Toward a Trauma-Responsive Criminal Justice System: Why, How and What Next?

5th ANNUAL IRISH CRIMINAL JUSTICE AGENCIES [ICJA] CONFERENCE

DUBLIN CASTLE CONFERENCE CENTRE 4th July, 2018

ICJA Conference 2018 - “Toward a Trauma-Responsive Criminal Justice System - Why, How and What Next?”

CONTENTS Conference Welcome and setting the scene 3 Michael Donnellan, Director General, Irish Prison Service Conference Opening 6 Charles Flanagan TD, Minister for Justice and Equality

Better the Devil you Know? Alternatives to the Adversarial System 11 Mary Rose Gearty, SC

What Happened to You? Understanding the Impact of Chronic Early Adversity and Neglect in Infancy and Early Childhood 17 Ciara McCarthy, Senior Clinical Psychologist, Primary Care Psychology Service, Health Service Executive

Vicarious Trauma: The Impact of Working with Survivors of Trauma 30 Dr. Sharon Lambert, School of Applied Psychology, University College Cork

Homeless Men with Mental Illness in Irish Prisons 37 Dr. Conor O’Neill, Consultant Forensic Psychiatrist, Central Mental Hospital

Delegate Recommendations towards Action Plans 42

WORKSHOP SUMMARIES 1. The Potential for Applying the Tusla-led Meitheal Practice Model in a Trauma- Responsive Criminal Justice System 45 Fergal Landy, Regional Implementation Manager for Prevention, Partnership and Family Support, Tusla, Galway and Eimear Ryan, Senior Speech and Language Therapist ACTS

2. Towards Trauma-Responsive Addiction Treatment Service at Tabor Group in Cork 49 Mick Devine, Clinical Director, Tabor Group, Cork

3. Poverty, Homelessness, then Prison - and back to Poverty, Homelessness again 52 Fr Peter McVerry

4. Prisons: Trauma Informed Interventions - Them and Us? 55 Claire Moloney, Chartered Counselling Psychologist, IPS Psychology Service, and Aoife Rice, Assistant Psychologist, IPS Psychology Service

5. From Exclusion, through Muddle, to Rights: The Place of Victims in Sexual Offences Trials 60 Noeline Blackwell, Chief Executive Officer, Dublin Rape Crisis Centre

6. Every Woman Every Story: Trauma, Criminality and Women in Prison 62 Governor Mary O’Connor and Dr. Maggie McGovern, Dóchas Centre

ICJA Conference 2018 - “Toward a Trauma-Responsive Criminal Justice System - Why, How and What Next?”

7. Pathways to Prison - The Experience of the Traveller Community 67 David Joyce, Solicitor, Mercy Law Resource Centre and Anne Costello, Coordinator, Travellers in Prison Initiative

8. Vulnerable Migrants and the Criminal Justice System 70 Wendy Lyon, Solicitor, KOD Lyons Solicitors

9. Trauma in Probation Practice 72 Margaret Griffin, Regional Manager, Probation Service, Elaine Kavanagh, Probation Officer and Jane Mulcahy, Irish Research Council funded PhD Candidate in Law at University College Cork

10. Addressing Psychiatric and Psychosocial Morbidity in Irish Prisons 75 Dr. Gautam Gulati, Consultant Psychiatrist, University Hospital Limerick, Adjunct Senior Clinical Lecturer, University of Limerick

CONFERENCE ATTENDEES 79

ICJA Conference 2018 - “Toward a Trauma-Responsive Criminal Justice System - Why, How and What Next?”

Conference Welcome and Setting the Scene Michael Donnellan, Director General, Irish Prison Service There are ten Adverse Childhood Experiences or ‘ACEs’ as identified in the seminal work in the US known as the CDC-Kaiser Permanente Adverse Childhood Experiences Study. ACEs include physical abuse, persistent emotional abuse, contact sexual abuse, physical neglect and emotional neglect, the presence of an alcoholic/drug abuser in the home, presence of a depressed, mentally ill or suicidal family member, domestic violence, loss of/separation from parent(s) and imprisonment of a family member.

These ten ACEs are major contributors to negative later life health and wellbeing including chronic physical and mental illness such as heart and liver disease, obesity, chronic anxiety and depression and Obsessive Compulsive Disorder (OCD), addiction, and early death. In the study a dose-response relationship was found between ACEs and negative health and wellbeing outcomes across the lifespan, in that the more ACEs the more negative the outcomes.

Of the 17,000 people interviewed for the study, a quarter of people reported experiencing one ACE and over a fifth experienced three or more ACEs. The original study did not include research subjects from psychiatric hospitals, prisons, or those accessing homeless services, where the rate of child neglect and abuse is higher than in the general population. In a Welsh study of ACEs by Public Health Wales (2015), 47 percent of the 2,028 adults surveyed reported having experienced at least one ACE and 14 percent experienced four or more ACEs. In this study, those who experienced four or more ACEs were 14 times more likely to have been a victim of violence over the last twelve months; 15 times more likely to have committed violence against another person in the last twelve months; 16 times more likely to have used crack cocaine or heroin and twenty times more likely to have been incarcerated at any point in their lifetime.

Recent investigation into the prevalence of ACEs among Cork Simon Community homeless service-users yielded fascinating results. Fifty service-users were surveyed and 77 percent had four or more ACEs, while eight percent had ten ACEs. The figures are staggering.

Criminal behaviour can undoubtedly be added to the host of negative outcomes associated with scores on the ACE Questionnaire. Childhood adversity is associated with increased likelihood of juvenile arrest and adult criminality. Yesterday’s traumatised become today’s traumatisers.

Consider this morning, 10 million people woke up in prison around the world. These 10 million people report nearly four times as many ACEs than their community counterparts, with significantly higher levels in this group reporting eight out of ten ACEs. Consider these statistics in terms of the people we work with. I’m not making excuses for people who hurt

ICJA Conference 2018 - “Toward a Trauma-Responsive Criminal Justice System - Why, How and What Next?” others. I am not asking you to use this information to make excuses for people either. What I am saying is that this information should inform the way we work with people who come in contact with the Criminal Justice System if we are serious about creating less victims now and in the future.

Consider also the often unpalatable, but very real, possibility that contact with the Criminal Justice System can and sometimes does re-traumatise already traumatised people: arrest, being locked in a small cell with other traumatised and sometimes angry and violent people, the sound of banging doors and gates, jangling keys, name calling, violence in prison, a lack of reliability and consistency, isolation. All of this can trigger angry, violent, impulsive, defensive or detached reactions by already hypervigilant and emotionally overwhelmed people.

We work in a sometimes high risk environment. We hear about, witness and sometimes become victim to violence. We ourselves can be traumatised. Traumatic events impact our own reactions to other people, including toward the people who are in our care and custody.

Unwittingly, the Criminal Justice System may at times maintain or exacerbate rather than reduce the symptoms of trauma, meaning it is possible we are in fact less likely to achieve our common goals of less victims and a safer Ireland.

Our clinical and research colleagues argue that traditional Criminal Justice System interventions to reduce risk are not as effective if underlying ACEs and related trauma symptoms are not treated. This makes sense. People who have done wrong cannot really look at themselves, recognise the hurt they have caused, allow people to challenge them and finally work to build themselves up into safer, happier, more rounded, connected citizens if their automatic trauma response to any challenge or perceived criticism is to become increasingly dysregulated, angry, violent, defensive or to shut down? Clearly these responses are fundamental targets in the first instance before we try anything else.

Attachment theorists and developmental or child psychologists highlight for us the importance of providing children with a ‘secure base’ so that they feel safe to explore and develop. Typically this means a safe home and at least one loving adult with whom they can depend on reliably. Mental health experts in prisons argue the same for people in contact with the Criminal Justice System. Traumatised people need to be provided with a secure base – a safe place and people whom they feel safe with, in order to explore what has happened to them.

Importantly, as you will hear today, being a trauma informed workforce or being trauma informed in your everyday work does not mean having to perform complex psychological or

ICJA Conference 2018 - “Toward a Trauma-Responsive Criminal Justice System - Why, How and What Next?” medical interventions. There are so many small things we can do in our working (and our personal) lives that can make a difference to someone. We may be working this way already. Do you follow through on what you say you will do? Do you tell someone when you can’t do something? Do you speak to people respectfully? Do you give short, clear instructions? Do you tell people what to expect in new situations? Do you give people choice? Do you close doors and gates without banging them? Do you give people realistic hope? Do you ensure contraband searches are done for a safer working environment? Do you do your daily and nightly checks reliably? All these seemingly small tasks provide for that secure base and a trauma informed way of working. You are here today ... and the fact that tickets for this conference sold out in less than 24 hours tells me that a wide variety of people within the Criminal Justice System and related agencies are willing and perhaps ready to hear what has to be said today.

The difference between hope and hopelessness can be just one person. People need people. It can be difficult to fathom why or how we might provide a trauma-informed approach with someone who has done untold harm to others, someone who has left multiple, now traumatised victims. But ignoring the facts, ignoring the statistics, ignoring the clinicians and researchers will only leave us less and less likely to achieve a safer country for ourselves, our family, friends, loved ones and neighbours. We are wasting money and resources. Potentially and unintentionally we may be creating more victims in a never ending cycle of trauma and violence if we turn a blind eye to the need for a trauma informed response to those we work with and preventative measures for children and young people at risk of, or experiencing ACEs today and in the future.

ICJA Conference 2018 - “Toward a Trauma-Responsive Criminal Justice System - Why, How and What Next?”

Conference Opening Charles Flanagan TD, Minister for Justice and Equality Colleagues, people working in the field of Criminal Justice, supported by my Department, can I would like to thank you for the invitation continually develop and implement more to open the 5th Annual Criminal Justice and more effective work practices in their Agencies Conference here today in Dublin agencies and across agencies for a safer Castle. Ireland.

It is so important that I am here today, to The ACJRD also provides a forum where lend support and encouragement to you experienced staff working in or having all who work in the broad spectrum of worked in the Criminal Justice System and Criminal Justice Agencies in our country. associated professions can talk through in You work with very complex and an informal setting, problems and challenging situations in the name of methods of working to the advancement supporting the Government to keep of community welfare. This opportunity Ireland and its people safe. You work with to network, learn from each other and people who come into contact with the work together is so important. Surely it’s Criminal Justice System, many of whom the bedrock of a sound Criminal Justice have multiple complex needs and sets of System? How can we work well with circumstances that you must navigate. people who move from one of our Faced with these sets of complex and at agencies to another - Courts to Prisons to times risky circumstances, it is essential Probation - if we are not talking to one that the decisions you make, and the another - formally and informally. policies and procedures you follow, are based on sound study and research. Only last week I was in Probation Without this - we are just ‘winging it’ in Headquarters in Haymarket, launching the our jobs. Probation Services and Irish Prison Services respective annual reports, their This is why this conference and others like Joint Strategic Plan and The Probation it, facilitated by the Association for Service Strategic Plan for the next three Criminal Justice Research and years. In launching these, I noted many of Development, are so important. To the initiatives that both Services are remind you all, the ACJRD was developed working on together and with other to promote study and research in the field agencies. I noted in particular, the very of criminal justice and to share results of successful Joint Agency Response to Crime that research in order to advance our initiative which involves intensive joined agencies and ultimately benefit our up working by The Probation Service, the community. What does this actually Irish Prison Service and An Garda mean? It means taking the learning from Síochána. This initiative wasn’t thought research and getting it out there so that up out of thin air. JARC was developed

ICJA Conference 2018 - “Toward a Trauma-Responsive Criminal Justice System - Why, How and What Next?” based on national and international research and practice which will allow us research which demonstrated that this to talk about, consider and implement way of working - intensive, joint where appropriate. The Conference monitoring, supervision and support of rightly recognises the impact of trauma on high risk offenders works. This is how those in contact with the Criminal Justice research becomes policy and policy System, victims of crime and those becomes practice. This is exactly why this working within the Criminal Justice conference is so important. It provides System. you with the material - the research findings - which will help you in your jobs Far too many people cycle through and ultimately will help keep our streets - Ireland’s Criminal Justice System, our communities - our families and friends wrestling with chronic mental health and safer. personality difficulties, addictions, relationship difficulties, unemployment, This year - 2018 - sees the Irish Prison poor use of leisure time, poor life skills, Service take lead partner status at the 5th homelessness and isolation from the Annual Irish Criminal Justice Agencies broader community. Many have Conference. Year to year, this is shared experienced significant trauma in their with colleagues in the Irish Youth Justice lives. Service, the Department of Justice and Equality, An Garda Síochána, and The Trauma is not an ‘excuse’ for criminal Probation Service. This year’s topic - behaviour but an experience common to Working toward a trauma informed many men, women and children who have Criminal Justice System - is not only a come into contact with the Irish Criminal very interesting, but a very worthwhile Justice System. In fact, research would topic. highlight that ninety-five percent of men and eighty- eight percent of women What is important about this conference involved with the Criminal Justice System is that it is opening a conversation about report a history of significant traumatic the impact of trauma on people who experiences prior to imprisonment. This is come into contact with the Criminal an extraordinary statistic. Justice System, the traumatic impact of crime on victims AND the impact of You will hear from our experts today that trauma on staff who work in the Criminal as adverse childhood experiences or Justice System. I’d like to say something ‘ACEs’ build in number over the course of about all three by way of introducing this a child’s development, the detrimental conference. impact this has on their ability to think clearly and rationally, make decisions, We are here today, as in similar years, to problem solve effectively and act without hear from expert colleagues who will impulse. These thinking difficulties are share with us the most up-to-date theory, now recognised biologically. These

ICJA Conference 2018 - “Toward a Trauma-Responsive Criminal Justice System - Why, How and What Next?” recognised thinking difficulties often lead agency co-operation and interventions to difficulties in the face of every day and with people in custody and, also, in the significant stressful life events, such as community to respond to the many addiction, complex mental health and complex challenges service-users personality difficulties, isolation, experience and present with, including homelessness and crime. mental distress, domestic violence, homelessness, trauma and alcohol and You might ask, what makes one person drug misuse. I know the Irish Prison who faces adverse childhood experiences Service Strategy 2019 - 2022 will have an lead a life free of crime and another turn equal focus on the need for trauma to crime. It seems to depend, in part, on informed approaches to meet its mission who and what that child learns – of providing safe and secure custody, remember, if a father goes to prison their dignity of care and rehabilitation of sons have a 59% chance of spending some prisoners for safer communities. time in prison over the course of their lives. It also depends on whether the Unfortunately, some people’s experiences person has many strengths or protective within the Criminal Justice System can factors to help keep them from crime. often contribute to new or repeat traumas, from arrest, through to We provide people in the Criminal Justice sentencing, incarceration and release. System who have addictions or mental Contact with the Criminal Justice System health difficulties with addiction and can itself become a cyclical relationship – mental health services as a way of hence the importance of working toward supporting them, meeting their needs and a trauma informed Criminal Justice reducing their risk of reoffending. It System. makes sense therefore, that having acknowledged the role of trauma in The very experience of having a crime people’s lives, that we would now look to committed against you or your loved one recognise, acknowledge and use every is traumatic. We know the operation of opportunity to intervene in trauma to the Criminal Justice System can also, in reduce offending, reduce victims and certain circumstances, re-traumatise create a safer Ireland. victims - known as secondary victimisation. I was heartened to see that The people you work with require a broad victims - too often left behind - have a range of support and assistance in custody voice at this Conference also. The new EU and in the community if they are to make Victims’ Directive, which is being better choices for themselves and their implemented by my Department, communities. The Probation Service, in its considerably strengthens the rights of Strategic Plan 2018-20, recognises this victims and their family members to exceptional need and that addressing it information, support and protection. It requires multi-disciplinary and multi- further strengthens the victims'

ICJA Conference 2018 - “Toward a Trauma-Responsive Criminal Justice System - Why, How and What Next?” procedural rights in criminal proceedings. note the introduction of Critical Incident The directive also requires that EU Stress Management by the Irish Prison countries ensure appropriate training on Service to meet the needs of staff who victims' needs for those staff who are face traumatic incidents, including the likely to come into contact with victims. introduction of free, independent counselling and psychological support Recognition and understanding of the role where needed. that trauma plays in contributing to an individual’s journey toward involvement Public safety and preventing future in the Criminal Justice System and the victims are fundamental to the potential for repeated exposure to trauma Department of Justice and Equality - can become a recipe for disaster for both indeed as I’ve mentioned - it is users of, and Criminal Justice Agency staff. fundamental to the whole of Government. Too often staff experience direct and This point is in fact reflected in the variety vicarious trauma within the context of of organisations and agencies represented their work - all those with responsibility in the speakers to this conference - we for the safe custody, sentencing, have the HSE, Tusla, Charities, Universities management, care, support, rehabilitation representatives - all working toward and supervision of people in contact with prevention of and intervention with the Criminal Justice System. Staff aren’t trauma for a safer, but also more robots. They experience trauma too and compassionate and humane Ireland. it’s important that they are supported to Indeed, what this tells me is that it is not recover so that they can continue to work only agencies within the Criminal Justice and support themselves, their families and System that need to keep talking to each their communities. Consider the Judge, other, but whole of Government agencies. Prison Psychologist, member of An Garda Síochána or Probation Officer who hears In order for the Department of Justice and or sees the most graphic aftermath of Equality to fulfil its responsibilities, it is harm committed by one person to time for us to focus on trauma for a safer, another, or the Prison Officer who is fairer, more equal Ireland. I challenge you assaulted in the course of their duty. As I today to really listen and hear what our said at the beginning of this address - you experts have to say, think critically about face some of the most challenging not only how you could change one or situations within any working two simple things you do to become more environment - often times - too often - aware of and responsive to trauma, but under-acknowledged, as you work toward also think big: How does the study and safer Ireland. I am heartened that many research you hear about today impact of our Criminal Justice Agencies have and your policies and procedures? See this as are continuing to acknowledge the impact the start of a very worthwhile journey for of your work on you and are working everyone who has contact with and works toward meeting this significant need. I within the Criminal Justice System.

ICJA Conference 2018 - “Toward a Trauma-Responsive Criminal Justice System - Why, How and What Next?”

Again, I thank you for the opportunity to speak with you today and I wish you all a successful and informative conference.

Pictured (L-R): Maura Butler, Chair, ACJRD, Charles Flanagan, TD, Minister for Justice and Equality, and Michael Donnellan, Director General, Irish Prison Service

ICJA Conference 2018 - “Toward a Trauma-Responsive Criminal Justice System - Why, How and What Next?”

Better the Devil you Know? Alternatives to the Adversarial System Mary Rose Gearty, SC

Picture a court scene. Justice – what do you there is no reason why more than one type of see when I say that? Our first experiences of system cannot co-exist. Perhaps it is as well most things come from our parents, our home to set out very clearly at the outset that no and our TV – or perhaps now, a home system run by human beings will ever be computer or smart phone. perfect but that this is no reason not to aim at perfection. From the very earliest days in our lives, we The type of dispute most relevant to this experience the courtroom setting as the place audience is the criminal wrong, serious or in which disputes are resolved, justice is done otherwise. In Brehon times, such wrongdoing (or not?), and decisions are made that affect was dealt with by assessing the damage to the our lives. You may have seen Angry Birds, for status of the individual wronged and instance? Red Bird is sentenced by a short appropriate compensation was decided by a bird in a long, purple gown to attend Anger community judge or mediator, the Brehon. Management Classes, courtroom scenes are commonplace in The Simpsons. Whether it is Argument Angry Birds or Airplane!, The Simpsons or The aim of our system is to seek truth and do Judge Judy, even as children this setting is so through disputation. We contrast this with reinforcing the traditional model of justice. the civil law system in place in most of Europe Can we defend it? Does it best suit our which is an investigative system. Common to purposes? both systems, however, is the view that if a serious offence is alleged and denied, the Challenge perspectives account given by the complainant should be This image of a man (and it is still the most challenged. common image of a judge) who sits on a high chair and decides and punishes, is one that we One of the most famous defenders of the imbibe as small children. It may be very hard system was Wigmore: to question this as a process, given how “Not even the abuses, the mishandlings and deeply it has been sown into our idea of the puerilities which are so often found justice. We have little cultural remnant of the associated with cross-examination have early Brehon or First Nations’ practices of availed to nullify its value. It may be that in community resolutions – where the people of more than one sense it takes the place in our the village collect, as a group, including system which torture occupied in the parties to the dispute, to discuss the potential mediaeval system of the civilians. resolution of serious wrongs inflicted by one Nevertheless, it is beyond any doubt the person on another in the society. greatest legal engine ever invented for the discovery of truth.” It is always worth examining our assumptions and looking at the options if we were to It is the last line that is most often quoted, yet improve our current system. Can we, should the preceding words compare the effect of we, challenge our perspectives? There is no cross-examination to torture! …it is beyond doubt that society needs some kind of system any doubt the greatest legal engine ever which helps citizens to resolve disputes and invented for the discovery of truth.

ICJA Conference 2018 - “Toward a Trauma-Responsive Criminal Justice System - Why, How and What Next?”

