Table of Contents

1. Agenda

2. Poem: “Self Portrait as State Property” by P.M. Dunne, 2019 Prison Writing Awards ​ Anthology, PEN AMERICA ​ 3. Working list of terms and definitions

4. Excerpts from SAMHSA’s “Concept of Trauma and Guidance for a Trauma-Informed

Approach”

5. Excerpt from “Trauma-Informed Care: Is Cultural Competence a Viable Solution for

Efficient Policy Strategies?” by Vittoria Ardino, Clinical Neuropsychiatry ​ 6. “The Mental Health of Crime Victims” by Judith Lewis Herman, Journal of Traumatic ​ Stress

7. People v. Abdur-Razzaq, Frye Hearing (Expert Testimony from Dr. Chitra Raghavan) ​ 8. “A Gun to His Head as a Child. In Prison as an Adult.” by Audra Burch, New York Times ​ 9. “How I Finally Learned That Trauma Does Not Define Me” by Marlon Peterson,The ​ Marshall Project

10. “Trauma for the Tough-Minded Prosecutor” by Stacy Miles Thrope, The Texas ​ Prosecutor Journal

11. Selected NY State Criminal Jury Instructions (Credibility of Witness, Prompt Outcry,

Insanity, Use of physical Force in Defense of a Person)

12. Participant Bios

Trauma-Informed Prosecution Roundtable Agenda

February 18, 2020 9:30 am- 1:00 pm John Jay College of Criminal Justice 524 W 59th St, New York, NY 10019 Room 9.64 (New Building, 9th Floor)

Important Guidelines:

The IIP’s Trauma-Informed Prosecution Roundtable is an off the record convening. Participants are welcome to take notes. The IIP staff will be taking notes and drafting a landscape analysis of the issues discussed at the convening in order to identify strengths, weaknesses and areas of further exploration.

During the discussion, we will be discussing sensitive topics and would encourage all participants to take a break and excuse yourself when necessary. Please help us cultivate a safe space for honest and open discussions. Assume best intentions when people are talking and allow space for understanding and correction.

Due to the short period of time we have together, we will be working straight through and ask that all participants remain present and limit use of technology.

If you have any concerns, please feel free to reach out to IIP staff members before, during, or after the roundtable. We are open to all feedback on our convenings and we are always looking to improve our facilitation of discussions.

9:30 AM Arrival and Breakfast

9:45 AM Opening Remarks

10:05 AM Grounding Exercise Led by Yaelle Yoran

10:10 AM Language Setting Discussion Discussion led by Allison Trenk

10:25 AM Neurobiology of Trauma Presentation

10:35 AM Criminal Justice System Mapping Presented by Rena Paul

11:00 AM Discussion 1: Initial System Contact

11:45 AM Discussion 2: Pendency of Prosecution or Investigation

12:30 PM Discussion 3: Outcomes and Ongoing Contact

1:00 PM Lunch and Next Steps Discussion

Wi-Fi: John Jay Events Password: eventswinter20

Working List of Trauma-Informed Terms Below is a list of terms and definitions. Please review the terms and come prepared with feedback for the roundtable. We will be taking 15 minutes at the beginning of the session to discuss these terms. We encourage all participants to share any additional terms or amendments to definitions during that time.

Trauma: “Individual trauma results from an event, series of events, or set of circumstances ​ ​ experienced by an individual as physically or emotionally harmful or life-threatening with lasting adverse effects on the individual’s functioning and mental, physical, social, emotional, or spiritual well-being.”1

PTSD: “Under DSM-5, post-traumatic stress disorder (PTSD) is an anxiety disorder that ​ ​ develops in relation to an event which creates psychological trauma in response to actual or threatened death, serious injury, or sexual violation. The exposure must involve directly experiencing the event, witnessing the event in person, learning of an actual or threatened death of a close family member or friend, or repeated first-hand, extreme exposure to the details of the event. A formal diagnosis of PTSD is made when the symptoms cause clinically significant distress or impairment in social and/or occupational dysfunction for a period of at least one month. The symptoms cannot be due to a medical condition, medication, or drugs or alcohol.”2

Complex trauma: Exposure to multiple traumatic events—often of an invasive, interpersonal ​ ​ nature—and the wide-ranging, long-term effects of this exposure. These events are severe and pervasive, such as abuse or profound neglect. They usually occur early in life and can disrupt many aspects of the child’s development and the formation of a sense of self. Complex trauma ​ typically involves exposure to sequential or simultaneous occurrences of maltreatment, “including psychological maltreatment, neglect, physical and sexual abuse, and domestic violence…. Exposure to these initial traumatic experiences—and the resulting emotional dysregulation and the loss of safety, direction, and the ability to detect or respond to danger cues—often sets off a chain of events leading to subsequent or repeated trauma exposure in adolescence and adulthood.” 3

Cultural responsiveness and cultural competence: “Cultural and linguistic competence is a set ​ of congruent behaviors, attitudes, and policies that come together in a system, agency, or among professionals Introduction to Cultural Competence That enables effective work in cross-cultural situations. “Culture” refers to integrated patterns of human behavior that include the language, thoughts, communications, actions, customs, beliefs, values, and institutions of racial, ethnic,

1 https://www.integration.samhsa.gov/clinical-practice/trauma ​ 2 https://www.theravive.com/therapedia/posttraumatic-stress-disorder-(ptsd)-dsm--5-309.81-(f43.10) ​ 3 http://www.nctsn.org/trauma-types ​ religious, or social groups. “Competence” implies having the capacity to function effectively as an individual and an organization within the context of the cultural beliefs, behaviors, and needs presented by consumers and their communities.”4

Retraumatization: “Retraumatization happens when people with PTSD are exposed to people, ​ ​ places, events, situations, or environments that cause them to re-experience past trauma as if it were fresh or new. While normal triggers can bring back unpleasant memories, or even provoke disturbing flashbacks, retraumatizing events are especially powerful triggers that somehow recreate the intense dynamics associated with the original traumatic encounters or episodes.5

Vicarious trauma: “An occupational challenge for people working and volunteering in the ​ fields of victim services, law enforcement, emergency medical services, fire services, and other allied professions, due to their continuous exposure to victims of trauma and violence. This work-related trauma exposure can occur from such experiences as listening to individual clients recount their victimization; looking at videos of exploited children; reviewing case files; hearing about or responding to the aftermath of violence and other traumatic events day after day; and responding to mass violence incidents that have resulted in numerous injuries and deaths.”6

Trauma-informed: “A trauma-informed approach to the delivery of behavioral health services ​ includes an understanding of trauma and an awareness of the impact it can have across settings, services, and populations. It involves viewing trauma through an ecological and cultural lens and recognizing that context plays a significant role in how individuals perceive and process traumatic events, whether acute or chronic. In May 2012, SAMHSA convened a group of national experts who identified three key elements of a trauma-informed approach: “(1) realizing the prevalence of trauma; (2) recognizing how trauma affects all individuals involved with the program, organization, or system, including its own workforce; and (3) responding by putting this knowledge into practice” (SAMHSA, 2012, p 4).”7

Trauma survivor: “This phrase can refer to anyone who has experienced trauma or has had a ​ traumatic stress reaction. Knowing that the use of language and words can set the tone for recovery or contribute to further retraumatization, it is the intent of this manual to put forth a message of hope by avoiding the term “victim” and instead using the term “survivor” when appropriate.”8

4 Office of Minority Health. (2000). Assuring cultural competence in health care: Recommendations for national standards and an outcomes-focused research agenda (p. 28). Rockville, MD: Author. 5 https://www.brightquest.com/post-traumatic-stress-disorder/retraumatization/ ​ 6 https://vtt.ovc.ojp.gov/what-is-vicarious-trauma ​ 7 https://store.samhsa.gov/system/files/sma14-4884.pdf ​ 8 https://store.samhsa.gov/system/files/sma14-4884.pdf ​ FETI: “The Forensic Experiential Trauma Interview (FETI®) provides interviewers with a ​ ​ science-informed interviewing framework that maximizes opportunities for information collection and accurately documents the participant's experience in a neutral, equitable, and fair manner.”9

Trauma Coerced Attachment (TCA): “Trauma-coerced attachment (TCA)—often referred to ​ as trauma bonding—has been noted and documented across various abusive contexts. TCA involves a powerful emotional dependency on the abusive partner and a shift in world- and self- view, which can result in feelings of gratitude or loyalty toward the abuser and denial or minimization of the coercion and abuse.”10

Adverse Childhood Experiences (ACES): “Adverse childhood experiences, or ACEs, are ​ potentially traumatic events that occur in childhood (0-17 years). For example:experiencing violence or abuse; witnessing violence in the home or community; having a family member attempt or die by suicide. Also included are aspects of the child’s environment that can undermine their sense of safety, stability, and bonding such as growing up in a household with:substance misuse; mental health problems; instability due to parental separation or household members being in jail or prison.ACEs are linked to chronic health problems, mental illness, and substance misuse in adulthood. ACEs can also negatively impact education and job opportunities.”11

Neurobiology: “Neurobiology is concerned with uncovering the biological mechanisms by ​ which nervous systems mediate behavior. Over the past half century, much of neurobiology has focused on the cells of the nervous system. The structure and physiology of nerve cells (neurons) and supporting glial cells has been elucidated in considerable detail as well as the functional contacts (synapses) made between neurons. How individual nerve and receptor cells generate, carry, and transmit electrical and chemical signals is now well under-stood, and many substances that are used by neurons to communicate information have been identified.”12

9 https://www.certifiedfeti.com/ ​ 10 Kendra Doychak & Chitra Raghavan (2018): “No voice or vote:” trauma-coerced attachment in victims of sex trafficking, Journal of Human Trafficking, DOI:10.1080/23322705.2018.1518625 11https://www.cdc.gov/violenceprevention/childabuseandneglect/aces/fastfact.html?CDC_AA_refVal=https%3A%2 F%2Fwww.cdc.gov%2Fviolenceprevention%2Fchildabuseandneglect%2Facestudy%2Faboutace.html 12 https://mbb.harvard.edu/pages/undergraduate-tracks-neurobiology ​ SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed Approach

Prepared by SAMHSA’s Trauma and Justice Strategic Initiative July 2014 Background: Trauma — Where We Are and How We Got Here

The concept of traumatic stress emerged in the Simultaneously, an emerging trauma survivors field of mental health at least four decades ago. movement has provided another perspective on the Over the last 20 years, SAMHSA has been a leader understanding of traumatic experiences. Trauma in recognizing the need to address trauma as a survivors, that is, people with lived experience fundamental obligation for public mental health and of trauma, have powerfully and systematically substance abuse service delivery and has supported documented their paths to recovery.26 Traumatic the development and promulgation of trauma-informed experiences complicate a child’s or an adult’s systems of care. In 1994, SAMHSA convened the capacity to make sense of their lives and to create Dare to Vision Conference, an event designed to meaningful consistent relationships in their families bring trauma to the foreground and the first national and communities. conference in which women trauma survivors talked about their experiences and ways in which standard practices in hospitals re-traumatized and often, Trauma survivors have powerfully triggered memories of previous abuse. In 1998, SAMHSA funded the Women, Co-Occurring Disorders and systematically documented and Violence Study to generate knowledge on the their paths to recovery. development and evaluation of integrated services approaches for women with co-occurring mental and substance use disorders who also had histories of physical and or sexual abuse. In 2001, SAMHSA The convergence of the trauma survivor’s perspective funded the National Child Traumatic Stress Initiative to with research and clinical work has underscored the increase understanding of child trauma and develop central role of traumatic experiences in the lives of effective interventions for children exposed to different people with mental and substance use conditions. types of traumatic events. The connection between trauma and these conditions offers a potential explanatory model for what has The American Psychiatric Association (APA) played an happened to individuals, both children and adults, important role in defining trauma. Diagnostic criteria for who come to the attention of the behavioral health and traumatic stress disorders have been debated through other service systems.25,27 several iterations of the Diagnostic and Statistical Manual of Mental Disorders (DSM) with a new People with traumatic experiences, however, do not category of Trauma- and Stressor-Related Disorders, show up only in behavioral health systems. Responses across the life-span, included in the recently released to these experiences often manifest in behaviors or DSM-V (APA, 2013). Measures and inventories of conditions that result in involvement with the child trauma exposure, with both clinical and research welfare and the criminal and juvenile justice system or applications, have proliferated since the 1970’s.18,19,20,21 in difficulties in the education, employment or primary National trauma research and practice centers have care system. Recently, there has also been a focus conducted significant work in the past few decades, on individuals in the military and increasing rates of further refining the concept of trauma, and developing posttraumatic stress disorders.28,29,30,31 effective trauma assessments and treatments.22,23,24,25 With the advances in neuroscience, a biopsychosocial approach to traumatic experiences has begun to delineate the mechanisms in which neurobiology, psychological processes, and social attachment interact and contribute to mental and substance use disorders across the life-span.3,25

page 5 Other federal agencies have increased their focus primary care on how to address trauma issues in on trauma. The Administration on Children Youth health care for women. The Department of Labor is and Families (ACYF) has focused on the complex examining trauma and the workplace through a federal trauma of children in the child welfare system and interagency workgroup. The Department of Defense is how screening and assessing for severity of trauma honing in on prevention of sexual violence and trauma and linkage with trauma treatments can contribute in the military. to improved well-being for these youth. In a joint effort among ACYF, SAMHSA and the Centers for As multiple federal agencies representing varied Medicare and Medicaid Services (CMS), the three sectors have recognized the impact of traumatic agencies developed and issued through the CMS experiences on the children, adults, and families State Directors’ mechanism, a letter to all State Child they serve, they have requested collaboration with Welfare Administrators, Mental Health Commissioners, SAMHSA in addressing these issues. The widespread Single State Agency Directors for Substance Abuse recognition of the impact of trauma and the burgeoning and State Medicaid Directors discussing trauma, interest in developing capacity to respond through its impact on children, screening, assessment and trauma-informed approaches compelled SAMHSA treatment interventions and strategies for paying to revisit its conceptual framework and approach for such care. The Office of Juvenile Justice and to trauma, as well as its applicability not only to Delinquency Prevention has specific recommendations behavioral health but also to other related fields. to address trauma in their Children Exposed to Violence Initiative. The Office of Women’s Health has developed a curriculum to train providers in

SAMHSA’s Concept of Trauma

Decades of work in the field of trauma have generated multiple definitions of trauma. Combing through this Individual trauma results from an work, SAMHSA developed an inventory of trauma definitions and recognized that there were subtle event, series of events, or set of nuances and differences in these definitions. circumstances that is experienced

Desiring a concept that could be shared among its by an individual as physically or constituencies — practitioners, researchers, and emotionally harmful or life threatening trauma survivors, SAMHSA turned to its expert panel and that has lasting adverse effects to help craft a concept that would be relevant to public on the individual’s functioning and health agencies and service systems. SAMHSA aims to provide a viable framework that can be used to mental, physical, social, emotional, support people receiving services, communities, and or spiritual well-being. stakeholders in the work they do. A review of the existing definitions and discussions of the expert panel generated the following concept:

page 7 The six key principles fundamental to a trauma-informed approach include:24,36

1. Safety: Throughout the organization, staff and the 5. Empowerment, Voice and Choice: Throughout people they serve, whether children or adults, feel the organization and among the clients served, physically and psychologically safe; the physical individuals’ strengths and experiences are setting is safe and interpersonal interactions recognized and built upon. The organization promote a sense of safety. Understanding safety as fosters a belief in the primacy of the people served, defined by those served is a high priority. in resilience, and in the ability of individuals, organizations, and communities to heal and promote recovery from trauma. The organization 2. Trustworthiness and Transparency: understands that the experience of trauma may Organizational operations and decisions are be a unifying aspect in the lives of those who run conducted with transparency with the goal of the organization, who provide the services, and/ building and maintaining trust with clients and family or who come to the organization for assistance members, among staff, and others involved in the and support. As such, operations, workforce organization. development and services are organized to foster empowerment for staff and clients alike. 3. Peer Support: Peer support and mutual self-help Organizations understand the importance of power are key vehicles for establishing safety and hope, differentials and ways in which clients, historically, building trust, enhancing collaboration, and utilizing have been diminished in voice and choice and their stories and lived experience to promote are often recipients of coercive treatment. Clients recovery and healing. The term “Peers” refers to are supported in shared decision-making, choice, individuals with lived experiences of trauma, or in and goal setting to determine the plan of action the case of children this may be family members of they need to heal and move forward. They are children who have experienced traumatic events supported in cultivating self-advocacy skills. Staff and are key caregivers in their recovery. Peers have are facilitators of recovery rather than controllers also been referred to as “trauma survivors.” of recovery.34 Staff are empowered to do their work as well as possible by adequate organizational support. This is a parallel process as staff need to 4. Collaboration and Mutuality: Importance is feel safe, as much as people receiving services. placed on partnering and the leveling of power differences between staff and clients and among organizational staff from clerical and housekeeping 6. Cultural, Historical, and Gender Issues: personnel, to professional staff to administrators, The organization actively moves past cultural demonstrating that healing happens in relationships stereotypes and biases (e.g. based on race, and in the meaningful sharing of power and ethnicity, sexual orientation, age, religion, gender- decision-making. The organization recognizes that identity, geography, etc.); offers, access to gender everyone has a role to play in a trauma-informed responsive services; leverages the healing value approach. As one expert stated: “one does not have of traditional cultural connections; incorporates to be a therapist to be therapeutic.”12 policies, protocols, and processes that are responsive to the racial, ethnic and cultural needs of individuals served; and recognizes and addresses historical trauma.

page 11 FINANCING: Financing structures are designed to key principles of a trauma-informed approach. Many support a trauma-informed approach which includes of these questions and concepts were adapted from resources for: staff training on trauma, key principles the work of Fallot and Harris, Henry, Black-Pond, of a trauma-informed approach; development of Richardson, & Vandervort, Hummer and Dollard, and appropriate and safe facilities; establishment of Penney and Cave.39, 40, 41,42 peer-support; provision of evidence-supported trauma screening, assessment, treatment, and recovery While the language in the chart may seem more supports; and development of trauma-informed cross- familiar to behavioral health settings, organizations agency collaborations. across systems are encouraged to adapt the sample questions to best fit the needs of the agency, staff, EVALUATION: Measures and evaluation designs used and individuals being served. For example, a to evaluate service or program implementation and juvenile justice agency may want to ask how it would effectiveness reflect an understanding of trauma and incorporate the principle of safety when examining appropriate trauma-oriented research instruments. its physical environment. A primary care setting may explore how it can use empowerment, voice, and To further guide implementation, the chart on the next choice when developing policies and procedures to page provides sample questions in each of the ten provide trauma-informed services (e.g. explaining step domains to stimulate change-focused discussion. by step a potentially invasive procedure to a patient at The questions address examples of the work to be an OBGYN office). done in any particular domain yet also reflect the six

SAMPLE QUESTIONS TO CONSIDER WHEN IMPLEMENTING A TRAUMA-INFORMED APPROACH

KEY PRINCIPLES

Safety Trustworthiness Peer Support Collaboration Empowerment, Cultural, and and Mutuality Voice, and Historical, and Transparency Choice Gender Issues

