Blog

           

Which clients in your treatment court have a history of trauma? How can you find out? Why does it matter? While the conversation about the prevalence and devastating effects of trauma has become increasingly open in justice settings, many treatment courts may be blind to it in their own programs or simply hope that good intentions will prevent further trauma. Perhaps now is the time to self-reflect as a treatment court and to take small, but meaningful actions right now.   According to SAMHSA, “Individual trauma results from an event, series of events, or a set of circumstances that is experienced by an individual as physically or emotionally harmful or life threatening and that has lasting adverse effects on the individual’s functioning and mental, physical, social, emotional, or spiritual well-being, (2014a, p. 7).” Trauma experiences can diminish the ability of treatment court participants to engage in programs and long-term recovery. So, what does it mean for organizations to be trauma-informed? First, in order for treatment court programs to fully embody a trauma-informed system of care, all program staff must:   1. Have a basic realization of the origins of trauma and the impact this can have on individuals, families, groups, and communities. 2. Be able to recognize the signs of trauma in individuals. 3. Continuously assess the ways in which policies, procedures, and practices should be revised in order to allow staff to respond to individuals appropriately. 4. Resist engaging in action(s) that may result in re-traumatization.   In addition, SAMHSA (2014a) identifies six key principles that should serve as the foundation for developing your trauma-informed systems of care.   1. Safety (this is #1 for a reason) – above all else, participants’ physical & emotional safety should be promoted in all settings & through all interactions. Individuals (i.e., staff and participants) who do not feel safe will not fully engage. 2. Trustworthiness & Transparency – treatment court operations should be transparent and conducted with an eye toward developing and maintaining mutual trust between and among stakeholders and participants. 3. Peer Support – incorporating peer recovery support specialists into your treatment court program is an effective way for individuals with lived experience to assist participants in their recovery. 4. Collaboration & Mutuality – recognizing and acknowledging that all treatment court team members and participants have unique roles/responsibilities is key to developing collaborative relationships based on mutuality and respect. 5. Empowerment, Voice, & Choice – treatment court team members look for opportunities to empower participants to make decisions and have a voice in their recovery. 6. Cultural, Historical, & Gender Issues – the treatment court program provides participants with access to clinical and recovery support services that are responsive to their cultural, racial/ethnic, and gender needs.   A good place to start moving toward being a trauma-informed treatment court is to screen participants for trauma exposure to determine which individuals are in need of a more thorough assessment and trauma-specific services. Several screening and assessment tools have been validated with justice-involved ...

   

 

       

• To enhance the relational alliance, treatment court team members should frequently discuss participants’ personal values and motivations, and collaboratively review program and client expectations.
• While these relationships must remain professional, expressing genuine caring for participants can help form bonds that are healthy, respectful and meaningful.
• Directly asking clients for feedback about the program and their experiences provides opportunities to improve collaboration, to modify approaches as needed, and prevent premature termination.
• Confrontation has historically been a problem in the addictions field. Interactions that are infused with motivational enhancement elements, such as rolling with resistance, reflective responding and active listening serve as antidotes to these all-too-human, but toxic reactions.
• Individualized treatment plans that consider the individual’s unique and diverse identities are a hallmark of treatment court Best Practices, and the Task Force’s findings confirm this. “Fair treatment” does not equal “identical treatment.” It means tailoring the program and services to match the evolving needs of each individual.

   

 

 

       

Participant #1: “I entered Treatment Court because I want treatment and a better life for my kids and myself.”    Participant #2: “I entered Treatment Court because I am sick of jail.”    Do clients freely choose to enter a treatment court? The answer is far from simple. Is it a “choice” when the criminal justice system relies on external motivators like incarceration and resulting cascade of losses? Ideally, the choice to enter a treatment court would be an autonomous one that reflects a participant’s internal motivations to live a healthier, more meaningful life. Deci and Ryan’s Self Determination Theory (SDT) holds that internally motivated behaviors are stronger, longer lasting, and produce better outcomes than those that are externally motivated (Deci & Ryan 1985). SDT provides the framework for a number of studies of the impact of treatment courts and other legally mandated programs (e.g. Morse et al., 2014; Wild et al., 2016).    According to SDT, three psychological needs must be met to foster internal motivation and self-determined behavior: Autonomy, Competence and Relatedness. To the extent that treatment courts support these inborn, intrinsic needs, clients are more likely to engage in treatment and maintain gains.    Autonomy is enhanced when clients feel they have options and take responsibility for choices. At intake, staff must make clear the voluntary nature of treatment court programs, especially because the consequences of refusing are often swift and aversive. Does the court notice and consistently praise and encourage values-driven choices, or does it emphasize missteps and sanctions, which detract from autonomy? Motivational Interviewing is a NADCP Best Practice designed to maximize autonomy and minimize coercion. Competence develops through a focus on skills development, repeated practice, and environmental support. Evidence-based practices such as relapse prevention training and stress management equip clients to face the challenges of recovery. Lapses are viewed as opportunities to refine skills and increase competence. Relatedness is the need to interact and be connected with others. Through treatment groups and treatment court membership, clients give and receive support, which is both healing and crucial to problem solving and competence.  While Client #1 seems more internally motivated and ready to engage, research indicates that Client #2 also has the potential to succeed in treatment court. SDT holds that over time, externally motivated behaviors can transition to become internally motivated. This process is at the heart of therapeutic jurisprudence.  

