Promoting Resilience in Treatment Courts: Best Practices ......ACEs Connection – Arizona Trauma Institute – Dr. Sandra Bloom, The Sanctuary Model –

Promoting Resilience in Treatment Courts:

Best Practices in Trauma-Informed

CareLauren Hyre, LMSW & Lori Robinson, MSW

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Treatment Courts in Tempe

Mental Health CourtEast Valley Regional Veterans CourtMore to come…

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Human Services PartnersCommunity Supervision Services

Diversion/ProbationCARE 7

Crisis InterventionHOPE Team

Homeless Outreach

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Session ObjectivesUnderstand the biology of stress - review of the Adverse Childhood Experiences StudyIdentify symptoms of trauma and damaging stress in culturally diverse populationsIntroduction of best practices in trauma-informed care, along with ethical considerations

Objectives, cont.Understand the intersection of trauma-informed care principles and Adult Drug Court Best Practice StandardsApplication of practical tools to move from a trauma-aware court to a trauma-informed court

Adverse Childhood

Experiences (ACEs) &

Resilience

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“In the beginner's mind there

are many possibilities, but in

the expert's mind there are

few. ”-Shunryu Suzuki

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Ecological Perspective

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Experience Shape Perspective (Identity, Values, Ideas, Beliefs, Safety, Trust)

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Scientific Advances are shifting the way that we understand human health and

behavior

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For Better or WorseEarly experiences build brain

architecture

Serve and return interactions

shape brain circuitry

Toxic Stress derails healthy

development

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The Adverse Childhood Experiences (ACE) Study

How many of you are familiar with the ACE Study and the research findings?

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Adverse Childhood Experiences (ACE) Research Study

1995-1997, published in 1998

CDC/Kaiser Permanente (Dr. Felitti and Dr. Anda)

17,421 participants

Middle Class, predominately white, college

educated

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Adverse Childhood Experiences

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ACEs are extremely common!

0 ACEs 32%1 ACE 26%2 ACEs 16%3 ACEs 10%4+ ACEs 16% (1 in 8)

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Adversity Impacts Health and Behavior

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Out

of 1

00 p

eopl

e…33% report no ACEs 51% report 1-3 ACEs 16% report 4-10

ACEsWith 0 ACEs With 3 ACEs With 7+ ACEs

1 in 16 smokes 1 in 9 smokes 1 in 6 smokes1 in 69 isalcoholic

1 in 9 is alcoholic 1 in 6 is alcoholic

1 in 480 uses IV drugs



1 in 14 has heart disease



1 in 96 attemptssuicide



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ACEs are Interrelated and have a Cumulative Stressor Effect

It is the number of differentcategories or the DOSE of stress, not the intensity of the ACEs that impact health outcomes.

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ACEs are Highly Interrelated Alcohol Abuse in the Home and the Risk of Other Household

Exposures During Childhood

Chart1

Mother treated violentlyMother treated violentlyMother treated violently

Mental illnessMental illnessMental illness

Drug useDrug useDrug use

Suicide attemptSuicide attemptSuicide attempt

Member imprisonedMember imprisonedMember imprisoned

0 alcohol abusers

1 alcohol abuser

2 or more

7

26

41

14

26.5

41

2

7.5

20

3

7

13

2

6

14

Sheet1

0 alcohol abusers1 alcohol abuser2 or more

Mother treated violently72641

Mental illness1426.541

Drug use27.520

Suicide attempt3713

Member imprisoned2614

To resize chart data range, drag lower right corner of range.

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Why is the ACE Study Important?ACEs are very commonStrong predictors of future healthResearch gives us a context – a framework for understanding behavior and healthReduces stigma, shame and social taboo

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What We See…• Mental Illness• Addiction• Domestic Violence

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What Happened First…

• ACEs

• Trauma

• Chronic

Hyperarousal

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Stress Response System: Our Brilliant Brains

Behavior is an ADAPTATIONfor survivalTrauma results in over activation of the stress response system

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Trauma is not an event or experience

but how an event or experience

remains within us

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Fight, Flight, or Freeze

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Traumais the result of

DAMAGING

stress

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By Adolescence, Children Seek Relief Drinking alcohol*Smoking tobaccoSexual promiscuityUsing drugs*Overeating/eating disordersDelinquent behavior, violence

*NOTE: nicotine and methamphetamines are anti-depressants

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Coping Solutions What are conventionally viewed as Public Health problems are often personal solutions to long concealed embarrassing, shameful experiences