10 IMPLEMENTATION DOMAINS

Governance • How does agency leadership communicate its support and guidance for implementing a and trauma-informed approach? Leadership • How do the agency’s mission statement and/or written policies and procedures include a commitment to providing trauma-informed services and supports? • How do leadership and governance structures demonstrate support for the voice and participation of people using their services who have trauma histories? Policy • How do the agency’s written policies and procedures include a focus on trauma and issues of safety and confidentiality? • How do the agency’s written policies and procedures recognize the pervasiveness of trauma in the lives of people using services, and express a commitment to reducing re-traumatization and promoting well-being and recovery? • How do the agency’s staffing policies demonstrate a commitment to staff training on providing services and supports that are culturally relevant and trauma-informed as part of staff orientation and in-service training? • How do human resources policies attend to the impact of working with people who have experienced trauma? • What policies and procedures are in place for including trauma survivors/people receiving services and peer supports in meaningful and significant roles in agency planning, governance, policy-making, services, and evaluation?

page 14 SAMPLE QUESTIONS TO CONSIDER WHEN IMPLEMENTING A TRAUMA-INFORMED APPROACH (continued)

10 IMPLEMENTATION DOMAINS continued Physical • How does the physical environment promote a sense of safety, calming, and de-escalation Environment for clients and staff? • In what ways do staff members recognize and address aspects of the physical environment that may be re-traumatizing, and work with people on developing strategies to deal with this? • How has the agency provided space that both staff and people receiving services can use to practice self-care? • How has the agency developed mechanisms to address gender-related physical and emotional safety concerns (e.g., gender-specific spaces and activities). Engagement • How do people with lived experience have the opportunity to provide feedback to the and organization on quality improvement processes for better engagement and services? Involvement • How do staff members keep people fully informed of rules, procedures, activities, and schedules, while being mindful that people who are frightened or overwhelmed may have a difficulty processing information? • How is transparency and trust among staff and clients promoted? • What strategies are used to reduce the sense of power differentials among staff and clients? • How do staff members help people to identify strategies that contribute to feeling comforted and empowered? Cross Sector • Is there a system of communication in place with other partner agencies working with the Collaboration individual receiving services for making trauma-informed decisions? • Are collaborative partners trauma-informed? • How does the organization identify community providers and referral agencies that have experience delivering evidence-based trauma services? • What mechanisms are in place to promote cross-sector training on trauma and trauma- informed approaches? Screening, • Is an individual’s own definition of emotional safety included in treatment plans? Assessment, • Is timely trauma-informed screening and assessment available and accessible to individuals Treatment receiving services? Services • Does the organization have the capacity to provide trauma-specific treatment or refer to appropriate trauma-specific services? • How are peer supports integrated into the service delivery approach? • How does the agency address gender-based needs in the context of trauma screening, assessment, and treatment? For instance, are gender-specific trauma services and supports available for both men and women? • Do staff members talk with people about the range of trauma reactions and work to minimize feelings of fear or shame and to increase self-understanding? • How are these trauma-specific practices incorporated into the organization’s ongoing operations?

page 15 SAMPLE QUESTIONS TO CONSIDER WHEN IMPLEMENTING A TRAUMA-INFORMED APPROACH (continued)

10 IMPLEMENTATION DOMAINS continued

Training and • How does the agency address the emotional stress that can arise when working with Workforce individuals who have had traumatic experiences? Development • How does the agency support training and workforce development for staff to understand and increase their trauma knowledge and interventions? • How does the organization ensure that all staff (direct care, supervisors, front desk and reception, support staff, housekeeping and maintenance) receive basic training on trauma, its impact, and strategies for trauma-informed approaches across the agency and across personnel functions? • How does workforce development/staff training address the ways identity, culture, community, and oppression can affect a person’s experience of trauma, access to supports and resources, and opportunities for safety? • How does on-going workforce development/staff training provide staff supports in developing the knowledge and skills to work sensitively and effectively with trauma survivors. • What types of training and resources are provided to staff and supervisors on incorporating trauma-informed practice and supervision in their work? • What workforce development strategies are in place to assist staff in working with peer supports and recognizing the value of peer support as integral to the organization’s workforce? Progress • Is there a system in place that monitors the agency’s progress in being trauma-informed? Monitoring • Does the agency solicit feedback from both staff and individuals receiving services? and Quality • What strategies and processes does the agency use to evaluate whether staff members feel Assurance safe and valued at the agency? • How does the agency incorporate attention to culture and trauma in agency operations and quality improvement processes? • What mechanisms are in place for information collected to be incorporated into the agency’s quality assurance processes and how well do those mechanisms address creating accessible, culturally relevant, trauma-informed services and supports? Financing • How does the agency’s budget include funding support for ongoing training on trauma and trauma-informed approaches for leadership and staff development? • What funding exists for cross-sector training on trauma and trauma-informed approaches? • What funding exists for peer specialists? • How does the budget support provision of a safe physical environment? Evaluation • How does the agency conduct a trauma-informed organizational assessment or have measures or indicators that show their level of trauma-informed approach? • How does the perspective of people who have experienced trauma inform the agency performance beyond consumer satisfaction survey? • What processes are in place to solicit feedback from people who use services and ensure anonymity and confidentiality? • What measures or indicators are used to assess the organizational progress in becoming trauma-informed?

page 16 Clinical Neuropsychiatry (2014) 11, 1, 45-51

TRAUMA-INFORMED CARE: IS CULTURAL COMPETENCE A VIABLE SOLUTION FOR EFFICIENT POLICY STRATEGIES?

Vittoria Ardino

Abstract

Treatment and support needs within the public system require a systemic approach characterized both by trauma- specific diagnostic and treatment services and a “trauma-informed” environment capable of sustaining these services and supporting the positive outcomes to clients who receive these services. The paper provides a critique of what steps are needed to promote a dialogue between evidence-based practices and culture competence in trauma-informed services highlighting the strategic gaps that may maintain a disconnection between treatment and service delivery, and between cultural psychology and the traumatic stress field. The paper concludes with policy reccomendations and with a reflection on the challenges ahead, especially in terms of effectiveness and the task of integrating psychotraumatology into the routine of mental health services.

Key words: trauma-informed care, policy, culture, service delivery

Vittoria Ardino, Ph.D. London School of Economics and Political Science Personal Social Services Research Unit King’s Chambers 2.07 Email [email protected]

Introduction practices and culture competence in trauma-informed services highlighting the strategic gaps that may Traumatic events interfere with the way one thinks, maintain a disconnection between treatment and service feels, and acts. Some people have minimal symptoms delivery, and between cultural psychology and the after trauma exposure or recover quickly, while others traumatic stress field. Furthermore, the paper identifies may develop more significant and longer-lasting the fundamental characteristics of a trauma-informed problems. Long-term consequences can also cause system of care including core service components multiple costs to victims and their families, and to (assessment and screening, inpatient treatment, whole society, such as unemployment, lost work time, residential services, addictions programming and case and increased health care utilization and costs (Chan management). In so doing, this work puts forward the et al. 2009, Goldin et al. 1988, Maguen et al. 2012). importance of the implementation of a broad spectrum In responding to adverse outcomes, the trauma field of policies and practices to reflect the needs of the mostly focused on evidence-based treatments resulting specific target population. in an explosion of randomized controlled trials. Mental health services have a long history of However, less research and policy initiatives have been serving victims of trauma without being aware of devoted to implement effective models of services to or considering the pervasiveness and long-term improve the system of care for traumatised individuals consequences of traumatic events (Harris and Fallot (Ko et al. 2008). For example, the prevalence of PTSD 2001). However, with the increasing understanding of in primary care settings is similar to those of depressive the clinical features of traumatic stress, the importance disorders and higher than those found for other anxiety of creating a Trauma Informed Care (TIC) approach has disorders (Prins et al. 2003); however, given the high been more recognised. prevalence and lack of attention to identification, it is no surprise that trauma-related disorders are frequently under-recognised and untreated leading to longer term conditions and healthcare utilisation (Grubaugh et al. 2005, Liebschutz et al. 2007). This effort is even less if we consider the role of culture in providing alternative pathways to healing and integration of extreme stress experiences (Moodley and West 2006). This paper provides a critique of what steps are needed to promote a dialogue between evidence-based

Submitted May 2013, accepted September 2013 © 2014 Giovanni Fioriti Editore s.r.l. 45 Trauma-informed care

Cultural competence as a core component of trauma-informed care Treatment providers must be able to understand the client’s cultural context. Cultural competency includes having the knowledge and skills to work within the client’s culture, understanding how one’s own cultural background and the program influence transactions with the client (Fong and Furuto 2001). Understanding the influence of someone’s culture is essential to making an effective therapeutic connection and to being part of the recovery process. The meaning one gives to trauma can vary by culture. Healing takes place within an individual’s cultural context and support network, and different cultural groups may have unique resources that support healing. Cultural competence does not require that every service provider have detailed knowledge of every culture, but rather that he or she recognize the importance of the cultural context. It is often helpful to ask question trying to understand client responses through the lens of culture. Therefore, the implementation of a culture- sensitive and trauma-informed approach requires a series of steps including appropriate screening and assessments, effective interventions and support, culturally and linguistically competent strategies, strong organisational capacity, including outcome monitoring. However, there is considerable confusion about what constitutes cultural competence. For example, it may be narrowly interpreted to mean better knowledge of the cultural beliefs and practices of a specific cultural group, with little attention to how culture modifies illness perceptions, illness behaviour, and acceptability of specific interventions. Cultural competency is somehow expected to emerge if the racial and ethnic mix of the workforce is representative of the local population. Not surprisingly, working practices following standardised professional trainings remain similar among staff from different ethnic groups because of the common pattern of training. Indeed, a patient and a health professional, ostensibly belonging to the same ethnic group because of shared country of origin, may actually differ in terms of social class, religious practices, languages, and cultural beliefs about illness and recovery. Despite a growing body of health and educational policies that prioritise cultural competency in health care provision, there is surprisingly little agreement on the meaning of cultural competence. Recent years have seen the development of professional standards for training and quality assurance in cultural competence (Lopez 1997, Sue 1998). In the case of trauma-informed care this specifically includes the clinician’s ability to elicit cultural information during

4747 Vittoria Ardino the clinical encounter, to understand how the different client-friendly approaches. Yet another major challenge cultural worlds of patients and their families influence facing psychology today is how psychological the course of the post-traumatic consequences, and to treatments developed in one country and culture can develop a treatment plan that empowers the patient be transferred to another culture and how this can be by acknowledging cultural background and resources translated to a trauma-informed service. To address while allowing appropriate psychiatric interventions. culture, an increasing number of practitioners and Cultural competence has to do with knowledge and scholars in the trauma field have focused on culture skills pertaining to a single cultural group, which specific interventions emphasizing differences among may include history, language, etiquette, styles of different cultural groups, rather than making profound child-rearing, emotional expression, and interpersonal revisions of the current approaches to the study of interaction, as well as cultural explanations of illness trauma. Another challenge is the creation of trauma and specifi c modalities of healing. Often, it is assumed assessment instruments that address the multiple that specific cultural competence is assured when cultural realities of clients. there is an ethnic match between clinician and patient. The creation of a culture-sensitive trauma- However, ethnic matching without explicit training in informed care emphasises the role of organizational models of culture and intercultural interaction may not culture because it represents the most inclusive and be sufficient to insure that clinicians become aware of general level of an agency or program’s fundamental their tacit cultural knowledge or biases and apply their approach to its work. Organizational culture reflects cultural skills in a clinically effective manner. In the what a program considers important and unimportant, course of professional training, clinicians may distance what warrants attention, how it understands the people themselves from their own culture of origin and it serves and the people who serve them, and how it become reluctant or unable to use (or understand the puts these understandings into daily practice. In short, impact of) their tacit cultural knowledge in their clinical culture expresses the basic values of a program. Culture work. Clinicians from ethnic minority backgrounds thus extends well beyond the introduction of new may resent being pigeon-holed and expected to work services or the training of a particular subset of staff predominately with a specific ethnocultural group. members; it is pervasive, including all aspects of an Patients may have complex reactions to meeting a agency’s functioning. clinician from the same background. In order to accomplish this cultural change, two At the level of services, ethnic match is represented steps are required: in the organization of the clinical service, which 1) Initial Planning: the program considers the should reflect the composition of the community it importance of, and weighs its commitment to, a trauma- serves (Kareem and Littlewood 1992). This is not informed change process. The following elements are merely a matter of hiring practices but it also involves key to the successful planning of organizational trauma- creating structures that allow a measure of community informed change: a) administrative commitment to and feedback and control of the service institution. When support of the initiative; b) the formation of a trauma people feel a sense of ownership in an institution, they initiative workgroup to lead and oversee the change will evince a higher level of trust and utilization. It is process; c) the full representation of each significant important, therefore, for clinicians to understand how stakeholder group on the workgroup—administrators, the institutional setting in which they are working is supervisors, direct service staff, support staff, and seen by specifi c ethnocultural communities. consumers; d) identification of trauma “champions” Increasingly, clinicians work in settings where there to keep the initiative alive and “on the front burner;” is great cultural diversity that precludes reaching a e) programmatic awareness of the scope (the entire high level of specific competence for any one group. agency and its culture) and timeline (usually up to two Changes in migration patterns and new waves of years) of the culture shift. immigrants and refugees lead to corresponding changes 2) A Kickoff Training Event. Usually two days in patient populations. For all these reasons, it is crucial long, the kickoff training is attended by as many to supplement specific cultural competence with more of the staff as practical and includes significant generic competence that is based on a broad theoretical consumer representation; it certainly includes all understanding of culture and ethnicity. members of the trauma initiative workgroup. During Generic cultural competence abstracts general this event, there are at least three presentations. In the principles from specific examples of cultural first, central ideas of trauma-informed cultures are differences. The core of generic competence resides presented, emphasizing shifts in both understanding in clinicians’ understanding of their own cultural and in practice. Second, the importance of staff background and assumptions, some of which are related support and care is emphasized, ensuring that staff to ethnicity and religion, and many of which are derived members experience the same values in the from professional training and the context of practice. organizational culture that consumers need to Appreciating the wide range of cultural variation experience. Finally, a third presentation addresses in gender roles, family structures, developmental the importance of trauma in the work of the specific trajectories, explanations of trauma, and responses agency (e.g., trauma and substance use, trauma and to adversity allows the clinician to ask appropriate children or youth, trauma and mental health questions about areas that would otherwise be taken for problems). There is also a great deal of time for the granted. The culturally competent clinician has a keen workgroup members and other attendees to discuss sense of what he or she does not know, and has a solid the planning process in more detail respect for difference in trauma processing. To challenge the notion of cultural competence a further examination of the core questions pertaining to culture and the patterns of posttraumatic adaptation is required. One important challenge is how to culturally translate the evidence provided in the traumatic stress study field. Another challenge is how to conceive and develop trauma-informed, culturally responsive, and

48 Clinical Neuropsychiatry (2014) 11, 1 P1: IZO Journal of Traumatic Stress PP754-jots-459864 March 5, 2003 14:13 Style file version July 26, 1999

Journal of Traumatic Stress, Vol. 16, No. 2, April 2003, pp. 159–166 (C 2003)

The Mental Health of Crime Victims: Impact of Legal Intervention1

Judith Lewis Herman2

In the aftermath of crime, victims must decide whether to seek justice. An encounter with the legal system offers major potential benefits to crime victims, but also exposes them to significant risks. Victims who file civil or criminal complaints are subject to the rules and procedures of a complex legal system, where their mental health and safety may be of marginal concern, and where the potential for retraumatization may be high. This paper reviews the social and psychological barriers that discourage victim participation in the legal system, and existing studies that document the impact of participation on victims’ mental health. Prospective longitudinal research focusing on victims in the legal system is recommended.

KEY WORDS: crime victims; legal system.

The Legal System as a High-Risk Environment enjoy. The Constitution, therefore, offers strong guaran- for Victims tees for the rights of the accused, but no corresponding protection for the rights of crime victims. As a result, vic- The U.S. legal system is organized as an adversarial tims who choose to seek justice may face serious obstacles contest: in civil cases, between two citizens; in criminal and risks to their health, safety, and mental health. cases, between a citizen and the state. Physical violence and intimidation are not allowed in court, whereas aggres- sive argument, selective presentation of the facts, and psy- Psychological Risks chological attack are permitted, with the presumption that this ritualized, hostile encounter offers the best method of Involvement in legal proceedings constitutes a signif- arriving at the truth. icant emotional stress for even the most robust citizen. For Constitutional limits on this form of conflict are de- victims of violent crime, who may suffer from psychologi- signed to protect criminal defendants from the superior cal trauma as the result of their victimization, involvement power of the state, but not to protect individual citizens in the justice system may compound the original injury. from one another. The law is technically blind to any dis- Many anecdotal accounts describe the experience of the parities in power based on age, race, gender, social status, victim in the justice system as a “revictimization.” Indeed, or wealth between accuser and accused. All citizens are if one set out intentionally to design a system for provok- presumed to enter the legal arena on an equal footing, re- ing symptoms of posttraumatic stress disorder, it might gardless of the real advantages that one of the parties may look very much like a court of law (Herman, 1992). The mental health needs of crime victims are often diametrically opposed to the requirements of legal pro- 1 This paper was presented at symposium on the Mental Health Needs of ceedings. Victims need social acknowledgment and sup- Crime Victims by, Office for Victims of Crime and National Institute of Justice, Washington, DC, June 2000. port; the court requires them to endure a public challenge 2Department of Psychiatry, Cambridge Hospital, 1493 Cambridge Street, to their credibility. Victims need to establish a sense of Cambridge, Massachusetts 02139; e-mail: [email protected]. power and control over their lives; the court requires them

159

0894-9867/03/0400-0159/1 C 2003 International Society for Traumatic Stress Studies P1: IZO Journal of Traumatic Stress PP754-jots-459864 March 5, 2003 14:13 Style file version July 26, 1999

160 Herman

to submit to a complex set of rules and procedures that isfaction with their treatment in the justice system, espe- they may not understand, and over which they have no cially in states lacking strong statutory protections (Byrne, control. Victims need an opportunity to tell their stories Kilpatrick, Beaty & Howley, 1998; Erez & Belknap, 1998; in their own way, in a setting of their choice; the court re- Fleury, 2000). quires them to respond to a set of yes-or-no questions that break down any personal attempt to construct a coherent and meaningful narrative. Victims often need to control or Additional Barriers to Participation limit their exposure to specific reminders of the trauma; the court requires them to relive the experience by di- Many crime victims also face linguistic, cultural, and rectly confronting the perpetrator. Mental health workers social obstacles to participation in the justice system. For who serve victims commonly report the impression that example, deaf victims cannot communicate effectively their patients’ traumatic symptoms are worsened by neg- with police investigators or court personnel if the services ative contacts with the justice system (Campbell & Raja, of skilled interpreters are lacking. Similarly, immigrants 1999). who are not fluent in English may be unable to make them- selves understood to legal personnel who do not speak their language and are unfamiliar with their culture. Safety Risks Refugees from countries where police corruption or despotism are the norm may be terrified of any encounter Victims who participate in the justice system may with state authorities. Distrust of the legal system may also fear for their safety, because of the threat of retaliation also deter participation when both victim and offender by the perpetrator. Unfortunately, this fear is often well- belong to a minority group that has suffered from dis- founded. In sexual assault and domestic violence cases, for criminatory law enforcement. Victims may be reluctant example, the perpetrator may use his intimate knowledge to report crimes of any sort, if they believe that they will of the victim to harass or threaten her, in order to force her thereby expose the offender to excessively harsh conse- to withdraw her complaint. To a victim who has already quences. Ethnic and cultural factors may also specifically been terrorized, the routine procedures of the legal system deter victims of sexual or domestic violence from coming do not offer much reassurance. Although intimidation of forward. For example, in many cultures, rape is consid- a witness is nominally criminalized, the state offers little ered a dishonor not only to the victim, but also to her entire in the way of practical protection for victims. Restrain- family. Victims therefore face strong social pressure from ing orders are not consistently enforced (Harrell, 1993), their families to remain silent. Finally, victims may also and except in notorious cases of organized crime, witness refrain from reporting when they are physically, emotion- tampering and obstruction of justice charges are rarely ally, or financially dependent upon the offender. Thus, for prosecuted, and witness-protection measures are rarely example, victims with disabilities may be reluctant to dis- implemented. close abuse by caretakers for fear that they will lose the Moreover, the accused perpetrator may use the legal care that they need to maintain independent living. And system itself as an additional means to harass or humili- immigrant victims of domestic violence may be reluctant ate the victim. As a defendant in a civil or criminal case, to disclose the abuse, because of both cultural traditions of the perpetrator can invoke the power of the state (in the family loyalty, and fears of jeopardizing their immigration form of subpoena or court order) to access his victim’s status. health and mental health records (Murphy, 1998). When multiple legal systems are involved, the perpetrator may manipulate differences in court policies or procedures to Potential Benefits of Participation his advantage. In domestic violence cases, for example, it is not uncommon for batterers to seek child custody or Despite these formidable obstacles, participation in unlimited child visitation rights in order to maintain their the justice system also offers major potential mental health dominance over their victims (Quirion, Lennett, Lund & benefits to crime victims (Clute, 1993; Kilpatrick & Otto, Tuck, 1997). The same case may be handled very dif- 1987). Engagement in the legal system may ultimately ferently in criminal court, where battering is more likely provide victims with greater safety and protection for to be viewed as a serious offense, compared to probate themselves, and may enhance victims’ sense of power court, where policies may favor mandatory mediation and to protect others, by deterring the offender from repeat- sensitivity to “fathers’ rights.” Not surprisingly, victims ing his crimes. Legal interventions may provide crime of domestic violence tend to report high levels of dissat- victims with public acknowledgment of their suffering, P1: IZO Journal of Traumatic Stress PP754-jots-459864 March 5, 2003 14:13 Style file version July 26, 1999

The Mental Health of Crime Victims: Impact of Legal Intervention 161

restitution for the harm done to them, and (in rare in- such as robbery, burglary, assault, and even homicide. In stances) an apology. Validation and intervention by the general, only a small percentage of crime reports result in legal authorities may restore the victim’s trust in the com- arrest, prosecution, and ultimate conviction of the offender munity, a trust that cannot be repaired as long as the of- (Galvin & Polk, 1983; Myers & LaFree, 1982). fender enjoys impunity.