This month, NDCRC Director of Clinical Treatment and UNCW professor of psychology Dr. Sally MacKain discusses how an understanding of the neurobiology of substance use disorders can inform treatment court practices. Treatment court clients struggle with significant cognitive, emotional, behavioral, and social problems. Understanding some basics of the neurobiology behind these difficulties may help court team members tailor their interactions and services more effectively.   Dr. MacKain breaks down the article Neurobiologic Advances from the Brain Disease Model of Addiction by Nora Volkow, George Koob & Thomas McLellan (2016) which reviews scientific evidence supporting the view that substance use disorders are rooted in changes in how our brains are structured and function. The authors contend that a brain disease model of substance use has facilitated a movement away from shaming, stigma and incarceration. Volkow and her colleagues have made an important contribution in helping those of us who are not brain scientists understand more about the neurobiological changes associated with substance use disorders, how a disease model of addiction fits the evidence, and why recovery can be so challenging.  

Would you prefer a delicious piece of chocolate now or a whole chocolate bar tomorrow? A 3-day vacation now or a 7-day vacation in 5 months? To spend an extra/bonus $500 now, or put it in a savings account to accrue interest? Most people prefer immediate rewards over delayed ones. However, people with substance use challenges tend to find it especially difficult to imagine their futures and delay rewards. Research indicates that people with substance use disorders have a narrower temporal window, meaning their attention is focused on gaining near-future rewards, such as the next drink or next drug use opportunity. For example, studies show that when asked about their own future, the typical individual reports goals and activities about 5 years in the future. In stark contrast, people with heroin use disorders offered reports that extended only 9 days in the future, on average (Patel & Amlen, 2020).   Delay discounting is the term used to describe the rate at which future rewards are less valued over time. Higher rates of delay discounting are related to impulsivity and risky behaviors like drug and alcohol use. Research in Episodic Future Thinking (EFT) suggests that helping people to vividly imagine personally salient future events could help them learn to delay rewards in order to get a bigger payoff in the longer term (Bulley & Gullo, 2017). Applied to a treatment court context, clients could learn to forgo short term rewards such as relief from craving or feeling euphoric, in favor of long-term goals, like graduating from the program, freedom from probation, and regaining custody of children.   Several promising studies of EFT with people with alcohol dependence show positive results. For example, Snider, LaConte & Bickel, (2016) encouraged participants to expand their temporal windows by thinking about personally relevant future events and describing them in salient detail. Participants reported the most positive event that could realistically happen at each of 5 points in the future (1 day, 1 week, 1 month, 3 months, and 1 year). Researchers then probed: What will you be doing? Whom will you be with? Where will you be? How will you be feeling? What will you be seeing? What will you be hearing? What will you be tasting? What will you be smelling? (pp. 1160-1161). They also asked a comparison group of people with alcohol dependence to imagine PAST events in the same timeframes, with similarly worded probes. This method allowed researchers to assess the unique contribution of a future time orientation.   Each participant's future or past personalized account was then integrated into a task in which they chose between hypothetical gains in money received now or after some delay (e.g., Would you like $50 now or $100 in a year? They also administered measures of alcohol use. They found that over time, people in the future-thinking/EFT group came to value future monetary rewards more highly and reduced their alcohol consumption. These improvements were also found in a study that involved a one-week, 4-session/practice protocol ...

      According to Lee & Miller (2013) “Self-care has been described as a process, an ability, but most often as engagement in particular behaviors that are suggested to promote specific outcomes such as a ‘sense of subjective well-being’, a healthy lifestyle, stress relief, and resiliency for the prevention of empathy fatigue” (97). They go on to describe two distinct, but inherently connected dimensions of self-care; personal and professional. Personal self-care focuses on holistic health and well-being of oneself, where as professional self-care “is understood as the process of purposeful engagement in practices that promote effective and appropriate use of the self in the professional role within the context of sustaining holistic health and well-being” (98). Lee & Miller argue that both dimensions of self-care must be cultivated in order to develop and maintain a healthy and resilient workforce.    So, what is needed in order to fully develop personal and professional self-care? What specific areas of one’s personal and professional life should be considered and supported? Lee & Miller (2013) identified several areas within both dimensions which are outlined in Table 1 below. A specific discussion of ...

