Opening the proverbial ‘can of worms’ on trauma‐specific treatment in prison: The association of adverse childhood experiences to treatment outcomes

Perceived friendships protect against the development of anger following childhood adversities in UK military veteran men residing in Northern Ireland

Background: Experience of childhood adversity is associated with greater anger as an adult, particularly in men. Soldiers and veterans report higher incidence of adverse childhood experiences, many of whom also experience elevated rates of PTSD and anger. However, little is known about factors which may protect against the development of anger after experiencing childhood adversity.Objective: This study aims to assess the potential protective aspects of perceived social support in military veterans.Methods: Data from the Northern Ireland Veterans' Health and Wellbeing Study (N = 590, Mage = 56) was utilised in regression models to examine perceived social support (family, friend, partner; MSPSS) as a moderator of the association between adverse childhood experiences (ACEQ-10) and anger (DAR-7). This sample comprised men who were UK Armed Forces veterans residing in Northern Ireland.Results: Significant interaction effects, visualised using interaction plots, were found between perceived friend support and both child abuse and household challenge. When men perceived high friend support, there was no association between child abuse or household challenge and anger. For veteran men who perceived the maximum amount of partner support, there was no association between child abuse and anger. Family support did not change the positive association between child abuse, child neglect or household challenge and future anger.Conclusions: This study indicates that it is especially important to foster supportive and empathetic friendships for men that have experienced adversity as a child, perhaps through programmes such as Men's Sheds, as these friendships may alleviate the negative influences of child abuse and household challenge on anger.

An Experimental Study of the Effectiveness of a Trauma- Specific Intervention for Incarcerated Men

Prisons are saturated with trauma survivors; yet trauma has not been the focal point of corrections-based treatment. This is the first randomized controlled trial assessing the effectiveness of a Peer-facilitated trauma-specific intervention among men incarcerated for violent offenses (Exploring Trauma: A 6-Session Brief Intervention for Men). The sample consisted of 221 participants (131 treatment / 90 waitlisted control group). Independent t tests determined change over 6-8 weeks on anxiety, depression, mental health, current traumatic distress, and anger. Hypotheses were predominantly supported. Significant improvement was found for the intervention group compared with the waitlisted control group on 11 of the 13 trauma-related outcomes. The greatest effect sizes ranged from .46 for mental health functioning, .42 for trait anger composite, and .40 for anxiety. Support for the effectiveness of this brief intervention and capability of a Peer-facilitated model of delivery was demonstrated. Future research should replicate the methodology and incorporate records data and post-release outcomes.

Adverse Childhood Experiences and Pathways to Violent Behavior for Women and Men

Childhood maltreatment is associated with risk for committing future violence, but the relationship between subgroups and biological sex is unknown. The relationship between adverse childhood experiences (ACEs), violence, and sex was examined using a nationally representative sample. Results from a latent class analysis suggested a four-class model (low adversity; moderate maltreatment with high household dysfunction; severe maltreatment with moderate household dysfunction; severe multi-type adversities). When compared to low adversity, all typology groups were at significantly higher risk to engage in violence (odds ratio > 2.10, ps < .013). The data supported a linear trajectory, meaning increased childhood trauma was associated with increased risk for violence. Although men endorsed more violent behavior, the relationship between ACEs and violence was significantly stronger among women. Prior findings identify that women are more negatively impacted by ACEs and the current findings newly identify that this extends to violent crime.

Study protocol paper for the multisite randomized controlled trial of comprehensive trauma informed reentry services for moderate to high-risk young males releasing from state prisons

INTRODUCTION

Nearly half of the individuals who release from state prisons each year are under the age of 35; 89% are men. These young men are highly likely to be re-incarcerated. Research suggests untreated trauma symptoms contribute to high rates of incarceration and re-incarceration. As trauma symptomatology can increase during reentry, implementing trauma treatment during this time is critical. The current study fills an important gap by implementing an evidence-driven trauma intervention with young, incarcerated men and extending treatment post-release in the community.

METHODS

This study evaluates the impact of the Resiliency in Stressful Experiences (RISE) program for 18-35-year-old incarcerated males releasing to participating counties. RISE is a multi-phased comprehensive trauma-based reentry program designed according to the transitional nature of reentry. The researchers will assess the influence of RISE on post-release housing and employment stability and recidivism and identify key mechanisms of change. Participants (n = 400) are randomly assigned 1:1 to RISE or a Treatment as Usual control group.

DISCUSSION

This study will provide critical information about how trauma-informed reentry programming impacts traditional reentry outcomes (e.g., recidivism, housing, employment) and identify key mechanisms of action (e.g., reduced impulsivity and aggression). Coping with trauma symptomatology is a largely untapped area of scientific inquiry for criminal justice-involved populations, despite the significant role trauma plays in individuals' lives. Results advance identification of critical components of trauma-informed reentry interventions for moderate- to high-risk young men. This study provides critical data to support policymakers and corrections professionals eager for innovative approaches to improve post-release outcomes.

