The National Registry of Evidence-based Programs and Practices (NREPP) is a searchable online database of mental health and substance abuse interventions. Sep 18, 2014Evidence Based Programs / NREPP | SAMHSAhttps://www.samhsa.gov/data/evidence-based-programs-nreppwww.integration.samhsa.gov/clinical-practice/screening-tools
NADCP Adult Drug Court Best Practice Standards:http://www.allrise.org/sites/default/files/nadcp/AdultDrugCourtBestPracticeStandards.pdf.
US Department of Health and Human Services, Office on Women’s Health:www.womenshealth.gov
National Drug Court Resource Center, List of Incentives and Sanctions:http://www.ndcrc.org/content/list-incentives-and-sanctions
Resources
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Thank you! Questions?
Justice Programs [email protected]://www.american.edu/spa/jpo/
@AU_JPO
facebook.com/aujpo
@theNDCRCNational Drug Court Resource [email protected]://ndcrc.org/
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