The term “self-care” has been used by scholars and practitioners across many disciplines (e.g., social work, psychology, nursing, education, etc.) as an identified strategy for bolstering health, well-being, and resiliency among members of their respective workforces. Despite this and the increasing discussion of self-care within the larger society, minimal consideration has been paid to the role of self-care in providing these same benefits to practitioners within the criminal justice system and specifically treatment courts. This is an obvious oversight and an area in need of empirical focus given the nature of work performed by criminal justice system and specifically treatment court practitioners.   According to Lee & Miller (2013) “Self-care has been described as a process, an ability, but most often as engagement in particular behaviors that are suggested to promote specific outcomes such as a ‘sense of subjective well-being’, a healthy lifestyle, stress relief, and resiliency for the prevention of empathy fatigue” (97). They go on to describe two distinct, but inherently connected dimensions of self-care; personal and professional. Personal self-care focuses on holistic health and well-being of oneself, where as professional self-care “is understood as the process of purposeful engagement in practices that promote effective and appropriate use of the self in the professional role within the context of sustaining holistic health and well-being” (98). Lee & Miller argue that both dimensions of self-care must be cultivated in order to develop and maintain a healthy and resilient workforce.   So, what is needed in order to fully develop personal and professional self-care? What specific areas of one’s personal and professional life should be considered and supported? Lee & Miller (2013) identified several areas within both dimensions which are outlined in Table 1 below. A specific discussion of each area of attention and support is provided in the journal article. Go check it out!  

It is widely acknowledged that therapeutic jurisprudence serves as the theoretical foundation for the treatment court model. This perspective “seeks to assess the therapeutic and anti-therapeutic consequences of law and how it is applied. It also seeks to affect legal change designed to increase the former and diminish the latter.” (Winick & Wexler, 2015, p. 479). Treatment court scholars and practitioners recognize that treatment courts stand in stark contrast to traditional criminal courts in how they are structured as well as how they operate. Winick & Wexler (2015) assert that “an important insight of therapeutic jurisprudence is that, how judges and other legal actors play their roles has inevitable consequences for the mental health and psychological well-being of the people with whom they interact.” (p. 481) One strategy for putting therapeutic jurisprudence into practice is through the practice of empathy. Empathy is defined as “the ability to see a situation from someone else’s perspective—combined with the emotional capacity to understand and feel that person’s emotions in that situation.”  (Colby, 2012, p. 1945)   Drug Court Key Component #7 & Adult Best Practice Standard #3 highlight the critical role of judges in treatment courts and specifically the interaction between judges and participants during court review hearings. More specifically,         While judges are integral to the success of any treatment court program, less is written about the specific role of other interdisciplinary team members (e.g. prosecuting attorney, defense attorney, case manager, law enforcement, etc.) in adopting the principles of therapeutic jurisprudence in their work. It is vital for all treatment court team members to practice empathy when interacting with program participants. The below-listed multimedia resources provide some additional insight into how to practice empathy within your work as a treatment court practitioner. According to scholar Jamil Zaki “empathy is like a skill. It's like a muscle. We can practice it like any other skill and get better at connecting with people.” (Young, 2020)  

According to Knottnerus (2005) “. . . daily life is normally characterized by an array of personal and social rituals. Such rituals help create stability to social life while expressing various symbolic meanings that give significance to our actions” (p. 8). Both positive and negative behaviors are part of daily life and when practiced often enough become ritualized. Individuals in recovery often report that certain “people, places, or things” can elicit behavioral responses without conscious awareness or intention. This reality underscores the need for the recovery process and programming to include an emphasis on individuals recognizing negative rituals and replacing them with positive (or prosocial) rituals.   We know from research that this behavioral change must be predicated on a change in attitudes/beliefs, an increase in knowledge regarding the behavior and associated consequences, as well as ample time to practice new behaviors within a structured and supportive environment. Changing ritualized behavior can be a difficult process and feel very foreign no matter how positive the results may be. Researchers, Van de Poel-Knottnerus and Knottnerus (2011), assert that “. . . when patterned, ritualized modes of behavior are severely disrupted, this is a very difficult and problematic situation for human beings” (p. 108). To this end, understanding how ritualized behavior forms, as well as how it can be effectively changed, is central to the work of treatment court practitioners and researchers. Understanding the specific mechanisms by which programs affect behavior change among various target populations, and sub-populations, is crucial to success and sustainability.  

The importance of social connectedness among human beings has been well-documented. Researchers have found physical, emotional, and social benefits for individuals who are and remain connected to others. These same researchers have found profoundly negative outcomes associated with experiencing social isolation.
In these current times, the methods by which individuals connect with each other have taken on multiple forms (e.g., face-to-face, by phone, via cloud-based technology, etc). How is this notion of social connectedness relevant to the treatment court field? It is hoped that the information presented in the multimedia resources featured here will encourage you to examine the ways in which your treatment court program facilitates meaningful social connection between and among participants, team members, and the recovery community through program requirements (e.g., case management sessions, pro-social activities, court review hearings, etc.). It is vital that opportunities for participants to connect with others are maintained.