1. Vicarious Traumatization in Treatment Providers and Law Enforcement Personnel: Recognition, Response and Prevention Dana P Neitlich, MSW Assistant Director of Clinical Programs Massachusetts Department of Correction MHM Services, Inc. July 12, 2011 Adapted from presentation developed by Maria Masotta, Psy.D.

2. Workshop Outline What is Trauma? Trauma Exposure in Inmate Populations Impact of Trauma in Law Enforcement What is Vicarious Traumatization? Risk and Protective Factors Prevention and Intervention

3. What is Trauma? Direct personal experience or event involving: –Actual or threatened death –Serious injury –Other threat to one’s physical safety Witnessing an event involving: –Death –Injury –Threat to physical integrity of another person

4. What is Trauma? Learning about –Unexpected or violent death –Serious harm –Threat experienced by family member or other close associate Response must involve intense fear, horror or helplessness

5. Traumatic Events... Emotional abuse Sexual abuse Physical abuse Painful or frightening medical procedure Catastrophic injuries or illnesses Natural disasters Rape or assault Mugging Domestic violence Burglary Combat Witnessing murder/ assault Immigration

6. Trauma History Among Inmates Physical Abuse: Males43% - 66% Females38% - 77% Threatened/Injured with a Weapon: Males35% - 46% Females29% - 52% Wolf & Shi, 2009

7. More Trauma Among Inmates… Choked or Experienced Attempt to Drown: Males14% - 40% Females17% - 41% Burned with Hot Object: Males11% - 29% Females 7% - 29% Wolf & Shi, 2009

8. More Trauma Among Inmates… Sexual Abuse: Males 2% - 26% Females19% - 65% Emotional Abuse: Males34% - 53% Females35% - 59% Wolf & Shi, 2009

9. Not So Fun Facts Incarcerated males with a mental disorder compared to incarcerated males without a mental disorder: –33% more likely to report being physically victimized in the past 6 months –Nearly twice as likely to report being sexually victimized 20% of male inmates report sexual assault during prison incarceration Polych, 1992

10. What’s important to know? Acknowledging trauma ≠ excusing antisocial behavior Acknowledging trauma ≠ digging trauma memories up Acknowledging trauma = proactive management Acknowledging trauma = staff support and care

11. Impact on the Workplace Risk of re-victimization Increased risk of: –prison paranoia –physical aggression –self-injury/suicide attempts –crisis calls –codes –uses of force –disciplinary reports

12. Impact of Trauma on Culture: Symptomatic inmates could result in: –Tension in the facility –Tension among inmates –Creates a stressful work environment Development of Vicarious Traumatization

13. What is Vicarious Traumatization? Developed by those that are exposed to a client’s trauma experiences… Includes listening to graphic descriptions of horrific events Bearing witness to people’s cruelty to one another and Witnessing traumatic reenactments Pearlman & MacIan, 1995

14. Signs and Symptoms Behavioral changes Intrusion of inmate stories Burn-out Feeling overwhelmed Withdrawal from inmates/colleagues Impaired self-care Numbing/flooding Denial PTSD symptoms Nausea Headaches Sleeplessness Difficulty trusting

15. It is a Normal Experience… Vicarious traumatization is: –Neither a reflection of inadequacy on the part of the staff –Nor the toxicity or badness on the part of the inmate –Best conceptualized as an occupational hazard within corrections Pearlman, 1999, p. 52

16. It Can Happen to Anyone Administrators Law Enforcement /Correctional officers Program staff Parole Medical staff Mental health staff Other inmates

17. Basic Statistics About Clinicians More than 50% of clinicians providing treatment to either a sex offender or victim experience symptoms in clinical range 33% of clinicians providing sex offender treatment experience hyper-vigilance regarding safety –Generally mistrustful of others, particularly those who have regular contact with children Moulden & Firestone, 2007

18. Elevated Vicarious Traumatization in Secure Settings Increased emotional exhaustion Feeling like nothing is real Decreased feelings of accomplishment May be result of: –Hardened environment –Isolation –Dangerousness of inmate population Moulden & Firestone, 2007, p. 67

19. Staff Exposure to Trauma Direct Witnessing use of force Witnessing or responding to self- injurious or suicidal behaviors Being threatened or assaulted Vicarious Hearing details of violent crimes Learning of inmates’ trauma in community and in prison Witnessing inmate relive trauma

20. Protective Factors Professional experience Training Social engagement/support system Balanced lifestyle

21. Risk Factors for LE/Custody Staff Forced overtime Responding to fights Responding to emergencies Use of force Unable to take breaks Limited support from peers, supervisors Code of silence

22. Risk Factors for Clinical Staff Substantial involvement in direct treatment High caseloads with trauma histories High exposure to inmates with trauma Female gender Personal history of trauma

23. Preventive Strategies Avoid professional and personal isolation Form/participate in a support group Stress self-care Training in vicarious traumatization Make time to relax

24. Prevention…. Healthy personal life Maintain a supportive work environment Provide supervision Seek supervision

25. Healthy Coping Strategies Balancing personal and professional lives Maintaining personal boundaries Maintaining realistic expectations for self in doing this work Allow yourself to experience emotional reactions Seek out non-victim related activities

26. More Healthy Coping Strategies Be aware of unresolved issues that may be impacted Get plenty of rest Use humor! Exercise Sports Hobbies

27. More Healthy Coping Strategies Eat healthy foods Remind yourself that you are having a natural reaction Talk to friends/family Spend time with others Provide support to other co-workers who may feel similarly

28. Not So Healthy Coping Strategies Drugs Alcohol Denial Isolating Code of silence

29. Systemic Responses (When Feasible) Supportive work environment Supervision Training in vicarious traumatization Support time away from work (breaks, PDO) Support an EAP program

30. Maintain Optimism and Hopefulness Identify and talk about positive aspects of work Recognize and cherish human resilience Take pride in having an impact on the effects of violence –All of these increase social activism

31. Questions? Dana P Neitlich, MSW dneitlich@mhm-services.com