Effect of Victims’ Rights Reforms Low Reporting Rates and High Attrition The movement for victims’ rights has instituted sev- At present, most crime victims decline to get involved eral major reforms aimed at empowering crime victims in the legal system, apparently preferring to suffer the in- who seek justice. These include first, the possibility of ob- justice rather than compromise their family or community taining compensation for the expense of medical or mental ties, their privacy, their safety, or their mental health. Ei- health treatment, on the basis of an administrative com- ther they do not report the crime in the first place (the plaint. This reform allows victims some public recognition great majority), or they decide not to proceed with crim- that harm has been done and supports their efforts to re- inal charges after reporting. Among rape victims, for ex- cover, without requiring them to endure the rigors of an ample, in spite of legal reforms designed to mitigate the adversarial legal process (Victims of Crime Act, 1984). most flagrant forms of institutional bias, still only a small Because victim compensation funds are drawn from fines minority choose to report the crime. In three large commu- on convicted offenders, the award of compensation con- nity studies conducted in the 1980s, the percentage of rape stitutes an indirect form of social restitution. Second, for victims who had filed a report with the police ranged from victims who do choose to go forward with a criminal com- 8 (Koss, 1987; Russell, 1984) to 16 (Kilpatrick, Saunders, plaint, an ally, in the person of a victim witness advocate, Veronen, Best, & Von, 1987). may make the proceedings less confusing, frightening, To date, no systematic study of victims’ decision and humiliating. The advocate explains the legal system, making regarding participation in the legal system has helps the victim prepare for trial, and often accompanies been carried out. Russell’s study identified some factors re- the victim in court. While advocates generally have no lated to reporting in cases of child sexual assault (Russell, formal training in mental health counseling, they do pro- 1984). Parents of child victims were more likely to file a vide crucial social support during periods of high stress. police report if the perpetrator was a stranger, if the per- Victims also have the right to discuss their cases with the petrator was a member of a minority group, or if the crime prosecutor and to be notified of major changes in the status was very violent. In child cases, however, the reporting of their cases (for example, the release of a defendant on rates were even lower than those for adult rape, ranging bail). Finally, if the offender is convicted or pleads guilty, from 6% for extrafamilial to 2% for intrafamilial child the option of giving a victim impact statement to the court sexual abuse. at sentencing allows victims to speak freely and to receive Following an initial police report, the attrition rate some public acknowledgment of their suffering. remains very high as a case proceeds through the criminal Implementation of these reforms has been uneven. justice system. For example, in a recent study of 569 rape Many crime victims still do not have access to the services cases reported to police in a Midwestern city, fewer than of an advocate and are not informed of their rights to one in four (22%) were referred for prosecution. In this discuss their case with a prosecutor, receive notification study, the most common reason for dropping the case was of major developments in their cases, address the court, that the victim did not wish to proceed. The victims’ spe- or receive compensation. In fact, many criminal justice cific reasons for their decisions were not reported. Pros- officials are themselves unaware of victims’ rights laws ecutors also declined to proceed with some cases even and services in their states (Kilpatrick, Beatty, & Howley, when the victims were willing to testify. Once a decision 1998). was made to go forward with prosecution, most of the ac- The lack of systematic study parallels the lack of sys- cused offenders pled or were found guilty. By this point, tematic implementation. Although one might reasonably however, most of the cases had been filtered out. Of the expect that these reforms would create a healthier psycho- original 569 cases, only 70 (12%) resulted in a conviction. logical climate for victims, their actual effects on victims’ This number included 16 cases, only 3% of the total, that mental health have not been well documented. In a recent actually went to trial (Frazier & Haney, 1996). review of the mental health implications of the victims’ Although rape may represent the most extreme case, rights movement, Wiebe (1996) concluded “although leg- similar high rates of attrition apply to other serious crimes islatures have enacted a plethora of statutes attempting P1: IZO Journal of Traumatic Stress PP754-jots-459864 March 5, 2003 14:13 Style file version July 26, 1999

162 Herman

to ease the victim’s experience with the court system, re- long disability and impede recovery, the authors found no search does not yet support the contention that the quality difference between the two groups in long-term mental of this experience significantly aids the victim’s eventual health outcomes (Green et al., 1990). Thus the best avail- psychological recovery” (p. 226). able data to date do not support the belief that involvement in the traditional legal system is necessarily detrimental to victims’ mental health. These findings may not be appli- Comparisons of Participants and Nonparticipants cable to criminal cases, however, because of the marked differences in both the nature of the harm and the nature One way to ascertain whether participation in the of the legal process in civil and criminal cases. legal system is psychologically beneficial or detrimental to victims is to compare victims who do not participate in the criminal justice system with those who do. Very Procedural Justice, Victim Satisfaction, and Mental few studies of this type have been undertaken to date, and Health Impact those few yield mixed results. For example, one study of rape victims found that 1 year after the rape, those The theory of procedural justice holds that litigants who chose to file criminal complaints had higher self- are likely to be satisfied with the justice system when esteem than those who did not (Cluss, Boughton, Frank, they perceive that the process is respectful and fair, and Stewant, & West, 1983). However, other studies found that when they have a voice in the proceedings (Lind & Tyler, rape victims whose cases went to trial reported more fear, 1988). Previous studies, both in the United States and in anxiety, and depression than did those who did not go to other countries, have found that victims’ satisfaction is court (Burgess & Holmstrom, 1984; McCahill, Meyer & positively correlated with policies favoring their inclu- Fischman, 1979; Sales, Baum & Shore, 1984). Although sion and active participation in the justice system (Erez, these results appear contradictory, they may simply reflect 1999). This appears to be true even when the desired the fact that most criminal cases are ultimately resolved outcome is not fully achieved. For example, in a recent without trial. Favorable psychological outcomes might be study of domestic violence victims, Ptacek (1999) inter- expected for those victims whose cases are accepted for viewed 40 women who had sought restraining orders in prosecution and resolved by a guilty plea, without the or- two Massachusetts courts. Most reported that their part- deal of a face-to-face confrontation in court. ners had violated the restraining order; nevertheless, the The quality of the encounter with the legal system great majority felt that legal intervention had helped re- may be the factor that ultimately determines whether par- duce the violence and thought that they had made the right ticipants fare better or worse than nonparticipants. For decision in going to court. The women cited the support example, another study of 102 rape survivors (Campbell and information they received from advocates, and the re- et al., 1999) found that those who had significant trou- spectful demeanor (in most cases) of judges as sources ble with the legal system, after reporting their rapes, had of validation and encouragement. The author commented higher levels of posttraumatic stress symptoms than did all that “the threat of criminal sanctions was seen as bene- other victims, including those who did not report or seek ficial; for many women, standing up for their rights also help of any kind. No firm conclusions can be drawn, how- offered its own rewards” (p. 167). ever, from the studies that have been done to date. A recent Two recent studies suggest that respectful and inclu- review of the literature on the effect of the legal system sive policies may affect victims’ mental health as well as on rape victims concluded that the data were sparse and their feelings of satisfaction. As part of a national tele- inconclusive (Ha1l & Koss, 1998). A systematic study of phone survey, Kilpatrick et al. (1998) studied 1,308 crime the mental health impact of crime victims’ participation victims in four states. Two states ranked in the top and two (or nonparticipation) in the criminal justice system has yet in the bottom quartile for the strength of their victims’ to be conducted. rights protections. Victims in states with strong protec- One large-scale study of a community destroyed by tions were better informed of their rights, were more fre- a flood (the Buffalo Creek Disaster) may be relevant as a quently notified of important developments in their cases, model. While this was not a criminal case, corporate neg- and exercised their rights to participate more frequently ligence was implicated in the cause of the dam collapse, than those in states with weak protections. Particularly which cost many lives. The study compared victims who noteworthy was the finding that, when offered the opportu- filed a civil suit against the offending company with oth- nity, most victims were eager to participate in the process. ers who declined to join the suit. Contrary to predictions For example, over 90% of victims who were informed of that involvement in a protracted court battle might pro- their right to make an impact statement chose to do so. P1: IZO Journal of Traumatic Stress PP754-jots-459864 March 5, 2003 14:13 Style file version July 26, 1999

The Mental Health of Crime Victims: Impact of Legal Intervention 163

In this study, victims’ overall satisfaction with the These concepts have been highly developed among criminal justice system was directly related to their sense Native American peoples, as well as indigenous peoples in of inclusion and empowerment. Those who were given Australia and New Zealand, and in some North American a chance to participate in the process and thought their religious communities such as the Society of Friends and participation had an impact on their cases were, quite un- the Mennonites. They lead, in practice, to a legal interven- derstandably, more satisfied with the system. They also tion that focuses on denunciation of the crime rather than appeared to have better mental health outcomes. Prelim- on conviction or punishment of the offender. The goals inary data from this study indicate that victim satisfac- of intervention are to “make things as right as possible” tion mitigated crime-related symptoms of PTSD (Byrne, for victims, and to hold offenders accountable for making Kilpatrick, Beaty & Howley, 1996). restitution to their victims and the community. Although Conversely, dissatisfaction appears to be highest offenders may find it difficult to carry out the obligations among victims who are denied a chance to participate imposed upon them by restorative programs, these obli- in the legal system, in spite of their expressed wish to do gations are not intended to humiliate or isolate them, but so. In a recent study of 102 rape victims in a large Mid- rather to reintegrate them with the community (Claassen, western city, Campbell, Wasco, Ahrens, Sefl, and Barnes 1995). (2001) found that many had reported their assaults, only Methods of restorative justice include victim– to be frustrated when prosecutors declined to go forward offender reconciliation and mediation programs, commu- with their cases. In this study, an unusually high percent- nity justice conferencing, sentencing circles, and repar- age of victims (39%) filed police reports, but only 25% ative probation. These alternative programs often make of these reported rapes (10% of the total) were accepted explicitly therapeutic claims, offering the possibility of for prosecution. Selection heavily favored atypical cases: “healing” for both offenders and victims (Boers, 1992; stranger rapes involving serious physical injury and/or use Zehr, 1985). of weapons. White women victims were also significantly This approach to resolution of criminal cases has im- more likely to have their cases accepted for prosecution, portant limitations. Restorative justice programs can be despite the fact that African American women victims effective only when the safety of the victim and other po- were equally interested in pressing charges against their tential victims has already been secured. No victim can assailants. safely participate in these programs so long as the perpe- In this study, the majority (52%) of victims who trator retains the power to harass or intimidate her. Fur- sought help from the legal system rated their experiences thermore, no offender can legitimately participate in such as harmful. Those whose cases were declined for prosecu- programs without an acknowlegment of guilt. Many of- tion were most likely to feel harmed. Victims’ subjective fenders, however, will not plead guilty to a crime unless ratings of satisfaction with the justice system were also faced with a credible threat of legal sanctions. This threat closely correlated with objective measures of psycholog- depends in turn on the victim’s resolve and the prosecu- ical health. Victims whose cases were not prosecuted, de- tors’ willingness to go forward to trial if necessary. pite their wishes, exhibited high levels of psychological For these reasons, restorative justice programs have distress. The results of these studies suggest that victim not generally been considered suitable for resolving inclusion, choice, and empowerment may be the best pre- crimes of violence. Most are restricted to less serious dictors of mental health outcomes. crimes, often those committed by juvenile or first-time offenders. The potential for restorative justice approaches to violent crimes, such as sexual assault or domestic vio- Restorative Justice Alternatives lence, is only now beginning to be explored (Koss, 2000; Pennell & Burford, 2000). Although many anecdotal re- In addition to the victims’ rights movement, the ports have been published, no systematic, data-based stud- movement for restorative justice offers several alternatives ies have yet been conducted to document the mental health to traditional forms of legal proceedings in criminal cases. effects (healing or otherwise) of victims’ participation in The basic principle of the restorative justice movement is restorative justice programs. to focus on the interpersonal harm of the crime rather than the rules that have been broken (Braithwaite, 1989). The Studies of Specific Legal Interventions violation of relationships, between offender and victim, and between offender and the wider community, is con- A few recent studies have attempted directly to assess sidered the fundamental problem, rather than the abstract the psychological impact of specific legal interventions on violation of the law. specific categories of crime victims. Although the P1: IZO Journal of Traumatic Stress PP754-jots-459864 March 5, 2003 14:13 Style file version July 26, 1999

164 Herman

numbers of participants are small, these studies may serve As might be expected, the groups differed in their as models for future research. In a study of victims seen reactions to their hearings, depending on the degree to at a rape crisis center in a Midwestern city, Frazier and which they were subjected to an adversarial process. Thus Haney (1996) identified 90 women who chose to report the class action group, whose testimony took place in a their rapes to the police. These participants generally re- supportive atmosphere, felt generally positive about their ported positive attitudes toward the police detectives they hearings; by contrast, the civil litigants generally reported encountered, but negative attitudes toward the legal sys- that the experience of testifying in court was very diffi- tem. For example, the majority agreed with the statements cult. Direct confrontation with the perpetrator and cross- “the legal system is generally unfair” and “rapists seem to examination by the defense attorney were generally iden- have more rights than victims.” Six to 12 months after the tified as the worst aspects of the proceedings. However, rape, however, measures of post-traumatic stress did not all three groups reported that they experienced some nega- correlate with the victims’ feelings about the legal system tive emotional consequences at the time of their hearings. or with the outcomes of their legal cases. Giving testimony, even in an affirming and supportive en- The study is limited by the lack of long-term follow- vironment, was a major stressor, which disrupted lives and up. Nevertheless, the authors find the results “heartening” relationships and often caused physical symptoms, such because most of their participants did not appear to be as nausea or vomiting, as well as psychological distress. “retraumatized” by their experience in the legal system, Despite these hardships, at the end of the day, roughly even if (as was commonly the case) they were dissatisfied half the participants felt that they had benefitted psycho- with the way they were treated. In contrast to the findings logically from their involvement in the legal system. Over- of Campbell et al. (2001) and Byrne et al. (1996), these all, 48% of the participants felt that the effect of their expe- authors concluded that satisfaction and mental health out- rience had been positive, 10% reported mixed results, and comes were not necesssarily linked. They speculate that 42% felt that their encounter with the legal system had “the rape victim’s experience in the legal system may have been psychologically detrimental. The three groups did less of an impact on her recovery than other factors over not differ as much as might have been expected in their which she has more control” (p. 626). overall assessment. Surprisingly, members of the class ac- In a Canadian study of adult survivors of childhood tion group, whose process was intentionally designed to sexual abuse, Feldthusen, Hankivsky, and Greaves (2000) be “therapeutic,” were the least likely to report a posi- compared three groups who had chosen different forms tive impact on their mental health. By contrast, the civil of civil action. All three options have analogies within litigants seemed to view themselves as psychologically the U.S. legal system. The first group (n = 19) had initi- stronger for having withstood their ordeal. The majority ated a civil complaint against their perpetrators, leading stated they would recommend their course of action to to direct confrontation in court. The second (n = 48) had others, but only with the qualification that it is “not for the filed claims for victim compensation, choosing to undergo weak at heart.” All emphasized the need for a strong social an administrative hearing without adversarial challenge. support system to endure the rigors of the legal process. The third group (n = 26) participated in a negotiated set- It is important to remember that these groups were tlement of a class action claim against a state residential self-selected. Victims chose the path that they deemed school in which they had been mistreated by the adults most appropriate for themselves. It would not be valid to responsible for their care. This third group was of partic- conclude from such a study that the most adversarial pro- ular interest because the settlement followed principles of cess would be the best for everyone. Nevertheless, these “therapeutic jurisprudence,” with “healing” of the victims findings suggest that engagement in the adversarial pro- as an explicit goal. Although this interview study did not cess, while intensely stressful at the time, is not necessarily include formal measures of psychological distress, it did harmful to survivors in the long run. offer an in-depth exploration of victims’own perceptions The clinical experience of the Victims of Violence of their experience in the legal system. Program, in the Department of Psychiatry at Cambridge The objectives of all three groups were similar; the Hospital, is consistent with the conclusions of these two most common goal, cited by 82% of the victims, was to ob- studies. This VOCA-supported model program receives tain public acknowledgment that they had been wronged. frequent referrals from victim-witness advocates in Other goals, such as protecting other potential victims or Middlesex County (Massachusetts) Superior Court. Pa- gaining money, apology, or revenge, were endorsed by tients are frequently seen for crisis intervention as soon less than half the victims, although the wish for an apol- as possible after the occurrence of the crime. The goal of ogy from representatives of the state figured strongly in this initial intervention is to help the victim understand the class action suit. and manage psychological distress symptoms, mobilize P1: IZO Journal of Traumatic Stress PP754-jots-459864 March 5, 2003 14:13 Style file version July 26, 1999

