Implementation of Trauma Informed Care Within Five Problem ...

Implementation of Trauma Informed Care Within Five Problem ...

MANAGING A TRAUMAINFORMED COURTROOM 2014 Drug Court Institute Boise, Idaho August 4th, 2014 Hon. Marcia Hirsch, Presiding Judge, Queens Treatment Courts Research Provided by; Dr. Pamela Linden, Assistant Professor, Stony Brook University and Dr. Shelly Cohen, Stony Brook Research & Evaluation Consulting Trauma Project Collaborators Treatment Court Teams Treatment Agencies Court staff from five felony treatment courts in Queens (QTC, QDWI, QMHC, QVTC, QDDC) Queens District Attorneys Office Defense Bar (Legal Aid, QLA, Private Attorneys)

Queens TASC NYS Departments of Probation and Education & US Department of Veterans Affairs Samaritan Village, Inc Counseling Services of the Eastern District of New York Elmcor Youth and Adult Activities Program Evaluators Stony Brook Research & Evaluation Consulting, LLC *Special Thanks to Policy Research Associates Queens Trauma Project (QTP) Funded by grant from the Center for Substance Abuse Treatment (CSAT) for three years from October 1, 2010 through September 30, 2013 Goals of QTP Provide enhanced screening and assessment of all participants in the five felony treatment courts in Queens County, NY (approximately 200/year) Provide trauma specific treatment services to participants that are identified as potentially benefitting from these services (approximately 40/year) Conduct evaluation of fidelity of implementation of

program activities and success of activities in achieving intended outcomes Trauma Informed Care WHY? WHO? WHAT? Why do we learn about trauma? Develop understanding Increase awareness Recognize signs Learn how to respond Goal: Trauma Informed Responses

Increase safety Reduce recidivism Promote recovery (SAMHSA) Traumatic Events: Physical abuse Loss Combat or victim of war Community trauma Sexual abuse Domestic violence Witness violence or other traumatic event Historical trauma Terrorism Natural Disaster (SAMHSA)

Trauma Is: An event, experience, or effect Sudden event or long standing abuse (can be in the past or present) The event is terrifying, threatening, and overwhelming Impact is pervasive Is shapes the world view of the participant Individualized experiences Many people cope or heal while others get stuck Demographic Characteristics of Participants (N=440, plea dates 10/1/10 -- 9/30/12) Court QTC (n=19 9) QDWI (n=113)

QMHC (n=71) QVTC (n=36) QDDC (n=21) 28 37 37 41 35 36% 33% 43% 4% 18% 19% 49% 14% 40% 40% 18%

3% 19% 65% 15% 0% 35% 30% 35% 0% 87% 92% 79% 94% 81% 26% (55%) 60% (78%) 11% (38%) 28% (46%)

20% (40%) % HS grad/GED 68% 75% 63% 100% 62% % Priv Attorney 48% 71% 20% 36% 14% % married 14%

45% 16% 28% 14% Mean Age (yrs) % % % % white black Hispanic Asian % male % Employed F/T (Employed/school ) Other Characteristics of Participants (N=440, plea dates 10/1/10 -- 9/30/12) Court QTC

(n=19 9) QDWI (n=113 ) QMHC (n=71) QVTC (n=36) QDDC (n=21) 2 15 11 53 19 92 2 0 6 0 Data not availabl e

33 25 8 21 13 11 27 32 11 19 CAGE (% 2+) 13% 26% 38% 44% % Prior AOD treatment 28% 27%

44% 76% 9% 5% 40% 29% 10% 2% 43% 43% 30 64 0 6 0 2 97 2

13 9 1 77 19 17 22 42 29 33 0 38 Drug of Choice Alcohol Cocaine/Crack Heroin Marijuana Other % Ever abused % Ever homeless Criminal Charge % Drug Sale % Drug Possession % DWI % Other Trauma Instruments

