The recently published Treatment Improvement Protocol 57, “Trauma-Informed Care in Behavioral Health Services” (SAMHSA, 2014), defines trauma-informed care as “a strengths-based delivery approach ‘that is grounded in an understanding of and responsiveness to the impact of trauma, that emphasizes physical, psychological, and emotional safety for both providers and survivors, and that creates opportunities for survivors to rebuild a sense of control and empowerment’ (Hopper, Bassuk, & Oliver, 2010, p. 82). It also involves vigilance in anticipating and avoiding institutional processes and individual practices that are likely to re-traumatize individuals who already have histories of trauma, and it upholds the importance of consumer participation in the development, delivery, and evaluation of services (p. xix).”
Increasingly behavioral health providers recognize the role of trauma in the lives of their clients and are developing systems of care that can be characterized as “trauma-informed.” Attention is also turning to trauma-informed correctional care (TICC) given higher rates of trauma histories among correctional populations as well as increased potential for both new and re-traumatization within correctional facilities. (See Trauma Matters, Summer 2014). For example a recent federal inquiry as reported in The New York Times (August 4, 2014) described conditions in the Rikers Island (N.Y.C.) Correctional Complex as a “deep-seated culture of violence” against its youthful inmates (ages 16-18) and suggested that the identified problems “may exist in equal measure” in the island’s seven other jails for adult men and women. One may reasonably conclude that significant traumatization and re-traumatization occur within this environment. The report also noted that juvenile inmates with behavioral disorders appear to be the targets of some of the most extreme violence.
So to what extent can trauma-informed care principles be applied to a correctional setting given its very different goals from a behavioral treatment setting? Miller & Najavits (2012) acknowledge that introducing TICC into prisons is challenging. “Prisons are designed to house perpetrators, not victims. Inmates arrive shackled and are crammed into overcrowded housing units; lights are on all night, loud speakers blare without warning and privacy is severely limited. Security staff is focused on maintaining order and must assume each inmate is potentially violent. The correctional environment is full of unavoidable triggers, such as pat downs and strip searches, frequent discipline from authority figures, and restricted movement. (Owens, Wells, Pollock, Muscat & Torres, 2008). This is likely to increase trauma-related behaviors and symptoms that can be difficult for prison staff to manage (Covington, 2008). Yet, if trauma-informed principles are introduced, all staff can play a major role in minimizing triggers, stabilizing offenders, reducing critical incidents, de-escalating situations, and avoiding restraint, seclusion or other measures that may repeat aspects of past abuse (Blanch, 2003; CMHS, 2005).” Furthermore, specific trauma treatment interventions may assist with the resolution of substance use issues, domestic violence and recidivism.
There are many practices that promote TICC. Some of the primary practices include the following:
• Ensure a correctional environment that is highly structured and safe with predictable and consistent limits, incentives and boundaries as well as swift and specific consequences so that inmates are treated fairly and equally.
• Provide education and training for correctional staff which includes information about trauma as well as ways to respond effectively to trauma symptoms.
• Screen new inmates for trauma histories.
• Use cognitive behavioral interventions to restructure criminal thinking and develop positive coping skills.
• Utilize trained staff to offer evidence-based specific treatment interventions for trauma.
• Address secondary traumatization among all corrections staff.
While there is continued growth in both theoretical and research-based literature about trauma and trauma-informed care among prison populations, disparities exist. In general it appears that while trauma issues among incarcerated women receive the bulk of attention, less attention has been focused on incarcerated men. Trauma-informed correctional care, while described well in principle and theory, appears to have been instituted minimally in men’s correctional facilities and with relatively more frequency in women’s and juvenile detention facilities. Literature searches reveal minimal information on correctional systems attempts to integrate TICC and/or discussions on the challenges, successes and barriers in making an institutional shift to TICC.
The National Center for Trauma-Informed Care (NCTIC Marketing Brochure, SAMHSA, 2012) briefly describes several instances in which TICC changes were successfully enacted:
• The North Carolina Department of Juvenile Justice has re-written job descriptions, eliminated the requirement for security-type uniforms, and provided “comfort bags” of sensory items to all youth.
• In Florida, one juvenile justice facility has repainted its cells to be welcoming rather than jail-like and, whenever possible, provides incarcerated youth their choice of rooms.
• The women’s prison in Hawaii has also made changes to the physical environment as part of an overall effort to become trauma-informed. In addition language has been changed (e.g., “what happened to you?” not “what’s wrong with you?&rdquo
, both staff and inmates are educated about trauma and its impact, and universal trauma screening has been implemented.
So where are we when it comes to more widely adopting TICC practices in correctional facilities, particularly those facilities which house male inmates? The answer to this question is actually a subset of questions remaining to be fully answered:
• Will some of the principles of TICC be considered so incompatible with the objectives of incarceration (e.g., control) that change is not deemed realistic?
• Will decision makers discount the role of trauma and its life-changing consequences within incarcerated populations?
• Will the belief that primarily women are subject to trauma and its effects and that trauma does not play a significant role in men’s lives continue the disparity?
• Will the belief that incarceration is punishment prevail over the concept of incarceration as rehabilitation?
• Will the perceived cost of transforming correctional facilities be perceived as too much of an expenditure to justify its implementation?
• Is there any evidence at this time that TICC could potentially reduce costs and recidivism in the long term (particularly for men)?
The answers to these questions remain for the most part unclear despite increasing efforts by some individuals and groups to understand and apply TICC to forensic and corrections settings. For now, growing awareness and ongoing discussion of TICC systems change can help support positive shifts toward improved incarceration outcomes.
Submitted by Steve Bistran, MA
This article has been reprinted from the TRAUMA MATTERS Summer 2014 edition. The TRAUMA MATTERS is a publication by the CT Women’s Consortium and the CT Department of Mental Health and Addiction Services in support of the CT Trauma Initiative.
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