The Mental Health of Crime Victims: Impact of Legal Intervention 165

social support, and develop a safety plan. Making an in- ertheless, the majority of these women, too, felt more self- formed choice whether or not to proceed with criminal respect and less fear. The validation and empowerment charges is often a major issue at this time. After the initial that they gained from court intervention apparently was stabilization period, many patients need no further treat- much more important to these victims than the behavior ment until their cases are scheduled for trial. At that point, of the perpetrator (Dobash, Dobash, Cavanaugh & Lewis, most patients experience renewed distress, and many re- 2000). turn for another round of counseling. Following resolu- This study highlights the potential for legal system tion of the case, however, most patients experience relief, intervention to have positive effects on the mental health and many report a positive sense of accomplishment. The and well-being of crime victims. Many more such studies program staff believe, but can not currently prove, that the are needed to identify those policies and practices associ- crisis counseling provided by the program, combined with ated with the best outcomes for victims, as well as those the services of the victim-witness advocate, increases pa- which may be detrimental. Ideally, future studies should tients’ ability to withstand the rigors of the court and con- be prospective, following victims from their point of entry tributes to positive mental health outcomes. This belief into the legal system and continuing for 6 months to 1 year (and the lack of data to substantiate it) is probably widely past the resolution of the case, whether or not the case pro- shared by frontline advocates and mental health workers ceeds to prosecution or conviction of the offender. Entry who serve victims. points could include the initial police report, request for a restraining order, contact with a victim-witness advocate, or mandated report by a third party. Recommendation for Further Research Such studies could be conducted in phases. In early phases, such studies might identify the factors influenc- As may be apparent from this brief review, system- ing victims’ decisions (e.g., whether or not to file a crim- atic research on this topic is almost nonexistent at present. inal complaint) and document the short term effects of In the absence of relevant data, it is difficult to develop these choices. In later stages, such studies might clarify more effective policies to promote the mental health of the longer-term psychological impact of participating (or crime victims in the legal system. Because the legal sys- declining to participate) in the legal system. Where dispo- tem is offender-oriented, outcomes of the legal process sition of the case includes an explicit promise of follow- are generally evaluated on the basis of what happens to up, such as probation or parole for the offender, the study the offender, rather than what happens to the victim. For should keep track of the victim as well as the offender as example, in a recent review of the impact of restraining long as the sentence is in effect. In complex cases involv- orders in domestic violence and stalking cases, the out- ing an ongoing relationship between victim and offender come was measured by the effect on the offender’s behav- (such as domestic violence cases) follow-up should con- ior (Meloy, Cowett, Parker, Holland, & Friedland, 1997). tinue as long as the relationship. This is a logical and necessary first step; however, at this Though prospective, longitudinal studies of crime stage of the development of the field, studies that focus victims in the legal system would be challenging to de- directly on the victims are badly needed. sign and implement, such research initiatives, if carried In a study that might serve as a model for future out with appropriate sensitivity, would be welcomed by victim-focused research, a group of investigators in both victims and the frontline workers who serve them. Scotland interviewed 134 women victims of domestic vi- Instead of hunches, gut feelings, success stories, and hor- olence whose partners were convicted of assault and sen- ror stories based on experience in the trenches, it would be tenced to an intensive treatment program as a condition most useful to have real data on what helps and does not of probation. At 1 year follow-up, the majority of these help. The results of such studies would be invaluable both women reported improvements in their psychological for clinicians and advocates working directly with crime state; they were happier, less fearful, and had gained in victims, and for future policy planning. self-respect. The majority also reported improvements in their partners’ attitudes and behavior and, not surprisingly, References greater marital satisfaction. These women were compared with 90 women whose partners received some other form Boers, A. P. (1992). Justice that heals: A Biblical vision for victims and of court sanction but were not mandated to attend a treat- offenders. Newton, KS: Faith and Life Press. ment program. In the comparison group, the majority of Braithwaite, J. (1989). Crime, shame and reintegration. Cambridge: Cambridge University Press. the women reported that their partners’ behavior had not Burgess, A. W., & Holmstrom, L. L. (1984). Rape: Victims of crisis. improved; in fact, in many cases it had gotten worse. Nev- Bowie, MD: Robert J. Brady. P1: IZO Journal of Traumatic Stress PP754-jots-459864 March 5, 2003 14:13 Style file version July 26, 1999

166 Herman

Byrne, C. A., Kilpatrick, D. G, Beaty D., & Howley, S. (1996, in Simon, L. J.: A therapeutic jurisprudence approach to the legal November). Victimization and psychological adjustment: Moder- processing of domestic violence cases. In Wexler, D. B., & Winick, ating effects of victim satisfaction with the criminal justice system. B. J. (Eds.), Law in a therapeutic key: Developments in therapeu- Paper presented at the Association for the Advancement ofBehavior tic jurisprudence (pp. 243–286) Durham, NC: Carolina Academic Therapy Annual Convention, NewYork. Press.) Byrne, C. A., Kilpatrick, D. G., Beaty, D., & Howley, S. (1998, Novem- Herman, J. L. (1992). Trauma and recovery. New York: Basic Books. ber). Female victims of partner violence: Experiences with the crim- Kilpatrick, D. G., Beatty, D., & Howley, S. S. (1998, December). inal justice system. Poster presented at the 14th Annual Meeting of The rights of crime victims—Does legal protection make a differ- the International Society for Traumatic Stress Studies, Washington, ence? Washington, DC: National Institute of Justice Research in DC. Brief. Campbell, R., & Raja, S. (1999). The secondary victimization of rape Kilpatrick, D. G., & Otto, R. K. (1987). Constitutionally guaranteed victims: Insights from mental health professionals who treat sur- participation in criminal proceedings for victims: Potential ef- vivors of violence. Violence and Victims, 14, 261–275. fects on psychological functioning. Wayne Law Review, 34, 7– Campbell, R., Sefl, T., Barnes, H. E., Ahrens, C. E., Wasco, S. M., & 28. Zaragoza-Diesfeld, Y. (1999). Community services for rape sur- Kilpatrick, D. G., Saunders, B. E., Veronen, L. G., Best, C. L., & Von, J. vivors: Enhancing psychological well-being or increasing trauma? M. (1987). Criminal victimization: Lifetime prevalence, reporting Journal of Consulting and Clinical Psychology, 67, 847–858. to police, and psychological impact. Crime and Delinquency, 33, Campbell, R., Wasco, S. M., Ahrens, C. E., Sefl, T., & Barnes, H. E. 479–489. (2001). Preventing the “second rape”: Rape survivors’ experiences Koss, M. P. (1987). Hidden rape: Sexual aggression and victimization with community service providers. J. Interpersonal Violence, 16, in a national sample of students of higher education. In Burgess, 1239–1259. A.W. (Ed.), Rape and sexual assault (Vol. 2, pp. 3–26). New York: Claassen, R. (1995). Restorative justice: Fundamental principles. Paper Garland. presented at the meeting of National Center for Peacemaking and Koss, M.P. (2000). Blame, shame, and community: Justice responses Conflict Resolution Studies, Fresno Pacific College, CA. to violence against women. American Psychologist, 55, 1332– Cluss, P. A., Boughton, I., Frank, E., Stewant, B. D., & West, D. (1983). 1343. The rape victim: Psychological correlates of participation in the Lind, A., & Tyler, T. (1988). The social psychology of procedural justice. legal process. Criminal Justice and Behavior, 10, 342–357. New York: Plenum. Clute, S. (1993). Adult survivor litigation as an integral part of the ther- McCahill, T. W., Meyer, L. C., & Fischman, A. M. (1979). The aftermath apeutic process. Journal of Child Sexual Abuse, 2, 121–127. of rape. Lexington, MA: Lexington Books. Dobash, R. E., Dobash, R. P., Cavanaugh, K., & Lewis, R. (2000) Chang- Meloy, J. R., Cowett, P., Parker, S., Holland, B., & Friedland, A. ing violent men. Thousand Oaks CA: Sage. (1997). Do restraining orders restrain? Proceedings of the Amer- Erez, E. (1999). Who’s afraid of the big bad victim? Victim impact ican Academy of Forensic Sciences, 3, 173. statements as victim empowerment and enhancement of justice. Murphy, W. (1998). Minimizing the likelihood of discovery of victims’ Criminal Law Review 545–555. counseling records and other personal information in criminal cases: Erez E., & Belknap, J. (1998). In their own words: Battered women’s Massachusetts gives a nod to a constitutional right to confidentiality. assessment of the crimnal proceeding system’s responses. Violence New England Law Review, 32, 4. and Victims, 13, 251–268. Myers, M. A., & LaFree, O. D. (1982). Sexual assault and its prosecution: Feldthusen, B., Hankivsky, O., & Greaves, L. (2000). Therapeutic con- A comparison with other crimes. Journal of Criminal Law and sequences of civil actions for damages and compensation claims by Criminology, 73, 1281–1305. victims of sexual abuse. Canadian Journal of Women and the Law, Pennell, J., & Burford, G. (2000). Family group decision-making: Pro- 12, 66–116. tecting women and children. Child Welfare, 79, 131–158. Fleury, R. E. (2000). Survivors’ satisfaction with the criminal legal sys- Ptacek, J. (1999). Battered women in the courtroom: The power of judi- tem response to intimate partner violence. Dissertation, Michigan cial responses. Boston, MA: Northeastern University Press. State University. Quirion, P., Lennett, J., Lund, K., & Tuck, C. (1997). Protecting children Frazier, P. A., & Haney, B. (1996). Sexual assault cases in the legal sys- exposed to domestic violence in contested custody and visitation tem: Police, prosecutor, and victim perspectives. Law and Human litigation. Boston Public Interest Law Journal, 6, 501. Behavior, 20, 607–628. Russell, D. E. H. ( 1984). Sexual exploitation: Rape, child sexual abuse, Galvin, J., & Polk, K. (1983). Attrition in case processing: Is rape unique? and sexual harassment. Beverly Hills, CA: Sage. Journal of Research in Crime and Delinquency, January, 126–153. Sales, E., Baum, M., & Shore, B. (1984). Victim readjustment following Green, B. L., Lindy, J. D., Grace, M. C., Gleser, G. C., Leonard A. C., assault. Journal of Social Issues, 40, 117–136. Korol, M., et al. (1990). Buffalo Creek survivors in the sec- Victims of Crime Act. (1984). US Code Title 42, Chapter 112. ond decade: Stability of stress symptoms. American Journal of Wiebe, R. P. (1996). The mental health implications of crime victims’ Orthopsychiatry, 60, 43–54. rights. In Wexler D. B., & Winick, B. J. (Eds.), Law in a therapeu- Hall J. D., & Koss, M. P. (1998). Effects of testifying in court on rape tic key: Developments in therapeutic jurisprudence (pp. 213–242). victims. Unpublished manuscript, Department of Psychology, Uni- Durham, NC: Carolina Academic Press. (Quote on p. 226). versity of Arizona. Zehr, H. ( 1985). Retributive justice, restorative justice. New Perspec- Harrell, A. (1993). Court processing and the effects of restraining or- tives in crime and justice (No. 4). Akron, PA: Mennonite Central ders for domestic violence victims. The Urban Institute 74. (Cited Committee Office of Crime and Justice. 1/27/2020 People v Abdur-Razzaq :: 2018 :: New York Other Courts Decisions :: New York Case Law :: New York Law :: US Law :: Justia

People v Abdur-Razzaq

[*1] People v Abdur-Razzaq 2018 NY Slip Op 28161 Decided on May 29, 2018 Supreme Court, Bronx County Barrett, J. Published by New York State Law Reporting Bureau pursuant to Judiciary Law § 431. This opinion is uncorrected and subject to revision before publication in the printed Official Reports.

Decided on May 29, 2018 Supreme Court, Bronx County

The People of the State of New York

against

Kareem Abdur-Razzaq, Defendant.

The People of the State of New York

against

Lemuel Skipper, MAHOGANY RANDOLPH, Defendants.

3154/13

https://law.justia.com/cases/new-york/other-courts/2018/2018-ny-slip-op-28161.html 1/17 1/27/2020 People v Abdur-Razzaq :: 2018 :: New York Other Courts Decisions :: New York Case Law :: New York Law :: US Law :: Justia

Assistant District Attorney Meagan Powers

Assistant District Attorney Lauren Di Chiara

Assistant District Attorney Stephen Knoepfler

Bronx County District Attorney's Office

198 East 161st Street, Bronx, N.Y. 10451

Abraham Mayers, Esq. (Attorney for defendant Lemuel Skipper)

30 Wall Street, 8th floor

New York, N.Y. 10005

212-227-9220

William Schwarz, Esq.

97 Spyglass Hill Road

Hopewell Junction, New York 12533

(845) 592-2301 Steven Barrett, J.

"If you want to control their bodies, you need to control their minds"

(Man, The Deuce, HBO, S:1, E:8, My name is Ruby)

Before the Court are two separate sex trafficking indictments. In each case the People have notified defense counsel of their intention to call an expert witness regarding trauma bonding between sex traffickers and their victims and the coercive control techniques utilized by traffickers in order to explain certain paradoxical conduct of the victims.[FN1] Each defendant has separately moved to preclude the expert's testimony. Because this Court found no written case where a trial or appellate court in New York has ruled on this issue, and because the Court believed that the theory of trauma bonding to explain the

https://law.justia.com/cases/new-york/other-courts/2018/2018-ny-slip-op-28161.html 2/17 1/27/2020 People v Abdur-Razzaq :: 2018 :: New York Other Courts Decisions :: New York Case Law :: New York Law :: US Law :: Justia

behaviors of prostitutes and pimps may involve a novel scientific theory whose general acceptance had not yet been ruled upon, the Court ordered a Frye hearing. Having now completed the hearing and reviewed all of the evidence and submissions of the parties, for the reasons set forth below, each defendant's motion is denied and the proffered expert testimony will be allowed at each defendant's trial.

People v. Skipper and Randolph

Defendant and co-defendant, Mahogany Randolph are charged, having acted in concert, with kidnapping in the first degree, aggravated sexual assault in the first degree, sex trafficking and related counts.[FN2] The People presented legally sufficient evidence to the Grand Jury establishing that beginning in April 2015, defendant and C.Y., who was then 26-years-old, met on social media and began what she perceived as a consensual, intimate relationship. Between June 29, 2015 and July 17, 2015, C.Y. represented to defendant and co-defendant Randolph that she would engage in prostitution, did so, and provided the proceeds to them. The evidence further established that, between July 18, 2015 and July 22, 2015, defendant and co-defendant sexually assaulted C.Y. by inserting a broomstick in her anus and vagina, physically assaulted her by punching her in the face and head with a cane and threatened to kill her. During this four day interval, notwithstanding the violence inflicted upon her, C.Y. continued to engage in prostitution on behalf of defendant and co- defendant and did not attempt to flee the location where she was being held by defendant and co-defendant. In addition, the People aver that in March 2015, defendant and co- defendant Randolph began a relationship that evolved into a pimp-prostitute relationship and that notwithstanding the fact that defendant assaulted her, Randolph engaged in prostitution on behalf of defendant and recruited other women to perform sex work on his behalf. (See post-Frye hearing Memorandum of Law at p.44.) Moreover, the People aver that both before and after Randolph was arrested she lied for defendant's benefit and attempted to protect him from prosecution by taking the blame for his actions. (See post- Frye Memorandum of Law at p.44.)

People v. Abdur-Razzaq

Defendant stands indicted having been charged with sex trafficking, assault in the third degree, strangulation in the second degree, abortion in the second degree and related charges in connection with his actions towards then seventeen-year-old M.N. The evidence

https://law.justia.com/cases/new-york/other-courts/2018/2018-ny-slip-op-28161.html 3/17 1/27/2020 People v Abdur-Razzaq :: 2018 :: New York Other Courts Decisions :: New York Case Law :: New York Law :: US Law :: Justia

presented to the Grand Jury established that beginning in mid-February 2013, defendant and M.N., who lived in the same apartment building as defendant, began an intimate relationship. Shortly thereafter, M.N. agreed to defendant's request to post an ad on Backpage.com and engaged in two sex acts for money. M.N. gave all of the money from the sex acts to defendant, and defendant gave her back a portion to pay her cell phone bill. After those two sex acts, M.N. told defendant she no longer wanted to engage in sex work. Defendant then punched her in the face and stomach, threatened to expose the fact that she had engaged in prostitution, and threatened to harm her physically. Between March 2013 and June 9, 2013, M.N. continued to engage in paid sexual acts on behalf of defendant and continued to have sexual relations with him despite the fact that she had been repeatedly punched, choked and threatened by him. During this period, defendant arranged for the performance of sex acts by M.N. and set the prices for these acts, and M.N. gave him all the money that she earned. In return, defendant gave her money to pay her cell phone bill and to get her hair and nails done, and he would buy her food and marijuana. M.N. referred to defendant as "Daddy." Between May 20, 2013 and May 24, 2013, M.N. informed defendant that she was pregnant. Defendant responded that she needed to get an abortion. When M.N. refused to do so, defendant punched her in the abdomen several times causing M.N. to miscarry the fetus. Throughout this time period, defendant went to work each day at a law firm.

On June 9, 2013, M.N's family discovered that she had been engaging in prostitution and that she had been advertised on Backpage. They contacted law enforcement, which resulted in defendant's eventual arrest and indictment on the instant charges. Notwithstanding a temporary order of protection requiring him to stay away from M.N., defendant and M.N. resumed a sexual relationship and M.N. recanted her Grand Jury testimony.[FN3]

On September 11, 2017, this case was sent out to another court part for trial. The People provided the court with a witness list that included Dr. Chitra Raghavan, who was proffered as an expert in traumatic bonding and coercive control in the context of sex trafficking. When defense counsel moved to preclude such testimony and requested a Frye hearing, the trial court sent the case back to this Court to determine whether such evidence would be admissible at trial. After reviewing the submissions of the parties, on November 30, 2017, this Court ordered a Frye hearing.[FN4]

The Frye Hearing

"I do the best job I can do to explain it, but there are many people who just will [*2]never understand or believe that one can be so totally controlled by other people that they don't

https://law.justia.com/cases/new-york/other-courts/2018/2018-ny-slip-op-28161.html 4/17 1/27/2020 People v Abdur-Razzaq :: 2018 :: New York Other Courts Decisions :: New York Case Law :: New York Law :: US Law :: Justia

even have to have them standing right there next to them any longer with a gun directly to their head. (Patty Hearst, The Radical Story of Patty Hearst, CNN, E:6, The Verdict)

The Frye hearing began on December 20, 2017 and three witnesses testified on behalf of the People — Dr. Chitra Raghavan, Dr. William Foote, and Dr. Kimberly Mehlman-Orozco. Dr. Raghavan is a tenured professor of forensic psychology at John Jay College, whose research, publications, and teaching have focused on trauma and coercive control in the contexts of domestic violence, sexual assault and harassment, and labor and sex trafficking. Dr. Raghavan is the Director of the Forensic Mental Health Counseling Master's Program at John Jay, which trains therapists, and she designed a program for master degree students who seek to specialize in victim services. Dr. Raghavan has been deemed an expert in the areas of sex trafficking and intimate partner violence in New York State courts and in Federal court and has also trained lawyers and judges who specialize in sex trafficking cases with respect to trauma bonding and coercive control. Dr. Foote is a forensic psychologist in private practice. Dr. Foote's clinical practice focuses on treating patients for trauma and he has conducted numerous evaluations of, and conducted research and published journal articles with respect to, victims of sexual abuse, particularly in the context of clergy and teacher abuse of students and interfamilial sexual abuse. Dr. Mehlman-Orozco is a researcher who has studied and written extensively on human trafficking. She has also testified as an expert witness in sex trafficking. In addition to the testimony of these three experts, numerous scholarly journal articles and books and other documents on trauma bonding and coercive control were received in evidence.