Is that so? It is certainly effective. While my afforded to both sides in the process, professional experience has been in the punishment, deterrence and rehabilitation. adversarial system, I have also been involved This is a very formal system. It depends on in more investigative processes. The danger the use of logic. It comes back to the principle of bias developing in the investigative system of justice and fairness: hear both sides of an is well-known. But what I found more argument. Make sure a criminal wrongdoing interesting was the information that emerged is proven before any punishment is inflicted. when an adversarial approach was taken, If a serious allegation is made, it must be which was more comprehensive than that challenged and proven. gleaned from investigative questions. This presupposes that we act logically or at Whichever of these two systems one prefers, least that we use reasons in decision making. there is one principle that must be adhered to The system also allows for extensive - if a serious allegation is made, it must be mitigation in how certain matters are dealt challenged and proven. If it is simply with and, in particular, the single most accepted by our society without any rigorous powerful factor in mitigation is a plea of test of its veracity, our security as a group is guilty. deeply damaged. We thereby hand any Is this civilised? In ancient times, there were person the means to destroy another on an other methods, some better than others. allegation only. Most impressively, and as already mentioned, in ancient Ireland there were systems of Is there a gentler way? If the system seeks community dialogue, led by the Brehon who the truth and any essential facts are disputed, was both judge and poet, though the role was it seems that some form of hearing involving a more akin to a mediator. There was no challenge must take place. There is certainly written record, no paper, no method of room for a more informal process involving recording proceedings or decisions, so the children - anyone under the age of 18. If judge had to have oratorical abilities including different types of hearing are suggested for the ability to recall and re-tell events. Hence, different types of crime, there is a danger that I suggest, the importance of his poetic skill. certain offences might be seen as inherently Some of the Brehon Laws survived all over the less serious, for instance. But if the distinction country right up until the early 1600s. While is made due to age and vulnerability, for some of its methods appear highly evolved, instance, that would be an entirely defensible and the treatment of women at the time is and a sensible policy choice. generally acknowledged to have been far more egalitarian than most other countries, If the parties agree on the facts, the search for nonetheless the importance of status means truth becomes secondary. This typically that it is not a model that could be adapted in happens with a guilty plea. It is here, its entirety. As is always the case, of course, quintessentially, that ideas of alternative we can examine those measures that might dispute resolution could be nurtured and best suit a modern system. developed. In Brehon Law, the real purpose of criminal The current system is one that is adversarial. hearings was compensation based on the One side argues against the other. The status of the victim. In a much larger world - system involves accusation, rights being is this a sufficient deterrent? Is it realistic to

ICJA Conference 2018 - “Toward a Trauma-Responsive Criminal Justice System - Why, How and What Next?” expect circles of reconciliation in such cases? the two - wrongdoer and victim - restoration And even while it may be an aim, it is far from of the status quo if that is possible, and being realised at the moment. restoration of the wrongdoer to their society.

There are other systems that place emphasis Will this work for very serious crime? Will this on dialogue, participation and reconciliation. work for cases with multiple victims? How to The language of such alternative methods is introduce it in such a way that it can be tested one of individual forgiveness or resolution, as a system? If ever there was a case for a community sanction and reprieve. These tend pilot programme, this is surely it – there is to be far less formal. simply no appetite for the whole system to change to a community based restorative The nearest comparator in use in Ireland system with no room for punishment in today is the Restorative Justice Scheme (and appropriate cases. Who will be the first its cousin, the Victim Offender Mediation) - a complainant to agree to that? large step towards a less adversarial model. This brings us to the single biggest obstacle to The European Forum, Restorative Justice and more widespread use of the system; that it Victim Offender Mediation and section 78 can only happen and can only be effective, by the consent of all parties. If the wrongdoer “78.—(1) Where, in any proceedings in which does not admit wrongdoing, it is doomed a child is charged with an offence— from the beginning. If the victim will not (a) the child accepts responsibility for his or meet him/her, there is no benefit to the her criminal behaviour, having had a process. reasonable opportunity to consult with his or her … guardian and obtained any legal advice, Stalemate (b) it appears to the Court that it is desirable Imagine a game of chess where it is obvious that an action plan for the child should be from an early stage that it is going to result in formulated at a family conference, and a stalemate, where neither party wins. (c) the child and child's parent or guardian, or family or relatives of the child, agree to attend Restorative Justice is very rarely used. What such a conference, the Court may direct the is the point in my extolling its virtues or in us probation and welfare service to arrange for recommending it if it has been there since the convening of a family conference and 2001 and is not a realistic option or is an adjourn until the conference has been held…” under-used provision? It is not even named!! While Restorative Justice models are not included in any other legislation, the Court Going back to the traditional model – the may request that the Probation Service make victim must come into court and effectively contact with the victim, if the victim agrees denounce their attacker if the accused denies to this, with a view to mediation. responsibility. These models do not assist in that instance and there can be no effective The purpose behind the two alternatives that system whereby an account of a serious crime have formal recognition here in Ireland is very is not tested. If an accused accepts similar - the clue is in the title: restoration, not responsibility, the benefits of these retribution. Restoration of dignity, insofar as approaches are perfectly clear – they are less that is possible, restoration of peace between corrosive for the victim, they are potentially

ICJA Conference 2018 - “Toward a Trauma-Responsive Criminal Justice System - Why, How and What Next?” very rewarding but the co-likelihood of both the European Forum for Restorative Justice sides being willing and able to avail of the shows that members of the public do not process is slim. So why are they not used have a clear understanding of what more often? Restorative Justice is. The European Forum for Restorative Justice published research in The main obstacles in the cases in which it 2010 which includes an interesting summary may have a benefit – few people know about of the Norwegian programme. They hired a this and it is insufficiently resourced. dedicated media agent, Gro Jørgensen, who was a journalist and a mediator. With her My own experience suggests, although this team, she maintains a list of media contacts, can only be anecdotal even if it is based on enjoys excellent relations with the media and over 20 years of practice in the criminal ensures that Restorative Justice stories are courts, that this kind of approach will work written in an accessible and interesting way so best, or is best-suited to, a case involving as to ensure maximum coverage. With this in children. Again, consent is key. mind, the forum published a toolkit on how to harness the power of the Media generally in Though limited in application perhaps, this is order to make Restorative Justice a more an approach which could be strongly realistic and, therefore, a more attractive recommended, even in serious cases, and option. could have far-reaching consequences if the parties involved consent to it. At the This toolkit and other reports on Restorative moment, there is no incentive and not much Justice projects generally, are available at the public awareness around the issue. There is website hosted by the forum.1 much that can be done to change public approaches to Restorative Justice. The first is It is difficult for me to say whether, in any of to make it available and, arguably, that has the cases in which I have been involved or been done. It is an option and The Probation have followed in my professional life, Service offers this option. It is not recognised Restorative Justice would ever have been formally in any legislation, however, chosen by any of the victims or by the accused although section 78 of the Children Act is whom I have represented. But this is largely used to facilitate such meetings. because it was not a realistic option - it was not even considered in cases in which it may The fact that the process is not named as such well have had an effect. But there is little in that Act leads to the second change that point in lawyers suggesting it if it is an entirely should be considered: Raising awareness. foreign idea to clients. How to do this? Lawyers … Norway! In most depictions of lawyers, we are not The process should be named as such in popular. I feel that this is most unfair, given legislation, awareness should be raised by the large body of lawyers who act entirely for advertising the process and this leads to the the rights of others, and are often underpaid third remedy – resources. 1 See: No process can survive and thrive unless is it http://www.euforumrj.org/publications/research- reports properly resourced. Research carried out for

ICJA Conference 2018 - “Toward a Trauma-Responsive Criminal Justice System - Why, How and What Next?” particularly when engaged in that kind of diversity at various levels (communities work. We are frequently victims of secondary should feel invested in their legal system) – trauma ourselves, hence the reliance on jokes the unthinking hatred or mockery of lawyers to comfort ourselves and to make light of should be revised also. We serve a function information that might otherwise be which is when trauma affects the judgment of overwhelming. The effects of reading and those intimately affected by the allegation of presenting traumatic material day after day, a crime. Either they are the victim or they are and managing the emotional trauma of the accused. Each party needs a friend in others, are cumulative and can be court and what I want is a friend who is not devastating. I do not compare this with the emotionally invested in the case, who is not trauma suffered by victims or by those in the traumatised by it, but who is a professional front-line, such as social and care workers, but and who can represent my interests. What it is a mistake not to recognise how corrosive good is a system which serves only those who its effects can be even at the remove of the are contrite, or apparently so? Our system lawyer who deals routinely with harrowing does at least enable all, even the poorest, to cases. In order to remain professional, we defend themselves against the most serious must be aware of the risks to ourselves and allegations. And it enables all those who are guard against the effects of secondary injured by crime to have their case trauma. In a conference which focuses on professionally presented to a judge or jury. trauma, this must be acknowledged. This is not a small privilege; it is not something we should ever take for granted. Shakespeare is responsible for this particular old gag: “first thing we do, let’s kill all the Swipe Right if you liked your lawyer? Am not lawyers”. Allow me to change this sure this will catch on. perspective, if I may? Most lawyers are young, female and they first Most scholarly discussions of this line studied law because they wanted to help recognise that it is open to many people. As such, they did not grab any interpretations. Is this a socially wry headlines as good news is not news. Just as comment set in the mouth of an ignorant the Restorative Justice projects suffer from thug? It is "Dick The Butcher" who suggests being too beneficial and not exciting enough how to improve the country by killing all the to make the news, so the well-intentioned lawyers as part of an attempted coup. lawyer does not get much attention. Those who got a good service in a criminal case or in Shakespeare knows which body of men, and a family law dispute do not write up their nowadays women, is likely to stand in the way review on social media. of the strong men, like himself, who seek to subdue the weak. How to use alternatives?

Back to Changing Perspectives Wrongdoer apologises… How is this news?? Just as we try to reframe or question the value of the adversarial system, and my own I’m being deliberately mischievous here. Of assessment is that, while it is difficult and course I’m not suggesting that you spread fraught with other problems that we should fake news but you do need to think very address – delay, archaic language and lack of seriously about public awareness across all

ICJA Conference 2018 - “Toward a Trauma-Responsive Criminal Justice System - Why, How and What Next?” the different media now available. As alternative. Hence the name of this paper. members of the public, not just stakeholders, Without a serious attempt to test the benefits we do have a bigger influence than we used of Restorative Justice or Victim Offender to have - we just don’t tend to use it… Mediation, few will avail of these services and we will stick with the devil we know. While Summary the value of Restorative Justice may be Restorative Justice models are not included by limited, if it can be enhanced, and becomes a name in legislation, the Court may request more visible option, it may well replace the that the Probation Service make contact with court case, even in criminal offences, the victim, if the victim agrees to this, with a wherever consent is obtained. This can only view to mediation. This is a vastly underused benefit children and vulnerable parties in service that could be of great worth, particular. particularly in cases involving children. I formally record my sincere thanks to Nina The minimal use of Restorative Justice in Paley for her instructive cartoons (included in Ireland means that our experience of it is the slide show at the conference). inadequate to fully explore its value as an

ICJA Conference 2018 - “Toward a Trauma-Responsive Criminal Justice System - Why, How and What Next?”

What Happened to You? Understanding the Impact of Chronic Early Adversity and Neglect in Infancy and Early Childhood Ciara McCarthy, Senior Clinical Psychologist, Primary Care Psychology Service, Health Service Executive

Introduction: Going Back to the identify and intervene as early as possible Beginning with at-risk infants and parents. It is increasingly understood that the impact of early adversity and unresolved The following paper is an introduction to trauma is becoming one of the greatest the beginning, that is to say that it is a public health concerns of our time (Van brief overview of the emerging discipline Der Kolk 2014; Harris 2014). The lifelong of Infant Mental Health (IMH). As an early significance of early childhood intervention and prevention framework, experiences has interested developmental IMH holds the antenatal to three years as researchers, clinicians, neuroscientists, being the optimal time period to social scientists, psychoanalysts, intervene and ameliorate trauma and economists, policy makers, artists and adversity. When faced with complex writers and many more, for decades. trauma, well-meaning services often Questions such as: “Why do we have approach the assessment and unresolved and left over issues from our intervention with the question “what is childhoods? Why do events from the past wrong with you?” IMH is an approach influence the present? Why do past that adopts a more curious stance, asking events continue to influence our present the question “what is your story?” perceptions?” (Siegel, 2012) The paper describes the main content of These kinds of questions have a significant the presentation at the 5th Irish Criminal role when we begin to explore the long Justice Agencies Conference in Dublin term impact of chronic early trauma and Castle on 4th July, 2018. There were two adversity. Like many practitioners video clips used during the presentation working across various services and which are recommended viewing while agencies with adults who present with reading the paper. They both last complex trauma, I often felt overwhelmed approximately two minutes and are and powerless to intervene meaningfully. available on YouTube: “Serve and Return I remember speaking about this with a Interaction Shapes Brain Circuitry” (Center clinical supervisor and describing how “I on the Developing Child at Harvard don’t know where to start!!” His reply University) and the “Still Face Experiment: was short and simple, he simply stated Dr. Edward Tronick”. “well…. start at the beginning”. While there is now widespread agreement that early experiences matter, the challenge faced by services and agencies is to

ICJA Conference 2018 - “Toward a Trauma-Responsive Criminal Justice System - Why, How and What Next?”

The Beginning- “Keeping the Baby in ideally her parent(s). She will leave the Mind” hospital with her mother who has been “There is no such thing as a baby, there is given no DIY book or parenting manual. only a baby & someone” (Donald However, the mother does have a highly Winnicott) influential “working model” or blueprint of relationships that has been embedded While the chances for a baby’s survival since she was a baby. This will go on to have improved significantly, it is not easy influence how she responds and cares for being born into the 21st century world. this new baby. Babies are not designed for noisy, fast moving and over stimulating The Beginning - Infant Mental Health environments. (Barlow & Svanberg 2010) “Babies don’t develop relationships with They are however driven to connect with caregivers. Relationships with caregivers their caregiver(s) who can help them develop babies.” (Powell et al 2014) make sense of the chaotic world that they find themselves in. (Powell, Cooper, Starting with the “beginning” has Hooper, & Benton, 2014) While this interested researchers for decades and connection is deemed essential for the has led to compelling evidence that early baby’s survival, the presence of a sensitive childhood experiences and relationships and responsive carer has more significant matter for lifelong mental and physical meaning than just meeting basic needs of health. (Cusick, Georgieff, 2018, Harris, hunger and shelter. The presence of the 2014; Barrandon et al, 2005) carer(s) is recognised as the most Internationally renowned child important ingredient for the baby’s social development experts now recognise that and emotional development, which in the first 1000 days, approximately from turn is central to their emotional well- conception to the second year of life mark being across the life span. a sensitive or unique period of development when the foundations for Imagine a baby who has been born in optimum physical and emotional well- Ireland today and for a moment consider being across the lifespan are established. how the next three years will determine: (Cusick, Georgieff, 2018, Stern, 1998, her mental health over the rest of her life, Schore, 1994, 2001, Shonkoff et al 2010) shape the brain she will live with for the It is equally recognised and acknowledged rest of her life and determine how much that the main ingredient of optimal her mental health will cost the state for development is the parent-child the remainder of her life. (Maguire, relationship. Carolan, 2017) Early parent-child relationships, which Decades of research has concluded that occur within multiple cultural and social this baby came into the world hard wired contexts, shape and support the to connect to a trusted attachment figure, development of social competence in

ICJA Conference 2018 - “Toward a Trauma-Responsive Criminal Justice System - Why, How and What Next?” young children, which is associated with prevention of disease begins in the first long term adaptive behavioural, years of life. The absence of a consistent, emotional and cognitive outcomes. sensitive and responsive care can have (Zeannah & Zeannah, 2009) When lifelong effects in two critical ways: the children experience abusive and accumulation of damage over time and or neglectful care their development is the biological embedding of trauma and significantly compromised and the need adversity that can last a lifetime. for services significantly increases. (Shonkoff et al 2010) Adverse and traumatic experiences in childhood are significantly exacerbated What is Infant Mental Health? when they occur in the context of poor A well-documented definition of Infant infant-parent relationships. Mental Health was created by a steering group in the USA. (Zeannah & Zeannah, The long term impact of positive and 2009) The definition holds the infant negative experiences during infancy and central from antenatal to three years and early childhood has strongly influenced describes IMH as: the growing field of Infant Mental Health “The young child’s capacity to experience, (IMH) and the need to place it centre regulate, and express emotions, form stage in the broader context of public close and secure relationships, and explore health and prevention. (O’Connor & Parfit, the environment and learn. All of these 2009) IMH is a relational model that capacities will be best accomplished places central importance on the within the context of the caregiving relational experiences of the infant and environment that includes family, views the parent-infant relationship as the community, and cultural expectations for key ingredient for the baby’s optimal young children. Developing these social and emotional development, with capacities is synonymous with healthy far reaching influences. social and emotional development.” (Zero to Three, 2001) The theory and clinical applications associated with IMH are informed by The discipline of IMH is thought to have normative childhood developmental and emerged in the post second world war trajectories that occur within contexts at years when Selma Fraiberg’s clinical work risk. The goal of IMH interventions is to in Michigan in the USA fuelled her interest support infants and their families in in the influences on deviations from establishing, maintaining, returning to or normal infant development. She became developing a developmental pathway of increasingly interested about the social emotional competence and well- importance of the parent-child being. (Rosenblum, Dayton & Muzik, relationship. She explored the role of 2009) Developmental psychologist unresolved trauma in the parent’s history Shonkoff states that meaningful and how this went on to present in the promotion of optimal health and current relationship with the baby.

ICJA Conference 2018 - “Toward a Trauma-Responsive Criminal Justice System - Why, How and What Next?”

Fraiberg et al’s (1975) seminal paper highlighted the need for services to “Ghosts in the Nursery”, illustrated how intervene with mother and baby. He “the visitors from the unremembered emphasised this point when he stated “if pasts of the parents” continued to we want to look after our children, we influence how the parent(s) cared for and must cherish their parents”. interacted with the baby. (Fraiberg et al, 1975) Fraiberg punctuated how the Why is Infant Mental Health Important? presenting past in the current parent-child Infant mental health as a discipline relationship could compel the mother to recognises the significance of the repeat the unresolved trauma with her antenatal to age 3 years period of baby “in terrible and exacting detail”. development in relation to laying the Fraiberg went on to establish Parent foundations for optimum emotional and Infant Psychotherapy which essentially physical health throughout the lifespan. held the mother and baby as being central Central to this period are the interactional to the intervention. experiences of the infant with their caregiver. The parent-child relationship Alongside Fraiberg, John Bowlby who was plays a key role in: based in London was exploring his theory of attachment and the central role of the  Attachment primary care giver in ensuring the baby’s John Bowlby (1969) was a key figure in survival. Bowlby highlighted the way identifying infancy as a sensitive period parents cared and responded to the needs based on the baby’s need to develop a of their children, and the way they in turn “secure base” from which to seek comfort make sense of these experiences, plays a and protection and explore their pivotal role in child development. His environment. In essence, this is the pioneering work explored the devastating baby’s experience of having a predictable, impact of separating children from their trusted and reliable caregiver who primary carers during wartime influences the formation of an “internal evacuations in the UK and the long term working model” that in turn enables the effect of childhood experiences of child to form expectations or predictions deprivation and family dysfunction in of all future relationships. (Bowlby , 1969; relation to “delinquent behaviour” 1989) Bowlby viewed attachment as (Bowlby 1989). essentially an evolutionary process to maximise survival. Since then, Bowlby emphasised the central attachment researchers have highlighted importance of attachment relationships how attachment has more significant and with regard to the baby’s emotional and far reaching functions. Decades of physical vulnerability, dependency, need research have led to widespread for protection, support and loving comfort agreement and acknowledgment that one from a reliable, consistent and stable of the most important aspects of a baby’s adult(s). Similar to Fraiberg, Bowlby also

ICJA Conference 2018 - “Toward a Trauma-Responsive Criminal Justice System - Why, How and What Next?” development is her attachment to the attachment is described throughout the adult or adults who care for her. literature as being indicative of patterns known as insecure avoidant; insecure A major finding from the attachment ambivalent and insecure disorganised. research over the past number of decades is that the greatest predictor of an infant’s Ainsworth (et al 1978) described how attachment security is the sensitivity and insecure attachment patterns of relating responsiveness of the parent. Mary emerge in the context of the parent’s Ainsworth and her colleagues (1978) inability to provide consistent, sensitive described the importance of the parent and responsive care. Insecure avoidant being attuned to the infant’s cues and strategies emerge as an infant needs, and responding in a meaningful, experiences the emotional unavailability predictable and consistent way. Within or withdrawal of the parent at times when this relational context the child is most they need them the most. In essence the likely to develop a secure attachment that infant “under regulates” their behaviour leads to the development of an internal when faced with overwhelming emotions working model of the ‘self’ that is lovable, for fear that they will drive the parent accepted and of interest to others, and of away. The child soon develops a adults as caring, protective and available. relational pattern that appears physically and emotionally independent as he or she In the context of the parent-child learns that the expression of needs has no relationship, the baby develops a range of meaningful influence on the parent. attachment behaviours that are aimed at (Ainsworth et al 1978) keeping the parent close in order to act as a “secure base”. Attachment behaviours The pattern of insecure ambivalent are activated at times of real or emerges within the context of a parent threatened separation, physical rejection who provides an inconsistent level of or frightening conditions within the responsiveness and sensitivity to the environment. Over time, these infant. Given that the infant experiences attachment behaviours emerge as the parent as being unreliable or habitual ways of relating to parents that unpredictable with regard to care, the have become known as “patterns of child over regulates their behaviour by attachment” which may be considered appearing overly clingy and dependent on “secure” or “insecure”. While most the parent. The infant or toddler fails to babies develop a secure attachment to develop the capacity to use the their parent(s), there are a significant relationship as a reliable secure base. This number who develop an insecure manifests in what may appear as attachment. This group of children are aggressive, disruptive and inconsolable considered to be at an increased risk of behaviour as the infant or child amplifies significant mental health difficulties in their emotional needs in an attempt to later child and adulthood. Insecure

ICJA Conference 2018 - “Toward a Trauma-Responsive Criminal Justice System - Why, How and What Next?” gain much needed connection. (Ainsworth A growing body of research highlights that et al 1978) while early relational patterns or “working models” can be modified, they are The third pattern of insecure attachment resistant to change as they begin at a was described by Main & Solomon (1990). preverbal stage of development. Repeated experiences of being with a (Crittendan, 1990) A significant mother, who is frightened or frightening, association between the parent’s leave the infant with what is known as “working model” and the infant’s suggests “disorganised attachment”, and is that insecurely attached adults are more particularly relevant to infants and likely to foster insecurely attached children who experience prolonged abuse children. (Fonaghy et al, 1991) and/or neglect. For some children the Attachment researcher Mary Main placed parent is the source of trauma when a strong emphasis on the role of repeated experiences of abuse and unresolved trauma and/or loss in the neglect become central to their parent’s early life. She stated that the interactions. Attachment as a relational enduring effects of these negative system serves to motivate the infant to experiences impact on parenting because seek proximity to the parent at times of of the chronic lack of opportunities for the distress. It follows then that a child is left parent to make sense of their early with a huge dilemma when the very trauma experiences. source of comfort is in fact the same source of fear. The terror experienced by  Brain development the child can be in numerous forms such “Human connections make neural as verbal, emotional, sexual, physical connections” (Siegel, 2012) abuse, parental intoxication, and exposure to domestic violence. Disorganised and The foundations of brain architecture chaotic behaviours manifest as the child begin before birth and continue into attempts to manage overwhelming adulthood. The antenatal to three years distress. Attachment strategies and represents a “sensitive period” of behaviours may appear as being development. This essentially refers to ambivalent or confused such as the infant “biological time points” during which the seeking the proximity to the parent only effects of experiences on the brain are to aggressively pull away at the last particularly strong and when certain types minute or hit out at the parent at times of of experience need to be present. (Cusick reunification. Other observable et al 2018; Shonkoff et al 2010) behaviours are zoning out or dissociating Essentially they are time periods of at times of distress. It is estimated that development when infants are most over 80 per cent of infants and toddlers receptive and expectant of specific who experience adversity and trauma in stimuli, experiences and interactions that their early years develop a disorganised are the essential ingredients for optimal attachment. (Siegel & Hartzel, 2014) development.