Adverse Childhood Experiences (ACE) N=270 74% reported score of 0-2 13 % reported score of 3-4 13% reported score of 5 or more Trauma Symptom Checklist-40 (TSC-40) N=249 63% reported score of 0-30 20% reported score of 16-30 18% reported score of 31-97 PTSD Checklist-Civilian Version (PCL-C) N=50 32% reported score of 17-22 (no clinical concern) 28% reported score of 23-31 (symptoms of some clinical concern) 40% reported score of 32-57 (likely presence of PTSD) Impact of Events Scale (IES) N=45 76% reported score of 0-23 (no clinical concern) 13% reported score of 24-32 (symptoms of some clinical concern) 11% reported score of 33-76 (likely presence of PTSD) Trauma History Screen (THS) Not formally scored , but used to gather more details about traumatic events

Combat Exposure Scale (CES) N=11 Administered only to Veterans Trauma in Veterans (N=36) Combat Exposure Scale (n=11) 9% moderate-heavy 55% light-moderate 36% light-none Adverse Childhood Experiences (n=25) 36% ACE score of 5 or more items endorsed 20% ACE score of 3-4 items endorsed 44% ACE score of 0-2 items endorsed Current Trauma Symptoms 100% indicate likely presence of PTSD on PCL-C (n=5) 50% score 31+ on TSC-40 (n=24) Program Status and Trauma 25 25

20 20 15 15 10 10 5 5 0 0 % graduate Low ACE High % fail Moderate % graduate % fail Low Symptoms High

Moderate New Arrest or Warrant and Trauma 20 18 16 14 12 10 8 6 4 2 0 30 25 20 15 10 5 0 % new arrest % warrant Low ACE High Moderate % new arrest Low Symptoms

High % warrant Moderate Phase Advancement and Trauma (median number of days) 132 140 130 135 128 130 126 124 125 122 120 120 118 115 110

116 Phase 1 Low ACE High Phase 2 Moderate Phase 1 Low Symptoms High Phase 2 Moderate Types of Reported Trauma (n = 39) Loss of close family member through death (16) or separation (2) Military Combat experience (3) Sexual abuse as a child or adult (5)

Auto accident (4) Work accident with injury (1) Witness family violence (4) Natural Disaster/Hurricane (1) Witness strangers death (1) Assault (2) Treatment Interventions Three (3) Trauma Case Managers hired in three Queens County treatment agencies and trained in three trauma treatment group models: Trauma, Addictions, Mental Health and Recovery (TAMAR) Seeking Safety Helping Men Recover TAMAR The TAMAR Program is designed to educate and treat those who have a history of physical and/or sexual abuse and a recent treatment history for a mental health condition as well as an alcohol or drug use or abuse disorder.

Structured, manualized 15-week intervention combining psychoeducational approaches with expressive therapies Seeking Safety Offers coping skills to help clients attain greater safety in their lives Highly flexible and can be used for group or individual format; women, men, and adolescents; all levels of care (e.g., outpatient, inpatient, residential); all types of trauma and substances; and any clinician. 25 treatment topics, each representing a safe coping skill relevant to both PTSD and SUD. Used broadly with clients who need improved coping skills; they do not have to meet criteria for PTSD and substance abuse as the skills can be generalized. Helping Men Recover

Helping Men Recover integrates a theory of addiction, a theory of trauma, and a theory of male psychosocial development. Program materials consist of a facilitator manual and a participant workbook 18 sessions in four modules: Module A: Self Module B: Relationships Module C: Sexuality Module D: Spirituality Participant Feedback Trauma services saved my life. I am very grateful for this experience. Though it has been difficult at times, I know it will better my life and my future. I was lost before and all this experience helped me improve my life and emotional issues that has led me to the wrong paths. I recommend it to those who really need it and would benefit from it. I enjoyed it. Recovery A process of change through which individuals improve their health and wellness, live a self-directed life and strive to reach their full potential. Questions?

Please contact: Hon. Marcia Hirsch, Presiding Judge [email protected] Dr. Shelly Cohen, Program Evaluator, Stony Brook Research & Evaluation Consulting, LLC [email protected] Dr. Pamela Linden, Evaluation Consultant , Stony Brook Research & Evaluation Consulting, LLC [email protected]

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