All three of the People's experts testified credibly; however, the Court found that the testimony of Dr. Raghavan was the most essential and relevant exposition of the scientific analysis that underlies the psychological theory here presented. Dr. Raghavan not only demonstrated scholarship and in-depth knowledge and experience in the field of trauma bonding and the use of coercive control as applied in the area of sex trafficking, but her testimony was free of bias and she was extremely articulate, answering often complex and sometimes convoluted questions with aplomb and in a clear and understandable way. She demonstrated conclusively the validity of the established applications of the theories of trauma bonding and coercive control and that extending these principles to the novel context of sex trafficking is warranted to explain scientifically the anomalous behavior of prostitutes within the prostitute/pimp relationship.

The testimony of the three witnesses at the hearing established that trauma bonding is the strong emotional attachment that forms between a victim and an abuser as a result of chronic interpersonal trauma in which the victim is strongly dependent on the abuser

https://law.justia.com/cases/new-york/other-courts/2018/2018-ny-slip-op-28161.html 5/17 1/27/2020 People v Abdur-Razzaq :: 2018 :: New York Other Courts Decisions :: New York Case Law :: New York Law :: US Law :: Justia

based on underlying fear. According to the witnesses, trauma bonds are formed when three main conditions are met: 1) the existence of an imbalance of power between the abuser and the victim; 2) the creation or maintenance of the power imbalance through the use of certain control tactics; and 3) a schedule of intermittent reward and punishment that the abuser metes out in the course of the relationship. Coercive control is the use of various tactics by an abuser to strip the abused target of his or her autonomy and liberty, and to create or maintain a power imbalance. Coercive control tactics include intimidation, deprivation, micro-regulation, manipulation, blackmail, degradation, [*3]isolation, or perceived isolation and are frequently tailored to the particular vulnerabilities and needs of the victim.[FN5] For example, a pimp may recognize the underlying fundamental needs of a prostitute, whether that is a place to sleep or a sense of family or the desire to build a future together, and will then exploit those needs to create an imbalance of power that removes her from her social network or support system. Isolation or perceived isolation of the victim by surrounding the victim with people who are allied with the perpetrator is a particularly important control tactic that helps to form the traumatic bond, as it both prevents the victim from reporting abusive conduct and leads the victim to negotiate with her abuser to end the abuse.

According to the witnesses, as a result of the use of these tactics, a cycle begins where the victim, in an attempt to form a human connection with her abuser, seeks to appease the abuser. The abuser then uses intermittent, arbitrary reward and punishment, which causes the victim to submit to the abuser. Over time, the victim's appeasement and submission to the abuser becomes second-nature and internalized. The victim compartmentalizes her thoughts and adopts the worldview of the abuser. Once the abuser has established dominance and the traumatic bond is forged, he can diminish the frequency and severity of his coercive control techniques and use of intermittent reward and punishment. The result of the abuser's use of coercive control tactics is that the victim becomes afraid, needy, and dependent on the abuser. The victim even comes to deify the abuser and see him as omnipotent, better than anyone she has ever been with, and she feels honored to be in the relationship.

These tactics and the resulting traumatic bond with the abuser give rise to paradoxical, incongruous behavior by the victim. The victim may not leave the abusive situation, may return to the abusive situation, or may delay reporting the abuser to law enforcement. The victim also may defend the abuser, downplay the treatment she received, testify on behalf of the abuser, recant, lie to protect the abuser, or provide inconsistent responses over time. According to Dr. Raghavan, based on her own research and review of scholarly literature, within specific traumatized populations such as cults, prisoners of war, battered spouses,

https://law.justia.com/cases/new-york/other-courts/2018/2018-ny-slip-op-28161.html 6/17 1/27/2020 People v Abdur-Razzaq :: 2018 :: New York Other Courts Decisions :: New York Case Law :: New York Law :: US Law :: Justia

and sex trafficking victims, trauma bonding occurs in fifty percent of the victims (T:136). [FN6]

In addition to defining trauma bonding and coercive control, Dr. Raghavan went on to provide a brief overview of the history of trauma bonding research.[FN7] According to Dr. Raghavan, [*4]researchers first began to notice trauma bonding though it hadn't yet been defined as such in the post WW II period, when psychoanalysts began observing that some Holocaust death camp survivors had identified with their prison guards. Then, in the early 1970s, after a bank robbery in Stockholm where four hostages were kept captive and tortured but then refused to testify against their captors, the term Stockholm Syndrome was first utilized to describe the traumatic bonds formed between captors and captives. Dr. Raghavan then briefly described another infamous case of Stockholm syndrome that involved the 1974 kidnapping of Patty Hearst, when she was kidnapped and treated brutally by the "SLA," but grew to love and identify with them and ultimately joined them in the commission of several violent crimes.

After this brief historical overview, most of Dr. Raghavan's testimony was devoted to a chronological overview of the major research studies, peer-reviewed journal articles, and books concerning trauma bonding and coercive control across a variety of contexts, including her own research on these topics in the area of sex trafficking. Dr. Raghavan began this walk through the literature in the area of intimate partner violence, which was originally known as battered woman's syndrome. According to Dr. Raghavan, the term battered woman's syndrome was first utilized in 1979 by Lenore Walker in her highly influential book, The Battered Woman, where she first observed that the common thread amongst the 120 victims of domestic abuse that she had interviewed was the psychosocial factors that bonded these women to their batterers. In 1981, Don Dutton and Lee Painter coined the term trauma bonding in their oft-cited, groundbreaking journal article, Traumatic Bonding: The Development of Attachments in Battered Woman and Other Relationships of Intermittent Abuse, which they followed with a longitudinal study involving 50 women who were physically abused and 25 women who were emotionally abused who had recently left their abusers. This later study provided empirical, quantifiable support for their 1981 theory that intermittency of abuse is a strong predictive factor in the formation of traumatic bonds, chief among their findings was the existence of a strong correlation between abuse intermittency/unpredictability and the strength of emotional attachment between abuser and victim.[FN8]

Dr. Raghavan next reviewed the scholarly literature with respect to trauma bonds and the coercive control techniques that forge them in a wide variety of contexts other than

https://law.justia.com/cases/new-york/other-courts/2018/2018-ny-slip-op-28161.html 7/17 1/27/2020 People v Abdur-Razzaq :: 2018 :: New York Other Courts Decisions :: New York Case Law :: New York Law :: US Law :: Justia

intimate partner violence. She described the work of Harvard professor Judith Herman who coined the term "complex PTSD" in her highly influential book, Trauma and Recovery, and corresponding peer-reviewed journal article.[FN9] Complex PTSD arises when one experiences a prolonged or chronic trauma that results in changes in the way one regulates emotions and causes difficulty in [*5]relationships. In both her book and article, Dr. Herman cites Dutton and Painter and compares the trauma bonding that occurs between a battered woman and her abuser to that of hostages and their captors and religious cult leaders and their followers. According to Herman, in all three contexts the victim is isolated and becomes increasingly dependent upon the perpetrator, not only for survival and basic bodily needs, but also for information and emotional sustenance. In these relationships, the repeated experience of terror and reprieve often results in a feeling of intense, almost worshipful dependence upon an all-powerful godlike authority. The victim may live in terror of his wrath, but may also view him as the source of strength, guidance, and life itself. Notwithstanding the abuse, the relationship may take on an extraordinary quality of specialness.Dr. Raghavan also described the findings of Nathalie de Fabrique in her seminal analysis of Stockholm syndrome.[FN10] De Fabrique conducted a quantitative peer-reviewed study in which she analyzed case histories of FBI files on hostage situations to try to determine what factors led to the formation of a traumatic bond between the captive and the hostage-taker. De Fabrique found that in the hostage context where there is an obvious power imbalance, the most important factors in whether a trauma bond was formed was whether the kidnappers were likable and whether they used intermittent reward and punishment. Lastly, Dr. Raghavan reviewed the work of Joan Reid, whose journal article provides a thorough summary of the empirical and clinical studies of trauma bonding to date in the contexts of Stockholm syndrome, battered woman's syndrome, and child sexual abuse syndrome.[FN11]

With respect to other contexts within which trauma bonding has been identified as a natural occurrence, the testimony at the hearing by Dr. Foote complemented that of Dr. Raghavan. Dr. Foote testified with respect to his clinical experience and research with respect to trauma bonding in the area of child sexual abuse. In his studies of clergy-child abuse, teacher-student abuse and coach-student abuse, where a power imbalance clearly exists, Dr. Foote observed that a trauma bond would form that would cause an abused to return to the abuser when the abuser used control tactics and intermittent reward and punishment.[FN12]

After this chronology of trauma bonding research in contexts other than sex trafficking, Dr. Raghavan then testified with respect to the studies and articles written that focused on the traumatic bonds formed between pimps and prostitutes, which is the subject of this Frye

https://law.justia.com/cases/new-york/other-courts/2018/2018-ny-slip-op-28161.html 8/17 1/27/2020 People v Abdur-Razzaq :: 2018 :: New York Other Courts Decisions :: New York Case Law :: New York Law :: US Law :: Justia

[*6]hearing.[FN13] The first such study she described was published in 2007 and was a qualitative study in which 66 individuals were interviewed, which included prostitutes, former prostitutes, vice police officers, social workers and parents of prostitutes.[FN14] Drawing upon the earlier works of Lenore Walker and Dutton and Painter with respect to battered women, the researchers concluded that the key element that kept prostitutes with their pimps was the fact that many of them continued to feel emotional attachments to the very men who had betrayed and abused them. The authors further concluded that these women were demonstrating a form of trauma bonding akin to that seen in battered women. They wrote:

Dutton's description of these dynamics in battered intimate relationships could also describe the prostituted woman's relationship with a lover pimp as, [in both of these relationships one sees] the development of strong emotional ties between two persons, with one person intermittently harassing, beating, threatening, abusing, or intimidating the other. Prostituted women reported having trouble giving up the fantasy of a perfect life that the pimps promised them and thinking that time on the streets was only a detour before their real future together would begin. Some women would never label the man who turned them out as a pimp; to them he is the man they love and they believe that they are showing their love to him by earning money for him. These same women often justified the beatings they regularly receive from their pimps in much the same way as battered women; they reported feeling that they must have deserved the beating. (See Exhibit 12 at 7-9)

Next, Dr. Raghavan described two peer-reviewed studies and journal articles by Joan Reid. [FN15] The first of these articles was published in 2010 and consisted of 34 interviews of representatives from various organizations and agencies that frequently interact with sex trafficking victims who are minors. Reid concluded that the grooming process used by sex traffickers is a mixture of reward and punishment which is used to produce intense loyalty and trauma bonding to the trafficker. According to the author, these tactics, similar to those associated with domestic abusers, are designed to keep the victims in physical and psychological bondage that becomes so ingrained that the minor will continue to return, defend, and cover for the abuser until the trauma bond is severed. Reid's second study was published in 2016 after she had reviewed the social service provider case files of 79 female minors who had been trafficked. Reid again found the widespread use of coercive control tactics that closely paralleled those previously observed in the context of intimate partner violence, child abuse, hostage situations [*7]and cults, which resulted in victims developing strong emotional attachments to their abusers or captors. Thus, Reid warned, the existence of trauma bonding and its lingering impact on victims of juvenile sex trafficking should not

https://law.justia.com/cases/new-york/other-courts/2018/2018-ny-slip-op-28161.html 9/17 1/27/2020 People v Abdur-Razzaq :: 2018 :: New York Other Courts Decisions :: New York Case Law :: New York Law :: US Law :: Justia

be overlooked when responding to and providing mental health treatment to victims. See Exhibit 14 at 505.[FN16]

Based upon all of these studies on trauma bonding and coercive control, as well as their own experience and research, all three of the People's experts opined that these concepts are generally accepted in the context of sex trafficking by the community of psychologists who specialize in trauma and that they provide a valid explanation for the often anomalous, counterintuitive behavior of victims of sex trafficking. Neither defendant called their own expert to offer a contrasting opinion.

The Applicable Law

With respect to expert testimony regarding new or novel scientific theories or techniques, New York still adheres to the Frye test of general acceptance by the relevant scientific community. See People v. Wesley, 83 NY2d 417 (1994). Once this threshold determination is made, the Court also must decide whether the proffered expert testimony is beyond the ken of the typical juror and will aid such juror in reaching a verdict. See People v. Taylor, 75 NY2d 277, 288 (1990). The Frye test asks not whether a particular procedure or theory is universally endorsed, but whether the analytical theory and techniques, when properly performed, generate results accepted as reliable within the scientific community. See People v. LeGrand, 8 NY3d 449, 457 (2007). Further, this test emphasizes counting scientists' votes, rather than verifying the soundness of a scientific conclusion. Id.

The issue of whether expert testimony regarding traumatic bonding and coercive control in the context of the pimp/prostitute relationship satisfies the Frye standard for admission is a matter of first impression in New York. However, the clear trend of recent decisions has been to permit expert testimony concerning complex psychological and social phenomena. See People v. Spicola, 16 NY3d 441, 460-65 (2011). For example, expert testimony regarding battered woman's syndrome has been deemed admissible since 1985 when an esteemed colleague first determined after a Frye hearing that such evidence had gained substantial enough scientific acceptance to warrant admissibility, and that such testimony would assist a jury in understanding "the unique pressures which are part and parcel of the life of a battered woman," and would enable the jury to "disregard their prior conclusions as being common myths rather than informed knowledge." See People v. Torres, 128 Misc 2d 129, 134 (Sup Ct. Bx. Co. 1985)(Bernstein, J.); see also People v. Turner, 143 AD3d 582 (1st Dept. 2016); People v. Jackson, 133 AD3d 474 (1st Dept. 2015); People v. Byrd, 51 A.D.3d 267 (1st Dept. 2008); People v. Ellis, 170 Misc 2d 945 (Sup. Ct. NY Co. 1996).

https://law.justia.com/cases/new-york/other-courts/2018/2018-ny-slip-op-28161.html 10/17 1/27/2020 People v Abdur-Razzaq :: 2018 :: New York Other Courts Decisions :: New York Case Law :: New York Law :: US Law :: Justia

Similarly, for many decades courts have allowed expert testimony with respect to rape trauma syndrome and child sexual abuse accommodation syndrome. In People v. Taylor, supra, 75 NY2d at 288-89, in allowing experts to testify about rape victims' counterintuitive behaviors, the Court of Appeals was satisfied that this type of evidence had been generally accepted in the relevant scientific community and that it would aid a lay juror by dispelling common misconceptions regarding the ordinary responses of rape victims. Likewise, In People v. Spicola, supra, 16 NY3d at 465, in allowing experts to testify about the incongruous behaviors of child sexual abuse victims, the Court of Appeals rejected defendant's attack on the scientific reliability of child sexual abuse accommodation syndrome and found that such evidence would aid the jury by explaining behaviors of child victims that might be puzzling to them. See also People v. Carroll, 95 NY2d 375 (2000); People v. Diaz, 20 NY3d 569 (2013); People v. Williams, 20 NY3d 579 (2013).

Although the Court is unaware of any New York case addressing the admissibility of expert testimony regarding trauma bonding and coercive control to explain the behavior of the victims of sex trafficking, a number of federal courts have done so under the less stringent Daubert standard for admission of expert testimony. In particular, the United States Court of Appeals, D.C. Circuit, ruled that expert testimony on the pimp/prostitute subculture, the modus operandi of pimps, and the nature of the relationship between pimps and prostitutes was admissible as its relevance outweighed any prejudice to defendant. United States v. Anderson, 851 F.2d 384, 393 (D.C. Cir. 1988). Similarly, in finding admissible expert testimony regarding the relationship between prostitutes and pimps, the Ninth Circuit opined that the pimp/prostitute relationship is not the subject of common knowledge and that a trier of fact who is uninformed about the relationship would be unprepared to assess the veracity of a victim testifying about prostitution. United States v. Taylor, 239 F.3d 994, 998 (9th Cir. 2001); see also United States v. King, 703 F. Supp. 2d 1063, 1075 (D. Hawaii 2010)(after a Daubert hearing, the court found that expert testimony regarding pimp/prostitute dynamics, including common ways sex traffickers use force and control over the victim, could aid the jury in understanding how prostitutes could be victims of fraud, force or coercion rather than be willing participants with free will to exit these situations).

Applying these principles of law to the evidence presented at the hearing leaves no doubt that the proffered testimony of Dr. Raghavan is admissible at the upcoming Skipper/Randolph trial and the Abdur-Razzaq trial. Initially, the hearing testimony and evidence established to the Court's satisfaction that the theories of trauma bonding and coercive control are well established in both the psychological and legal communities. The People have demonstrated through Dr. Raghavan's testimony and the numerous peer-

https://law.justia.com/cases/new-york/other-courts/2018/2018-ny-slip-op-28161.html 11/17 1/27/2020 People v Abdur-Razzaq :: 2018 :: New York Other Courts Decisions :: New York Case Law :: New York Law :: US Law :: Justia

reviewed journal articles in evidence at the hearing that all three of the elements inherent in the forging of traumatic bonds — power imbalance, use of control tactics, and meting of intermittent rewards and punishment — that are present in cases of intimate partner violence, child sex abuse, and kidnapper/hostage situations, are present in cases in which sex trafficking is alleged. Thus, it is both logical and reasonable to extend the principle of trauma bonding, which has been generally accepted to explain anomalous behavior in these other contexts, to explain the anomalous behavior of victims of sex trafficking. Therefore, the Court concludes that the underlying, well established principles are fully applicable to sex trafficking, that this application, though novel, emerges from adaptation and [*8]extension of these principles, and that the proffered testimony is admissible in a sex trafficking case based upon the existing precedent cited above relating to, inter alia, battered woman's, rape trauma, and child sexual abuse accommodation syndrome evidence. See People v. Foster-Bey, 158 AD3d 641 (2d Dept. 2018)(expert testimony regarding LCN DNA testing and the FST are admissible because they are not novel scientific techniques and also are generally accepted); People v. Gonzalez, 155 AD3d 507 (1st Dept. 2017).[FN17]

Moreover, the hearing evidence also established that trauma bonding and coercive control are scientific theories that provide the most logical and persuasive explanation for often paradoxical behaviors of victims of sex trafficking, and have gained substantial and preeminent scientific acceptance to warrant admissibility.[FN18] Indeed, the testimony of the People's three expert witnesses and the substantial body of academic empirical and analytical literature in evidence clearly demonstrate that trauma bonding occurs between many pimps and prostitutes. Thus, the People have satisfied their burden of establishing general acceptance of these theories within the relevant scientific community. See People v. Middleton, 54 NY2d 42, 49-50 (1981)(expert testimony admissible where general acceptance shown by virtue of journal articles that demonstrate a majority of the experts in the field accept and approve the procedures and that all of the sister state and federal courts have accepted the reliability of the procedures).[FN19]

Moreover, as in the cases cited above, expert testimony pertaining to trauma bonding and coercive control tactics used by sex traffickers would aid the average juror in understanding the anomalous behavior of victims of sex trafficking. As with rape victims and child sex abuse victims, the hearing evidence established that victims of sex trafficking, who often endure daily physical, psychological, and sexual abuse inflicted by their pimp, often engage in counterintuitive conduct — such as staying with and not leaving their pimp, not reporting or even lying on behalf of their pimp, and professing their love for their pimp. Thus, the Court finds that the proffered testimony is relevant and helpful to explain these

https://law.justia.com/cases/new-york/other-courts/2018/2018-ny-slip-op-28161.html 12/17 1/27/2020 People v Abdur-Razzaq :: 2018 :: New York Other Courts Decisions :: New York Case Law :: New York Law :: US Law :: Justia

behaviors, which might appear unusual to a lay [*9]juror, and would help dispel any juror misconceptions regarding how someone would be expected to behave under these circumstances. See People v. Spicola, supra; People v. Taylor, supra; People v. Diaz, supra; United States v. Anderson, supra; United States v. Taylor, supra.