ICJA Conference 2018 - “Toward a Trauma-Responsive Criminal Justice System - Why, How and What Next?”

The quality and nature of these brain architecture. (Shonkoff 2010, experiences affect the development of the Tronick 1989) brain which provides the foundation for all future learning, behaviour and health. In the “Serve and Return” video clip we (Siegal, 2014) Similar to how the weak can observe serve and return interactions foundations of a house impacts the between a mother and young baby. The strength and quality, experiences in early interactions illustrate the reciprocal life can impair brain architecture, with nature of the communication through negative effects that can last a life time. facial expressions and gestures. These (Shonkoff et al, 2010) daily back and forth communications are deemed essential in forming neural The interactions of genes and early connections in the brain, which are the experiences are an essential process for building blocks for more complex shaping the developing brain. While connections that emerge later. The early genes effectively provide the genetic interactions, in the context of a sensitive blueprint for the formation of brain and responsive parent-child relationship, circuits, it is through repeated support the social and emotional well- interactional experiences that lead to being of the infant and the emerging them being reinforced. Developmental cognitive and linguistic capacities that are psychologist Edward Tronick began to deemed essential for meaningful take a closer look at the specific participation in the school, workplace and interactions between mothers and infants community. (Shonkoff et al 2000) that were thought to influence learning, cognitive, social and emotional In the absence of consistent sensitive and development. He began to explore and responsive caregiving the brain’s observe “protoconversational turn taking” architecture cannot develop as it is also known as “Serve and Return”, biologically expected or intended, leading between mothers and preverbal infants as to disparities in later learning and young as two months. Tronick’s behaviour. A developmental psychologist observations helped to illustrate the from Harvard University emphasises the baby’s instinctive skills and strategies to unique opportunity in the early years as engage in face to face social experiences he describes how optimal interactions and the key presence of a sensitive adult allow the brain to develop in a way that is to respond and make sense of the similar to pushing open a door with a light interaction. The baby actively uses social touch. In the absence of optimal care skills such as babbling, facial expressions during the early years “this is more like and or gestures to engage the adult who trying to push open a heavy door that in turn responds to the communication in weighs about 1000 pounds”. a meaningful way. (Murray, 2014) “Serve and Return” interactions are considered to be the main ingredient for optimal

ICJA Conference 2018 - “Toward a Trauma-Responsive Criminal Justice System - Why, How and What Next?”

 Self-Regulation  Adverse Childhood Experiences Self-regulation is widely recognised as (ACES) playing a pivotal role in promoting social There is mounting evidence that traumatic and emotional wellbeing throughout the Adverse Childhood Experiences (ACES) lifespan including mental and physical have long term consequences for physical, health, relationships, educational and mental health and social problems. ACES vocational achievements. It may be include: physical, sexual and emotional defined as the ability to manage thoughts abuse; neglect; exposure to domestic and feelings in order to enable goal violence; household substance misuse; directed actions and achievements. Self- parental separation/divorce; and regulation involves sets of behaviours that incarceration of close family member. are deemed essential for positive Consistent findings from the research outcomes in relationships, school, and the reveal that while ACES are common workplace and throughout life. (Gallinsky, among the population, they have a dose- 2010) While the term “self” implies that it response relationship with numerous is an individual or internal process, negative outcomes across the lifespan emotional regulation is essentially a including physical health and diseases, gradual, developmental process that social/emotional and behavioural begins at birth and continues throughout difficulties, risk behaviours and substance the lifespan. It is widely accepted and misuse. (Felitti et al 1998) In the context understood that babies cannot regulate of poor family functioning and the their emotional world and therefore need absence of early sensitive and responsive the presence of a parent to help them care the infant has no “buffer” or person manage and make sense of their feelings to help make sense of and mitigate the through the dyadic process of “co- trauma. Therefore, the trauma of ACES is regulation”. Sensitive and responsive care exacerbated with far reaching ensures that a baby is not overwhelmed consequences throughout physical and by distressing experiences as the presence mental health well-being. While poverty of the parent essentially supports the is associated with multiple risk factors for infant to be calm and make sense of the physical and emotional health, it is distress. In turn, the baby learns “my thought to exert its strongest influence on feelings are manageable”; “my feelings the outcomes for infants through its won’t push other people away”, “my effects on parenting. ACES are thought to feelings won’t kill me”. (Lyons et al, 2018) affect physical and emotional health in While the capacity for self-regulation may adults in a number of ways such as the grow, the relational process of co- accumulative damage over time and the regulation is deemed an essential biological embedding of adversity and resource throughout development and trauma during sensitive periods of indeed life. development. (Shonkoff, 2000) As one of the researchers stated “time does not heal all wounds, since humans convert

ICJA Conference 2018 - “Toward a Trauma-Responsive Criminal Justice System - Why, How and What Next?” traumatic experiences in childhood into  Interdisciplinary and Interagency organic disease in later life”. (Felitti et al IMH is recognised to be a multi- 1998) disciplinary and interagency field. It is not just of interest to any individual service,  “An ounce of prevention is worth a agency or discipline such as nursing, pound of cure” paediatric medicine, psychology, The economic benefits of early psychiatry or social work, but requires a intervention in the antenatal to age three comprehensive approach with regard to years period are well documented by child investment and commitment. There is development, mental health, social mounting recognition that the science, and economic researchers alike. implementation of an IMH framework While a large portion of studies have requires additional education, training originated in the USA, they are still and reflective supervision to build relevant to service providers and policy workforce capacity and competencies in makers closer to home. order to respond and meet the needs of infants and their parents/carers. A UK study in 2014 found that public (Svanberg & Barlow, 2010) health spending surrounding Perinatal Depression cost £8.5 billion a year. The Still Face Experiment - Dr. Edward Almost two thirds of these costs related to Tronick - “The Good, the Bad & the Ugly” the adverse impact on the child. (Bauer et In the brief “Serve and Return” video clip al 2014) In the USA longitudinal we observed the serve and return evaluations of early interventions tailored interactions that are described as being to support the parent and child to foster essential in the early years for optimal the optimal emotional and social brain development. We also observe development of infants have consistently these interactions in the video clip revealed positive results. Crucially in “Still Face Experiment” terms of physical and mental health (https://www.umb.edu/Why_UMass/Ed_ outcomes, the net benefits are shown to Tronic). We see a mother and baby aged increase over time and with the age of the one year engage in this developmental individual, far into the future. (Moffit et game of attunement. The baby serves al, 2008) Professor of Economics Cunha using babbling, smiling, pointing, and (2017) describes how several programmes other gestures to engage the mother who in the USA that targeted parent/infant in turn returns the serve with meaningful interventions aimed at improving the responses. Initially the mother is attuned emotional and social development, to the baby as she shares the emotional showed positive returns that were in line experience and responds to her needs in a and above some of the most attractive sensitive and regulating manner. The investments on the current stock market. mother uses warm, amplified facial expressions, a soft tone of voice, smiles and touch throughout the serve and

ICJA Conference 2018 - “Toward a Trauma-Responsive Criminal Justice System - Why, How and What Next?” return interaction. The baby responds of adrenalin, release of stress hormones and appears to experience the mother as and increased heart rate. “being with” her throughout the initial interaction. It is clear in the video clip Thankfully the mother does come back that this baby is used to the attuned serve and empathically co-regulates the infant’s and return experiences with her mother distress using facial expressions, a soft as she clearly serves with the expectation tone of voice, touch, and affection to that her mother will return. repair the disruption. The baby and mother return to the attuned dance of Tronick describes the interaction as “the “serve and return” with relative ease. The good” meaning the everyday attuned baby appears to recover and overcome moments when both mother and infant the distress with the return and emotional are engaged in playful, coordinated, co- availability of the mother. While the regulated and meaningful interaction. “bad” illustrates distress from the infant’s Attuned parents can engage in this dance perspective, experiences of disruption and or developmental game as they regulate repair with the parent are considered the interaction to meet the baby’s needs essential developmental processes. and repair disruptions with relative ease. Opportunities to repair and “reconnect” It is widely recognised that attunement is are associated with enhanced an essential ingredient in fostering a relationships, security and building secure attachment. resilience. (Rosenblum, Dayton & Muzik, 2009; Hoffman et al 2017) We go on to observe the mother disengaging from the interaction with the The “ugly” which we don’t fully observe in baby as she adopts a still face and non- this clip, is the baby’s prolonged responsive stance. Tronick refers to this experience of distress in the context of as “the bad”, as from the baby’s the emotional unavailability or absence of perspective the mother is now the mother. As Tronick describes, it is emotionally unavailable and unresponsive when the infant has no opportunity “to to her emotional needs. We painfully get the mother back” and therefore no observe how the infant “feels the stress” opportunity to regulate and make sense of her mother’s withdrawal and uses “all of or repair this experience. From the of her abilities to get the mother back”. baby’s perspective, this is terrifying and (Tronick) In a brief period, she attempts over time can foster detrimental to engage her mother through gestures, consequences. screeching, pointing, and eventually crying. The emotional unavailability or Hoffman et al (2017) urge us to imagine absence of her mother activates negative an acrobat free falling from a trapeze. He emotions and the baby’s stress response. lets go of his bar and reaches out his Physiologically her body and brain are hands expecting the support of his fellow now on alert “fight or flight”, with a rush acrobat to catch him, only to discover

ICJA Conference 2018 - “Toward a Trauma-Responsive Criminal Justice System - Why, How and What Next?” there is no one there. Expecting and sensory system as “implicit” or sensory needing someone to be there is memories. (Siegal 2012) Implicit memory experienced as a very real threat to is present from birth and continues survival. This frightening, prolonged throughout the lifespan. It involves the sensation of abandonment for a preverbal lower part of the brain, the amygdala, infant activates the stress response of which is responsible for basic biological “fight, flight or freeze” and becomes functions that are essential for survival embedded in “sensory” or implicit such as heart rate and temperature. memory. Chronic or toxic stress for an While implicit memory is non-verbal, it infant who has no capacity to understand involves the sensory systems of sight, or make sense of the frightening sounds, smells, touch and images and is sensations has detrimental effects that responsible for generating emotions, will endure for a life time. (Shonkoff et al behavioural responses, perceptions and 2012) bodily sensations. It requires no cognitive thought or awareness. It shows up in As a preverbal, sensitive developmental behaviour and actions without any period, toxic stress can lead to the conscious awareness that the memory or biological embedding of adversity. “sensation” is being recalled from a past Chronic exposure leads to structural and experience. functional abnormalities in sensitive regions of the brain: the amygdala, Additional trauma in the environment hippocampus and prefrontal cortex. such as loud noises or screams, banging, During the second year of life the infant’s aggressive handling, and neglect to meet brain is developing to incorporate more basic needs such as hunger are complex cognitive functions involving exacerbated in the context of the poor merging capacities for language, infant-parent relationships. The baby reasoning and problem solving. At the faces the impossible dilemma of needing very time cognitive skills are optimally the very person or buffer who is playing a unfolding to help and support a child to central role in the traumatic experiences. make sense of their experiences, toxic Implicit memory means that the body and stress derails the neural connections brain are compelled to a state of high needed for this developmental process. alert even when there is no apparent (Shonkoff & Garner, 2012) harm. In the absence of a sensitive and responsive adult the trauma and adversity It was assumed that babies would not become embedded within the sensory remember or recall the past because they system with far reaching consequences. lack the language skills to speak about Implicit memories are vulnerable to experiences. However, it is now reactivate frightening sensations in the understood that while a baby may not be present when the child or adult perceives able to speak about memories, the a facial expression, door slamming, touch, experiences are stored in the body and smell, scream, feeling of hunger as being a

ICJA Conference 2018 - “Toward a Trauma-Responsive Criminal Justice System - Why, How and What Next?” threat to their survival without having any responsibility of nurturing the optimal awareness that the original trauma emotional development of a baby and actually occurred in the past. child goes way beyond the parent and family to broader society. (Sroufe et al While going “back to the beginning” may 2005) In order to improve outcomes for be the ideal in an attempt to ameliorate infants and children it is vital that services early trauma and adversity, staying with are willing and supported to establish the beginning often proves challenging. approaches or frameworks that address Bearing witness to an infant or young the complex factors that influence the child experiencing emotional distress can early parent-child relationship. (Svanberg be an evocative and painful experience for & Barlow, 2010) the observer who may be a frontline practitioner, researcher, service manager, IMH in Practice in an Irish Context developer or policy maker. Despite the A major challenge in terms of service wide range of experience and expertise in delivery and provision is translating the the room on the day of the ICJA compelling evidence into practice. As a conference, there was a notable sigh of relatively new discipline, it is recognised relief when the baby’s distress in the internationally that there is a need to video came to an end. It is almost build workforce capacity and unthinkable to imagine that for some competencies among all services and infants this distress is experienced on an disciplines working with young children ongoing chronic basis with minimal or no and their parents. The Irish Association of opportunity to experience the sensitive Infant Mental Health (I-AIMH) was presence of a reliable carer. established in 2009 to advance the social and emotional health and well-being of It is challenging to think about or feel the infants, children and their families. Since distress of an infant. To do so can stir up then I-AIMH has provided training and issues that may resonate on a personal networking opportunities to advance the level in relation to one’s own childhood skills and competencies across all experiences and parent(s) and or one’s disciplines working with children under own children and parenting. It is five years. As an affiliate of the World understandable why we would use a Association of Infant Mental Health, I- range of defensive manoeuvres to keep AIMH launched their publication of the infant’s distress at a distance that can competency guidelines, I-AIMH often manifest as “them” and “us”. As Endorsement for Culturally Sensitive noted earlier, it is difficult being born into Relationship Focused Practice Promoting today’s modern society for all infants. It is Mental Health (McSweeney, Lovett & also difficult and at times overwhelming Maguire, 2018) earlier this year. Building being a parent in today’s increasingly on similar guidelines that were developed challenging and complex society. The by the Michigan Association of IMH, they discipline of IMH illustrates how the provide a framework that outlines the

ICJA Conference 2018 - “Toward a Trauma-Responsive Criminal Justice System - Why, How and What Next?” core knowledge, skills, capacities and implement a meaningful infant mental abilities for the early years’ entire health framework. workforce. (McSweeney et al 2018) The widely quoted proverb “it takes a village to raise a child” has a particular The emergence of the Area Based relevance when we consider young babies Childhood Programmes (ABC’s) across born in Ireland today. The responsibility Ireland has provided a meaningful of nurturing the baby’s optimal emotional platform to facilitate the implementation well-being belongs to all services, of an Infant Mental Health framework. As agencies, developers, and policy makers an early intervention and prevention working with children and families. programme, the ABC’s help to identify Meaningful investment and commitment infants, children and families living in to keep the baby in mind and support areas of disadvantage and considered to early child/carer relationships has far be at risk of a wide range of adverse reaching benefits for the individual, experiences. The most established family, community and society. Decades programmes are currently Young of compelling evidence support the need Ballymun (YB) in Dublin and Young for early intervention and prevention of Knocknaheeny (YK) in Cork. At the time of adverse and traumatic experiences in writing YK are about to launch their infancy and childhood. As Frederick “Learning Together” Young Knocknaheeny Douglass stated as far back as the 1800s Process Evaluation which documents the “it is easier to build strong children than to establishment and implementation of repair broken men”. As a relational their programme from January 2015 to model, IMH not only helps us to December 2017. This programme is understand “what has happened to you?” underpinned by an infant mental health but also how services and agencies can framework and is currently available on intervene meaningfully with infants, their website children and their carers. While early www.youngknocknaheeny.ie. A adversity and trauma may originate in the considerable number of other ABC’s are context of key infant/parent relationships, also implementing an IMH framework and IMH provides a vital framework that are at different stages of the process. nurtures those relationships to heal, These include Tallaght West, Finglas, repair and improve the outcomes for Ballyfermot, Clondalkin, Bray and infants, children, families and society. Limerick. There is no doubt that other ABC’s around the country will continue to Correspondence: Any correspondence in relation to benefit from the YK guidance and support. this article may be directed to Ciara McCarthy at [email protected] It is hoped that other services, agencies Acknowledgments: This paper was completed in and policy makers will make a similar consultation with Dr. Catherine Maguire, Senior investment and commitment to Clinical Psychologist Infant Mental Health Specialist & Mentor, Young Knocknaheeny, Cork.

ICJA Conference 2018 - “Toward a Trauma-Responsive Criminal Justice System - Why, How and What Next?”

Vicarious Trauma: The Impact of Working with Survivors of Trauma Dr. Sharon Lambert, School of Applied Psychology, University College Cork

Practitioners who work in the criminal childhood experiences (Teicher & Samson, justice services, both statutory and 2013). This conference paper will discuss voluntary, have long known that a huge the impact on front line staff of working number of the people they come into with vulnerable people and ways in which contact with have long histories of organisations can respond to improve challenging life circumstances. While in outcomes for service users, staff and the Ireland we have limited data regarding the whole organisation. In order to breadth and depth of traumatic understand the impact on staff we must experiences in the lives of people who are first understand the types of trauma incarcerated, we are aware that most presenting. emerge from situations of marginalisation, poverty, mental health and addiction1, Psychological trauma can be understood (Kennedy et al., 2005). There is growing as exposure to primary trauma (i.e. recognition that early life experiences, directly exposed to a traumatic event) and particularly adverse childhood secondary trauma (indirect exposure to experiences, have a direct role in the traumatic events from exposure to others development of later negative events and stories). It is important to not assume behaviours (Taylor et al., 2008: Fellitti et that all clients present with primary al 1998). The public often lacks empathy trauma and that all staff are impacted by for those who commit crime (Schissel, secondary trauma. However, to act as if 2016) as too can professionals (Kjelsberg there is a trauma history maximises the et al., 2007). However, the client safety of the worker and client by blameworthy perspective is being reducing the likelihood of further re- challenged by advances in research, traumatisation (SAMSHA, 2014). There particularly public health, neuroscience are many variables at play in human and developmental psychology. This new services organisations. As workers we evidence indicates that people who have bring with us our own life experiences and been exposed to chronic stress and some of us will have been exposed to our trauma in childhood are not engaged in own personal trauma histories. ‘bad behaviour’ but ‘adaptive behaviour’ Additionally workers can face primary (Lambert & Gill-Emerson, 2017). Adverse trauma experiences through their work, structural changes occur in the developing such as exposure to threats and violence, brain due to exposure to adverse finding a person deceased etc. (McGinley & Lambert, 2018). It is important to be

1 Oberstown Children’s Detention Campus (2018). cognisant of our own stories and how this Key characteristics of young people in detention. may make us more vulnerable to hearing https://www.oberstown.com/wp- the stories of others. content/uploads/2018/06/Key-Characteristics- 2018.pdf

ICJA Conference 2018 - “Toward a Trauma-Responsive Criminal Justice System - Why, How and What Next?”

