1. Rewards and Sanctions in Veterans Treatment Court

2. some returning veterans suffer from invisible wounds

3. ptsd service Of the more then two million troops who served in Iraq and Afghanistan more the half a million will return with invisible wounds

4. PTSD or post-traumatic stress disorder: An anxiety disorder that occurs after a traumatic event in which a threat of serious injury or death was experienced or witnessed and to which the individual responds with intense fear, helplessness, or horror.

5. the disorder is marked by the following symptoms occurring for more than one month and causing significant distress and/or impairment: re-experiencing the event, avoiding stimuli relating to the event, numbing of general responsiveness, and hyper-arousal.

6. percentage of vietnam veterans who suffered from ptsd who also suffered from a substance abuse issue

7. Fifty percent of individuals arrested for drunk driving have at least one psychiatric comorbidity other than substance use disorder....post traumatic stress disorder (PTSD) is one of the most common psychiatric comorbidities among treatment samples of first-time and repeat DUI offenders

8. There is a link between combat related PTSD and violent behavior

9. Vietnam veterans suffering ptsd committed on average 4 times as many criminal assaults as those not suffering from ptsd

10. PTSD has been correlated with five general types of criminal behavior, drunk driving, weapons charges, disorderly conduct, drug possession and assault

11. alcohol related offenses dwi, felony dwi, death resulting, intoxication alcohol related offenses dwi, felony dwi, death resulting, intoxication drugs possession, sale drugs possession, sale assaultive crimes sexual, aggravated, kidnapping, simple, weapons assaultive crimes sexual, aggravated, kidnapping, simple, weapons criminal traffic criminal traffic thief felony misdemeanor thief felony misdemeanor trespass 90 ‐ day period, from September 1, 2008 through November 30, 2008, to identify Veterans who were booked into the Travis County jail

12. 47.5% of vietnan Veterans suffering ptsd were subsequently arrested

13. Judges imposed harsher sentences to the men and women who served their country then to those who did not. The United States Department of Justice, which studied incarcerated veterans, concluded that there was a sentencing disparity of about one additional year imprisonment

14. How does this relate to incentives and sanctions in Veterans Treatment Court?

15. The military has unique “belief’s, norms, values and language”

16. Military training is designed to make the use of lethal force a mere muscle memory done without thinking is a valued in the culture as it makes the job easier and more efficient it eliminates moral reasoning and judgment moral thinking is not conducive to battle field survival the primary distinction between civilian and military culture: violence becomes re-defined

17. military culture prizes and wants there to be no psychological cost to the use of violence as this results in “degradation” of the fighting unit. This results in the individual soldier being taught that it is weak, embarrassing and shameful as well as a bad career move to admit to any symptoms or moral qualms.

18. Your Defendants were all trained in a Military Culture

19. procedural Fairness in a Veterans Treatment Court Voice: Opportunity to be heard Neutrality: Clear and known policies and procedures Respect: Rights and dignity are protected Trustworthy authorities: Known consequences with flexible application

20. procedural fairnessAllow participants a reasonable chance to explain their side of any dispute, administer equivalent consequences for equivalent behaviors, and accord all participants respect and dignity throughout the process.Specify policies and procedures concerning incentives and sanctions in a written program handbook or manual, and ensure that all staff members and participants are familiarized with the procedures.

21. Carrot and stick

22. the carrot is 4 times more effective

23. Incentive systems provide a rationale for drug-involved individuals to meet milestones and targets and comply with criminal justice conditions

24. but you still need the stick

25. a graduated sanction system, where penalties are progressively more onerous

26. Effective sanctions must have four components: (a) clear identification of noncompliant behavior; (b) swift response; (c) certain, clear, transparent definitions; (d) proportionality to the behavior

27. Requiring more treatment is not a sanction

28. SUBSTANCE ABUSE vs. DEPENDENCE Do not assume that merely because an veteran has been arrested for an alcohol or drug-related offense, he or she must be an addict.

29. SUBSTANCE ABUSE vs. DEPENDENCE Drug use particularly marijuana may simply be a from of coping with PTSD or brain injury.

30. SUBSTANCE ABUSE vs. DEPENDENCE The sanctions for those who are addicted should be different then for those who are using drugs to cope with their mental health problems

31. Violence While a violent act is grounds for a high sanction it is not necessarily grounds for removal from the program

32. Trust but Verify

33. The most influential factor in veteran behavior modification is certainty. The more consistently veterans receive rewards for accomplishments and sanctions for infractions, the more effective the program

34. rewards can be quite effective at low to moderate magnitudes. For example, positive outcomes have been achieved with low- magnitude rewards, such as verbal praise, diplomas, certificates of progress, transportation passes, and gift cards to local stores or restaurants.

35. sanctions tend to be the least effective at the lowest and highest magnitudes, and most effective within the moderate range

36. Stay CenteredDevelop a wide range of intermediate rewards and sanctions that can be ratcheted upward or downward in response to participants’ behaviors.Avoid using sanctions that are low or high in magnitude if possible.

37. Thank you for you kind attention If you wish more information or to make a comment contact: Judge Brian W. MacKenzie @ mackenzieb@oakgov.com