With respect to the two cases that are the subjects of the instant motions to preclude, the Court believes that jurors would benefit from the specialized knowledge of Dr. Raghavan. [FN20] With respect to People v. Abdur-Razzaq, the evidence presented to the Grand Jury established that defendant repeatedly assaulted and threatened M.N., yet she continued to engage in a sexual relationship with him and continued to do sex work on his behalf. Further, when defendant was faced with criminal prosecution, M.N. lied and recanted her inculpatory testimony. Thus, Dr. Raghavan's testimony will aid the typical juror in understanding why M.N. did not remove herself from the abusive situation, why she failed to report the abuse earlier, why she continued to engage in prostitution even while defendant was at work and not at home, why she returned to defendant, and why she recanted.

Likewise, in People v. Skipper, the typical juror may question why C.Y. stayed with defendant although she was not physically restrained during the entire period she remained at the location where she was being held. Moreover, should co-defendant Randolph testify, jurors may question why she remained with defendant, why she engaged in prostitution on his behalf, and why, after she had been arrested, she lied on behalf of defendant. Thus, Dr. Raghavan's testimony will help the jurors understand these potentially puzzling behaviors.[FN21]

Conclusion

Being satisfied that the proffered expert testimony regarding trauma bonding between sex traffickers and their victims and coercive control tactics utilized by sex traffickers have the required scientific basis for admission, that it is not within the common knowledge of the average juror, and that it is relevant to the two cases at bar, this Court concludes that such expert testimony is admissible in each case. Accordingly, each defendant's motion to preclude such evidence is denied.

This is the decision, order and opinion of the Court.

https://law.justia.com/cases/new-york/other-courts/2018/2018-ny-slip-op-28161.html 13/17 12/12/2019 A Gun to His Head as a Child. In Prison as an Adult. - The New York Times

A Gun to His Head as a Child. In Prison as an Adult.

By Audra D. S. Burch

Oct. 15, 2017

LEBANON, Conn. — Rob Sullivan still remembers the gun and the sound of his mother’s high-pitched pleas. Two thieves had burst into his parents’ Hartford home. Demanding his father’s dope stash, one of the men placed a gun to Rob’s right temple. “Just give it to them,” his mother begged his father.

He was 6 years old.

The incident, charred in his memory, was an early trauma among many he recalls from his childhood. He watched his father beat his mother for not having dinner ready on time or for not cleaning the house, he said. Often, she fought back. Sometimes when he got home, his parents were too drunk or high to let him in. Truancy charges landed him in juvenile detention in his early teens.

“Chaotic — there is no other way to describe my childhood,” he said. “I always felt alone.”

Given his history, it perhaps comes as no surprise that he has spent as much of his adult life in prison and in drug rehab as he has spent out.

Mr. Sullivan acknowledges that he has “made my own trouble” and “done stupid things.” But in a justice system built upon the idea of choice and personal responsibility, experts say the path to trouble may begin long before an individual has any say in the matter. What happens to people in childhood can make a difference in whether they end up in a prison cell, or whether they are even wired to make rational decisions.

“Childhood trauma is a huge factor within the criminal justice system,” said Christopher Wildeman, a sociologist at Cornell University and co-director of the National Data Archive on Child Abuse and Neglect. “It is among the most important things that shapes addictive and criminal behavior in adulthood.”

Mr. Sullivan was one of 10 newly released prisoners in Connecticut whom the PBS series “Frontline” and The New York Times followed for more than a year. The state is working to reduce its prison population and improve former prisoners’ chances of successfully rejoining society. But those convicted of crimes often have complex problems that date back to childhood. More than half, including Mr. Sullivan, went back inside.

A look at their histories showed that long before they were perpetrators, many of them were victims. Seven completed a questionnaire intended to quantify childhood trauma on a scale of one to 10, including the experience of or exposure to physical and sexual abuse, drug and alcohol abuse or mental illness in the home. High scores predict a wide variety of negative outcomes. All but one of them scored four or more, indicating a substantially elevated risk of chronic disease, depression, suicide attempts, substance abuse and violence.

Mr. Sullivan scored a 9.

_____

Bald with blue eyes, wearing his mother’s silver cross around his neck, Mr. Sullivan, 43, has two tears tattooed under his right eye, an intimate reminder of death. One is for his mother, who died of a heroin overdose when he was 21; the second is for a cousin, as close as a sister, who overdosed four years later. https://www.nytimes.com/2017/10/15/us/childhood-trauma-prison-addiction.html 1/4 12/12/2019 A Gun to His Head as a Child. In Prison as an Adult. - The New York Times What Mr. Sullivan saw, he eventually imitated. During one of Mr. Sullivan’s many trips to jail, he said, he passed his father, a fellow inmate, in the hallway.

His mother was unpredictable. “I remember her sleeping all the time, nodding out and burning holes in the floor,” he said. At first, this seemed normal. “I used to wonder why I couldn’t have a friend sleep over,” he said. “Then it was, I didn’t want to have a friend sleep over.”

He took his first sip of beer at 12 or 13 years old. By the time he was 19 — three years after quitting high school — he was, by his own estimation, an alcoholic, guzzling a 12-pack of Budweiser daily.

For the longest time, he resisted the temptation to try heroin. But so many of his friends were using. “I fell in love with the feeling of it,” he said. “It was calming and numbing and soothing, like a warm embrace.”

Mr. Sullivan has survived almost two decades of drug and alcohol use, cycling among short-term jobs, arrests and rehab. But the pattern has taken a toll: his relationship with his three oldest children — ages 23, 21 and 17 — is tumultuous, mostly because he was an absent father. He owes about $100,000 in child support.

With Raeann, the youngest, he wanted things to be different. Though jail often kept them apart, Mr. Sullivan doted on his daughter and tried to shield her from his habits and temper. He called her “Chewy” and “Peanut,” drew her elaborate pictures and texted her every day from the halfway house where he went after his release from prison.

But he hated the restrictions of life there, with his whereabouts and spending closely monitored. Finally he walked out, even though he knew it would mean a return to prison.

Before he turned himself in, he took his last paycheck and treated Raeann to the pair of silver high-tops with fuchsia laces that she wanted for her first basketball game.

“The sneakers were important to both of us,” he said. “And I wanted to see her play.”

Outside the store, there was a tearful goodbye. “You know you can tell me anything,” he said.

But Raeann was getting older. More mature. More perceptive.

https://www.nytimes.com/2017/10/15/us/childhood-trauma-prison-addiction.html 2/4 12/12/2019 A Gun to His Head as a Child. In Prison as an Adult. - The New York Times

Raeann Sullivan at the house in Manchester, Conn., where she lives with her mother. Kassie Bracken/The New York Times

When Mr. Sullivan missed her 10th birthday because he was locked up, she was forgiving. When she turned 11, he was out of jail, and the family had a birthday party. One year later, as her 12th birthday neared, Raeann finally got a good, hard look at her father’s other side.

_____

In the mid-1990s, Dr. Vincent Felitti, the chief of Kaiser Permanente’s obesity clinic, and Dr. Robert Anda, a medical epidemiologist with the Centers for Disease Control, developed 10 questions to assess cumulative childhood stress called the Adverse Childhood Experiences, or ACE, survey. The higher the ACE score, the higher the risk of negative outcomes: Among those who scored at least four, there was a 1,220 percent increase in suicide attempts over those who scored zero.

“This clearly showed children’s adverse experiences are a public health problem,” Dr. Anda said. “What we now know is that childhood adversity and stress can chemically change the way our brains work.”

The changes can affect impulse control, decision making and executive functions. From there, it can be a short hop to breaking the law.

But treatment can be complicated, and patients often resist it. Scientists have been testing the theory that higher levels of childhood trauma make recovery from addiction more difficult. They are developing approaches that capitalize on the brain’s ability to rewire itself.

Some schools, hospitals and jails have incorporated this emerging understanding of trauma, shifting the question from “What is wrong with you?” to “What happened to you?”

In Connecticut, the Department of Correction offers a program to help inmates understand how trauma changes the normal stress response and how to control triggers (the program is still small, and Mr. Sullivan was not a participant). Studies show that childhood trauma increases the likelihood of arrest and that inmates report much higher rates of trauma than other adults. https://www.nytimes.com/2017/10/15/us/childhood-trauma-prison-addiction.html 3/4 12/12/2019 A Gun to His Head as a Child. In Prison as an Adult. - The New York Times “It is safe to assume that the people I deal with have experienced some kind of horrible trauma as children and adults, so for me, that is a starting point,” said Katherine Montoya, a 10-year veteran parole officer in Connecticut who works with women.

For one parolee who had been the victim of sex trafficking, Ms. Montoya worked to avoid triggering the woman’s trauma by making sure she came in contact only with female officers.

_____

In May 2016, after serving his time following the halfway house incident, Mr. Sullivan walked out of the Enfield Correctional Institution. For about nine months, he did well, living with Raeann and her mother, Kelly Shepard, 44, whom he has known since middle school. (While it was not possible to independently verify some of Mr. Sullivan’s accounts of his childhood, Ms. Shepard said they were consistent with what he had told her.)

He found work with a construction company, and managed to shield Raeann from the worst of his temper.

But in February, there was a bad blowup. He called Raeann and Ms. Shepard nasty names. He smashed Ms. Shepard’s cellphone.

Raeann stopped speaking to her father.

“She idolizes him. But she finally saw the other side of him, when he drinks, and she is really angry now,” said Ms. Shepard, who keeps a close watch on her daughter and makes sure she is in counseling. “He adores her, but he can’t get himself together long enough to maintain the relationship.”

Mr. Sullivan checked himself into Lebanon Pines, a rural 56-acre residential rehab facility for men. Six years before, he had been required to go to Lebanon Pines as a condition of probation. This time was voluntary. He received therapy and daily doses of methadone.

But he refused to talk in depth about his childhood trauma. And he struggles to explain why. “I just haven’t wanted to go there,” he said. “It’s painful.”

Mr. Sullivan had two decades on many fellow patients at Lebanon Pines. He was banking on his age and the high cost of street life being enough to finally break the generational cycle. Still, about six weeks before his release date, he was worried that he might not make it.

“I have never followed through on anything in my life,” he said, tears in his eyes. “It’s hard. I know if I end up back in the streets I will end up drinking and using again.”

Mr. Sullivan was right. He did not finish the program.

https://www.nytimes.com/2017/10/15/us/childhood-trauma-prison-addiction.html 4/4 1/28/2020 My Trauma Does Not Define Me | The Marshall Project

01.23.2020 LIFE INSIDE How I Finally Learned That Trauma Does Not Define Me

“It can be exhausting to tell and retell your painful story just to get people to listen to you about other things.”

By MARLON PETERSON

I celebrated the 10th anniversary of my release from a New York prison in Accra, the capital city of Ghana. I was there to participate in e Year of Return, a countrywide commemoration of the 400 years since the rst Africans were tracked to the British colony now known as Virginia.

Yes, I went to Afrochella. But on December 23—10 years to the day that I left prison—I was compelled to visit the Cape Coast Castle, a trading post and fort where Europeans brutally warehoused thousands of Africans and exported them to unknown lands. I walked through this door of no return because I needed to feel the spirit of resistance and be in community with the beauty of my ancestors who found ways to survive the ugliness of white people and their growing system of anti-black racism.

But my time in Ghana also forced me to consider how I was caring for my own freedom. Since serving a decade in prison for a crime I committed as a teenager, I’ve done countless presentations https://www.themarshallproject.org/2020/01/23/how-i-finally-learned-that-trauma-does-not-define-me 1/4 1/28/2020 My Trauma Does Not Define Me | The Marshall Project

for youth. I’ve published numerous essays and delivered a bunch of keynotes, including a TED Talk with a million views. I also have a podcast, Decarcerated, where I interview people who have spent time in prison about their journeys to success.

But I have come to realize that there is a hidden cost to my work: my identity.

The truth is, I have been in a prison of some sort for nearly half of my 40 years of life. My rst connement came in the form of the broken man who sexually assaulted me when I was 14. at man took away my childhood freedom and sentenced me to absolute silence.

e assault, coupled with the Brooklyn street violence I had to deal with in my teens, marked the beginning of me convincing myself that I was irreparable. I didn’t know it at the time, but I was becoming the person abolitionist Frederick Douglass was describing when he famously said, “It is easier to build strong children than to repair broken men.''

e next prison I entered was a physical one, and this time it was my own fault. At 19, I went to jail, facing a life sentence for my part in a fatal robbery. My parents could not understand why their previously nerdy son ended up in such a terrible place.

I remember what my father told me during his rst visit to the Manhattan Detention Complex. rough tears, he said, “Marlon, I need you to learn to how to become a man now.” I was more terried, and thought, How can I become a man in here?

But slowly I gured it out. After lots of self-talk in my cell, journaling, feeling scared as shit every day and crying myself to sleep, I decided to be a sponge and learn as much as I could. I listened to the men talking about their lives before prison—the girlfriends and wives they relied on for emotional support, and the children they left behind. I wanted to grow into a man who had stories of my own that I could draw on to teach others. https://www.themarshallproject.org/2020/01/23/how-i-finally-learned-that-trauma-does-not-define-me 2/4 1/28/2020 My Trauma Does Not Define Me | The Marshall Project

So I earned a college degree in prison. I designed a workshop that bridged our community of incarcerated men with a student community at Vassar College. After I got out in 2009, I implemented H.O.L.L.A, (How Our Lives Link Altogether), a youth development program that I co- created in prison with several other men I served time with. A few years later I started another youth development group, Youth Organizing to Save Our Streets (YO S.O.S), and earned another degree that allows me to put my people on to opportunities they might not get otherwise. I have become a gun-violence prevention advocate and a leader in the justice reform arena.

For all of that I am blessed.

Still, this work is a gift and a curse. e gift is helping people feel a little more hopeful about their possibilities. e curse is living in a perpetual narrative of pain. It can be exhausting to tell and retell the story of your trauma just to get people to listen to you about other things. Trauma and testimony are codependents. ere is no testimony without trauma, and your trauma may not be addressed without your testimony. en you nd yourself in a prison dened by trauma.

is brings me back to the Cape Coast in Ghana. Sitting on the shore, I could almost hear my ancestors declaring, “We were enslaved, but we were not ‘slaves.’”

My people were West Africans who named their children based on the day of the week. Some were designers who wove colorful silk, cotton and rayon into Kente cloth. Some were traveling poets, musicians and storytellers known as griots.

e point is that being enslaved by the worst of white people was not their entire identity.

Ghana pushed me to experience my own personal journey of restorative justice.

Who I am is a black writer and a humanitarian, a steelpan player and a lover of soca music. I am a person in pursuit of justice for black people, because justice for us is justice for all.

https://www.themarshallproject.org/2020/01/23/how-i-finally-learned-that-trauma-does-not-define-me 3/4 1/28/2020 My Trauma Does Not Define Me | The Marshall Project

I will wear the label of “formerly incarcerated person” when I choose to.

I am what I create today, and there is no burnout in creation.

And this feels good.

Marlon Peterson is the Brooklyn-based host of the Decarcerated Podcast and an essayist. He is working on his rst book, “Bird Uncaged: Promise to Sing About Me,” with Bold Type Books. Follow him on twitter at @_marlonpeterson.

https://www.themarshallproject.org/2020/01/23/how-i-finally-learned-that-trauma-does-not-define-me 4/4 JA16 Prosecutor Revised.qxp_Prosecutor 7/26/16 12:21 PM Page 34

S POTLIGHT Trauma for the tough-minded prosecutor As a profession, lawyers consistently rank high for stress, depression, and suicide. Those in prosecutor’s offices are hit with the double-whammy of repeated sec - ondary trauma (exposure to other people’s trauma). Here’s how to recognize these stresses and care for yourself in the midst of seeking justice for our communities. everal months ago I began to that something awful has happened Vulnerabilities have a series of violent night - to her? When you see a man holding in the legal profession Smares. In one, I went out with hands with a little girl, do you think Lawyers are particularly vulnerable my investigator to a it’s a sweet image, or do to burnout and stress, and as a pro - dangerous area of you wonder if the man is fessional group they are at a high risk town to find a victim molesting her? Even put - for depression, substance abuse, and for a trial we were ting these examples in suicide. The problems can be working on. In the writing sounds crazy, but observed in law school and continue dream, my investiga - I have had these throughout one’s career. tor walked up to the thoughts, and other peo - According to the Dave Nee door to see if it was ple in my office have Foundation, whose program the correct house confided the same. Uncommon Counsel helps combat while I stayed in the Most people are famil - depression and suicide among law car. I watched as a iar with burnout, which students, stress among law students man burst through is mental, physical, and is reported at 96 percent, compared the front door and emotional exhaustion to 43 percent for other graduate stu - shot her, then stood By Stacy Miles- due to prolonged stress. dents. Chronic stress can trigger the over her while I Thorpe, LCSW Burnout can happen to onset of clinical depression, and screamed frantically Victim Assistance anyone. And those of us depression among law students is 8– from the car. I got on Coordinator in the Travis in prosecutor’s offices are 9 percent prior to matriculation and the radio and called County District also prone to secondary 40 percent after three years. Lawyers in, yelling, “Officer Attorney’s Office trauma, also referred to are 3.6 times more likely to suffer down, officer down!” as vicarious trauma or from depression than non-lawyers. The next day at work, I begged her compassion fatigue. It is a condition Lawyers also rank fifth in incidence not to go out looking for this victim, unique to professionals repeatedly of suicide by occupational group. 1 In that there must be some other means exposed to the trauma of others, such a survey conducted by the American to find him. as law enforcement officers, firefight - Bar Association and the Hazelden I’m sure many of us who work in ers, nurses, social workers, judges, Betty Ford Foundation of 15,000 prosecution can relate to the creep - and criminal lawyers (among others). American lawyers, 21 percent ing feeling of vulnerability we experi - While burnout is the result of gener - acknowledged a drinking problem, ence. Some of it can be attributed to al stress and frustration over a long 28 percent battle depression, and real threats and dangers we face in period of time, secondary trauma has 11.5 percent reported suicidal our roles, but other fears are more a much more pervasive impact. It thoughts. 2 likely because of our exposure to likely includes physical and emotion - Not only does the work of prose - trauma. When you can’t reach a al symptoms and disruption of one’s cution itself induce stress, but the loved one on the phone, for example, social life and spiritual beliefs. legal culture can also create condi - do you tend to think her phone must tions that exacerbate stress and pre - not be charged, or do you imagine vent people from seeking support.