Trauma can be classified and includes emerging and on-going but it is argued developmental trauma, intergenerational that epigenetic changes occur in the trauma, and one off trauma events such presence of consistent toxic stress as illness or accident. The last ten years (Meaney, 2010 ). Advances in has seen an increased interest in Adverse neuroscience have revealed that exposure Childhood Experiences (ACEs) and their to toxic stress or trauma in childhood impact on later life outcomes. The impacts on the ways in which the original ACE study conducted by Fellitti et developing brain hard wires with very al. (1998) utilised a ten item scale serious consequences for later life recording a range of traumatic events in functioning (Shonkoff et al., 2009; Danese childhood such as abuse, neglect and et al., 2012). The adult brain is not fully household dysfunction (e.g. loss of a formed until the 25th year of life and parent, exposure to addiction, mental undergoes many changes throughout health and domestic violence). This study childhood and adolescence (Johnson, had been replicated many times and the Blum & Giedd, 2009). Experiences of a findings indicate that exposure to early warm responsive caregiver and exposure life adversity increases the risk for poor to a range of educational experiences physical and mental health and poor facilitate healthy brain development social functioning (Lambert & Gill- (Gunner, 1998). However, exposure to Emerson, 2017; Bethell et al., 2014), even toxic stress or developmental trauma can in the absence of health risk behaviours cause synaptic pruning or the death of (Fellitti et al., 1998). The original study neural connections at just the time when revealed that exposure to adverse the brain should be forming and growing childhood experiences is common with (Schore, 2001)2. Individuals exposed to almost 40% of the general population high levels of stress have highly experiencing two ACEs. However this responsive fight or flight systems (Danese decreases to 12.5% for four or more ACEs. & McEwen, 2012). Arousal of the It has been argued that four ACEs are sympathetic nervous system has clinically significant and that each consequences for thinking and behaviour additional ACE has a dose response for (Perry et al., 1995); individuals whose increasing the likelihood of illness and systems are set on flight or fight dysfunction (SAMSHA, 2018). For experience both their internal and example a score of 4 increases the risk for external world as threatening (Janoff- attempted suicide 23.2 times (WHO, Bullman, 1989). The behavioural 2014). manifestation of this stress response can range from aggression to withdrawal Is this then simply a case that having a bad (Kisiel et al., 2014). Often these childhood means you engage in bad behaviours are viewed as challenging behaviour? Not necessarily, and the research reveals that it is much more 2 complicated than that. Research is https://developingchild.harvard.edu/resources/tox ic-stress-derails-healthy-development/

ICJA Conference 2018 - “Toward a Trauma-Responsive Criminal Justice System - Why, How and What Next?” when in fact the impacted individual has of high risk behaviours, social dysfunction little control over these automatic and risk of early death (Fellitti et al., 1998; systems. The ‘challenging’ behaviours Lambert & Gill-Emerson, 2017) presenting may well have once been required for survival in childhood. An ACE study was conducted in a Cork based homelessness organisation. A Research advancements have improved collaboration between Applied our understanding of the impact of Psychology, UCC, the HSE Adult Homeless trauma. In terms of understanding the Integrated Team and Cork Simon implications of this for a criminal justice Community, the study collected ACE and context one must consider the profile of other data from fifty service users. The those passing through the systems. results indicated very high levels of Within the criminal justice system there exposure to early childhood adversity and are a disproportionately higher number of demonstrated the stark differences former care leavers, mental health between the childhoods of those sufferers, and people experiencing experiencing homelessness and those homelessness, people from impoverished from the general public (See figure below: and deprived backgrounds and those who courtesy of Cork Simon Community). are socially excluded. High levels of childhood trauma have been identified in The evidence suggests that many people all of these cohorts. There can be no transitioning through the criminal justice dispute but that the most vulnerable and system have high levels of trauma and marginalised amongst our community are researchers would argue that there is a those who end up incarcerated. Exposure potential for trauma contagion (Gill- to childhood adversity with limited or no Emerson, 2015). Trauma contagion refers intervention leads directly to the adoption to the concept that working with trauma

ICJA Conference 2018 - “Toward a Trauma-Responsive Criminal Justice System - Why, How and What Next?” survivors may increase the risk for connection with service users (Jacobson, vicarious trauma, secondary traumatic 2006). Burnout occurs when the demands stress and burnout for some. The terms outweigh the resources and results in are at times used interchangeably in the physical and emotional fatigue that may literature. According to Pearlman & Mac also result in disengagement from work Ian (1995) vicarious trauma occurs and the depersonalisation of service following long-term exposure to the users. This is an adaptive response where stories of traumatised service users and the stress becomes so overwhelming that, may cause decreased motivation and in order to continue to function, the empathy. An additional feature of this is a worker needs to disengage from risk of a ‘distorted world view’ (McCann & empathising with service users in order to Pearlman, 1990). The experiences of protect one’s own mental health; this workers in front line services represent a usually occurs over a period of time and small minority of the general population may be an unconscious process for the as a whole. However if a worker develops worker. Other symptoms of burnout may vicarious trauma they may perceive their include feelings of helplessness and world as more unsafe than the actual despair, insomnia, health risk behaviours statistical risk. Staff may isolate (e.g. over eating, misuse of substances), themselves from others who do not work difficulties within personal relationships in front line services as they no longer etc. (Baker et al., 2007; McGinley & hold similar views of risk, danger and Lambert, 2018). It can become systemic trauma and may tend to gravitate more in that a whole organisation can be towards others who share similar impacted. Vicarious and secondary occupational experiences. Secondary trauma have been described as trauma stress differs to vicarious trauma ‘occupational hazards’ for those who work in that it does not change a person’s in front line services, therefore the world view. It has instead been described organisations have a “practical and ethical as a syndrome among staff working with responsibility to address this risk” (Bell, trauma survivors that mimics post- Kulkarni, & Dalton, 2003, p. 465). There traumatic stress disorder (Figley, 1995). are a number of ways that an organisation This can be as a result of exposure to can respond to their staff needs; regular service users’ trauma stories or it can and effective supervision that is separate occur suddenly as a direct result of and distinct from line management, the exposure to a stressful incident such as focus is on the impact of the work. violence or finding a service user dead Reflective practice in supervision is an (Baird & Kracen, 2006; McGinley & effective way to reduce the impact of the Lambert, 2018). It must be noted that not work on staff (O’Sullivan, 2018). A work all staff in front line services are impacted environment that demonstrates good by secondary or vicarious trauma and practice in relation to self-care is vital. many report feeling satisfaction with their ability to offer care and develop a

ICJA Conference 2018 - “Toward a Trauma-Responsive Criminal Justice System - Why, How and What Next?”

Addressing the trauma needs of both content/uploads/2018/06/Key- service users and staff results in a range of Characteristics-2018.pdf benefits for the organisation such as 3. Taylor, P., Moore, P., Pezzullo, decreased incidents, increased morale L., Tucci, J., Goddard, C. & De Bortoli, and staff retention to name but a few. L. (2008). The Cost of Child Abuse in Many organisations that provide services Australia. Available from: to vulnerable and marginalised groups URL: http://www.stopchildabusenow.c now recognise the importance of adopting om.au/pdf/Access%20Economic%20R a trauma informed work environment. A eport_Exec%20Summary_FINAL.pdf trauma informed environment is one that 4. Kjelsberg, E., Skoglund, T. H., & understands the impact of trauma on Rustad, A. B. (2007). Attitudes towards both service users and staff and makes prisoners, as reported by prison changes to policies, procedures and inmates, prison employees and college practices (SAMSHA, 2014). A trauma students. BMC Public Health, 7(1), 71. informed service does not necessarily 5. Lambert, S., & Gill-Emerson, G. (2017). treat trauma using clinical interventions. Moving towards trauma-informed It does however recognise the levels of care. A model of research and practice trauma within its organisation and www.drugandalcohol.ie responds to these (Lambert & Gill- 6. Teicher M., & Samson J. (2013). Emerson, 2017). Workspaces have Childhood maltreatment and become increasingly focused on output, psychopathology: A case for risk management and paperwork. Taking ecophenotypic variants as clinically the focus away from the people, both and neurobiologically distinct staff and service users, increases the risk subtypes. Am J Psychiatry. for all involved including the organisation 170(10):1114- 33. itself. Workplaces need to invest in 7. Substance Abuse and Mental Health understanding trauma and its impact in Services Administration (SAMHSA). order to maximise the safety of all within Trauma-Informed Care in Behavioral that organisation. Health Services. Treatment Improvement Protocol (TIP) Series 57. References: HHS Publication No. (SMA) 13-4801. 1. Kennedy et al., (2005). Mental Illness Rockville, MD: Substance Abuse in Irish Prisoners. and Mental Health Services http://www.drugsandalcohol.ie/6393/ Administration, 2014. 1/4338_Kennedy_Mental_illness_in_Ir http://store.samhsa.gov ish_prisoners.pdf 8. Felitti, V. J., Anda, R. F., Nordenberg, 2. Oberstown Children’s Detention D., Williamson, D. F., Spitz, A. M., Campus (2018). Key characteristics of Edwards, V., ... & Marks, J. S. (1998). young people in detention. Relationship of childhood abuse and https://www.oberstown.com/wp- household dysfunction to many of the leading causes of death in adults: The

ICJA Conference 2018 - “Toward a Trauma-Responsive Criminal Justice System - Why, How and What Next?”

Adverse Childhood Experiences (ACE) 15. Meaney MJ. (2010). Epigenetics and Study. American journal of preventive the biological definition of gene x medicine, 14(4), 245-258. environment interactions. Child 9. Bethell, C. D., Newacheck, P., Hawes, Dev.;81:41-79. E., & Halfon, N. (2014). Adverse 16. Johnson, S. B., Blum, R. W., & Giedd, J. childhood experiences: assessing the N. (2009). Adolescent maturity and the impact on health and school brain: the promise and pitfalls of engagement and the mitigating role of neuroscience research in adolescent resilience. Health Affairs, 33(12), health policy. Journal of Adolescent 2106-2115. Health, 45(3), 216-221. 10. Substance Abuse and Mental Health 17. Music, G. (2016). Nurturing natures: Services Administration (SAMHSA), Attachment and children's emotional, (2018). Adverse Childhood sociocultural and brain development. Experiences. Routledge. https://www.samhsa.gov/capt/practic 18. Schore, A. N. (2001). The effects of ing-effective-prevention/prevention- early relational trauma on right brain behavioral-health/adverse-childhood- development, affect regulation, and experiences infant mental health. Infant mental 11. World Health Organisation (2014). health journal, 22(1‐2), 201-269. http://www.euro.who.int/__data/asse 19. Gunnar, M. R. (1998). Quality of early ts/pdf_file/0010/267283/Survey-on- care and buffering of neuroendocrine the-prevalence-of-adverse-childhood- stress reactions: Potential effects on experiences-among-young-people-in- the developing human brain. the-Russian-Federation-Eng.pdf Preventive medicine, 27(2), 208-211. 12. Johnson, S. B., Blum, R. W., & Giedd, J. 20. Perry, B. D., Pollard, R. A., Blakley, T. N. (2009). Adolescent maturity and the L., Baker, W. L., & Vigilante, D. (1995). brain: the promise and pitfalls of Childhood trauma, the neurobiology neuroscience research in adolescent of adaptation, and “use‐dependent” health policy. Journal of Adolescent development of the brain: How Health, 45(3), 216-221. “states” become “traits”. Infant 13. Danese A, McEwen BS (2012). Adverse mental health journal, 16(4), 271-291. childhood experiences, allostasis, 21. Janoff-Bulman, R. (1989). Assumptive allostatic load, and age-related worlds and the stress of traumatic disease. Physiol Behav.;106:29-39. events: Applications of the schema 14. Shonkoff JP, Boyce WT, McEwen BS construct. Social cognition, 7(2), 113- (2009). Neuroscience, molecular 136. biology, and the childhood roots of 22. Kisiel, C. L., Fehrenbach, T., Torgersen, health disparities: building a new E., Stolbach, B., McClelland, G., Griffin, framework for health promotion and G., & Burkman, K. (2014). disease prevention. JAMA.;301:2252- Constellations of interpersonal trauma 9. and symptoms in child welfare:

ICJA Conference 2018 - “Toward a Trauma-Responsive Criminal Justice System - Why, How and What Next?”

Implications for a developmental disaster management services. Journal trauma framework. Journal of Family of Workplace Behavioral Health, 21(3- Violence, 29(1), 1-14. 4), 133-152. 23. Wilson, F. E., Hennessy, E., Dooley, B., 28. Figley, C. R. (1995). Compassion Kelly, B. D., & Ryan, D. A. (2013). fatigue: Toward a new understanding Trauma and PTSD rates in an Irish of the costs of caring. In B. H. Stamm psychiatric population: A comparison (Ed.), Secondary traumatic stress: Self- of native and immigrant care issues for clinicians, researchers, samples. Disaster health, 1(2), 74-83. and educators (pp. 3-28). Baltimore: 24. Pearlman, L. A., & Mac Ian, P. S. The Sidran Press. (1995). Vicarious traumatization: An 29. Gill-Emerson, G. (2015). The Trauma empirical study of the effects of Contagion. Eisteach, 15(1), 8-11. trauma work on trauma therapists. 30. McCann, I. L., & Pearlman, L. A. (1990). Professional Psychology: Research and Vicarious traumatization: A framework Practice, 26(6), 558. for understanding the psychological 25. Bell, H., Kulkarni, S., & Dalton, L. effects of working with (2003). Organizational prevention of victims. Journal of traumatic vicarious trauma. Families in Society: stress, 3(1), 131-149. The Journal of Contemporary Social 31. Baird, K., & Kracen, A. C. (2006). Services, 84(4), 463-470. Vicarious traumatization and 26. Baker, L. M., O’Brien, K. M., & secondary traumatic stress: A research Salahuddin, N. M. (2007). Are shelter synthesis. Counselling Psychology workers burned out?: An examination Quarterly, 19(2), 181-188. of stress, social support, and 32. McGinley, M. & Lambert, S. (2018). coping. Journal of Family Homelessness: A Trauma Contagion? Violence, 22(6), 465-474. In press 27. Jacobson, J. M. (2006). Compassion 33. O’Sullivan, N (2018): Creating space to fatigue, compassion satisfaction, and think and feel in child protection social burnout: Reactions among employee work; a psychodynamic intervention, assistance professionals providing Journal of Social Work Practice, DOI: workplace crisis intervention and 10.1080/02650533.2018.1460589

ICJA Conference 2018 - “Toward a Trauma-Responsive Criminal Justice System - Why, How and What Next?”

Homeless Men with Mental Illness in Irish Prisons Dr. Conor O’Neill, Consultant Forensic Psychiatrist, Central Mental Hospital

Psychiatric bed numbers have reduced people being arrested, but people who sharply in recent decades from around are acutely psychotic are over- 20,000 in 1963 to under 2,500 today as represented in Irish prisons. part of the community policy of replacing Homeless, psychotic young men are less institution-based care with treatment and likely to qualify for bail, even when support in the person’s own home where charged with relatively trivial offences, possible. This process has been very compared with similar offenders who do effective for many people. not suffer from mental illness. This is because they tend to be unable to provide Certain sections of the population may be an address or a small sum of money. unable to benefit from this approach. It is argued that this applies particularly to Young psychotic men may paradoxically homeless, impoverished young men with have the greatest difficulty accessing psychotic illnesses like schizophrenia, at psychiatric services at times when they times when they are acutely ill and most are most in need. Homelessness may lead in need. It has been suggested that some to rejection by local services on the basis of these are people who would previously that they are “not from the catchment have been admitted to hospital when area” - this may occur even when people there were more beds. The number of have been born and reared in a given prison places has increased as the number area, later becoming homeless in the of psychiatric hospital beds has reduced in context of psychotic illness. Admissions, recent decades. when they do occur, are much shorter than in the past. Among the most severe forms of mental illness are conditions related to Psychiatric Hostels, developed to enable schizophrenia. When people are acutely certain “long stay” patients from previous unwell with these conditions, they may be decades to return to the community, are unable to think clearly, experience not equipped to deal with young men frightening hallucinations (such as hearing with recurrent psychotic conditions. Night voices, often menacing or frightening shelters whereby these young men which seem real to the person wander the streets during the day are experiencing them), and delusions unlikely to provide the stable base (believing things which are bizarre and envisaged in “Housing First” (1) for these untrue, for example paranoid beliefs young men to manage their mental illness about those close to them). or avoid drug use. Frequent relapses are to be expected in such circumstances and Minor mental illnesses are unlikely to be meaningful recovery is highly unlikely. associated with behaviours that lead to Young single men are unlikely to be

ICJA Conference 2018 - “Toward a Trauma-Responsive Criminal Justice System - Why, How and What Next?” prioritised on a waiting list for housing. bed numbers in Ireland are less than one- Services such as the Father Peter McVerry quarter of those in equivalent western Trust do provide supports for these young jurisdictions such as the UK or Sweden. people at such times of greatest need. Ireland is also towards the lower end of countries in terms of per capita general This presentation argues, with evidence beds and mental health spend. over twelve years from Ireland’s main remand prison, that the current There were 2,408 psychiatric inpatients in systematic failure to fully implement the Ireland on a census date on 31st March, components of community care for 2016 (3). Of these, approximately half were younger men with psychotic illness, female. Over a quarter were in private largely from deprived areas, constitutes a hospitals, and unlikely to be accessible to “cycle of rejection” and echoes previous young psychotic men from deprived areas. examples in Irish history when our more Over one third were occupied by persons vulnerable young people have been ill- over 65 years and over one third were served at times of their greatest need. occupied by persons who had been in hospital for over one year. Again, such The National Forensic Mental Health beds are unlikely to be available to young, Service delivers a structured approach to psychotic men. Possibly 400-450 acute mental health care to the majority of beds are available nationally to young prisons in the state, involving screening, men from deprived areas with all assessment and treatment, liaison and psychiatric conditions. A system of pre-release planning. There is a validated psychiatric intensive care units planned in and structured approach to making the mental health blueprint “A Vision for decisions regarding location of treatment Change” (4) has not been delivered. and prioritising need for treatment (2). The DUNDRUM Toolkit has been adopted The large and continuing reduction in Irish in jurisdictions in Europe, America, psychiatric beds in recent decades has Australia and New Zealand. been associated with a similar increase in prisoner numbers. Typically, general Inpatient forensic psychiatry beds in psychiatric inpatients are approximately Ireland are only available at the Central 50% male, while prison populations and Mental Hospital, which has 97 beds. “forensic” psychiatric inpatients are Capacity to admit patients from prison has mostly men. Rates of the most severe reduced to a very small number each year, forms of mental illness, particularly in recent years. This is mainly because the psychotic illnesses, are much higher in number of people found not guilty by prison populations than in the reason of insanity has increased from one community, for both genders. Predicted or two a year to over ten a year since the forensic admission rates increase implementation of the Criminal Law exponentially in deprived urban areas (5,6). (Insanity) Act in 2006. Per capita forensic Men die by suicide at over five times the

ICJA Conference 2018 - “Toward a Trauma-Responsive Criminal Justice System - Why, How and What Next?” rate of women. The difference is even treated. Involuntary treatment when greater for men under 54 years. required cannot be given in prison under current legislation, as a result severely ill Numbers of young men with psychotic young men can spend long periods illness have increased sharply in Ireland’s untreated awaiting admission beds which main male remand prison at Cloverhill. are increasingly unavailable. Most of The presentation describes, for the nine those receiving inpatient treatment in years 2006 to 2014, a subgroup of recent years from remand settings have “revolving door” patients who repeatedly had this arranged in general psychiatric present to remand prisons, usually after hospitals, rather than the Central Mental minor offences, at times when they are Hospital. homeless and actively psychotic. There is a need for a coherent approach Proactive screening, coupled with for delivering care for mentally ill men, diversion to appropriate healthcare (as particularly those who are poor, homeless recommended in “A Vision for Change”) and suffer from the most severe has helped to mitigate the time such conditions. It is argued that the people spend in toxic prison environments catchment area approach leads to where they cannot benefit from discrimination against young men with treatment (7-10). However, as the small psychotic illnesses, so that at times of number of acute inpatient beds continues greatest need it is most difficult for them to shrink year on year, psychotic young to access community inpatient services. men accumulate in larger numbers and spend longer in prison before they can There is a need for increased funding for, access treatment which cannot be and access to, beds for Homeless delivered in prison. Psychiatry services. There is a need for more access to psychiatric intensive care Conclusions: facilities. There is a particular need for There are a large number of young men Intensive Care Rehabilitation Units (ICRU) suffering from very severe mental illness as identified in the policy document “A in Irish prisons. A number present Vision for Change”. In order for these repeatedly at times when they are young men to achieve meaningful homeless, actively psychotic and charged recovery, quality of life and dignity, they with minor offences. As the number of require access to longer term structured, psychiatric beds accessible to young men supported, secure care. There is a need continues to reduce year on year, and in for more forensic inpatient places for the absence of non-forensic Intensive those who could not be managed in such Care Rehabilitation Beds in most parts of ICRU facilities. Ireland lacks certain the country, these severely ill young men legislative options for diversion, accumulate in toxic prison environments community treatment orders and hospital where they cannot be appropriately orders as exist in other jurisdictions.

ICJA Conference 2018 - “Toward a Trauma-Responsive Criminal Justice System - Why, How and What Next?”