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Ariz

ona

Yout

h Su

rvey

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Arizona Children Ages 12-17(2011/2012 National Survey of Children’s Health)

44.4% have experienced two or more ACEs (Natl. average 30.5%)

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Arizona Children

Estimated 69,213 have 5+ ACEs

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AZ Kids with 5+ ACES Would Fill University of Phoenix Stadium

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Or, Equal to the Population of Flagstaff

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Resilience = Biology + Environment

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Protective Factor = CONNECTION

Relationships =Vital Sign

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What Can I Do?SafetyConnection

Ask first, “What happened to you?”NOT

“What’s wrong with you?”

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Safety = Trust = Cooperation

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Trauma-Informed SystemsRealizes the widespread impact of traumaRecognizes the signs and symptoms of traumaResponds by fulling integrating knowledge about trauma into policies, procedures, and practices

SAMHSA – Trauma Informed Approach

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Principles of Trauma-Informed CareSafetyTrust TransparencyPeer SupportVoice, ChoiceCultural Humility

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• Learn• Process information• Regulate behavior

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Science is clear…

“Children’s exposure to ACEs is the greatest unaddressed public health threat of our time.” Dr. Robert Block, former president, American Academy of Pediatrics

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ACEs Often Last a Lifetime . . . But They Don’t Have To

• Healing can occur

• Cycle can be broken

• Safe, stable, nurturing relationships

repair the injury of ACEs

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Out

of 1

00 p

eopl

e…33% report no

ACEs51% report 1-3

ACEs16% report 4-10

ACEsWith 0 ACEs With 3 ACEs With 7+ ACEs

1 in 16 smokes 1 in 9 smokes 1 in 6 smokes 1 in 69 isalcoholic

1 in 9 is alcoholic

1 in 6 is alcoholic










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Not everything that is faced can be changed but nothing can be changed until it is faced.-James Baldwin

Building a Trauma-Informed Treatment

Court

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What is Trauma-Informed Care?According to SAMHSA (2012), “A program, organization, or system that is trauma-informed realizesthe widespread impact of trauma and understands the potential paths for recovery; recognizes the signs and symptoms of trauma in clients, families, staff, and others involved with the system; and responds by fully integrating knowledge about trauma into policies, procedures, and practices, and seeks to actively resistre-traumatization.”

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“Balancing traditional objectives with innovative

responses.”

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Why It’s ImportantIncreased participationIncreased quality of servicesReduction of unnecessary interventionsReduced costsImproved outcomesIncreased participant satisfactionDon’t forget about staff!

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The Best Part??

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Even Better??It aligns with best

practices!

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SAMHSA TIC PrinciplesSafetyTrustworthiness & TransparencyPeer Support

Collaboration & MutualityEmpowerment, Voice, and ChoiceCultural, Historical, & Gender Issues

(SAMHSA, 2012)

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NADCP Best PracticesTarget PopulationEquity and InclusionRoles & Responsibilities of the JudgeIncentives, Sanctions, & Therapeutic Adjustments Substance Use Disorder Treatment

Complementary Treatment & Social ServicesDrug & Alcohol TestingMultidisciplinary TeamCensus & CaseloadsMonitoring & Evaluation

(NADCP, 2015)

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Equity & Inclusion (NADCP)

Cultural, Historical, & Gender Issues (SAMHSA)

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Complementary Treatment & Social Services (NADCP)

Collaboration & Mutuality (SAMHSA)

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What It Looks Like - CommunicationRemove judgmental language from vocabularyUse strengths-based languageEncourage safety with communicationCommunicate open and honestly with participantsProvide expectationsSpeak in a supportive mannerCelebrate victories, no matter how small!

(SAMHSA, 2013)

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What It Looks Like - ProceduresAsk “what happened” rather than “what’s wrong”Introduce trauma assessmentsTransparencyExplain everythingProvide scheduling informationTell the participant what is happening and whyFacilitate access to appropriate trauma treatmentBe flexible with requirements, make adjustments as necessaryProvide culturally-appropriate resources to participants (trauma specific, basic needs, employment, etc)Adapt to what arises – staff needs resources too

(SAMHSA, 2013)

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What It Looks Like – Courtroom EnvironmentCreate physical and emotional safetyReduce crowdingProvide comforts like tissues, snacksAdjust the lightingRemove analog clocksReview signageAllow participants to come to the benchEliminate non-verbal intimidationEnsure safety when using storiesWhen possible, judges step down from the bench

(SAMHSA, 2013)

64(ECHO Parenting & Education, 2018)

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What Can You Do?Judge

Demonstrate a commitment to providing trauma-informed care; consider the language used in the courtroom and by the team.

