Miller, N., and L. Najavits. (2012). Creating trauma-informed correctional care: A balance of goals and environment. European Journal of Psychotraumatology, 3, DOI: 10.3402/ejpt.v3i0.17246.
By Lori Whitten, Staff Writer, RTI International, Rockville, MD
Rates of posttraumatic stress disorder and exposure to violence among inmates are much higher than among those in the general population. In recognition of this, a new approach, called trauma-informed care, has been developed. This kind of care aims to identify trauma and its symptoms among inmates, train staff to understand the impact of trauma, minimize re-traumatization, maintain sensitivity to triggers of trauma, and identify how traumatic dynamics may, without intent, repeatedly play out in prisons.
A review of trauma-informed care, by Niki A. Miller, M.S., CPS, and Lisa M. Najavits, Ph.D., describes the need for such care in correctional institutions. The authors note that institutional environments and practices—including the constant presence of authorities and the frequent discipline they impose, the lack of privacy, restricted movement, pat downs, and strip searches—may trigger trauma-related memories and symptoms among prisoners and threaten not only the stability of individuals but also the overall safety of corrections facilities. The authors argue that trauma-informed care is feasible to implement in prisons, and they describe its benefits and discuss therapeutic approaches and staff-training issues.
Many incarcerated women and men have experienced some sort of trauma (e.g., abuse as a child, witnessing violence, sexual abuse), often ongoing, during their lives. There are, however, important gender differences—including the typical source of trauma, behavioral responses to these experiences, and treatment needs. For example, the most common traumatic experience for women is childhood sexual abuse, followed by intimate partner violence; for men, it is witnessing someone being killed or seriously injured, followed by physical assault, and childhood sexual abuse. For both men and women, childhood sexual abuse is a risk factor for crime; trauma may shape pathways to criminal behavior, for example, by increasing a person’s risk for violence and substance abuse.
Prisoners with any type of trauma history may have symptoms—emotional numbing, dissociation, and hyper-responsiveness to perceived threats—that make it more difficult to adjust to the institution and deal with other inmates and staff. Once in prison, however, women are often much safer than they were in the community, particularly if incarceration allows them to escape homelessness, sex work, violent partners, dealers, and pimps. But those who have experienced sexual abuse and neglect are at high risk for anger and hostility, which is linked with behavioral problems during incarceration. In addition, research suggests that female offenders who have experienced sexual abuse often experience multiple triggers while incarcerated that evoke symptoms such as disorientation and disconnection. Women who have limited coping skills do not fully engage in or benefit from the cognitive-behavioral therapy interventions often implemented in prison.
In contrast, men are rarely safer in prison, where risks of sexual assault and the threat of lethal violence may trigger high levels of unease and aggression directed at others, particularly for those who were traumatized early in life. Men with trauma who participate in substance abuse treatment programs during incarceration also may not fully benefit from therapy. When trauma and PTSD co-occur, treatment is less likely to be successful than it is for men with no PTSD. Men who have both trauma and PTSD also fare more poorly in therapy than those with other co-occurring disorders.
Miller and Najavits argue that, in this context, a trauma-informed approach to prison care—along with interventions designed to address trauma symptoms—minimizes potential harm to inmates and staff and reduces mental health and security costs for institutions. They say that correctional staff who are familiar with trauma, its symptoms, and how men and women respond to it are better prepared to deal with the range of reactions that inmates can have to situations and triggers (e.g., pat downs, coercion from another inmate). Although trauma is often perceived as a “women’s issue,” officers can benefit from staff training that explores male trauma dynamics and recovery too. Through exercises and role playing, officers can learn how trauma influences institutional safety.
One important aspect of trauma-informed care is the recognition and identification of prisoners who are affected by trauma. Under-reporting of trauma history is common, perhaps because of mistrust, guilt, self-blame, or, especially for males, a sense of shame and fears about sexual identity. To maintain autonomy, inmates (particularly males) may learn to manage symptoms as a way of limiting vulnerability.
Some correctional facilities have recently augmented staff training on trauma, including programs on techniques to respond effectively to trauma symptoms, the trauma-recovery approach, and trauma-specific interventions. During training, staff learn ways to minimize triggers, stabilize offenders, reduce critical incidents, deescalate situations, and avoid measures that may repeat aspects of past abuse (e.g., restraint and seclusion). This approach not only enhances effective behavior management but also creates safer facilities and greater job satisfaction. Both clinical and non-clinical staff members should participate in such training, because a better understanding of trauma improves an institution’s focus on safety, support of good coping skills, and reinforcement of treatment gains.
Evidenced-based counseling approaches that address trauma are available, and prison administrators are growing increasingly aware of them. Treatment for women emphasizes empowerment, emotion regulation, and safety. For men, treatment emphasizes feelings, relationships, and empathy. Present-focused, cognitive-behavioral, and coping-skills treatments with strong educational components have helped women inmates with trauma symptoms and substance abuse problems.
For example, Seeking Safety, has been shown to be effective without causing distress or triggering symptoms that require attention from mental health staff. This treatment addresses trauma in terms of its current impact, symptoms, related problems (e.g., substance abuse) without requiring individuals to explore distressing memories, which helps to instill new coping skills that promote rehabilitation. Education about trauma and training on how to cope with symptoms and feel safe also benefit participants. A fairly broad range of staff can implement Seeking Safety and do not necessarily require extensive formal training, enabling this treatment to be implemented at a very low cost.
For more information contact Ms. Niki A. Miller, Advocates for Human Potential, Sudbury. MA. firstname.lastname@example.org.
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This blog is funded by a contract from the National Institute of Corrections, U.S. Department of Justice. Points of view or opinions stated in this document are those of the authors and do not necessarily represent the official position or policies of the U.S. Department of Justice.