While some people charged with serious http://www.hrb.ie/fileadmin/publicati offences will need forensic care, many of ons_files/Irish_Psychaitric_Units_and_ those charged with less serious offences Hospitals_Census_2016_Main_Finding can and should be managed by local s.pdf general mental health services. Being homeless should not act as an obstacle to 4. Department of Health and Children this. There needs to be an identified (2006) A Vision for Change. Report of person or position at national level to the Expert Group on Mental Health resolve issues of catchment area Policy. Stationery Office, Dublin. responsibility for such individuals. 5. O'Neill C, Sinclair H, Kelly A, Kennedy References: H. Interaction of forensic and general 1. Substance Abuse and Mental Health psychiatric services in Ireland: Services Administration (SAMHSA) Learning the lessons or repeating the Rockville (MD): SAMHSA; 2007. mistakes? (Original Research) Irish SAMHSA’s National Registry of Journal of Psychological Medicine Evidence-based Programs and 2002; 19 (2): 48-54. Practices. Pathways’ Housing First https://www.cambridge.org/core/jour program. US Department of Health nals/irish-journal-of-psychological- and Human Services. medicine/article/interaction-of- http://www.nrepp.samhsa.gov/ViewIn forensic-and-general-psychiatric- tervention.aspx?id=365. services-in-ireland-learning-the- lessons-or-repeating-the- 2. Kennedy HG, O’Neill C, Flynn G, Gill P, mistakes/9D5AF1454E57D23DF42A2A The Dundrum Toolkit. Dangerousness, 8E13E98D49 Understanding, Recovery and Urgency Manual (The Dundrum Quartet) 6. O'Neill C, Kelly A, Sinclair H, Kennedy V1.0.22 (18/03/10). Four Structured H. Deprivation: Different implications Professional Judgment Instruments for for forensic psychiatric need in urban Admission Triage, Urgency, Treatment and rural areas. (Original Research) Completion and Recovery Social Psychiatry and Psychiatric Assessments, Dublin, Ireland, Trinity Epidemiology 2005 College Dublin, April, 2010. http://hdl.handle.net/2262/391 7. O'Neill C. Liaison between Criminal 31 Justice and Psychiatric Systems: Diversion Services. (Editorial) Irish 3. Daly A, Craig S. HRB Statistics Series 32 Journal of Psychological Medicine Irish Psychiatric Units 2006; 23 (3): 87-88. and Hospitals Census 2016: Main www.ijpm.org/content/pdf/317/edit.p Findings. Health Research Board, df Dublin, 2017.

ICJA Conference 2018 - “Toward a Trauma-Responsive Criminal Justice System - Why, How and What Next?”

8. McInerney C, O’Neill C. Prison Inreach 10.1186/1752-4458-7-18. and Court Liaison Services in Ireland. https://ijmhs.biomedcentral.com/artic (Original Research) Judicial Studies les/10.1186/1752-4458-7-18 Institute Journal. 2008; Vol 2: 147-158. http://www.ijsj.ie/assets/uploads/doc 10. O'Neill C, Smith D, Caddow M, Duffy F, uments/pdfs/2008-Edition- Hickey P, Fitzpatrick M, Caddow F, 02/article/prison-psychiatric-inreach- Cronin T, Joynt M, Azvee Z, Gallagher and-court-liaison-services-in- B, Kehoe C, Maddock C, O'Keeffe B, ireland.pdf Brennan L, Davoren M, Owens E, Mullaney R, Keevans L, Maher R, 9. McInerney C, Davoren M, Flynn G, Kennedy HG. STRESS-testing clinical Mullins D, Fitzpatrick M, Caddow M, activity and outcomes for a Caddow F, Quigley S, Black F, Kennedy combined prison in-reach and court HG, O'Neill C. Implementing liaison service: a 3-year observational a court diversion and liaison scheme in study of 6177 consecutive male a remand prison by systematic remands. International Journal of screening of new receptions: a 6 year Mental Health Systems. 2016 Oct participatory action research study of 11;10:67. 20,084 consecutive male remands. https://ijmhs.biomedcentral.com/artic International Journal of Mental Health les/10.1186/s13033-016-0097-z Systems. 2013; 25 (7):18. doi:

ICJA Conference 2018 - “Toward a Trauma-Responsive Criminal Justice System - Why, How and What Next?”

Delegate Recommendations Towards Action Plans

Delegates answered questionnaires at the conclusion of each Workshop session and made the following recommendations which were presented during the final plenary session of the conference.

Workshop 1 - The Potential for Applying Delegate recommended actions for the Tusla-led Meitheal Practice Model in implementation in the near future: a Trauma-Responsive Criminal Justice  A professional qualification. System  A national strategy.

Delegate recommended actions for implementation immediately: Workshop 3 - Poverty, Homelessness,  Further development of inter-agency then Prison - and back to Poverty, work, particularly between Tusla and Homelessness again Criminal Justice agencies.  Tusla should deliver family and Delegate recommended actions for parenting programs. implementation immediately:  Increased supports for parents.  Mental Health - Improving psychiatric  Introduction of Trauma-Responsive services for the homeless, including training across all agencies. residential services.  Addiction- (a) Improving access to Delegate recommended actions for addiction services through implementation in the near future: collaboration with HSE services in  Mandatory training in the Meitheal prison and (b) establish a custodial process, similar to mandatory drug treatment centre for courts to reporting. refer or divert to.  Training for as many professionals as  Release - (a) Advance planning of possible in the Meitheal model and release and (b) Develop a different Trauma-Responsive care. style room for homeless prisoner access upon release.

Workshop 2 - Towards Trauma- Responsive Addiction Treatment Service Workshop 4 - Prisons: Trauma at Tabor Group in Cork Informed Interventions - Them and Us?

Delegate recommended actions for Delegate recommended actions for implementation immediately: implementation immediately:  Trauma-Responsive training for  Training of staff in Comprehensive frontline staff across all services. Resource Model (CRM).

ICJA Conference 2018 - “Toward a Trauma-Responsive Criminal Justice System - Why, How and What Next?”

 Development of research in CRM and  Simple changes, like ensuring victims complex Post Traumatic Stress do not need to sit across from the Disorder (PTSD). accused at the trial.  Better Public Awareness.  Raise awareness and promote  Feedback to Governors on the discussion about sexual violence and outcome of the CRM group. its effects to ensure public consciousness of trauma. Delegate recommended actions for  Adequate resourcing for supporting implementation in the near future: victims within the CJS.  Continued resourcing.  Make sure existing rights for victims  Shared research and learning. are implemented and realized.  A national roll-out.

 More understanding surrounding this area. Workshop 6 - Every Woman Every Story: Trauma, Criminality and Women

in Prison Workshop 5 - From Exclusion, through Delegate recommended actions for Muddle, to Rights: The Place of Victims implementation in the near future: in Sexual Offences Trials  Learn from the approach taken with Delegate recommended actions for women to see what can be applied to implementation immediately: men.  Devise strategies on how best to  Train staff to deal more effectively understand trauma in the courtroom with trauma of women in the prison setting. service.  Consider how to develop legal  Encourage and implement a peer-to- representation for victims of sexual peer structure. offence cases.  Reduce unnecessary committals to  Conduct further research into the prison. experiences of victims in the CJS to

understand the trauma they encounter and to seek their views on Workshop 7- Pathways to Prison - The how to improve the system. Experience of the Traveller Community  Training for lawyers and legal Delegate recommended actions for professionals on the best practice implementation in the near future: responses to trauma and to be  Study into the over representation of cognizant of trauma when carrying out the Traveller population in prisons. their work.  Awareness of the issues faced by the

travelling community, i.e. racism and Delegate recommended actions for discrimination. implementation in the near future:

ICJA Conference 2018 - “Toward a Trauma-Responsive Criminal Justice System - Why, How and What Next?”

 Awareness of the positive aspects of  Incorporate ACEs model risk the travelling community. assessment and practice.  Discussion on the wider societal issues  Inform clients of the benefits of doing facing the Traveller community and ACEs assessment. the impact of these on their mental health. Delegate recommended actions for implementation in the near future:

 Additional Research. Workshop 8 - Vulnerable Migrants and  Pilot Scheme ACEs. the Criminal Justice System  Massive investment in early intervention is needed. Delegate recommended actions for  Another conference on ACEs implementation near future: interventions.  Training and accreditation for translator services.  Translate essential legal documents. Workshop 10 - Addressing Psychiatric

 Trauma/Culturally-Responsive training and Psychosocial Morbidity in Irish for Criminal Justice Agencies Prisons interacting with vulnerable migrant groups and translators. Delegate recommended actions for  Changes in legislation for the implementation in the near future: temporary release of non-nationals.  Implementation of A Vision for Change  Encouraging minority groups to get recommendations. involved in public life.  Psychiatric nurses in Garda stations for  Look at best practices in other early diversion. countries.  Additional communication and coordination between the services.

 Better multi-disciplinary working and Workshop 9 – Trauma in Probation fewer barriers to patient entry. Practice  Increased numbers of low security beds for community diversion. Delegate recommended actions for  Customized treatment programs to implementation immediately: meet low IQ needs.  Interagency approach.

ICJA Conference 2018 - “Toward a Trauma-Responsive Criminal Justice System - Why, How and What Next?” WORKSHOP SUMMARIES

1. The Potential for Applying the agencies centred on being preventative, Tusla-led Meitheal Practice Model evidence-based, integrated and outcome- in a Trauma-Responsive Criminal focused. Central to this programme are five distinct but complementary and Justice System interwoven work packages: parental support, public awareness, participation, Presenters: Fergal Landy, Regional commissioning (which focuses on the use Implementation Manager for Prevention, of resources to achieve outcomes) and the Partnership and Family Support, Tusla, development of Child and Family Support and Eimear Ryan, Senior Speech and Networks and the Meitheal model. The Language Therapist, Assessment development of cohesive Child and Family Consultation and Therapy Service (ACTS) Support Networks and the Meitheal Chairperson: Enda Kelly Model at the front line alongside the Rapporteur: Kate Daniels development of strategic responses at Children and Young People’s Committees Introduction (Fergal Landy) together represent an opportunity to Tusla is the statutory state agency prevent and mitigate Adverse Childhood responsible for improving wellbeing and Experiences (ACEs) through the outcomes for children and families. development of trauma-informed Adverse childhood experiences and services. trauma-responsive care are among the broad range of services offered by Tusla. What is Meitheal? The Child and Family Agency’s services Tusla has a preventative resource include a range of universal and targeted structure in all of its seventeen areas services: implementing the Meitheal model. ● Child protection and welfare services Meitheal is a national early intervention ● Educational welfare services practice model to ensure that the needs ● Psychological services (ACTS Scheme) and strengths of children and their ● Alternative care (foster and residential families are effectively identified, care) understood and responded to in a timely ● Family and locally-based community way so that children and families get the services help and support needed to improve children’s outcomes and to realise their The Prevention, Partnership and Family rights. It places an importance not only Support Programme (PPFS) on the child but also on the parent to This programme aims to make all Tusla facilitate an open conversation with services and partnerships with other families. The Meitheal process facilitates

ICJA Conference 2018 - “Toward a Trauma-Responsive Criminal Justice System - Why, How and What Next?” the early identification of need; the co- strengths based and participatory nature production of a support plan to meet that of Meitheal may help to offset concerns need and the ongoing coordination and that ACE awareness and trauma-informed review of that support until the desired practice can be deficit oriented. outcome is achieved. In using Meitheal to coordinate supports to children in Pathways to Meitheal youth justice projects, Tusla has had direct ● Direct - as a result of a discussion involvement from An Garda Síochána, as between a parent and Lead Lead Practitioners as both Juvenile Liaison Practitioner Officers and Community Gardaí, and the ● Diverted - this occurs when the Irish Youth Justice Service. situation does not reach the threshold for social work intervention so the How does it work? family can be diverted Meitheal is a voluntary process in which ● Step down pathway - this occurs the relationship between the Lead following social work intervention Practitioner and the families is critical. All when further support would be aspects are led by the parent/guardian beneficial due to an outstanding and child/young person, from the decision unmet need to enter the process, to the nature of information to be shared, the outcomes Future Steps desired and the agencies to be involved. ● ACE aware and Trauma-informed Child The Lead Practitioner acts as a source of and Family Support Networks – all ongoing support in the families’ services working together locally with engagement with services and provides a common understanding of the practical assistance to parents and impact of adversity and trauma on children. children and young people’s lifelong developmental trajectory. A number of other strengths associated ● Meitheal as a multi-agency trauma- with Meitheal are also outlined. These informed process – training of Lead include its multi-agency approach, less Practitioners in ACE aware and trauma duplication of services provided to informed practice. families, improvements in communication ● Whole system approach (inclusive of between practitioners and between the Criminal Justice System, the HSE, practitioners and parents and the the Education System etc.) – wider development of more tailored plans to uptake and application of Meitheal to support families in reaching their ensure a whole system response to outcomes. Tusla recognises that all adversity and trauma. elements within Meitheal can be looked at with an ACE aware and trauma informed lens in order to achieve better outcomes for families and children. The

ICJA Conference 2018 - “Toward a Trauma-Responsive Criminal Justice System - Why, How and What Next?”

A Trauma Responsive Clinical Service: that is too hot can be a trigger for the What, Why, How & What Next? (Eimear general experience and feeling of not Ryan) having their needs met. When someone The Assessment Consultation & Therapy has experienced trauma, they see the Service (ACTS) provides a multidisciplinary world through a trauma lens. Difficulties in-reach clinical service to special care also present in the formation and units and Oberstown Children Detention maintenance of trusting relationships with Campus. ACTS consists of five disciplines: others. A trauma-responsive clinical social work, social care, speech and service is therefore fundamental to language therapy, addiction counselling engaging young people in secure settings. and clinical psychology. All clinicians share common skills around engaging and Why? working therapeutically with young Findings from a number of international people and their families. Young people studies such as the Adverse Childhood in secure settings generally present with Experiences (Feletti et al. 1998) high risk behaviour and complex clinical consistently demonstrate the long term needs. effects of childhood neglect and abuse. Closer to home, research exploring the What? views of young people and professionals As described by van der Kolk (2005), on the mental health needs of children developmental trauma disorder refers to: and young people with experience of the  Multiple exposure to developmentally care and youth justice systems in Ireland adverse interpersonal trauma and emphasised the requirement for services subjective experience to focus on engagement, significant  Triggered pattern of repeated relationships and trust (McElvaney et al. dysregulation in response to trauma 2013). Furthermore, a quantitative study cues based on an audit of mental health  Persistently altered attributions and screening profiles of young people in expectations detention in Ireland highlighted high  Functional impairment: educational, levels of traumatic experiences and a familial and peer, legal and vocational range of emotional/behavioural difficulties (McInerney et al. 2018). Young people with a history of developmental trauma tend to be ‘on How? alert’ and hyper-vigilant in their daily The therapeutic relationship between the routines. Responses in everyday young person and their key clinician is a interactions can be over- or under- what priority in a trauma-responsive clinical would be expected. Young people may service. Young people may already have re-enact their earlier traumatic met a large number of professionals in experiences without it being apparent their life and they may often have done so that they are doing so e.g. a cup of tea under duress. It is therefore crucial that

ICJA Conference 2018 - “Toward a Trauma-Responsive Criminal Justice System - Why, How and What Next?” clinicians take time to get to know the  More careful transition planning for young person and to be flexible in how young people as they return to the they try engage with them. Following the community young person’s lead provides the young  Continued focus on activities based person with a sense of agency and a ‘say’ modalities in how they work with the clinician. What  Development of specific evidence this looks like in practice includes based trauma interventions (e.g. changing the time of an appointment at EMDR, neuro-feedback) the young person’s request or engaging in a therapeutic session while the young Discussion person is shooting some basketball hoops. Participants were curious about the A trauma-responsive clinical service is one Meitheal model and recognized its that is creative and readily adapts to suit potential use in their own agencies and each young person’s needs and organizations. Some participants preferences. Relational repair through highlighted that the Meitheal model has reliability and consistency are also vital; already been implemented in their do as you say and don’t let the young agencies and workers are being trained in person down unexpectedly. A balance trauma-responsive care. The challenge of also needs to be struck between multi-agency work was also discussed. It assessment and intervention; the system was noted by delegates that all around young people is often keen for stakeholders need to be brought together repeat formal assessments and finding out to create a whole system approach. ‘what is wrong?’ so that it can be ‘fixed’. Instead, a trauma-responsive clinical Concerns were also raised in relation to service emphasises working with the how the parents of children in care can young person and developing a shared get more involved when their child is in understanding of their strengths and custody. It was noted that ACTS has weaknesses in a way that makes sense to services if a child wants more support in them and is helpful. Young people are transitioning back into the community. It then better able to think of goals in a was acknowledged that it is difficult to get therapeutic intervention and to monitor parents of children in care into Oberstown their own progress. Supporting the young due to practical problems and logistics. person to notice their gains and However, the service has plans to develop achievement, however small, can lead to a a wider network in the future, subject to development of a sense of mastery and government funding. competence. Delegates were delighted to hear and What next? learn about the Meitheal practice model  Increased systemic working with other and were enthusiastic about services implementing the process in their own agencies. A strong emphasis was placed

ICJA Conference 2018 - “Toward a Trauma-Responsive Criminal Justice System - Why, How and What Next?” on the need for multi-agency training. It  Initial Contact was also recommended that a public  Initial Assessment awareness and communications strategy  Stabilisation Period should be implemented to raise  Admission to Residential Programme awareness among professionals and at Tabor Lodge practitioners who could lead a Meitheal,  Admission to Residential Extended and also among the wider population. Care Treatment At Renewal (Women) and Fellowship House (Men) - 12 weeks  Sheltered Accommodation - 12 2. Towards Trauma-Responsive weeks Addiction Treatment Service at  Community Continuing Care Tabor Group in Cork Programme - 52 weeks  Community Family Programme - 4 Presenter: Mick Devine, Clinical Director, Weeks, 12 Weeks and 52 weeks Tabor Group, Cork Chairperson: Assistant Governor In 2017 there were 316 initial assessments Constantin Cazac completed, 213 admissions to Tabor Rapporteur: Rory Penny Lodge’s 28 Day treatment programme, and 183 who completed the residential Tabor Group is a leading provider of programme. The age profile of those residential addiction treatment services in admitted is generally between 25-45 Ireland. Tabor Lodge is their primary years, with the number of men admitted residential treatment centre. It is located twice that of women. The highest rates of 15 miles southwest of Cork City and is referral to the lodge are self-referral and surrounded by woodlands and rolling those from concerned families. pastures. Tabor Group was awarded ‘Rehabilitation Clinic of the Year’ at the What is Trauma? 2016 Irish Health Centre Awards. The Substance Abuse and Mental Health Services Administration (SAMHSA) Trauma When a traumatic state is triggered there and Justice Strategic Initiative states that: is a tendency to seek sedation through “Trauma results from an event, series of alcohol or drugs. The aims of Tabor Group events, or set of circumstances that is include teaching coping skills and to experienced by an individual as physically restore people to the window of or emotionally harmful or threatening and tolerance. The 28-day programme that has lasting adverse effects on the consists of one-to-one counselling, group individual’s functioning and physical, therapy, education, meditation and social, emotional, or spiritual well-being”. nature walks. Step-down facilities are utilised to create a safe environment. Symptoms of trauma include depression, Treatment Pathway panic attacks, and self-destructive

ICJA Conference 2018 - “Toward a Trauma-Responsive Criminal Justice System - Why, How and What Next?” behaviour. A substance dependency may develop in an effort to be well and solve Knowledge, skills and attitude are three the underlying issue. fundamental attributes imparted to staff at Tabor Lodge. Tabor Lodge Staff possess After Trauma, the nervous systems remain the skills to assess the nature, severity and prepared for danger (Ogden, Minton & impact of trauma of an individual’s Pain, 2006). The Window of Tolerance is a capacity to engage with addiction term used to understand and describe treatment. These skills help facilitate normal brain and body reactions, clients to develop capacities to cope with especially following adversity. The complex trauma while learning to manage concept suggests that humans have an addiction. optimal level within the Window that allows for the ups and downs of emotions. The attitudes that are cultivated are It is crucial to remain within the Window focussed on working respectfully and of Tolerance. Here, feelings and reactions emphatically with clients. It is essential to remain tolerable. An individual can think develop awareness of the pace at which and feel simultaneously, and reactions clients develop resilience and capacity to adapt to fit the situation. Outside the manage addiction and complex trauma. Window of Tolerance the polar sensations of chronic hyperarousal (emotional Integrating Trauma Informed Dimension overwhelm, panic, impulsivity, to Treatment Delivery at Tabor Group hypervigilance, defensiveness, feeling The central findings of this recent unsafe, reactive, angry, racing thoughts) integration of a trauma informed and chronic hypoarousal (numb, “dead”, dimension are of staff feeling better passive, no feelings, no energy, can’t prepared to deal with trauma. Clinical think, disconnected, shut down, “not staff have witnessed that the acute needs there”, ashamed, can’t say No) may occur. of residents are now being addressed with Hyperarousal was previously mistaken as the development of a competence to aggressiveness and a danger. Tabor respond to the dysregulation of a client Group now works to return patients to the with significant trauma history. Window of Tolerance. From the perspective of residents, they Tabor Group Training Programme 2017: feel safer in the knowledge that clinical Seeking Safety staff can communicate understanding of Treatment Topics include: this dimension of their lived experience  Safety and can respond to this need with skill so  PTSD: Taking Back your Power that distress is alleviated. This has  Detaching From Emotional Pain resulted in everybody in Tabor Lodge  Taking Good Care of Yourself feeling safer. Staff report significant  Integrating the Split Self professional development and stronger  Asking for Help

ICJA Conference 2018 - “Toward a Trauma-Responsive Criminal Justice System - Why, How and What Next?” team ethos as a result of the training this would be for non-literate individuals programme. who may be ashamed of this. When a traumatic state is triggered for an The commitment to implement a trauma individual, showing compassion can help informed approach to treatment is high calm them down. It is easy to invoke an among staff participating in this training intolerant response, but this ultimately project. The structures put in place to just contributes to extended trauma. Help facilitate delivery of this training project with bills and home life is also provided are now being embedded into the for. Even the interior design of the Lodge treatment delivery in Tabor Lodge. These is now aimed at trauma responsiveness. include physical activities (such as yoga) which assist with emotional regulation How Tabor Group is seeking to better help and a follow through to treatment the families of those with addiction issues delivered post Tabor Lodge treatment was then discussed. Family members of episodes. An attitude of sensitivity to the individuals in treatment often experience pace the client can engage with treatment a form of trauma and there is a implied that extended care and continuing recognition that they need help too. care programmes need to become trauma There have now been workshops set up informed. for families, to help become more trauma informed. As well as this, there is a 12-24 The challenges of implementation include month rollout for a family programme maintaining the primacy of the focus on which will involve assessments and care addiction treatment be maintained in the plans. The role of children, in the face of continued integration of trauma treatment of parents with addiction informed approach. There are also issues, was also mentioned. However, resource implications to extending this this may be done at the risk of new capacity to all clinical staff of Tabor traumatising the child. Group. It is essential that the element of review and evaluation be maintained in The issue of how best to help children the implementation phase. affected by parental addiction issues was highlighted. Examples of the ‘Silent Discussion Voices’ report by the Children's The discussion section of the workshop Commissioner for England and the presented some important aspects that children’s programme run by the Betty still need development, as well as Ford Centre in America were given to proposals offered for future success. How highlight successful initiatives enacted Tabor Group has become more trauma- abroad. responsive was initially discussed. Those with aggression used to be discharged. Another major concern for those present However, they now try to alter care plans was the critical issue of homelessness, to avoid certain triggers. An example of which can result in the perpetuation of

ICJA Conference 2018 - “Toward a Trauma-Responsive Criminal Justice System - Why, How and What Next?” trauma. There is no trauma informed care 3. Poverty, Homelessness, then found in hostels, and it can be extremely Prison - and back to Poverty, difficult to break the cycle of addiction Homelessness again living on the streets.