34 July –August 2016 • The Texas Prosecutor journal • www.tdcaa.com JA16 Prosecutor Revised.qxp_Prosecutor 7/26/16 12:21 PM Page 35

Attorneys are in an adversarial posi - thing that has happened to them. more depth. Hypervigilance is the tion most of their working hours and During trial preparation meetings, sense of being “on” at all times—it are expected to be tough-minded the devastating or terrifying facts are can be exhausting and leave a person and strong. Emotional vulnerability laid out before us, accompanied by frazzled. Some of my colleagues feel is viewed as a weakness and a prob - the victims’ powerful and raw emo - nervous about being in large crowds lem. Perfection is expected, as any tions. Our role in these times is to and have said they constantly watch mistake or oversight can dramatical - listen objectively, assess our case, and people’s hands in case somebody ly change the outcome of a case or a analyze how to present it to a jury. tries to make a sudden move for a trial. This expectation leaves little Naturally we are deeply moved or weapon. Prosecutors and investiga - room for the very normal human upset by the victims’ pain, but the tors sometimes fear going to every - experience and error. Spending most role demands a professional persona. day places like the grocery store or of the work day in the “lawyer” In addition to this continual expo - restaurants because they may run mindset can establish the habit of sure to trauma, prosecutors shoulder into a defendant or defendant’s fam - viewing the world through the lens the enormous expectation that they ily. of pessimism and perfectionism. alone will be responsible for bringing The inability to embrace com - When you take that legal persona justice about, both for the victims plexity can result in black-or-white into the grocery store, your child’s and the offenders. thinking: that there is good and bad, school, or dinner with your partner, While everyone responds differ - that this person is right and that per - the stress permeates your entire life. ently to trauma, in their book Trau - son is wrong. In the workplace this ma Stewardship , authors Lipsky and can take the form of gossip and neg - Secondary trauma Burk explore 16 of the most com - ativity. It’s harder to assess and Secondary trauma (also called sec - mon responses people have to trau - understand others’ perspectives or ondary traumatic stress) is defined as ma exposure: 4 situations than it is to label others “the emotional duress that results • feeling helpless and hopeless, with sweeping generalizations. This when an individual hears about the • a sense that one can never do polarization is easy to slip into when firsthand trauma experiences of enough, you work within the criminal justice another. Its symptoms mimic those • hypervigilance, system, where the set-up is us vs. of post-traumatic stress disorder • diminished creativity, them, guilty or not-guilty, and good (PTSD).” 3 Exposure to a single trau - • inability to embrace complexity, guys vs. bad guys. matic incident can induce a reaction • minimizing, Minimizing occurs when we get in some people—victims of crime • chronic exhaustion or physical so flooded with others’ pain that we experience PTSD to some extent. ailments, have difficulty relating in an empa - But secondary trauma is the cumula - • inability to listen or deliberate thetic way to less-serious situations. tive effect of repeated exposure to avoidance, Once, when my teenage daughter trauma that can impact us in numer - • dissociative moments, expressed frustration at my husband ous ways and ultimately erode our • sense of persecution, and me for being too attentive and sense of self, damage our outlook on • guilt, overly involved in her life, I proceed - life, and harm our overall well-being. • fear, ed to tell her about a girl her same Exposure to constant trauma • anger and cynicism, age who had run away from her and violence is an added burden that • inability to empathize or numb - group foster home to fall into the attorneys and other professionals in ing, hands of a sex trafficker. Boy, didn’t criminal law shoulder. The victims • addictions, and she wish she had involved parents we work with aren’t in our office • grandiosity (an inflated sense of who loved her?! My response was because they’re having a great day. importance related to one’s work). clearly not helpful or empathetic. We meet to talk about what is most Many of these are self-explana - Inability to listen or deliberate likely the worst or most horrifying tory, but I’d like to explore a few in avoidance may manifest at work or Continued on page 36 www..tdcaa..com • The Texas Prosecutor journal • July –August 2016 35 JA16 Prosecutor Revised.qxp_Prosecutor 7/26/16 12:21 PM Page 36

Continued from page 35 in our personal lives. I know a num - are things we won’t talk about with long-term solutions to secondary ber of people who can’t stand our non-prosecutor friends because trauma, but they are absolutely criti - answering the phone and have a dif - we think they won’t understand or cal to our well-being. What do you ficult time going to social engage - would think we are losing our do that brings you pleasure? Is it ments because they are so drained. minds. What do you do with the evil renting a kayak and spending time At work, you may find yourself long - you’ve seen? How can you possibly on the water alone? Going on a hike ing for distractions or shuffling files process with loved ones when what’s in a beautiful place? Getting a mas - without making any progress. My bothering you is that you spent the sage? Having a get-together with personal nemesis is the message light day sorting through child pornogra - friends? Make sure you are doing blinking on my phone. I find myself phy to prepare for a trial? Or that these things regularly. Be careful putting off checking it, stealing you sat all afternoon with a man about letting work constantly bleed glances at the message light with whose wife was murdered in their into your personal life. Some of this, guilt and dread. home and had to ask him question such as working a long weekend to Dissociative moments may after question about it? meet a deadline or making some calls sound severe, but this can be any - This work will change us, but by after office hours, is necessary, but thing from checking out in a meet - recognizing its impact and employ - when you don’t have to be “on,” ing, to realizing that you’ve had to ing strategies to address the second - drop your work persona and don’t read the same sentence five times, to ary trauma, we can hope to avoid or check your email. If a reminder of a finding yourself running scenarios in transform the damage it does. work task pops up, jot a note and put your head over and over. You may be Authors Karen Saakvitne and Laurie it aside for later. Be fully present in in the middle of dinner and images Anne Pearlman break down the trau - your life and with your family and from a crime scene keep coming up. ma response into two categories and friends. And use those vacation This can be especially difficult for recommend addressing each. 5 First, hours! those who have experienced trauma secondary trauma creates day-to-day themselves, as certain types of cases stress. Then, at a deeper level, sec - Transforming despair may bring back a flood of memories. ondary trauma can cause demoral - Secondly, how do we turn our As I’ve worked with colleagues ization, which impacts our core despair into something hopeful? The over the years, I’ve seen secondary beliefs, strips our lives of meaning strategies Saakvitne and Pearlman trauma manifest in countless ways. and hope, and leads to despair. suggest for transforming despair Do any of these sound familiar? involve: “I would feel really bad right Addressing 1) creating meaning or infusing an now if I had any feelings left.” day-to-day stress activity you currently engage in with “I used to be such a happy per - First, how do we address the every - meaning, son—I wish I could be like that day stress we feel? Doing so involves 2) challenging your negative beliefs again.” self-care, nurturing activities, and and assumptions, and “When I drive around town, I escape. It’s critical that we’re inten - 3) participating in community- see crime scenes everywhere. Over tional about putting in place habits building. there is where that child was raped. and activities that sustain us and To find or reclaim meaning, This is the field where that woman’s reduce stress. For each of us, this pic - think about why you got into prose - body was found.” ture will look different. Healthy cution. You could have chosen a dif - habits are an important foundation, ferent course involving more money Addressing the trauma so we can start by making a commit - and no interaction with crime vic - If there’s anything I would stress ment to improving our diet, moving tims or criminals, but here you are. here, it’s that these are all normal our bodies more, and spending time Perhaps there are more frustrations, reactions to being exposed to such with people who nurture us. hassle, and bureaucracy than we intense pain and horror. And these Nurturing and escape aren’t anticipated, but the meaning in and

36 July –August 2016 • The Texas Prosecutor journal • www..tdcaa..com JA16 Prosecutor Revised.qxp_Prosecutor 7/26/16 12:21 PM Page 37

importance of our jobs is still pres - ent. We do make a difference, and Helpful resources we matter a great deal to the crime victims and communities we serve. I Books regularly start the day by asking • The Anxious Lawyer: An 8-week Beginner’s Guide to Meditation and myself, “Who do I want to be today Mindfulness by Jeena Cho and Karen Gifford in the midst of any difficulties?” It’s a • In the Body of the World: A Memoir of Cancer and Connection by Eve good centering question and helps Ensler me focus less on my bursting inbox • Transforming the Pain: A Workbook on Vicarious Traumatization by and more on providing a caring pres - Karen Saakvitne and Laurie Anne Pearlman ence for crime victims. Outside of • Trauma Stewardship: An Everyday Guide to Caring for Self While Caring work, you can sit on the playground for Others by Laura van Dernoot Lipsky and Connie Burk with your kids checking Facebook, or you can soak up the joy of their Organizations play and delight in the feel of the sun • The Compassion Fatigue Awareness Project promotes awareness and and that particular shade of green in understanding of compassion fatigue and its effects: http://compassionfa - the trees and grass. It’s all a matter of tigue.org. perspective, so figure out what you • Psychology Today has a therapist finder to assist in locating a therapist already do as a part of your daily life, in your area and can narrow down by topic, such as trauma, depression, and focus on the grace and beauty in and substance abuse: https://www.psychologytoday.com. the moment. Allow yourself to expe - • Suicide Prevention Lifeline is a 24-hour crisis hotline and website rience awe and relish it, whatever offering a chat option: http://www.suicidepreventionlifeline.org. that may be for you. • Texas Lawyers’ Assistance Program provides confidential help for Challenging negative beliefs and lawyers, law students, and judges https://www.texasbar.com/TLAP. assumptions begins with becoming aware of them. As you experience Other goodies frustration or anger, pay attention to • Above The Law , a blog providing news and commentary about the your internal dialogue. Thinking U.S. legal profession: http://abovethelaw.com. patterns can become a habit, just as • The Professional Quality of Life Scale is a self-scoring instrument that water rushing down a slope will form measures compassion satisfaction, burnout, and secondary traumatic a groove over time. When you find stress. Take the assessment at http://proqol.org. yourself furious at someone who cut • The Resilient Lawyer podcast is available on iTunes. i you off during this morning’s com - mute, pause to reflect: Is it really true even a number of legal professionals cy in ourselves and control our reac - that all the other drivers are idiots, or bringing mindfulness and medita - tions to outside stimuli. could some of them be tired and dis - tion into their law practice. (Attor - Participating in community- tracted like we all are? Is the world ney Jeena Cho, for example, is a building is an important way to con - actually a terrible and dangerous partner at her firm, an author, and nect with others at work and person - place, or do terrible things happen the host of the podcast “The ally and to build meaning in your along with the millions of wonderful Resilient Lawyer.” She is a strong life. Friendships on the job con - acts? Asking such questions is part of advocate for mindfulness and medi - tribute a great deal of job satisfaction “mindfulness,” which simply means tation and has a number of good and provide the camaraderie that being fully present and aware of your resources for attorneys, including helps reduce stress. If you are able to reactions. The “mindfulness move - her book The Anxious Lawyer , which cultivate the kind of friendships at ment” has been embraced by numer - I highly recommend. 6) It’s an effec - work that allow for vulnerability and ous fields in recent years—there are tive and proven way to build resilien - Continued on page 38

www..tdcaa..com • The Texas Prosecutor journal • July –August 2016 37 JA16 Prosecutor Revised.qxp_Prosecutor 7/26/16 12:21 PM Page 38

Continued from page 37 emotional support, these connec - wave of pain this man caused. In ing a therapist who specifically treats tions can be a lifeline. Think also hearing stories from witnesses and trauma is important. Lastly, if there about the kind of support and victims, I reminded myself that one is a concern about suicide, the encouragement you can provide person did something evil and creat - National Suicide Prevention Lifeline your colleagues. It doesn’t have to be ed a horrible tragedy, but in the is available 24 hours a day at sappy or sentimental, but it helps to midst of that were dozens, even hun - 800/273-8255. have someone you can talk to when a dreds of people whose compassion case really gets under your skin. Out - moved them to act: a bystander Conclusion side of work, make space for connec - holding the hand of a stranger lying You are here for a reason, whether tions. Friends, family, and even vol - on the ground; people taking off you believe you were called to this unteer work can help you feel that their shirts to cover injured victims work or just find it exciting and there is more to life than your work because it was a chilly night; a man interesting. We aren’t going to persona and that life is more mean - waiting at the hospital for someone change the nature of it, but we do ingful than the crime and punish - he didn’t know, just so that that have control over who we are in the ment we’re mired in every day. injured victim wouldn’t be alone; midst of it. Don’t run from your feel - I also remember a quote by Fred people donating money for funerals ings. Pushing them underground Rogers of “Mister Rogers’ Neighbor - and therapy; and hundreds praying doesn’t eliminate them, it just buries hood,” which resonated with me. earnestly for total strangers. them. Much healthier is to recognize When he was a child and he saw in the moment that you’re sad, horri - something frightening on the news, Emergency measures fied, or overwhelmed by whatever is his mother would try to find out Given the statistics on depression, going on around you, and you can who was helping the people who substance abuse, and suicide in our then focus on breathing and staying were hurt. “‘Always look for the peo - field, it is important to know how to present. Find one or two safe people ple who are helping,’ she’d tell us,” reach out for help, either for yourself at work to debrief with, and be avail - he said in an interview. “‘You’ll or for someone else. One of the best able for them when they need to talk always find somebody who’s trying resources for attorneys practicing in as well. Using the suggestions above, to help.’ So even today, when I read Texas is the Texas Lawyers’ Assis - create a plan for yourself to manage the newspaper and see the news on tance Program (TLAP), a service of stress, take care of yourself, and culti - television, I look for the people who the State Bar of Texas. TLAP pro - vate hope and meaning. are trying to help.” 7 vides confidential help for lawyers, I’d like to close with a quote This incredible piece of wisdom law students, and judges by phone or from Iain Thomas: “Be soft. Do not has become part of my strategy to email. They are peers who are pas - let the world make you hard. Do not transform despair when I work on a sionate about helping others in the let the pain make you hate. Do not case or navigate a family through a field and provide life-saving peer let the bitterness steal your sweet - trial. I intentionally pay attention to support programs and CLE. You can ness. Take pride that even though the the many acts of kindness and com - call for yourself or call if you’re con - rest of the world may disagree, you passion that usually surround tragic cerned about a colleague at 800/343- still believe it to be a beautiful events. We had a case in our jurisdic - 8527. 8 place.” i tion of a horrible auto-pedestrian If you work for a governmental crash where the defendant drove entity, you likely have access to an Endnotes through a crowd of people, killing employee assistance program that can provide crisis intervention and four and injuring many others. (You 1 Uncommon Counsel. (n.d.). Retrieved May 02, can read about it at http://www resources for ongoing support. The 2016, from www.daveneefoundation.org/uncom - .tdcaa.com/journal/charging-capi - same therapy appropriate for crime mon-counsel. tal-murder-sxsw-tragedy.) It was victims is also recommended for 2 Middleton, M. (2015, December). “Big Trouble: overwhelming to think of the tidal help with secondary trauma, so find - Experts say Substance Abuse and Mental Health

38 July –August 2016 • The Texas Prosecutor journal • www..tdcaa..com JA16 Prosecutor Revised.qxp_Prosecutor 7/26/16 12:21 PM Page 39

Issues are a growing problem for the legal profes - sion.” Retrieved from www.abajournal.com.

3 “Secondary Traumatic Stress.” (n.d.). Retrieved April 28, 2016, from www.nctsn.org/resources/ topics/secondary-traumatic-stress.

4 Lipsky, L. v. D., & Burk, C. (2009). Trauma stew - ardship: An everyday guide to caring for self while caring for others. San Francisco, CA: Berrett- Koehler Publishers.

Saakvitne, K. W., & Pearlman, L. A. (1996). Trans - forming the pain: A workbook on vicarious traumati - zation. New York: W.W. Norton & Company.

Cho, J. (2015). The Anxious Lawyer: An 8-week guide to a happier, saner law practice using medita - tion. Place of publication not identified: American Bar Association.

7 Rare Video: Mister Rogers Talks to Children & Adults About Violence. (n.d.). Retrieved May 06, 2016, from www.fredrogers.org/frc/news/rare- video-mister-rogers-talks-children-adults-about- violence.

8 www.texasbar.com/TLAP.

www..tdcaa..com • The Texas Prosecutor journal • July –August 2016 39

NY State Jury Instructions https://www.nycourts.gov/judges/cji/1-General/cjigc.shtml

Credibility of Witnesses

As judges of the facts, you alone determine the truthfulness and accuracy of the testimony of each witness. You must decide whether a witness told the truth and was accurate, or instead, testified falsely or was mistaken. You must also decide what importance to give to the testimony you accept as truthful and accurate. It is the quality of the testimony that is controlling, not the number of witnesses who testify.1

Accept in Whole or in Part (Falsus in Uno)

If you find that any witness has intentionally testified falsely as to any material fact, you may disregard that witness's entire testimony. Or, you may disregard so much of it as you find was untruthful, and accept so much of it as you find to have been truthful and accurate.2

Credibility factors

There is no particular formula for evaluating the truthfulness and accuracy of another person's statements or testimony. You bring to this process all of your varied experiences. In life, you frequently decide the truthfulness and accuracy of statements made to you by other people. The same factors used to make those decisions, should be used in this case when evaluating the testimony.

In General

Some of the factors that you may wish to consider in evaluating the testimony of a witness are as follows:

Did the witness have an opportunity to see or hear the events about which he or she testified?

1 Did the witness have the ability to recall those events accurately?

Was the testimony of the witness plausible and likely to be true, or was it implausible and not likely to be true?

Was the testimony of the witness consistent or inconsistent with other testimony or evidence in the case?

Did the manner in which the witness testified reflect upon the truthfulness of that witness's testimony?

To what extent, if any, did the witness's background, training, education, or experience affect the believability of that witness's testimony?

Did the witness have a bias, hostility or some other attitude that affected the truthfulness of the witness's testimony?3

Motive

You may consider whether a witness had, or did not have, a motive to lie.

If a witness had a motive to lie, you may consider whether and to what extent, if any, that motive affected the truthfulness of that witness's testimony.

If a witness did not have a motive to lie, you may consider that as well in evaluating the witness's truthfulness.4

[Add if appropriate: Benefit

You may consider whether a witness hopes for or expects to receive a benefit for testifying. If so, you may consider

2 whether and to what extent it affected the truthfulness of the witness's testimony.5 ]

Interest/Lack of Interest 6

You may consider whether a witness has any interest in the outcome of the case, or instead, whether the witness has no such interest.

[Note: Add if appropriate: A defendant who testifies is a person who has an interest in the outcome of the case.]

You are not required to reject the testimony of an interested witness, or to accept the testimony of a witness who has no interest in the outcome of the case.

You may, however, consider whether an interest in the outcome, or the lack of such interest, affected the truthfulness of the witness's testimony.

Previous Criminal Conduct7

You may consider whether a witness has been convicted of a crime or has engaged in criminal conduct, and if so, whether and to what extent it affects the truthfulness of that witness's testimony.

You are not required to reject the testimony of a witness who has been convicted of a crime or has engaged in criminal conduct, or to accept the testimony of a witness who has not.

You may, however, consider whether a witness's criminal conviction or conduct has affected the truthfulness of the witness's testimony.

3 [Note: Add if appropriate: With respect to the defendant, such prior convictions or criminal conduct are not evidence of defendant's guilt in this case, or evidence that defendant is a person who is disposed to commit crimes. You are permitted to consider such convictions or conduct only to evaluate the defendant's truthfulness.]

Inconsistent Statements8

You may consider whether a witness made statements at this trial that are inconsistent with each other.

You may also consider whether a witness made previous statements that are inconsistent with his or her testimony at trial.

[Add if appropriate: You may consider whether a witness testified to a fact here at trial that the witness omitted to state, at a prior time, when it would have been reasonable and logical for the witness to have stated the fact. In determining whether it would have been reasonable and logical for the witness to have stated the omitted fact, you may consider whether the witness' attention was called to the matter and whether the witness was specifically asked about it. 9]

If a witness has made such inconsistent statements [or omissions], you may consider whether and to what extent they affect the truthfulness or accuracy of that witness's testimony here at this trial.

The contents of a prior inconsistent statement are not proof of what happened. You may use evidence of a prior inconsistent statement only to evaluate the truthfulness or accuracy of the witness's testimony here at trial.10

4 Consistency

You may consider whether a witness's testimony is consistent with the testimony of other witnesses or with other evidence in the case.

If there were inconsistencies by or among witnesses, you may consider whether they were significant inconsistencies related to important facts, or instead were the kind of minor inconsistencies that one might expect from multiple witnesses to the same event?