Coordinator/Case ManagerConduct trauma screens; compile list of trauma resources and programs for participants; plan trainings on trauma; reexamine policies and procedures.

Treatment ProviderConduct a validated trauma assessment and provide or refer the individual to appropriate trauma-informed treatment services.

Public DefenderReceive training on trauma; learn grounding techniques to help your client feel safe; communicate with your client in a respectful manner.

ProsecutorReceive training on trauma; be transparent in interactions with participants.

(Fuhrmann, 2018)

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Becoming Trauma-Informed is a Journey…

(Child Family Community Australia, 2018)

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Resources For YouACEs Connection – www.acesconnection.comArizona Trauma Institute – www.aztrauma.orgDr. Sandra Bloom, The Sanctuary Model – www.santuaryweb.comACEs Study -https://www.cdc.gov/violenceprevention/acestudy/index.html National Child Traumatic Stress Network – www.nctsnet.orgSAMHSA – Trauma Informed Care –www.samhsa.goc/nctic/trauma-interventionsACEs Too High – www.acestoohigh.comNational Association of Drug Court Professionals – www.nadcp.orgHealing Neen - https://vimeo.com/15851924Dr. Nadine Burke-Harris’s TED Talk - https://ed.ted.com/on/iOyQVfhd“The Body Keeps Score” by Bessel van der Kolk“The Deepest Well” by Dr. Nadine Burke-Harris

http://www.nadcp.org/https://vimeo.com/15851924

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SAMHSA GAINS CenterTrauma Training for Criminal Justice Professionals:

https://www.samhsa.gov/gains-center/trauma-training-criminal-justice-professionals

https://www.samhsa.gov/gains-center/trauma-training-criminal-justice-professionals

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Contact InformationLauren Hyre, LMSW

[email protected]

Lori Robinson, [email protected]

mailto:[email protected]:[email protected]

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ReferencesAdult Drug Court Best Practice Standards [Vol. II]. National Association of Drug Court Professionals.

(2015).

Fuhrmann, M. (n.d.). The Urgency to Address Trauma in Our Treatment Courts: What It Means to Be Trauma-Informed. Https://www.american.edu/spa/jpo/initiatives/drug-court/upload/TIC-Fact-Sheet.pdf.

Substance Abuse and Mental Health Services Administration (SAMHSA). 2012. National Center for Trauma Informed Care. Retrieved from http://www.samhsa.gov/nctic/

Substance Abuse and Mental Health Services Administration, SAMHSA’s National Center on Trauma-Informed Care and SAMHSA’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.

Trauma Informed Care. (n.d.). Retrieved March 02, 2018, from https://www.echoparenting.org/

Trauma Informed Care Fact Sheet [Native Children: Trauma and its Effects]. National Indian Child Welfare Association. (2014, April).

Trauma-Informed Care(n.d.). Retrieved March 02, 2018, from https://aifs.gov.au/cfca/publications/trauma-informed-care-child-family-welfare-services/export

http://www.samhsa.gov/nctic/https://www.echoparenting.org/https://aifs.gov.au/cfca/publications/trauma-informed-care-child-family-welfare-

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References, cont.Academic Pediatric Association

Arizona Trauma Institute

Arizona’s Children

Arizona Youth Survey

Dr. Robert Anda

Bronfenbrenner Ecological Systems Theory

Center on the Developing Child, Harvard University

Changing Minds.org

Dr. Sandra Bloom. The Sanctuary Model http://www.sanctuaryweb.com/

Felitti, Vincent et al. ACE Study. Journal of American Medicine. 1998

International Association of Trauma Professionals

National Child Traumatic Stress Network – www.nctsnet.org

SAMSHA- Trauma Informed Approach and Systems

https://www.samhsa.gov/nctic/trauma-interventions

http://www.sanctuaryweb.com/http://www.nctsnet.org/https://www.samhsa.gov/nctic/trauma-interventions

THANK YOU!

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Promoting Resilience in Treatment Courts: Best Practices ......ACEs Connection – Arizona Trauma Institute – Dr. Sandra Bloom, The Sanctuary Model –