Presenter: Fr Peter McVerry, Peter The mentality of trauma victims was then McVerry Trust considered. Many present who had Chairperson: Fergal Black previously encountered an addict had Rapporteur: Beth Duane witnessed how they would refer to themselves as a ‘scumbag’. They would Introduction use this phrase due to their lack of self- The Peter McVerry Trust is a charity esteem and thoughts on how society established by Fr. Peter McVerry with the viewed them. It is therefore essential to aim to reduce homelessness and the harm avoid pre-conceived notions when seeking caused by drug misuse and social to help them. disadvantage. The charity provides low-

threshold entry services, primarily to A criminal defence solicitor then broached younger people and vulnerable adults the issue of training and referrals to who have complex needs, by offering trauma services. In his experience with pathways out of homelessness based on clients he had found it very difficult the principles of the Housing First model. sometimes to find help for them. As he Housing First is an approach that offers put it, ‘there is no training in dealing with permanent, affordable housing as quickly traumatised clients in Blackhall’. He as possible for individuals and families stated it would be helpful to be able to experiencing homelessness, and then refer clients to trauma services, although provides the supportive services and the issue of time waiting for the service is connections to the community-based still present. supports people need to keep their

housing and avoid returning to When the discussion finished a feedback homelessness. The Peter McVerry Trust questionnaire was distributed. It was has developed a range of services such as found that trauma informed training for prevention services, homelessness front-line staff (such as social welfare services, drug treatment services, and officers, Gardaí etc.) was an immediate under 18s residential services. In addition concern. In the near future it would be to these services, the Trust is committed ideal to have a cohesive national strategy, to developing and maintaining links with as well as potentially implementing a other relevant agencies to provide an professional qualification to entice effective wrap around service. This individuals to undertake trauma informed interagency model is designed to ensure training. efficient service delivery, and to eliminate

gaps in services, and to assist in client

ICJA Conference 2018 - “Toward a Trauma-Responsive Criminal Justice System - Why, How and What Next?” progression. The Peter McVerry Trust’s stopped taking his medication, as he had Vision statement reads no medical card and could not afford to “An Ireland that supports all those on the pay for them. This is the way that the margins and upholds their rights to full system has let this young man down. inclusion in society” Mental illness has recently been outlined Prisons are full of people who are poor, as being a major problem in Oberstown not just in Ireland but in every jurisdiction, Detention Centre. In the Key but not just poor economically, but Characteristics of Young People in socially, psychologically, educationally, Detention Report (2018), it was found that and with people who have very limited over half (52%) of young people arriving in opportunities in life. It is an unfortunate Oberstown have a mental health need, fact of life that within the prison service 27% of young people were prescribed the issues of mental health and addiction medication for a mental health concern, are huge challenges for everybody. There and there were concerns about self-harm are a large number of people in prisons in respect of 23% of people. These figures who suffer from serious mental health present an interesting narrative proving illnesses in custody. Despite efforts by that mental illness remains an increasing staff and others, drugs are readily and difficult problem in Irish prisons. available in prisons and have become a huge scourge for everybody in custody. Addiction Prisons are one of the biggest methadone Mental Health clinics in the country. People use drugs as Mental illness poses a huge problem in an escape from the trauma that they have Irish prisons. A young man was recently experienced in their lives. Up to 70/75% released from prison after serving a five- of prisoners have an addiction. They use year sentence for a serious assault on a drugs to provide a temporary escape from passer-by on the street - it was a their incarceration. Additionally, many random, unprovoked assault. He spent people cannot cope with these most of his time in the Central Mental experiences, and have never been to Hospital, and a few weeks before he was therapy and have never developed coping released there was a case conference strategies to deal with this abuse. Thus, regarding the terms of his release. It was using drugs provides an effective release argued that he was not fit for release, and from this trauma. that he should be admitted to a psychiatric hospital following his release. A young man told the Peter McVerry trust However, no psychiatric hospital in the that when he was thirteen years old, he country would take responsibility for him, would sit at his kitchen table every night and he was released into homelessness. and watch his parents inject heroin. He is He stated that the reason why he stabbed now in prison. Correspondingly, an eleven the victim was due to the fact that he had year old boy went to Fr. McVerry and

ICJA Conference 2018 - “Toward a Trauma-Responsive Criminal Justice System - Why, How and What Next?” asked for help. It was found that his Discussion alcoholic parents were sending the young Participants explored possible resolutions boy out every night into prostitution to under the headings; mental health, collect money for them, and if he didn’t addiction and release planning. he would be physically abused. He too is currently in prison. An informal Mentally ill homeless people are failed questionnaire taken by Fr. McVerry at St again and again by a system which is not Patrick’s Institution, when it was open to set up to adequately meet their needs. children, found that out of 20 of the The participants agreed that there is a children, 19 of them had a parent who need to reform homeless psychiatric was addicted to alcohol and/or drugs. services to try to solve this issue. Therefore, negative childhood Developing psychiatric services for experiences have a considerable impact homeless people, and specifically, access on how an individual responds to these to residential care for homeless people is life experiences. a priority.

Release It was suggested that access to addiction Prison is the only public service in this counselling in prison is insufficient. The country to which the poor have access participants outlined how a majority of that has no waiting lists. Recidivism the prison population (up to 70%) have depends not so much on what goes on in issues relating to addiction. Therefore, the prison, but as to what happens in the the participants suggested that improving six weeks following the individual’s access to addiction services in prison, in release. If you are released from prison addition to HSE support for prison back into homelessness, back into nothing services, would be an effective solution to to do, back into having no money to this problem. There was a discussion sustain yourself, it would be more difficult regarding how a custodial drug treatment to maintain a drug and crime free lifestyle. centre, in lieu of a custodial prison The one thing that pushes people back sentence, would be a better alternative to into crime is being released into treat offenders who are addicted to nothingness, with nothing to do all day substances. However, the participants long, and this drives people back into maintained that prisoners being released drugs and crime. It is essential to secure from custody need a wraparound service accommodation for prisoners on release, to stop them from destabilising and in conjunction with having a medical card becoming an addict again. and access to addiction or mental health services in the community. More advanced planning needs to be developed to ensure that, on release, individuals are not homeless and have an appropriate level of care. The discussion group outlined how it would be possible

ICJA Conference 2018 - “Toward a Trauma-Responsive Criminal Justice System - Why, How and What Next?” to make emergency accommodation beds Cork prison. This research project was the for prisoners on release, and how focus behind the workshop. The important it is that they were given their psychology team in Cork Prison felt it was own space to feel safe and have the of benefit to conduct this intervention due choice to isolate themselves from other to the prevalence of Post-Traumatic Stress drug users. The discussion group brought Disorder (PTSD) within the prison up how an extra two hundred beds are population. The title of the workshop found for homeless people during the relates to the fact that a given individual Christmas period, and remarked how can be both traumatised and a renovating a building would be a logical traumatiser. solution to this problem. The group found the pilot schemes involving the securing of Understanding Post-Traumatic Stress medical cards for prisoners on release to Disorder (PTSD) be promising. They stated that the PTSD is a mental health disorder which provision of these cards was essential so sometimes develops in the aftermath of a that newly released prisoners could terrifying or horrific life-threatening continue to receive any psychiatric or experience. It is characterised by three addiction-related prescriptions. However, clusters of symptoms: the participants found that there were  Re-experiencing – flashbacks, issues relating to acquiring medical cards nightmares, intrusive thoughts due to the non-compliance of GPs and  Avoidance – of people, places, other related services. They suggested thoughts, activities, feeling detached that this scheme should be continued and from others urged for greater compliance between  Increased arousal – vigilance, sleep GPs, the HSE, and the Irish Prison Service. problems, anger, poor concentration PTSD may be diagnosed if these symptoms are still present a month after the event and cause clinically significant 4. Prisons: Trauma Informed distress/impairment in social, Interventions - Them and Us? occupational, or other daily functioning. NICE (National Institute for Health and Care Excellence UK) Guidelines set out Presenters: Claire Moloney, Chartered recommendations regarding when and if, Counselling Psychologist, IPS Psychology trauma-focussed interventions should be Service, and Aoife Rice, Assistant provided and the guidelines also Psychologist, IPS Psychology Service recommend specific types of Chairperson: Mark Wilson psychological intervention. Rapporteur: Annita Harty

However, PTSD alone does not adequately

describe the full range of traumas or A small research project began as a short trauma responses. In 1992 Judith Herman group intervention and was conducted in

ICJA Conference 2018 - “Toward a Trauma-Responsive Criminal Justice System - Why, How and What Next?” first proposed the idea of Complex PTSD  Maladaptive attempts at self-soothing as “an attempt to bring some kind of order (e.g. rocking) to the bewildering array of clinical  Habitual (intentional or automatic) or presentations in survivors who had reactive self-harm endured long periods of abuse”. In 2009  Inability to initiate or sustain goal- the National Child Traumatic Stress directed behaviour” Network (NCTSN) led by Bessel van der How difficult and dangerous must life be Kolk proposed the new diagnosis of for children who have the above Developmental Trauma Disorder for symptoms? It is worth considering how inclusion in the Diagnostic and Statistical these symptoms can actually give rise to Manual of Mental Disorders (DSM-5). The further trauma, for both the original NCTSN asserted that Developmental patient and those he/she encounters. Trauma results from prolonged or multiple exposure to adverse events While the DSM-5 subcommittee rejected including repeated and severe the 2009 NCTSN proposal on interpersonal violence and disruptions of Developmental Trauma, in 2018, the 11th caregiving. Such experiences typically give revision to the World Health rise to: Organization’s International Classification  Affective and physiological of Diseases (ICD-11) proposed two distinct dysregulation sibling conditions: Posttraumatic Stress  Attentional and behavioural Disorder (PTSD) and Complex PTSD dysregulation (CPTSD). ICD-11 describes Complex PTSD  Self and relational dysregulation as a disorder that may develop following  Post traumatic spectrum symptoms exposure to an event or series of events of  Functional Impairment an extremely threatening or horrific nature, most commonly prolonged or It is interesting to focus a little more repetitive events from which escape is closely on what is meant by “attentional difficult or impossible (e.g., torture, and behavioural dysregulation” and more slavery, genocide campaigns, prolonged importantly, the implications of this for domestic violence, repeated childhood the child concerned. The NCTSN’s sexual or physical abuse). The disorder is description of “attentional and characterized by the core symptoms of behavioural dysregulation” includes: PTSD; that is, all diagnostic requirements  Preoccupation with threat, or for PTSD have been met at some point impaired capacity to perceive threat, during the course of the disorder. In including misreading of safety and addition, Complex PTSD is characterized danger cues by 1) severe and pervasive problems in  Impaired capacity for self-protection, affect regulation; 2) persistent beliefs including extreme risk-taking or thrill- about oneself as diminished, defeated or seeking worthless, accompanied by deep and pervasive feelings of shame, guilt or

ICJA Conference 2018 - “Toward a Trauma-Responsive Criminal Justice System - Why, How and What Next?” failure related to the traumatic event; and witnessing violence. A further 3) persistent difficulties in sustaining complicating factor is the instability which elationships and in feeling close to others. often characterises the prison setting. The disturbance causes significant impairment in personal, family, social, As we noted earlier, the NICE Guidelines educational, occupational or other provide direction on treating PTSD in a important areas of functioning. community setting, but what of Complex PTSD in a prison setting? Why is it important to treat trauma? Trauma begets trauma. This is not to say The Comprehensive Resource Model that people who have experienced trauma The Comprehensive Resource Model intentionally set out to traumatize others, (CRM) is a relatively new, but Complex PTSD can leave a person neurobiologically-based trauma therapy. vulnerable to both experiencing and It is a nested modality which is perpetrating trauma in later life. There is conceptually represented by the nested a known association between trauma and Russian Dolls (Schwarz, Corrigan, Hull and subsequent offending behaviour (Ardino, Raju, 2017) - see Figure A. The client is 2011) and researchers such as Lyons-Ruth provided with positive and internally (1996) have found evidence for the sourced attachment resources which intergenerational transmission of trauma. facilitate the client in remaining fully present while processing traumatic The challenges of treating trauma in a material. prison setting All psychological therapies are predicated Stabilization, processing and integration on a trusting relationship between occur simultaneously while the resources therapist and client, yet trauma interferes utilised are anchored through eye with a person’s ability to trust and this is positions in the brainstem. heightened in a prison setting. As CRM is especially suited to the Experiences in prison can trigger treatment of Complex PTSD, it was this memories of a prior traumatic event e.g. model which was chosen for the Cork having to remove one’s clothing, being Prison Psychology Group. restrained, being confined, being alone and not having opportunity to connect with a loved one, feeling abandoned, or

ICJA Conference 2018 - “Toward a Trauma-Responsive Criminal Justice System - Why, How and What Next?”

Figure A

The Group The CRM group ran for six weeks and study utilised both qualitative and included seven male participants ranging quantitative measures. The quantitative in age from 19-65 years, the majority of measures provided data on PTSD (PCL-5), whom had convictions for violent Dissociation (MDI), Depression, Anxiety offences. Their time in custody varied and Stress (DASS) and Alexythymia (TAS- from 2.3 years to 16.3 years, all had 20). alcohol and substance misuse issues and some had very poor literacy. Results A paired samples t-test was conducted to A culture of responsibility and belonging evaluate the impact of the intervention on was cultivated in the group and all four measures. (Figure B) There was a participants were given the choice to opt statistically significant decrease in DASS in, or out, of both the exercises and group. scores from pre (m=29.14, SD=20.84) to The intervention involved teaching the post (M=13.29, SD=12.50), t(6)=2.48,p participants about trauma and teaching =.048 (two-tailed). The eta squared them Attachment and Neurobiologically statistic (.51) indicated a large effect size. based CRM resourcing exercises (5 of the Qualitative data indicated that seven resources plus the secondary participants found the group both resource Intention). A quasi-experimental enjoyable and useful and reported finding research design was employed and the in it, a sense of belonging.

ICJA Conference 2018 - “Toward a Trauma-Responsive Criminal Justice System - Why, How and What Next?”

60 Figure B 49 48 50 45 44 40 32 29 30 19 20 13

Average Score Average 10 Avg PRE 0 Avg POST Measures MDI DASS PCL-5 TAS-20

Workshop Discussion The following questions arose at the end Q. Were the prison officers interviewed of this workshop: after the sessions were completed to ascertain dialogue coming from prisoners Q. Was it the sense of belonging to about the group experience? something (the group) or the actual No dialogue was obtained from prison therapy model that created the positive officers before or after the group, as it results? would have been impossible to control. The research group cannot exactly determine what produced the results, it Concluding Remarks could have been the psycho-educational Structural issues in society have also been aspect of the group, and the CRM recognised as factors to trauma. resources or it could have been a mixture Addressing issues at a micro and macro of other factors. Data was collected after level has an effect on all in society. one week of completion of the group. It Clinicians are addressing one area and it is would be beneficial for long-term data to up to policy makers to address other be collected. However, this is difficult to factors, such as homelessness, in order to do because there is a variance in custody reduce trauma which may occur. A times and some of the participants were general consensus from the workshop was due to be released from prison earlier that there needs to be training for all than others. prison staff in trauma, more public awareness on trauma and the CRM Q. Has this model ever been used with model, and to have this model rolled out children? nationally to all Prison environments. It was uncertain if CRM had been used Moving toward a Trauma-Responsive with children. Any trauma therapy Criminal Justice System could lead to employed with children would need to be reductions in suffering, offending and one which provided the child with costs to all in society. sufficient resources to tolerate the therapy.

ICJA Conference 2018 - “Toward a Trauma-Responsive Criminal Justice System - Why, How and What Next?”

5. From Exclusion, through balance between the two parties to the Muddle, to Rights: The Place of trial in the twentieth century articulated Victims in Sexual Offence Trials internationally in the enactment of various instruments such as:

 The Universal Declaration of Human Presenter: Noeline Blackwell, Chief Rights Executive Officer, Dublin Rape Crisis  The International Covenant on Civil Centre and Political Rights Chairperson: Dr. Susan Leahy  The European Convention on Human Rapporteur: Alaina Maher Rights

Historically within the Irish Criminal Domestically, the right of the accused to a Justice System it was nearly impossible to fair hearing was established in the Irish have the victim’s voice heard; the victim constitution and was elaborated by the was seen to have no place within the Irish courts over time. system. The basis of the common law system hampers our domestic system These developments saw the recognition from recognising the rights and place of and implementation of rights of the victims within the Criminal Justice System. accused such as the right to Due Process

and to a fair hearing. Initially, communities meted out justice at a local level within the community. Over One crucial party to this scenario was the centuries, as the system became more being ignored and excluded - “the administrative and power was pulled Victim”. There was a general suspicion away from the community, victims could that triangulating the system by including have a place in the Criminal Justice System the victim would create mess and muddle. if they had the money to pay the State to By the 1980s, victims of sexual and take a case on their behalf. As time domestic violence were recognised as progressed, the State came to recognise being traumatised and in need of personal that society was harmed by crime and as help but also as being key players in the such, the State was entitled to prosecute, Criminal Justice System. As such, rights on behalf of society, and to require the for these victims began to develop and citizens of the State to assist with their were being recognised internationally as prosecution as jurors or witnesses. Today Human Rights. In our domestic system, within our domestic system, it is up to the however, the victim was still being State to present the case on behalf of overlooked. society. Over the past 100 years or so, an imbalance of power between the State By waiving her right to anonymity and the accused was recognised, with the following the trial of her attacker, Lavinia accused being very poorly served against Kerwick spurred a movement toward the might of the State. As such, there was recognising the need to challenge leniency a movement toward striking a power

ICJA Conference 2018 - “Toward a Trauma-Responsive Criminal Justice System - Why, How and What Next?” of sentencing and allowing the victim’s Criminal Justice System. Whilst there is voice to be heard. There have been provision in our legislation for limited developments in relation to the victim’s representation for these victims there is a place within the Criminal Justice System in need to extend this further to achieve the past twenty-five to thirty years which fairness. continue apace. Particularly with the enactment of the binding EU Victims’ There is a just case for trauma experts to Directive, victims’ rights are recognised, be brought into the courts to deal with inclusive of the right to information, due such cases because lawyers and jurors are process, compensation and privacy. The not trained in the area of trauma and, as rights of victims are much better such, do not understand the impact of integrated into systems in mainland trauma on human recollection and the Europe than in our domestic system in effect on the human mind. Within the that our common law structure makes the Criminal Justice System as it currently integration of these rights more difficult. stands, victims’ rights to due process and to a fair hearing are not being effectively What needs to be done? implemented. By failing to recognise There needs to be recognition, victims in the process, our system is failing understanding and implementation of to give effect to the Victims’ Directive and victims’ rights within the Criminal Justice is also adding to the re-traumatisation of System in Ireland. The system needs to victims. recognise that implementing victims’ rights will not take away from the right of Discussion the State or the accused but it will Participants queried how the Criminal rebalance the system in a positive and fair Justice System could extend the manner. In many sexual and domestic representation available to victims. The violence cases, where the crime only Minister for Justice and Equality has occurs if the behaviour was non- ordered a review of the treatment of consensual, a jury is looking at a “he- victims in the Criminal Justice System and said/she-said” scenario where the “he- this is to be concluded by the end of the said” side of the case is being made to the summer. The Dublin Rape Crisis Centre jury by experienced, trained, expert will be asking the Minister to review this advocates. On the other hand, the “she- shortfall. There is already a model in said”, who may never have been in a place so it is just about finding a way to courtroom before and who has carry out this change in a way that is cost- experienced great trauma and undergone contained. re-traumatisation throughout the proceedings, is expected to be able to Delegates were interested in the aspect of make the same case to a jury without restorative justice in terms of sexual representation or support. This is a violence. They stressed the importance of complete imbalance of power within our practitioners and facilitators in sexual

