Category: Beyond The Field

Beyond the Field

The Science of Conducting Successful Meetings

How many hours per week do you spend in meetings? Is it time well spent? Do you leave meetings with a sense of a way forward? Frustration? Could your team use a meetings “tune-up”? Workplace meetings are a mainstay of all organizations. For treatment court teams, regular pre-court staff meetings are required as a Best Practice (NADCP, 2018). But teams engage other meetings as well, including those with community stakeholders, program evaluation and planning, and others.
 
Industrial/organizational (I/0) psychologists Joseph Mroz and colleagues reviewed over 200 empirical studies of meetings in their article “Do we really need another meeting? The science of workplace meetings” (Mroz, Allen, Verhoeven & Shuffler, 2018). They identify worthy goals and provide specific recommendations for conducting successful meetings.
 
Nationally, they note, the average employee spends 6 hours per week in meetings, and that half of those meetings are rated as “poor” by those who attend. For most organizations, there is a clear need to revisit current practices and consider improvements. Mroz and colleagues identify four primary purposes of meetings:
 
1) Information Sharing;
2) Problem solving and decision making,
3) to develop and implement organizational strategies, and
4) to debrief a team after particular events.
 
They recommend that care should be taken before, during and after meetings to facilitate positive outcomes. For example, before a meeting, attendees should have read the agenda, be prepared and arrive on time. The agenda should list clear goals and outcomes and be realistic in terms of allotted time. During meetings, leaders should make the meeting short, and relevant. Humor and laughter can stimulate positive behaviors, but complaining leads to poor performance. Leaders should also intervene when communication becomes dysfunctional or off-track. A clear agenda as described above can go a long way toward mitigating these issues. By the same token, leaders should attend to perceptions of fairness and encourage participation from all attendees. After meetings, effective leaders send out action items and minutes and seek feedback about how others perceived the meeting, to improve the process.
While many of these recommendations seem obvious, researchers have objectively analyzed the costs, interpersonal conflicts, and inefficiencies that arise when these recommendations are not followed. The authors describe a problematic dynamic noted in a study by Simone Kauffeld and Nale Lehmann-Willenbrock, that many readers may find familiar:
 
When one person starts to complain in a meeting by expressing so-called “killer phrases” that reflects futility or an unchangeable state (e.g., “nothing can be done about that issue” or “nothing works”) other meeting attendees being to complain, which begins a complaining cycle that can reduce group outcomes (p. 488).
 
This “cycle” is common among professionals in human services fields, and while realism and pragmatism are valuable, pessimism can be contagious and toxic. This is one of the major challenges in treatment court work—even when participants behave in ways that look like “giving up,” staff would do well to convey a sense of hope in how they conduct themselves in meetings.
 
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Beyond the Field

Microaggressions

  • An African American client stops attending intensive outpatient groups. He explains, “I was the only Black person there-I wasn’t comfortable.” He asks for individual therapy instead but is told “No, group is always best for the intensive treatment people need early in the program. Besides, there is only one race-the human race.”
  • A young Latina who is affiliated with a gang is not referred to treatment court, while a young white woman who is also gang affiliated is referred and admitted, “because she’s not as hard core.”
  • A transgender client tells her counselor about violence she has faced. The counselor says: “I understand. As a woman, I experience discrimination too.”
 
Decades of research in cognitive and social sciences show that categorizing, stereotyping, and even discrimination is part and parcel of being a human being. All of us process information and aim to make judgments as quickly and efficiently as possible. We’ve needed to, in order to survive as a species. But a byproduct of this process is that we form implicit biases. Automatic and unintentional, implicit biases are “mistakes” that can lead us to discriminate against others and cause lasting harm.
 
Microaggressions flow from implicit biases. In the article Racial microaggressions in everyday life: Implications for clinical practice, psychologist Derald Wing Sue defines microaggressions as “brief and commonplace daily verbal, behavioral, or environmental indignities, whether intentional or unintentional, that communicate hostile, derogatory, or negative messages to (marginalized) people,” (Sue et al., 2007; p. 279). The person committing the microaggression can usually “explain it away” by seemingly nonbiased and valid reasons.
 
Sue and colleagues would consider the first scenario above as an example of colorblindness, or denying a person of color’s racial or ethnic experiences. The message is “You are not a racial/cultural being. You must assimilate/acculturate to the dominant culture.” The second example represents assumption of criminality, when a person of color is presumed to be more deviant on the basis of their race. The third scenario seems well intentioned but reflects a denial of biases. The therapist implies, “Your oppression is no different than mine. I can’t be biased. I’m just like you.” While the therapist is unaware of their mistake, the client feels diminished and misunderstood, adding to their suffering.
 