Just Like a Woman: Gender Role Stereotypes in Forensic Psychiatry

The relationship between violence, gender and mental health is a complex one which is yet to be fully understood. Gender role stereotypes are social constructs that can powerfully influence and regulate human behaviour, including violence; and so it is likely that they also influence the nexus of violence management and mental health which is at the core of forensic psychiatry. In this article, we examine how gender role stereotypes might influence the practice of forensic psychiatry: specifically, in relation to women as violent offenders, as patients in secure psychiatric care and as clinicians working in forensic settings. We identify areas of development in women's forensic mental health services, and examine whether patriarchal influences and gender role stereotypes may have inadvertently impacted upon these changes. We also consider whether these changes may maintain pre-existing barriers to treatment for both men and women.

Trauma, Mental Health Distress, and Infectious Disease Prevention Among Women Recently Released From Incarceration

BACKGROUND

U.S. women recently released from incarceration experience significantly higher rates of trauma and exacerbation of mental health conditions, and the period following release has been identified as a window of heightened risk for mental health distress and human immunodeficiency virus (HIV), sexually transmitted infections (STI) and hepatitis C (HCV) transmissions. Despite these vulnerabilities, and an urgent need for supports, optimal engagement strategies remain unclear. WORTH Transitions is a program made up of two evidence-based interventions focused on improving the health of women returning to the community from incarceration with substance use disorders. Combining the two was designed to reduce HIV/STIs/HCV risks and increase overall health treatment engagement using a community health worker led intervention.

METHODS

We examined associations between trauma, mental health symptomology, and HIV/STI/HCV outcomes among women who engaged in the WORTH Transitions intervention (N = 206) Specifically, bivariate and longitudinal multivariate models were created to examine associations between trauma and mental health distress (defined as depressive and PTSD symptoms), on (1) types of engagement in HIV/STIs/HCV prevention and behavioral health services; and (2) HIV/STIs/HCV risk outcomes. The women who engaged in the intervention were 18 years and older and some were White, Black and other racial or ethnic minority.

RESULTS

PTSD symptomology and being a Black or indigenous woman of color was significantly (p = 0.014) associated with individual or group session engagement. Neither trauma nor PTSD symptoms were associated with higher HIV/STIs/HCV risks. Instead, relative to those who did not engage in HIV/STI/HCV risky behaviors, PTSD symptomology (p = 0.040) was associated with more than 3-fold increase in the probability of being lost to follow up (relative risk ratio = 3.722).

CONCLUSION

Given the impact of PTSD-related symptoms on driving both engagement in HIV/STIs/HCV prevention services and intervention attrition among women leaving incarceration, physical and behavioral health interventions must be both overtly trauma- and mental health-informed. As was the case with WORTH Transitions, physical and behavioral health services for this population must include intentional and active support of the forms of treatment participants endorse to ensure maximal engagement.

The 'trauma' of trauma-informed care

OBJECTIVES

As mental health services increasingly position themselves as providing 'trauma-informed care', there is a need for ongoing critical reflection on the challenges that this movement highlights for mental health services, including those related to the concept of trauma itself.

CONCLUSIONS

To become trauma-informed requires opportunities to reflect on what trauma means and consideration of the challenges the concept poses to diagnostically driven systems. Alongside uptake, further debate is required.

Trajectories of victimization to violence among incarcerated women

INTRODUCTION

Limited research has focused on the trajectories of victimization to violence in women's lives. Furthermore, literature assessing women's use of violence has primarily focused on adult risk factors (e.g., substance use and criminal histories). Drawing from the pathway's framework, we explored the impact of multiple forms of childhood victimization and subsequent harmful behaviors on adult-perpetrated violence among women convicted of violent or serious crimes.

METHODS

This secondary data analysis included a sample of 1118 incarcerated women from two prisons. Based on prior literature outlining the lifelong negative impact of childhood victimization, we hypothesized that cumulatively, occurrence of abuses, arrest as a minor, number of lifetime arrests, and poly-substance use prior to incarceration, would increase the likelihood of perpetration of multiple forms of violence. GEE regression models were used to examine the relationship between the predictors and adult perpetration of intimidation and physical violence.

RESULTS

Experiences with childhood victimization, early (under age 18) and ongoing criminal justice involvement, and substance use significantly increased the likelihood of adult perpetration of violence, regardless of the type of violence measured (intimidation or physical violence).

CONCLUSION

Given the documented high prevalence of childhood trauma and abuse among justice-involved women, findings from this study can be used to promote the implementation of trauma-specific treatment for at-risk juvenile girls, whose trajectories of violence might be mitigated.