ICJA Conference 2018 - “Toward a Trauma-Responsive Criminal Justice System - Why, How and What Next?” offence cases including the victim in the Suggestions for changes to be made decision making process and that they included: must be mindful of the trauma that comes  Provision of trauma-specialists to with such cases in an effort to eliminate accompany victims through the court re-traumatisation for the victim. In process addition, it was acknowledged that the  Moving toward specialist investigation media and the community must be in training front-line Gardaí in how to trauma-informed and be mindful of the deal with victims in a trauma-informed way that their actions in reporting and way when taking statements commenting affect the victim in these  Train lawyers to use appropriate cases. sensitive language when dealing with victims of sexual offences to avoid re- Participants were also concerned about traumatisation how the Equality of Arms is dealt with.  Offering support post-trial The Irish Criminal Justice System assumes  Managing the physicality of the that this is solely between the State and Courtroom so as to avoid re- the accused with the victim being ignored. traumatising the victim e.g. not having Currently, there is a total inequality of the victim walk past the offender or arms which needs to be addressed going have to sit facing the offender forward. It was acknowledged that total  Provision of a victim liaison officer representation for the victim is not essential but that each side to the case should have an equal opportunity to tell their side of the story to the jury in the 6. Every Woman, Every Story: same way. Trauma, Criminality and Women in

It was acknowledged that the system Prison must become more trauma-informed and be cognisant of the fact that mental Presenters: Governor Mary O’Connor and health issues are real. It was brought up Dr. Maggie McGovern, Dóchas Centre in discussion that justice in sexual offence Chairperson: Deirdre Byrne cases extends beyond trial and sentencing Rapporteur: Alaina Maher and that this needs to be acknowledged by the system. The Probation Service is The Dóchas Centre operates a multi- currently running a scheme in victim- disciplinary approach which keeps women offender mediation in which Probation in custody at the centre of its services. Officers are being trained. It is hoped that The Centre aims to provide a safe this practice will continue to grow as it has environment for women and to provide been evidenced as beneficial to the victim. each individual with services to improve their quality of life and achieve a more law-abiding future. Each woman has a

ICJA Conference 2018 - “Toward a Trauma-Responsive Criminal Justice System - Why, How and What Next?” story, and often this story is challenging in does not excuse offences it remains its human suffering and involves many relevant to understanding offending traumatic experiences. The Dóchas behaviour. Centre provides one to one supports along with group programmes to offer When women enter prison they often feel each woman a space to address her needs negatively about themselves, lack and in doing so develop new skills and confidence and don’t believe they have a awareness. This work is challenged by the future worth looking forward to. Staff realities of homelessness, poverty and training is accepted as essential in guiding addiction. Many of the women practice that can support positive committed to The Dóchas Centre, like outcomes for women both while in women in custody in the UK, are better custody and when reintegrating to the understood as troubled rather than community. Training that supports troublesome, more a danger to officers and other prison based themselves than to society. (Baroness professionals to better understand the Corston, 2007) needs of those in custody continues to be vital. There is a necessity to continue This workshop explored the experiences improving training in the prison service of women in custody and how and across the broader Criminal Justice understanding and responding to trauma System particularly with regard to related needs is helpful in working toward understanding how experiences of the goals of the Criminal Justice System. complex trauma may be impacting on an The workshop considered the role of individual’s ability to engage with services trauma-informed practice in creating an aimed at supporting the offender and environment that is more responsive to ensuring public safety. trauma related needs and which maximises the potential for custody to be What is Trauma? used as an opportunity for learning. Episodes of “once-off” single traumatic events which can result in post-traumatic Understanding trauma and its effects is stress disorder (PTSD) are very different to crucial to adequately supporting women the problem of Complex PTSD. This in prison and in the Criminal Justice relates to exposure to traumatic events System. Trauma within the Criminal that are repetitive, prolonged, or Justice System is not a new phenomenon, cumulative. Usually these events are but understanding its effects is crucial. interpersonal, involving direct harm, exploitation, and maltreatment including Women in custody have often neglect/abandonment/hostility by experienced considerable trauma and the primary caregivers or other, and often actions of some have caused substantial occur at developmentally vulnerable times trauma in the lives of others. Whilst it is in the victim's life, especially in early acknowledged that a history of trauma childhood or adolescence. Such traumatic

ICJA Conference 2018 - “Toward a Trauma-Responsive Criminal Justice System - Why, How and What Next?” events can also occur later in life and in experiences of others, sometimes those of conditions of adult vulnerability. their peers in custody.

Complex trauma is a frequent feature in Trauma and Criminality the presentation of women entering the The more Adverse Childhood Experiences Dóchas Centre; many having lived with (ACES) one has, the more likely they are to the ever-present threat of danger. Such enter the Criminal Justice System, as a experiences have a profound impact on history of childhood trauma is linked to development and learning. In the higher rates of offending in adult life. absence of safety, the attention needed While research has not demonstrated a for other developmental tasks is required causal link between trauma and to scan for threat. Consequently, the criminality, there is a strong association attention required for new learning may between trauma exposure and women’s be unavailable and this can continue in offending behaviour in particular. Given the absence of any objective danger. that early trauma can disrupt emotional Women coping with complex trauma and behavioural skills development, it is experience the world in traumatised important that women affected in this bodies and minds. In this way, trauma way are taught skills to help them experienced in the past can be more experience their emotions in a more accurately understood as a description of healthy way. Dóchas can present a safe the here and now. In the context of environment where women can develop complex trauma, individuals often new skills that help them to cope more develop a deeply embedded belief that effectively. This means coping in ways they are in some way to blame for their that do not add needlessly to their experiences of trauma (abuse, neglect) suffering or cause needless suffering to and this inaccurate and unhelpful belief others. Responding to trauma is the can be very difficult to shift. humane thing to do. The Criminal Justice System has opportunities to bring Vicarious trauma is prevalent among compassion into action when linking with support staff in prison environments and offenders whose offending behaviours across the Criminal Justice System. It is may be attributable in part to the impact important that training and support are of trauma. provided in relation to this in order to protect staff and officers from vicarious How do we become trauma responsive? trauma and to maintain their good Two strands: practice. This also serves to protect  Staff and Environment people in custody who themselves can be  Targeted Supports and Intervention impacted by the well-being of officers and who can experience vicarious trauma The impact of complex trauma can be through exposure to the traumatic minimised and is sometimes not recognised for its serious consequences,

ICJA Conference 2018 - “Toward a Trauma-Responsive Criminal Justice System - Why, How and What Next?” not least in terms of quality of life. change and encouraging conversation are Understanding and responding to trauma all proactive steps in becoming trauma- based needs can be reparative and lead to responsive. Trust is an important aspect better outcomes at an individual and to this work and fostering and offering societal level. In light of this, there is trust upfront can be the corner stone of merit in all of our communities developing progress. Management are required to greater understanding of complex trauma lead, demonstrate and challenge and how it can impinge on human lives appropriately and understand the power and behaviour as well as developing of enhanced knowledge and empowers greater skill in responding to those who others in this way. In order for any have been exposed to multiple traumatic trauma-responsive approach to succeed, events. consistency in day to day operations is essential. Consistency across all aspects  Realise the impact of trauma and of a prison environment is not easily understand potential paths for achieved. However, with awareness, recovery progress toward this can be made in  Recognise the signs and symptoms of increments and sometimes in strides. trauma on clients, families, staff and Also necessary is the provision of others in the system comprehensive training and support to  Respond by integrating knowledge offenders, agencies and teams. about trauma into policies, procedures and practices Coping strategies  Resist re-traumatisation Coping strategies such as aggression and substance abuse can develop to help one Dóchas encourages positive appropriate deal with trauma. Whilst over time, relationships within the community, coping strategies can become where women feel supported and maladaptive, it is important to understand challenged, and can learn from role these strategies developed for a reason models who encourage attachment and and served a purpose for the trauma provide support. The ethos must start victim at a time when survival was with compassion in understanding trauma necessary. Understanding the origin of and its effects on the women in custody. these strategies can support the Criminal Dóchas strives to facilitate women in Justice System to respond more reaching their potential. At its best effectively. Prison can be a safe place “Prison is an opportunity for repair”; the where victims can work through their time in custody can benefit both the trauma and learn new ways of coping with women and society more broadly. their traumatic experiences. In some Facilitating a trauma-responsive instances, peer-to-peer counselling is an community is down to knowledge and effective way for women in Dóchas to training. Demonstrating compassion and work together in overcoming issues and understanding, being open to ideas and building healthy relationships.

ICJA Conference 2018 - “Toward a Trauma-Responsive Criminal Justice System - Why, How and What Next?”

Discussion Dóchas as do a number of other ethnic Participants queried the number of minorities at the Centre. In terms of committals of women due solely to service access, Dóchas provides equality homelessness or drug abuse. Whilst there of access to all programmes e.g. from are services available for these women in Psychology, Probation Services, Ireland, some cannot engage with the Psychiatry. Services at Dóchas endeavour programmes because of difficulties in to respond to each woman as an breaking away from their current, familiar individual whilst remaining culturally lifestyle. Having a more trauma-informed conscious and informed. society and an opportunity to engage with trauma specialists in the community could Others queried the availability of services reduce the amount of unnecessary for new mothers in prison. Dóchas committals. encourages the baby to be the mother’s main focus, but new mothers are still Participants were interested in the expected to engage with the counsellors effectiveness of peer-to-peer mentoring and attend classes. Often there are deep amongst women in prison. Dóchas hopes feelings of distrust between women in to provide a safe, supportive environment custody and child protective services. for those who feel victimised. Peer Dóchas cooperates with Coolmine support is powerful and has the capacity Therapeutic Community and Tusla to to be extremely helpful; confiding in ensure the provision of adequate services others who have experienced similar and to ensure that if it is reasonably trauma is very effective. Dóchas possible, a mother and baby will leave encourages a collaborative environment prison together. There is limited where offenders are encouraged to availability of residential treatment for contribute ideas as how best to carry out offenders who are new mothers in Ireland services in an effective way. and it was noted that this could be expanded on. The educational Participants asked about services programme within the Dóchas Centre designed for specific minorities such as provides child care classes which new those with mental health issues in the mothers are encouraged to attend. There Travelling Community. Psychiatric is also a level of one-to-one work available services in the Centre provide for those to new mothers to help in achieving who were once seen as “troublesome” to attunement between mother and child. be diagnosed and treated for mental health problems if these apply. This work lead by the National Forensic Mental Health Team has made a substantial difference to many women in terms of their mental well-being. Travellers represent an ethnic minority within

ICJA Conference 2018 - “Toward a Trauma-Responsive Criminal Justice System - Why, How and What Next?”

7. Pathways to Prison - The difficulty in accessing medical cards due to Experience of the Traveller changing postal address or a lack of a Community postal address. This leads to a difficulty in accessing a wide range of medical services

including dental services, mental health Presenters: David Joyce, Solicitor, Mercy services, and health screening Law Resource Centre, and Anne Costello, programmes. This inequality has Coordinator, Travellers in Prison Initiative contributed to high rates of mortality, a Chairperson: Dr. Lucy Rowell higher infant mortality rate, low life Rapporteur: Ciara McQuillan expectancy and suicide rates which are seven times the national average. Introduction The Traveller Community is a distinct The lack of Traveller specific ethnic minority group in Ireland. This accommodation is also a significant cause group make up less than 1% of the of trauma for the Traveller Community. population and have experienced Homelessness amongst Travellers is unparalleled levels of inequality which is eleven times the national average. evidenced by the All-Ireland Traveller Health Study 2010 (AITHS). This inequality In terms of education, a source of trauma (discrimination, oppression, racism and may become evident when Travellers are social exclusion) has contributed to denied access to the education system. trauma within the Traveller Community. Some Travellers experience discrimination The Travellers in Prison Initiative (TPI) because some schools operate a quota on developed as a response to the specific accepting Traveller children. Therefore, requirements of Travellers in custody in from the very beginning of their prisons in the Republic of Ireland. educational journey these children experience the trauma of social exclusion, Trauma in the Traveller Community discrimination and racism. Travellers have There are numerous possible factors poorer educational outcomes than the which may cause trauma in the lives of general population; the AITHS found that Travellers. These include: 55% of Travellers leave school by the age  poor health of 15 years. Recent years have seen an  poor accommodation increase in participation in third level  poor educational experiences and education. However, the barrier of unemployment discrimination still exists in relation to  experiences of discrimination and gaining employment. 80% of the Traveller racism community suffer the trauma of unemployment; in a 2017 Behaviours and In relation to poor health, Travellers have Attitudes survey only 25% of people experienced disadvantage in accessing would accept a Traveller as a colleague. health services. Many Travellers have

ICJA Conference 2018 - “Toward a Trauma-Responsive Criminal Justice System - Why, How and What Next?”

These high levels of racism, discrimination discussion group considered the reasons and a lack of recognition and why minorities are over-represented in understanding of Traveller culture have the prison population. The following led to the wholesale social exclusion of reasons emerged as possible contributory this ethnic minority. This has resulted in a factors in the over-representation of community which has suffered trauma Travellers in prison: and internalised oppression. Internalised  socio-economic reasons, including oppression manifests in minority groups unemployment and poverty whereby members of the group believe  educational disadvantage the negative stereotypes and myths  prejudice, discrimination, racism and attributed to the group by the majority marginalisation population. This manifests itself in the  high levels of drug and alcohol following forms: addiction  low self-esteem, anxiety, depression  accommodation and mental health and self-destruction, issues  destructive behaviour towards their families and other Travellers The disproportionate representation of  high levels of addiction linked to Travellers in the prison system is not trauma unique to Ireland and comparison was  the over-representation of Travellers drawn with the indigenous Maori people in prison in New Zealand, who comprise 14% of the  conflict and unease with their own general population but 50% of prison ethnic identity population. Similarly, in Australia, Aboriginals account for 2% of the Internalised oppression supports the population yet 27% of the prison position that the established majority population emerges from this ethnic population is superior - it is the standard; minority. thus it undermines the self-identity of the minority ethnic community. The trauma Other possible explanations for the over experienced by the Traveller community representation of Traveller and ethnic provides the background reasons for over- minorities in the prison system included; representation of Travellers in prison.  ethnic minorities simply commit more crime than the general population Pathways to Prison  ‘over-policing’ - the conscious or Membership of the Traveller community unconscious profiling by ethnicity. accounts for less than 1% of the overall These ethnic minorities are then population. The Irish Prison Service targeted by law enforcement. estimates that Traveller men make up  in general, ethnic minorities are given 15% of the prison population, and that harsher sentences for similar offences Traveller women constitute an estimated than the dominant population. 22% of the prison population. A

ICJA Conference 2018 - “Toward a Trauma-Responsive Criminal Justice System - Why, How and What Next?”

It was concluded that there is still a void in separated from their children, many of information regarding this over- whom are in foster care representation though with the collection  Many Traveller women have post of data using the ethnic identifier a release concerns. They fear for their stronger knowledge base will emerge. safety on release and fear racist and discriminatory provocation from law Experience in Prison enforcement. When members of the Traveller Community are imprisoned they Conclusion experience trauma which is particularly The discussion groups concluded that unique to their ethnic group. Travellers, there is a need: many having experienced a nomadic  To gather information through ethnic lifestyle, now experience the restriction of data collection about the pathways prison - this is a physical environmental into prison of Travellers, and to further trauma. When a Traveller is imprisoned research the relationship between they are removed from their community social exclusion, marginalisation and and their only ‘safe space’ within society is offending behaviour. gone. Prison has been designed for the  To recognise and draw on the general population, and the prison staff knowledge of Travellers and their members are not specifically trained to experiences and expertise, particularly work with Travellers. Much of the trauma in relation to their experiences of and internal oppression experienced by prison and prison services, and their the Traveller community generally now experiences with the Gardaí and the manifests and impacts on their Criminal Justice System. experiences in prison.  It was widely accepted that there was  Travellers often experience racist a need for post -release strategies for name calling by other prisoners, and prisoners, such plans need to include prison staff access to employment and education,  The low literacy levels impact on housing and health care. Travellers’ ability to participate in  Equality and anti-racism and educational opportunities in prison intercultural training for the Gardaí  Many Travellers fear being targeted by and employees in the criminal justice other Traveller groups, leading to system. many choosing to seek protection and  Traveller pride – education of the 23 hour lock up. general population on Traveller  Many experience mental health Culture and heritage. issues, depression, suicidal thoughts and many begin to use drugs as a means of coping with prison life  Traveller women experience stigma, anxiety, and fear as they were

ICJA Conference 2018 - “Toward a Trauma-Responsive Criminal Justice System - Why, How and What Next?”

8. Vulnerable Migrants and the The experience of racism Criminal Justice System The experience of racism is said to exist at all levels of the CJS. It is difficult to ascertain the amount of racial abuse Presenter: Wendy Lyon, Solicitor, KOD which has gone unreported for fear of it Lyons Solicitors not being taken seriously. The European Chairperson: Dr. Emma Black Network Against Racism (ENAR) is working Rapporteur: Annita Harty to combat racism and discrimination. The

ENAR breaks down structural barriers and This workshop focused on migrants’ policies that limit the opportunities for interaction with the Criminal Justice migrants to participate fully in society. System (CJS). There are particular areas of concern which may affect migrants more Workforce Diversity so than citizens in contact with the CJS, There is a lack of diversity within the including language barriers, potential Criminal Justice System. Only 0.4% of experiences of racism and the lack of Gardaí are from an ethnic minority diversity in the CJS workforce. background. The percentage of applicants

from ethnic minority backgrounds is Language barriers reportedly in decline. It is unclear as to It can be extremely difficult for migrants what percentage of legal professionals who come into contact with the Criminal come from an ethnic minority Justice System, as the availability of an background. interpreter is not guaranteed. Further, languages have many different dialects Discussion and this can create difficulties with Migrants who are sex workers are interpreting. The qualifications of the particularly vulnerable within the CJS. interpreters should be examined as there Migrant sex workers in Ireland are mainly is no formal accreditation system in from Eastern European or South American Ireland for general skill in interpretation. backgrounds. They tend to be single Further, an understanding of Irish law and mothers who send the money home to the CJS would be helpful. This is so the support their family. These women have interpreter would be able to relay the been known to work in pairs for safety complex information to the migrant. reasons. However, under Irish Law those However, it is not for the interpreter to who work in pairs can be subjected to advise the migrant, as there are concerns brothel keeping offences. These women that this occurs. tend to be unaware of their rights within

the CJS.

ICJA Conference 2018 - “Toward a Trauma-Responsive Criminal Justice System - Why, How and What Next?”

A website commonly used by sex workers Ireland cannot easily be released, as they for safety purposes called technically have no state existence www.uglymugs.ie gives sex workers the outside of the prison. opportunity to advise each other of potential areas of risk. The above It was thought that providing relevant and (unverified) statistics have been obtained important criminal justice information in from the ugly mugs website, which have different languages would be extremely recorded a number of crime incidents useful to migrants and victims of amongst the sex worker community trafficking. Interpreters should be trauma and CJS informed. Ireland should develop Migrant victims of trafficking often work an accredited qualification for translators in cannabis cultivation, the fishing in order to ensure consistency and a industry and domestic work. These quality service. Finally more awareness migrants mainly come from Vietnamese and training should be provided to or Chinese backgrounds. Criminal Justice Agencies on the trauma a migrant or victim of trafficking may be There was recognition made of all the experiencing. complexities that arise within the CJS with regard to migrants and victims of trafficking. Victims of trafficking who come to the attention of the CJS have sixty days to decide if they wish to assist Gardaí with their investigation. Further, those migrants serving life sentences and who do not have a permit to reside in

ICJA Conference 2018 - “Toward a Trauma-Responsive Criminal Justice System - Why, How and What Next?”