Recognizing and confronting implicit biases and microaggressions in ourselves takes courage and humility. Sue and colleagues (2007) offer a model that invites us to be more aware and intentional in each of our personal and professional actions.
 
 
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Beyond the Field

Traumatic Brain Injury and Treatment Courts

A client continually misses appointments, drug tests and curfews. Another has no insight into their problems and repeatedly puts themselves in dangerous situations. Another can’t focus in group treatment and interrupts with off-topic, embarrassing comments. Another is irritable and gets angry quickly. Are these signs of long-term substance use? Mental illness? Traumatic brain injury (TBI)? It could be any and all of these, as they frequently co-occur.
 
Treatment courts target people with mental health and substance use challenges, but TBI and its long-term impacts are often “off the radars” of court professionals and providers. Lasting effects of TBIs can be easily mistaken for “personality problems” or intense resistance to treatment. The prevalence of TBIs among treatment court clients is unknown, but they are common in the justice system, resulting from accidents, falls, fights, domestic violence, and military service (CDC, 2010).
 
So, can people with a TBI benefit from treatment court programs? The structure, predictability and case management support that treatment courts provide can make it a good fit, especially if the team is knowledgeable and adapts their practices to meet client needs. Veteran’s Courts are especially aware of these issues, and trainings are periodically offered (check the calendar).
 
But you don’t need to wait: three online guides for substance use treatment, criminal justice, and mental health professionals are listed below and offer strategies for assessing the impact of TBIs and for adapting daily practices and services. Adaptations include using visual aids, patiently repeating information, slowing down interactions, demonstrating self-regulation skills, and tailoring clients’ environments for reminders. Trauma-informed care in this case requires that teams be aware of the cognitive, emotional and behavioral challenges that can persist well beyond the initial injury, and a willingness to respond with compassion--even though it can be very challenging.
 
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Beyond the Field

Self Determination Theory and Internal Motivation in Treatment Courts

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.  
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Beyond the Field

The Neurobiology of Substance Use Disorders

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.  
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Beyond the Field

The Science of Future Thinking and its Role in Recovery

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 ...
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Beyond the Field

Compassion Fatigue

Compassion is defined as “the ability to understand the emotional state of another person or oneself…and a desire to alleviate or reduce the suffering” (Engel, 2008). Given that treatment courts are an application of therapeutic jurisprudence (see Winick & Wexler, 2015) and seek to facilitate the rehabilitation process, all team members (e.g., prosecuting attorneys, defense attorneys, law enforcement representatives, case managers, probation/parole agents, etc.) should display compassion when interacting with participants.
 
We know that the work of treatment court practitioners can be both rewarding and challenging. On one had treatment courts facilitate change within individuals who may have repeatedly cycled through the criminal justice system. However, asking team members to embody principles of therapeutic jurisprudence generally and compassion more specifically may run contrary to previous schooling and/or training. For example, Norton, Johnson, & Woods (2016) highlight the challenges lawyers may experience given their law school training (e.g., Socratic method) and the structure of the legal profession (e.g., adversarial system). This reality underscores the need to be mindful of a phenomenon titled “compassion fatigue” (or secondary trauma). Compassion fatigue has been defined as “’the cost of caring’ for those in professions that regularly see and care for others in pain and trauma” (Grant, Lavery, & Decarlo, 2019:1).
 
Dr. Françoise Mathieu’s TEDx Talk “The Edge of Compassion” addresses strategies for sustaining both compassion and empathy for others.
 
In order to maintain fidelity to the treatment court model, it is imperative that all team members are operating in accordance with the principles of therapeutic jurisprudence and are mindful of how compassion fatigue (or secondary trauma) manifests itself and what it “looks” like. This level of awareness among treatment court practitioners will allow for course correction should they experience the “psychological and physical effects of exposure to the pain, distress, or injustice suffered by clients” (Norton, Johnson, & Woods, 2016:988).
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 ...
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Beyond the Field

Self Care

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!  
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Beyond the Field

Therapeutic Jurisprudence & Empathy

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,    
 Judges…need to understand how to convey empathy, how to recognize and deal with denial, and how to apply principles of behavioral psychology and motivation theory. They need to understand the psychology of procedural justice, which teaches that people appearing in court experience greater satisfaction and comply more willingly with court orders when they are given a sense of voice and validation and treated with dignity and respect. (Winick & Wexler, 2015, p. 482)
    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)  
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Beyond the Field

Developing Good Habits

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.  
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Beyond the Field

The Importance of Social Connectedness

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.
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