Download Vanessa Price Trauma Informed Responses in Specialty Courts

National Drug Court Institute
Drug Court Training
DRUG COURTS
Trauma Informed Police Responses
PRESENTED BY:
VANESSA PRICE,
INSPECTOR, RETIRED
Collaboration of:
Cary Heck, Ph.D.
Steve Hanson
Charles Armhein, PsyD
Vanessa Price
NDCI: A Professional Services Division of NADCP
Presentation Objectives
• Identify the types of Axis 1 Disorders and how
to effectively communicate with those having
a disorder
• Define and list the symptoms and behaviors
associated with Personality Disorder
• Identify the types of trauma and associated
behaviors
2
The Drug Court Model
• Collaborative approach to treating substance
abusing offenders in the community
• Program Participants receive:
– Frequent drug and alcohol testing
– Intensive supervision by local or state probation
agencies
– Appropriate levels of treatment for substance
abuse disorders
– Regular contact with the supervising judge
3
The Ten Key Components
1. Justice and Treatment
Integration
2. Non-adversarial Approach
3. Early Identification
4. Continuum of services
5. Drug Testing
6. Coordinated Strategy
7. Judicial Supervision
8. Monitoring and Evaluation
9. Interdisciplinary Education
10. Forging Partnerships
4
Behavior Pathways
• Rewarding behaviors can
become routine
• “Subconscious” control of the
behavior
• Difficult to extinguish
behaviors because people are
not always aware when they
are initiated
• Resistant to change
5
Introduction
Part I Disorders
• Mental illness: Axis
• Personality: Axis II
Part II Trauma
• Related Disorders
• Traumatic Events
6
Mental Illness in Jails
• 2 million annual
bookings nationwide
• 16 % males suffer
• 31% female suffer
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Axis I Disorders
• Axis I disorders are like a medical illness, an illness
that impairs behavioral functioning in some way:
•
•
•
•
Florid
Episodic
Dysfunction
Disruption
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Axis I Disorders
When it’s the personality that’s disordered
•
•
Not about an illness but about
difficulties of someone’s personality,
what they are like as a person, and
how they handle stress.
Some personality disorders can be a
challenge for law enforcement, such
as people prone to interpersonal
conflicts.
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Broad Categories
• Thinking
• Mood
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What is Psychosis?
Psychosis is when thinking is severely
impaired, either how thoughts are
put together or the content of one’s
thoughts. Most common in
schizophrenia and schizoaffective
disorder. Three main symptoms:
•
•
•
Delusions
Hallucinations
Impaired thinking processes
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Delusions
• Paranoid - the person believes that
there are people who are trying to hurt
him or her, “someone is out to get me.”
They may even report this to the police.
• Grandiose - “I own four states and two
countries,” superhuman abilities,
related to famous people, believes to
have great wealth (but can’t get access),
etc.
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Hallucinations
False perceptual experience
through one of the senses.
• Auditory (voices)
• Visual
13
Disorganized Thinking
Problem in organizing thoughts, may be hard for the
person to communicate or make himself understood.
14
Disorganized Behavior
• Poor hygiene
• Inappropriate clothing
• Silence – non
responsive to questions
15
The Psychotic Disorders
• Schizophrenia – a chronic illness, but it can occur in episodes
and have remissions. Usually overall functioning is lower than
before onset of the illness. Marked by hallucinations,
delusions, and/or thought disorder.
• Schizoaffective disorder –Rather the person has episodes of
both psychotic symptoms and mood symptoms that are not
connected.
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Mood disorders
Major Depressive
Disorder
•
•
•
•
•
Psychological pain
Fatigue
Loss of energy
Poor concentration
Poor memory
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Bipolar
• Once called manic•
•
•
•
•
•
depression
Manic episodes
Feeling exceptionally
Irritable and aggressive.
Grandiose delusions.
High level of energy
Paranoid.
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Major Depressive
Major depressive disorder
with psychotic features – the
person is so depressed that
the depression leads to
psychotic symptoms.
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Anxiety Disorders
Sense of being…
•Danger
• Worry
•Fear
•Threatened
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Anxiety Disorders
• Obsessive compulsive
disorder
• Generalized anxiety
disorder
• Panic disorder
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Impulse Control Disorder
•Outbursts
•Aggressive feelings,
•Poor frustration tolerance
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The Approach: Talking to People
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Talking to People
Caveat: Follow your training and department
policies to assure safety at the scene, safety, as
you already know, is the priority. This module
will build on your knowledge of mental illness
and trauma to help you add skills, but this
material does not replace previous training nor
department policy guidance.
24
Talking to People
That being said, engagement is the key…
Engagement is not only good for the person you
are responding to, it is also a good risk reduction
strategy when it is appropriate.
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People with Psychosis
• Do not reason instead, emphasize with emotions:
 Feelings first: “It sounds like you feel...”
• Don’t try to talk them out of unusual ideas
 “What you’re telling me is…”
 “Given all that you told me it must be very
difficult to…”
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People with Psychosis
•Give them your full attention.
•“I’m sorry I have to interrupt but I
need to take care of this quickly.” Add
I’m sorry about that you were telling
me about … before I had to interrupt.
•Maintain calm and open body
language.
•Silences are okay.
27
People with Psychosis
• If asked do you believe the delusion just simply say,
“I want to hear more about what you’re having to
deal with, can you help me understand…?”
• Ask him or her: “I want to check if I’m getting this
right, is this it…? ?
28
People who are Agitated
De-escalation: Communication that calms someone
• One person takes lead communicating
• Take your time
• Speak slowly and calmly
• An attitude of trying to help, vs. threats
or arguing
29
People who are Agitated
•
•
•
•
Eye contact – neither too much or too little
Maintain safe distance
Sit with person if seated, perhaps at side
But…, avoid unrealistic statements or
promises.
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Talking to People -- Agitation
• Show empathy
• Acknowledge a grievance
• Use open ended questions
• Emphasize the person’s point of view, not yours
• “Tell me what happened” and “What can I do to
help?”
• “I want to help but it’s hard for me to understand
when you’re shouting.”
31
Personality Disorders
The major ones with high relevance for law enforcement
include:
• Narcissistic
• Borderline
• Antisocial
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Narcissistic
•
•
•
•
•
•
Grandiose
Self-centered
Entitled
Arrogant
Needs admiration
Lacks empathy
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Borderline
• Highly emotional and agitated
• Poor coping with negative
feelings
• Needy and dependent on
others
• Impulsive behavior
• Suicidal thinking or attempts
• History of childhood trauma
(sexual abuse)
34
Other Personality Disorders
• Schizotypal
• Schizoid
• Antisocial
35
Post-Traumatic Stress Disorder
Caused by exposure to, or witnessing, an event that
threatened death or serious injury, along with a
sense of fear, horror, or helplessness.
36
Trauma
•
Events that are beyond
expectable experience
and overwhelm the
person’s psychological
resources.
• Think of the war veteran
where the family said he
was never the same after
he returned.
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Types Trauma
• Recent traumatic event
• Chronic PTSD
• Delayed PTSD
• Chronic abuse, in childhood or later
38
Dissociation
Cutting off awareness and
connection to memory,
thoughts, and feelings.
39
Always on the edge
• Memories and thoughts
remain unbearably intense
• Thoughts are intrusive and
cannot be stopped
• Nightmares are frequent
• People react as if they are
back at the traumatic scene
40
Following a Traumatic Event
Person may be:
• Confused
• Numbed
• Calm
• Severely distressed.
41
Trauma
Speaking quickly
Matter of fact tone
42