9. Trauma in Probation Practice health services in the U.S. The three Presenters: Margaret Griffin, Regional broad categories that are referred to are Manager, The Probation Service, Elaine abuse, neglect and household Kavanagh, Probation Officer, The dysfunction. Probation Service and Jane Mulcahy, Irish Research Council funded PhD Candidate in Adverse Childhood Experiences have a Law at UCC cumulative effect on our lives and Chairperson: Ben Ryan behaviour. Having four or more ACEs can Rapporteur: Tina Cronin be devastating. That puts the women from the Limerick study at high risk. Findings from a small Limerick Study - Points of note from the study found that Margaret Griffin participants were seven times more likely The number of women in Limerick on to have grown up in a house with an general probation supervision was incarcerated person and six times more consistently around 23% despite a likely to have five ACEs than women in the protracted period of time, various judges general population. Additionally, trauma and no reason to suggest variances in continued into adulthood with 91% of the arrest practices compared to the rest of women experiencing intimate partner the country, where the national average is violence in adulthood and 95% considered approximately 11%. This lead to the their substance abuse to be related to, or question ‘What’s going on for these somewhat related to, their experiences of women?’ It was found that 50% of those trauma. The participants were extremely presenting for drug treatment services resilient women who were generous with were women, with a higher proportion of their knowledge and experiences in the homeless women in comparison to hope of improving outcomes for other national patterns. At a local level, The women. The study highlighted the need Probation Service in Limerick was aware for services that are safe, caring, that they were not meeting these understanding, valued and are respectful women’s needs. The same women were and trusting of the service user. When coming in and out of services and never service users and providers rated the really getting off that merry go round. service, gaps were highlighted, with the Criminal Justice System ranking lowest in As a result, research was conducted by any of the rated domains. Organisations Quality Matters with twenty-four women that scored best were voluntary services, who were attending eight different and drug and alcohol services. The services, to evaluate their issues, concerns disparity needs to be further investigated. and experience of the service. The semi- structured interviews were influenced by ‘Flip the Script’ Resilience - Elaine the ‘Adverse Childhood Experiences (ACE) Kavanagh Study’ which looked at seventeen Resilience is “more like Batman than thousand middle class patients of various Superman, because resilience is about

ICJA Conference 2018 - “Toward a Trauma-Responsive Criminal Justice System - Why, How and What Next?” being adaptable not invincible” (Anaut, that is, poor self-esteem, poor world view 2009). Neuroscience has shown the and little hope, with higher levels of malleable and flexible brain can learn to depression. A study with students found cope and adapt when experiencing toxic Beck’s negative triad could be flipped, levels of stress. People need to know heretofore known as the ‘positive when experiencing those extreme cognitive triad’, with these combined episodes that things will improve. Part of aspects resulting in higher levels of what The Probation Service does is look at resilience (Mak, Ng & Wong, 2011). desistance - what needs to be done to desist from crime and become more Investigations by Woldgabreal et al. resilient? Desistance occurs naturally over (2016) on the promotion of positive time, but some may need more support psychological constructs throughout the than others, so how can resilience be Court mandated supervision process promoted? suggested that resilience could be promoted if the LSI-R risk assessment was The Irish Probation Service applies an paired with such constructs, for example, aspect of the Risk-Need-Responsivity the positive cognitive triad. Further input approach, namely, the Level of Service on this concept would be welcomed. The Inventory Revised (LSI-R) which is used to presentation concluded with the inform decisions about level of acknowledgment that nature may occur supervision intensity, rehabilitation and via nurture. However human nature treatment needs and to predict remains open to adaptation and change, recidivism. Additionally, it is important to which is resilient. focus on a person’s strengths and abilities, and approaches such as that espoused by The Impact of toxic stress on Probation the Good Lives Model (GLM) could be clients: learning from neuroscience and employed to promote personal strengths Adverse Childhood Experiences (ACE) and thus, promote resilience. studies - Jane Mulcahy Those who grow up poor, in a deprived Both models need to be used in tandem area, where there are more single parent to combine risk, resilience and desistance. families, greater levels of addiction and Research has found that the use of general dysfunction, will experience more positive psychological constructs, community ACEs, i.e. massive levels of including hope and promotion of self- childhood adversity in their immediate esteem, have resulted in more positive surroundings. ‘Daring to ask, “What outcomes in areas including employment, Happened to You?” – Why Correctional sports performance and, crucially, for Systems Must Become Trauma- probation court mandated supervision. Responsive’, a paper by Jane Mulcahy, examines the need for the Criminal Justice Beck’s negative cognitive triad (2002) System and Probation Services to become correlated the negative cognitive triad, ACE-aware and tuned into trauma. The

ICJA Conference 2018 - “Toward a Trauma-Responsive Criminal Justice System - Why, How and What Next?”

LSI-R is completely un-trauma informed what is familiar. A Probation Officer is and un-trauma responsive. It fails to their own best tool; a caring attitude, explore what happened to a client as a ability to build a safe, respectful child and the crucial timing of adversity. relationship and to see the person in their Cognitive Behaviour Therapy (CBT) is the social context, is more important than a dominant response to the LSI-R which is risk assessment instrument. ineffective with people who are highly traumatised, because their pre-frontal Discussion cortex goes “offline” when fearful. Body- Participants acknowledged the need to based interventions, such as yoga and look beyond trauma in probation practice mindfulness, are likely to be more due to wider political and societal aspects effective. at play. Challenges of how to address trauma was a recurring focal point. It was Maslow’s ‘Hierarchy of Needs’ highlights noted by participants that the LSI-R model the need to meet basic requirements if was only part of the probation process adults are to progress up the needs and while being very aware of the need to pyramid. ACEs impede this progression; address trauma, practitioners were aware four or more ACEs make you twenty times or the risk of re-traumatising clients. more likely to go through the doors of Discussions highlighted that there is no prison, according to the Welsh ACEs study need to go deep into the trauma to have (2015). Treatments like Schwartz’s benefit, but it is an area that needs to be Comprehensive Resource Model are built into practice. It was agreed CBT is exciting as this looks at how trauma is not always the answer; alternatives need held in the body and people benefit from to be provided to address trauma. A acquiring different types of tools to calm possible solution put forward would be to visceral body sensations and expand their run a pilot programme within a project window of tolerance. Criminality, like where an ACE score calculator and a bio- addiction or mental illness, is a symptom psycho social history are used as an of trauma. We often forget that crime is alternative to a risk assessment. not the biggest issue for people. Homelessness or the fundamental lack of Participants were also curious to know if safety in their lives may be of greater the Limerick Study ascertained why personal concern. This is not to say that figures were higher, which it had not, but the conversation on offending behaviour it was noted there is a very particular set ceases, but interactions with Probation of circumstances in Limerick with a need to be relevant and beneficial to particular criminality history warranting a them for offending behaviour to reduce. systematic examination. Without better coping strategies, despite best intentions, in times of stress they will revert straight back into addictions or antisocial peer groups, because that is

ICJA Conference 2018 - “Toward a Trauma-Responsive Criminal Justice System - Why, How and What Next?”

10. Addressing Psychiatric and Discussing Estimates of Morbidity in Irish Psychosocial Morbidity in Irish Prisons Prisons Study 1 - ‘The prevalence of major Presenter: Dr. Gautam Gulati, Consultant mental illness, substance misuse and Psychiatrist, University Hospital Limerick, homelessness in Irish prisons: systematic Adjunct Senior Clinical Lecturer, University review and meta-analyses’ of Limerick This study, which was conducted to Chairperson: Gerry McNally estimate the point prevalence of major Rapporteur: Beth Duane mental illness, substance misuse and

homelessness in Irish prisons, put Introduction together a systematic review of all the There are 10.35 million people worldwide studies which have been published over who are incarcerated (Walmsley, 2016). It the last twenty years. The results has been found that a large number of showed: prisoners suffer from multiple Psychotic Disorder vulnerabilities such as substance misuse, Eight studies with a total sample size of mental disorders, homelessness, and 28,012 reported that 3.6% were suffering intellectual disabilities. It is generally from a psychotic disorder accepted that certain people who are Major Affective Disorder mentally ill and have contact with the Seven studies with a total sample size of criminal justice system should be diverted 7,928 prisoners reported that 4.3% were to psychiatric care rather than suffering from an affective disorder imprisoned. Ireland is no different. With Substance Misuse a high prevalence of mental illness, a Six studies with a total sample size of concerning number of individuals 1,659 prisoners reported that 28.3% were suffering from an intellectual disability are suffering from an alcohol misuse disorder not correctly diverted into appropriate and 50.9% were suffering from a services. “A Vision for Change”, the substance misuse disorders report of the Expert Group on Mental Homelessness Health Policy (Department of Children and Five studies with a total sample size of Health 2007) states: 1,523 prisoners reported that 17.4% of ‘The lack of appropriate services for this prisoners were homeless at the time of group of service users has had major committal consequences for mental health services and for the individuals themselves. In Study 2 - ‘Estimating the prevalence of addition to the distress of illness, they are intellectual disabilities in Irish prisons’ at high risk of ending up homeless, It is difficult to ascertain the number of becoming involved in petty crime, being people with intellectual disabilities in inappropriately imprisoned, or being in a prisons as the definition of an intellectual state of social isolation and dereliction’. disability varies across studies.

ICJA Conference 2018 - “Toward a Trauma-Responsive Criminal Justice System - Why, How and What Next?”

Additionally, even in the same jurisdiction Discussing Strategies to Address there are different diagnostic systems and Vulnerabilities different cut offs. So, this is an incredibly difficult area to research. Study 3 - ‘Diversion: What are the key priorities for development?’ Only one study based on research carried This study carried out a comparative out in Irish prisons met the methodology’s review in relation to the provision for strict inclusion criteria (Murphy et al, psychiatric diversion across the offender 2000). The criteria for diagnosis used in pathway in Ireland, England and Wales. this study included the Kaufman Brief The aim of this study was to comment on Intelligence Test, the Wide Range priorities relating to the development of Achievement Test, the Vocabulary subtest diversion services in Ireland through from the Wechsler Adult Intelligence Scale comparison with developments in a Revised, and the National Adult Prisoner neighbouring jurisdiction. Survey. This study found that 28.8% of the sample of prisoners had an intellectual The results showed that developments in disability. However, it is important to England and Wales have focussed on the note that the diagnosis of an intellectual broader offender pathway in comparison disability not only requires psychological to diversion services in Ireland which are testing, but also how someone functions chiefly linked to imprisonment. in the real world. A test of functioning Additionally, the study found that there is was not included in the methodology of little or no specialist psychiatric expertise this study, and therefore, the results can available to Gardaí in Ireland. However, be interpreted as being high. Prison In-reach and Court Liaison Services (PICLS) are currently developing in Ireland Implications from Study 1 and Study 2 but expertise and resourcing are variable The data presented by these geographically. The study found that aforementioned studies provides us with there is a lack of Intensive Care Regional a narrative that there is significant Units in Ireland, as compared to the morbidity in Irish prisons, which gives rise availability of Intensive Care and Low to humanitarian implications. Many Secure Units in England and Wales. There people in the prison system have a mental is limited scope to divert to hospital at illness. Effectively treating these sentencing stage in the absence of a vulnerabilities or addressing them would ‘hospital order’ provision in Irish support people in custody who suffer legislation. from a mental illness or have an intellectual disability. Moreover, doing so Study 4 - ‘Prison psychiatric in-reach in clearly has greater gains for society as a ‘’peripheral prisons”’ whole. This study was designed to identify who was being referred to psychiatric services in peripheral prisons such as Limerick

ICJA Conference 2018 - “Toward a Trauma-Responsive Criminal Justice System - Why, How and What Next?” prison. The data showed that of the such as Dundrum have medium to high people referred to the psychiatric service security beds for forensic patients. by their GPs, 21% had a psychotic illness, However, most patients here have not 12% had a major affective disorder, and committed serious crimes and do not 40% roughly had substance misuse or need to be treated in a high security unit. alcohol related disorders. In terms of Moreover, the participants pointed out outcomes, 51% needed psychotropic that “A Vision for Change” outlined the medication, 40% needed referral to need to create one Intensive Care psychology, and over 60% needed referral Regional Unit (ICRU) for every health to addiction counselling, and 10% needed region in Ireland, but this has not diversion from prison to a hospital setting. materialised due to the lack of funding. The discussion group stressed the Study 5 - ‘People with Intellectual importance of fulfilling this Disability in Prisons need specific care recommendation set forth by the 2007 and a compassionate approach’ document. This study was made to get a consensus on what people with a learning difficulty Additionally, it was suggested that there need. The Delphi method was used to needs to be customised treatment collect a lot of views and get a coherent programmes for individuals with an consensus. The study found that very few intellectual disability. Because of the jurisdictions succeed in screening for an difficulties associated with accessing intellectual disability. Additionally, the treatment due to barriers resulting from study found that if someone is diagnosed conviction status and artificial interfaces with an intellectual disability, they would based on arbitrary cut-offs for healthcare need specialised care while they are in services, it is imperative to invest in prison. In particular, if they are extremely specialised services for this group. vulnerable they could be sexually or financially exploited, thus, a higher level There was also a discussion that there of care is needed. If you take 100 people must be a strict commitment to solving with an intellectual disability, about one the issues which were outlined during the third of them will have seizures. The workshop. Participants agreed that to study also found that it was difficult to effectively solve these issues, there has to divert people with an intellectual disability be cooperation between services and the out of prison as there are very few courts system to appropriately care for psychiatric beds for people with an people suffering from a mental illness or intellectual disability. an intellectual disability.

Discussion The participants considered the practicality of having or creating a facility of low secure beds. Psychiatric hospitals

ICJA Conference 2018 - “Toward a Trauma-Responsive Criminal Justice System - Why, How and What Next?”

References: Gulati, G., Otuokpaikhian, K., Crowley, M., Gulati, G., Murphy, V., Clarke, A.M., Pradeep, V., Meagher, D. & Dunne, C.P. DelCelliher, K., Meagher D. & Dunne, C.P. (2019). Mental healthcare interfaces in a (2018). Intellectual disability in Irish regional Irish prison. International Journal prisoners; systematic review of of Prisoner Health. (accepted, in press) prevalence. International Journal of Gulati, G., Keating, N., O’Neill, A., Prisoner Health. 14 (4), DOI 10.1108/IJPH- Delaunois, I., Meagher, D., & Dunne, C.P. 01-2017-0003 (accepted, in press) (2018). The prevalence of major mental Gulati, G., Quigley, S., Murphy,V., Yacoub, illness, substance misuse and E., Bogue, J., Kearns, A., O'Neill, C., Kelly, homelessness in Irish prisoners: M. Morrison, A., Griffin, G.; Blewitt, M., Systematic review and meta- Fistein, E., Meagher, D. & Dunne, C.P. analyses. Irish Journal of Psychological (2018). A novel care pathway for prisoners Medicine, 1-11. doi:10.1017/ipm.2018.15 with intellectual disability designed Gulati, G., and Kelly, B.D. (2018). Diversion through a Delphi process. International of mentally ill offenders from the criminal Journal of Prisoner Health, 14(3), DOI justice system in Ireland: comparison with 10.1108/IJPH-08-2017-0037 (accepted, in England and Wales. Irish Medical Journal, press). P719. Available at: http://imj.ie/diversion- of-mentally-ill-offenders-from-the- criminal-justice-system-in-ireland- comparison-with-england-and-wales/

ICJA Conference 2018 - “Toward a Trauma-Responsive Criminal Justice System - Why, How and What Next?” CONFERENCE ATTENDEES

Thelma Abernethy Extern Michal Alfasi-Hanley Policing Authority Emma Barry Tivoli Training Centre Emma Black Irish Prison Service Fergal Black Irish Prison Service Noeline Blackwell Dublin Rape Crisis Centre Patricia Bourke Mental Health/Trauma Specialist Andy Bray Le Chéile Mentoring Siobhán Buckley Maynooth University Laura Burke The Probation Service Gillian Butler Cork Alliance Centre Lucy Butler The Probation Service Maura Butler ACJRD Chairperson Deirdre Byrne Office of the DPP Hanna Byrne Law Reform Commission Graham Cambridge University College Cork Eoin Carroll Jesuit Centre for Faith and Justice Eithne Casey Helen Casey Inspector of Prisons Constantin Cazac Irish Prison Service Maggie Clune PACE Training Services Jenna Coakley Irish Prison Service Ingrid Colvin PACE Sheila Connolly Cork Alliance Centre Anne Conroy Le Chéile Mentoring Dr. Pauline Conroy IPS Visiting Committee Aidan Cooney National Forensic Services Ríoghnach Corbett Office of the Director of Public Prosecutions Anne Costello St Stephen's Green Trust Stephen Coughlan Bail Supervision Scheme Tim Coughlan Facing Forward Mick Crimmins Tivoli Training Centre Gerry Cronin Department of Justice and Equality Karyn Cronin Youth Work Ireland Galway Tina Cronin Conference Volunteer Dr. Lisa Cuthbert PACE Brian Dack The Probation Service Kate Daniels Conference Volunteer Dr. Shelley Deane Brehon Advisory Mick Devine Tabor Group Michael Donnellan Irish Prison Service Pauline Downey The Probation Service

ICJA Conference 2018 - “Toward a Trauma-Responsive Criminal Justice System - Why, How and What Next?”

Leonora B. Doyle Leonora B. Doyle Orna Doyle ACTS Tusla Pamela Drumgoole Irish Penal Reform Trust Beth Duane Conference Volunteer Caroline Duane Kerry Diocesan Youth Services Simon Duffy Irish Prison Service Frank Dunleavy One in Four Eileen Farrell Institute of Technology Carlow Mary Fennessy IPS Mountjoy Visiting Committee Eileen Finnegan One in Four Sarah Finnegan The Probation Service Charlie Flanagan Minister for Justice and Equality Orla Gallagher Irish Prison Service & University College Dublin Paul Gates The Probation Service Mary Rose Gearty SC Vivian Geiran The Probation Service Patricia Gilheaney Inspector of Prisons Ailish Glennon The Probation Service Margaret Griffin The Probation Service Dr. Ciara Guiney Health Research Board Dr. Gautam Gulati University Hospital Limerick Annita Harty Conference Volunteer Niall Hassett Depaul Ireland Greg Heylin Department of Justice and Equality Christine Hoctor Irish Prison Service Judge Gillian Hussey Carmen Iordache Depaul David Joyce Mercy Law Resource Centre Elaine Kavanagh The Probation Service Siobhán Kavanagh The Probation Service Ann Marie Keane Human Trafficking Investigation and Coordination Unit Billy Keane Barrister Linda Kearin Kerry Diocesan Youth Services Bernie Keigher Peter McVerry Trust Patricia Kelleher Irish Prison Service Enda Kelly Irish Prison Service Niamh Kelly Michael J. Staines & Company Sharon Kennedy The Probation Service Mark Kennedy Irish Prison Service Dr. Louise Kennefick Maynooth University Deirdre Kenny One in Four Des Kirwan Irish Prison Service Przemyslaw Kluczenko Depaul Raymond Lambert Dr. Sharon Lambert University College Cork Fergal Landy TUSLA Charles Larkin Trinity College Dublin

ICJA Conference 2018 - “Toward a Trauma-Responsive Criminal Justice System - Why, How and What Next?”

Philip Larragy Release Eileen Leahy IYJS / DCYA Noreen Leahy IYJS / DCYA Dr. Susan Leahy University of Limerick Dr. Cliona Loughnane National Women's Council of Ireland Wendy Lyon KOD Lyons Ciara McCarthy Health Service Executive David McDonagh Winnie McDonagh National Travellers Women Forum Saragh McGarrigle The Probation Service Dr. Maggie McGovern Dóchas Centre Damien McKenna One In Four Pauline McKeown Coolmine TC Aideen McLaughlin Extern Dr. Louise McLoughlin Central Mental Hospital Ronan McLoughlin CAMHS- Forensic Gerry McNally The Probation Service Gillian McNamee ICJDN and Rehab Group Ciara McQuillan Conference Volunteer Fr. Peter McVerry Peter McVerry Trust Alaina Maher Conference Volunteer Shauna Markey SAFE Ireland Lisa Marmion SAFE Ireland Michelle Martyn Irish Penal Reform Trust Claire Moloney Irish Prison Service Martin Moucheron Irish Prison Service Jane Mulcahy PhD Student UCC Ian Mulholland Department of Justice and Equality Kate Mulkerrins An Garda Síochána Lynda Mullin Office of the Director of Public Prosecutions Fiona Murphy Bail Supervision Scheme Dr. Catherine Naughton University of Limerick Jane Newman City of Dublin Education and Training Board Fíona Ní Chinnéide Irish Penal Reform Trust Sinéad O'Connell The Probation Service Gov. Mary O'Connor Dóchas Centre Dr. Muireann O'Donnell Central Mental Hospital Dr. Kieran O'Dwyer Alice O'Flynn Care After Prison Ray O'Keeffe Irish Prison Service Dr. Sinéad O'Malley UNESCO Child and Family Research Centre Dr. Conor O'Neill Central Mental Hospital Michael O'Neill IHREC Cindy O'Shea University College Dublin Mal O'Sullivan Irish Prison Service Rory Penny Conference Volunteer David Peters David Peters Solicitors

ICJA Conference 2018 - “Toward a Trauma-Responsive Criminal Justice System - Why, How and What Next?”

Dr. Etáin Quigley Maynooth University Marion Rackard Project Manager HSE Alcohol Programme Aoife Reddy Central Mental Hospital Caitríona Redmond ACTS, TUSLA Joanne Redmond Office of the Director of Public Prosecutions Dr. Seán Redmond University of Limerick Aoife Rice Irish Prison Service Dr. Lucy Rowell Irish Prison Service Rev. Alan Rufli Church of Ireland Dr. Aisling Ryan Forensic CAMHS Ben Ryan Department of Justice and Equality Eimear Ryan ACTS Miriam Ryan Chrysalis Brian Santry The Probation Service Shirley Scott Dublin Rape Crisis Centre Vicky Seaman University College Cork Brendan Sheehy IYJS Emma Sliney Cork Alliance Centre Aisling Somers Tivoli Training Centre Kim Spendlove Tower Programme Maighréad Tobin Maynooth University Tadhg Twomey IYJS Niamh Wade Maynooth University Tanya Walker Woodale Youth Justice Project (Sphere 17) Dr. Jamie Walsh Central Mental Hospital Marion Walsh Department of Justice and Equality Pyers Walsh IASIO Daniel Watters IYJS / DCYA Kathleen White University College Cork Mark Wilson Irish Prison Service Sarah Winston Restorative Justice Service Rachel Woods Department of Justice and Equality