Police Testimony

In this case you have heard the testimony of (a) police officer(s). The testimony of a witness should not be believed solely and simply because the witness is a police officer. At the same time, a witness's testimony should not be disbelieved solely and simply because the witness is a police officer. You must evaluate a police officer's testimony in the same way you would evaluate the testimony of any other witness.11

[Note: Add if appropriate: A Judge Found Witness Testified Falsely

You have heard testimony that a judge found that (specify) testified falsely in an unrelated proceeding. That judge’s determination is not binding on your determination of (specify)’s credibility in this case. You may, however, consider that determination, along with the other evidence in the case, in evaluating the truthfulness and accuracy of (specify)’s testimony before you.12

[Note: Add if appropriate: Witness Pre-trial Preparation13

You have heard testimony about (specify: the

5 prosecutor, defense lawyer, and/or investigator) speaking to a witness about the case before the witness testified at this trial. The law permits a (specify) to speak to a witness about the case before the witness testifies, and permits a (specify) to review with the witness the questions that will or may be asked at trial, including the questions that may be asked on cross- examination.14 [You have also heard testimony that a witness read or reviewed certain materials pertaining to this case before the witness testified at trial. The law permits a witness to do so.] Speaking to a witness about his or her testimony and permitting the witness to review materials pertaining to the case before the witness testifies is a normal part of preparing for trial. It is not improper as long as it is not suggested that the witness depart from the truth.]

1. See generally People v Ward, 282 AD2d 819 (3d Dept 2001); People v Love, 244 AD2d 431 (2d Dept 1997); People v Turton, 221 AD2d 671, 671- 672 (2d Dept 1995); People v Jansen, 130 AD2d 764 (2d Dept 1987).

2. This portion of the charge was revised in January, 2008 to make it clear that the jury may accept so much of testimony as they find to have been truthful “and accurate.” See People v Perry, 277 NY 460, 467-468 (1938); People v Laudiero, 192 NY 304, 309 (1908); Hoag v Wright, 174 NY 36, 43 (1903); People v Petmecky, 99 NY 415, 422-423 (1885); Moett v People, 85 NY 373 (1881); People v Johnson, 225 AD2d 464 (1st Dept 1996).

3. See People v Jackson, 74 NY2d 787, 790 (1989); People v Hudy, 73 NY2d 40, 56 (1988).

4. See People v Jackson, supra at 790; People v Hudy, supra at 56.

5. See People v Jackson, supra at 790; See also Caldwell v Cablevision Sys. Corp., 20 NY3d 365, 372 (2013), holding as follows: "Supreme Court should have instructed the jury that fact witnesses may be compensated for their lost time but that the jury should assess whether the compensation was disproportionately more than what was reasonable for the loss of the witness's time from work or business. Should the jury find that the

6 compensation is disproportionate, it should then consider whether it had the effect of influencing the witness's testimony (see PJI 1:90.4).”

6. See People v Agosto, 73 NY2d 963, 967 (1989).

7. See People v Jackson, supra at 790; People v Sherman, 156 AD2d 889, 891 (3d Dept 1989); People v Smith, 285 AD 590, 591 (4th Dept 1955). Compare People v Coleman, 70 AD2d 600 (2d Dept 1979).

8. See People v Duncan, 46 NY2d 74, 80 (1978).

9. See People v Bornholdt, 33 NY2d 75, 88 (1973); People v Savage, 50 NY2d 673 (1980); People v Medina, 249 AD2d 166 (1st Dept 1998); People v Byrd, 284 AD2d 201 (1st Dept 2001).

10. See CPL 60.35 (2).

11. See People v Freier, 228 AD2d 520 (2d Dept 1996); People v Graham, 196 AD2d 552, 552-553 (2d Dept 1993); People v Allan, 192 AD2d 433, 435 (1st Dept 1993); People v McCain, 177 AD2d 513, 514 (2d Dept 1991). Compare People v Rawlins, 166 AD2d 64, 67 (1st Dept 1991).

12. In People v Rouse, 2019 NY Slip Op 08522, 2019 WL 6255781[Nov. 25, 2019], the Court of Appeals held that a police officer may be cross-examined “with respect to prior judicial determinations that addressed the credibility of their prior testimony in judicial proceedings. The Court added that: “The only countervailing prejudice articulated by the [trial] court in precluding defense counsel from this line of inquiry was concern that the jury may view the prior judicial determinations of credibility as binding. Such concern, however, could be mitigated by providing the jury with clarifying or limiting instructions.”

13. Revised in September, 2018 to conform to the same instruction in the General Applicability section and in the Model Charges, Final Instructions section.

13. See People v Townsley, 20 NY3d 294, 300 (2012) (“The [prosecutor’s] argument suggested to the jury that there was something improper in a lawyer’s interviewing a witness in the hope of getting favorable testimony. That is not in the least improper. It is what good lawyers do.”); People v Liverpool, 262 AD2d 425 (2d Dept 1999) (“[W]here the defense counsel argued in summation that the prosecutor improperly coached his witnesses to ‘clean ... up’ problematic information in a police report, it was proper for the court to instruct the jury that there is nothing wrong with a prosecutor speaking to his or her witnesses before trial.”); People v Fountain, 170 AD2d 414, 415 (2d Dept 1991) (“This court finds no error in the trial court's charge to the jury that it is usual, and not illegal, for a prosecutor to talk to his witnesses, in light of the clear and continued suggestion by the defense

7 through cross-examination by defendant's counsel of the People's witnesses and summation, that the prosecutor improperly coached the People's witnesses to effect a ‘cover-up’ of the mistaken arrest of defendant.”).

8 PROMPT OUTCRY ______

The following charge should be included among the factors to consider on the credibility of a witness's testimony: ______

You may consider whether (specify name of complainant) complained of the crime promptly or within a reasonable period of time after its alleged commission.1

If you find that the complaint was made promptly or within a reasonable time, you may consider whether and to what extent, if any, that fact tends to support the believability of the witness's testimony.2

If you find that the complaint was unreasonably delayed, you may consider whether and to what extent, if any, that fact tends not to support the believability of the witness's testimony.3

[Add the following if there is a factual issue on the promptness of the complaint:

In determining whether a complaint was made within a reasonable period of time, you may consider such circumstances as:

the complainant's age, past experiences, and mental state;

whether or not the complainant feared for his/her own safety or the safety of others;

whether or not the complainant had an opportunity to make a complaint; and

any other circumstance that operated to prevent or delay disclosure within a reasonable period of time.4] 1. People v McDaniel, 81 NY2d 10 (1993); People v Rice, 75 NY2d 929 (1990); Baccio v People, 41 NY 265, 271 (1869).

2. People v Williams, 75 NY2d 858 (1990).

3. People v Geddes, 186 A.D.2d 993 (4th Dept 1992).

4. See Baccio v People, 41 NY at 271, supra (“But in a case, in which the fact of complaint is admissible, it is perhaps competent to explain the want of such early complaint, by facts which show that it was impracticable, or that it was prevented by circumstances consistent with the natural impulse to complain thereof....”).

2 INSANITY (LACK OF CRIMINAL RESPONSIBILITY BY REASON OF MENTAL DISEASE OR DEFECT) Penal Law § 40.15 ______

If the affirmative defense of insanity is applicable, omit the final two paragraphs of the instructions of the crime charged, and substitute the following: ______

If you find that the People have not proven beyond a reasonable doubt any one of those elements, you must find the defendant not guilty of (specify).

If you find that the People have proven beyond a reasonable doubt each of those elements, you must consider the defendant’s affirmative defense that he/she lacked criminal responsibility by reason of mental disease or defect. If you find that the defendant has proven that affirmative defense, then you must return a verdict of not responsible by reason of mental disease or defect.

A jury during its deliberations must never consider or speculate concerning matters relating to the consequences of its verdict. However, because of the lack of common knowledge regarding the consequences of a verdict of not responsible by reason of mental disease or defect, I charge you that if this verdict is rendered by you there will be hearings as to the defendant`s present mental condition and, where appropriate, involuntary commitment proceedings.1

Under our law, the defendant has the burden of proving an affirmative defense by a preponderance of the evidence. A preponderance of the evidence means the greater part of the believable and reliable evidence, not in terms of the number of witnesses or the length of time taken to present the evidence, but in terms of its quality and the weight and convincing effect it has. For the affirmative defense to be proved by a preponderance of the evidence, the evidence that supports the affirmative defense must be of such convincing quality as to outweigh any evidence to the contrary.

Under our law, it is an affirmative defense to the crime(s) charged that, when the defendant engaged in the prohibited conduct, he/she lacked criminal responsibility by reason of mental disease or defect.

A person lacks criminal responsibility by reason of mental disease or defect when, at the time of the prohibited conduct, as a result of mental disease or defect, that person lacked substantial capacity to know or appreciate either:

1. The nature and consequences of such conduct; or

2. That such conduct was wrong.2

Let us examine that definition.3

First, the lack of substantial capacity to know or appreciate must have existed at the time the prohibited conduct was committed.

Second, the lack of substantial capacity to know or

2 appreciate must have been the result of mental disease or defect.

Third, a lack of substantial capacity to know or appreciate does not require a lack of total capacity to know or appreciate.

Fourth, the term “know or appreciate” means to have some understanding; it means more than mere surface knowledge.

For example, children can sometimes recite things that they cannot understand. In those circumstances, the children may be said to have surface knowledge of what they recited, but no true understanding. Thus, a lack of substantial capacity to know or appreciate either the nature and consequences of the prohibited conduct, or that such conduct was wrong, means a lack of substantial capacity to have some true understanding beyond surface knowledge of either the nature and consequences of such conduct, or that such conduct was wrong.4

Fifth, with respect to the term “wrong,” a person lacks substantial capacity to know or appreciate that conduct is wrong if that person, as a result of mental disease or defect, lacked substantial capacity to know or appreciate either that the conduct was against the law or that it was against commonly held moral principles, or both.5

As I have explained, the defendant has the burden of proving that he/she lacked criminal responsibility by reason of mental disease or defect and he/she must do so by a preponderance of the evidence. I remind you, however, that

3 placing this burden of proof of the affirmative defense on the defendant does not relieve the People of the burden of proving, beyond a reasonable doubt, all the elements of the crime(s) charged.

In this case, one of those elements was (specify element containing culpable mental state; e.g. That the defendant intended to cause the death of ....). The affirmative defense does not transfer to the defendant the burden of proving (specify, e.g. That the defendant did not intend to cause the death of....”) The burden remains on the People to prove (specify, e.g., That the defendant intended to cause the death of...) and to prove it beyond a reasonable doubt.

In determining whether the People have proven that element beyond a reasonable doubt, you may consider any evidence, psychiatric or otherwise, that relates to the defendant's state of mind at the time of the commission of the crime(s) charged. If you find that the People have not proven that element, or any other element beyond a reasonable doubt, then you must find the defendant not guilty. If you find that the People have proven all the elements beyond a reasonable doubt, then you must consider whether the defendant has proven the affirmative defense by a preponderance of the evidence.

In determining whether the defendant has proven the affirmative defense by a preponderance of the evidence, you may consider evidence introduced by the People or by the defendant, including but not limited to:

Select appropriate alternative(s):

4 – opinions of psychiatric witnesses, – prior hospitalizations of the defendant, – hospital and other medical records, – the nature and manner in which the crime was committed, –(specify)

If you find that the defendant has not proven the affirmative defense by a preponderance of the evidence, then, based upon your initial determination that the People have proven beyond a reasonable doubt the elements of the charged crime, you must find the defendant guilty of that crime.

If you find that the defendant has proven the affirmative defense by a preponderance of the evidence, then you must find the defendant not responsible by reason of mental disease or defect for that crime.

5 1. CPL 300.10(3) requires the quoted instruction “without elaboration.”

2. Penal Law § 40.15.

3. See generally People v. Adams, 26 N.Y.2d 129 (1970).

4. See Adams, 26 N.Y.2d at 135-136.

5. See People v. Wood, 12 N.Y.2d 69, 76 (1962); People v. Schmidt, 216 N.Y. 324 (1915); Moett v. People, 85 N.Y. 373 (1881).

6 JUSTIFICATION: USE OF PHYSICAL FORCE IN DEFENSE OF A PERSON PENAL LAW 35.15 (1) (Effective Sept. 1, 1980) (Revised Jan. 2015; Feb. & July 2016; and Jan 2018)1 ______

NOTE: This charge should precede the reading of the elements of the charged crime, and then, the final element of the crime charged should read as follows:

“and, #. That the defendant was not justified.” 2 ______

[With respect to count(s) (specify),] [T]he defendant has raised the defense of justification, also known as self defense. The defendant, however, is not required to prove that he was justified. The People are required to prove beyond a reasonable doubt that the defendant was not justified.

I will now explain our law's definition of the defense of justification as it applies to this case.

Under our law, a person may use physical force upon another individual when, and to the extent that, he/she reasonably believes it to be necessary to defend himself/herself [or someone else] from what he/she reasonably believes to be the use or imminent use of [unlawful3] physical force by such individual.

The determination of whether a person REASONABLY BELIEVES physical force to be necessary to defend himself/herself [or someone else] from what he/she reasonably believes to be the use or imminent use of physical force by another individual requires the application of a two-part test.4 That test applies to this case in the following way:

First, the defendant must have actually believed that (specify) was using or was about to use physical force against him/her [or someone else], and that the defendant’s own use of physical force was necessary to defend himself/herself [or someone else] from it; and Second, a “reasonable person” in the defendant’s position, knowing what the defendant knew and being in the same circumstances, would have had those same beliefs.

It does not matter that the defendant was or may have been mistaken in his/her belief; provided that such belief was both honestly held and reasonable.

[Add if there was evidence of a party’s reputation for violence:

Now, you have heard testimony that (specify) had a reputation for violence and engaged in violent acts. Normally, the law does not permit such testimony. The reason is that every person, regardless of that person's relative worth to the community, has the right to live undisturbed by an unlawful assault.

However, in assessing whether the defendant did "reasonably believe" that the physical force he/she used was necessary to defend himself/herself [or someone else] from what he/she "reasonably believed" to be the use or imminent use of such force by (specify), you may consider whether the defendant knew that (specify) had a reputation for violence or had engaged in violent acts. If so, you may then consider to what extent, if any, that knowledge contributed to a "reasonable belief" that the physical force the defendant used was necessary to defend himself/herself [or someone else] from what he/she "reasonably believed" was the use or imminent use of such force by (specify).5

Further, provided the defendant believed (specify) had such reputation or engaged in such acts, it does not matter whether that belief was correct.]

[Add as applicable:

Notwithstanding the rules I have just explained, the defendant would not be justified in using physical force under the following circumstances:

2 Select appropriate alternative(s):

(1) The defendant would not be justified if he/she was the initial aggressor;

[Add if applicable: except, that the defendant’s use of physical force would nevertheless be justified if he/she had withdrawn from the encounter and effectively communicated such withdrawal to (specify) but (specify) persisted in continuing the incident by the use or threatened imminent use of (unlawful6) physical force.]

[Arguing, using abusive language, calling a person names, or the like, unaccompanied by physical threats or acts, does not make a person an initial aggressor and does not justify physical force.]

“Initial aggressor” means the person who first attacks or threatens to attack; that is, the first person who uses or threatens the imminent use of offensive physical force.

The actual striking of the first blow or inflicting of the first wound, however, does not necessarily determine who was the initial aggressor.

A person who reasonably believes that another is about to use physical force upon him/her need not wait until he/she is struck or wounded. He/she may, in such circumstances, be the first to use physical force, so long as he/she reasonably believed it was about to be used against him/her [or someone else]. He/she is then not considered to be the “initial aggressor,” even though he/she strikes the first blow or inflicts the first wound.

[Add if there was evidence that the defendant was an intervenor: If a person intervenes in a conflict in defense of another, that person is an initial aggressor only if he/she somehow initiated or participated in the initiation of the original use of [deadly] physical force or the threat to use it,

3 or reasonably should have known that the person he/she was defending initiated it. On the other hand, if he/she neither initiated, nor participated in the initiation of [deadly] physical force, or the threat to use it, and had no reason to know who initiated it, then he/she is not the initial aggressor.7]

[Add if there was evidence of a reputation for violence: A person cannot be considered the initial aggressor simply because he/she has a reputation for violence or has previously engaged in violent acts.8]

[Add if there was evidence of threats: You may (however) consider whether the deceased made threats against the defendant prior to the time in question and whether such threats indicated an intent to act upon them as the initial aggressor. In making that assessment, it does not matter whether the defendant was aware of the threats.9]

(2) The defendant would not be justified if (specify’s) conduct was provoked by the defendant himself/herself with intent to cause physical injury to (specify).

(3) The defendant would not be justified if the physical force involved was the product of a combat by agreement not specifically authorized by law.

(4) A person may not use physical force to resist an arrest, whether authorized or unauthorized, which is being effected or attempted by a police officer or peace officer when it would reasonably appear that the latter is a police officer or peace officer.10

The People are required to prove beyond a reasonable doubt that the defendant was not justified.

NOTE: At this point, the trial court must select the appropriate alternative set forth below to fulfill the mandate of appellate decisions. See endnote ( 11 ). Those decisions require that in a case with multiple counts, in which some or

4 all of the counts include the same definition of justification as an element, the trial court’s instructions (as well as its verdict sheet) need to convey to the jury that once the jury has determined that the People have failed to prove that the defendant was not justified as to a count, the jury must not reconsider that same justification defense as to any other count and they must find the defendant not guilty of each and every count for which that same definition of justification is an element. (For a sample verdict sheet, see CJI2d Model Verdict Sheet for Justification.)

Select appropriate alternative:

(1) If justification applies to only one count, add the following:

It is thus an element of count [specify number and name of offense] that the defendant was not justified. As a result, if you find that the People have failed to prove beyond a reasonable doubt that the defendant was not justified, then you must find the defendant not guilty of that count.

(2) If justification applies to more than one count submitted to the jury on the verdict sheet, add the following:

It is thus an element of counts [specify numbers and names of the offenses on verdict sheet] that the defendant was not justified. As a result, if you find, as to the first of those counts that you consider pursuant to my instructions, that the People have failed to prove beyond a reasonable doubt that the defendant was not justified, then you must find the defendant not guilty of that count and of the remaining count(s) to which that same definition of justification applies.

(3) If there are additional counts for which justification is not an element, add the following:

If you find the defendant not guilty of counts (specify numbers and names of the offenses for which lack of justification was an element), you still must consider the count(s) (specify name of

5 count) for which the People are not required to prove that the defendant was not justified.

1. The January, 2015 revision added the section dealing with evidence of a party's reputation for violence. The February, 2016 revision added a supplemental instruction for situations involving an intervener to accord with People v Walker, 26 NY3d 170 (2015); See endnote 8. A Note was also added at the end of the charge. The Jully, 2016 revision included instructions regarding the consideration of evidence of threats made by the deceased against the defendant. The January, 2018 revision provided more detailed instructions at the end of the charge on how to instruct the jury to consider counts with the lack of justification as an element. See text associate with endnote 11.

2. See People v McManus, 67 NY2d 541, 549 (1986); People v Higgins, 188 AD2d 839, 840 (3d Dept 1992).

3. If the lawfulness of this physical force is in issue, then include the word “unlawful,” which appears in the statute (see Penal Law § 35.15 [1]), and explain how it applies to the case.

4. See People v Goetz, 68 NY2d 96, 115 (1986).

5. See People v Miller, 39 NY2d 543, 550-551 (1976).

6. If the lawfulness of this physical force is in issue, then include the word “unlawful,” which appears in the statute (see Penal Law § 35.15 [1] [b]), and explain how it applies to the case.

7. See People v Walker, 26 NY3d 170,177 (2015).

8. While evidence of the defendant's knowledge of the victim's reputation for violence or specific acts of violence is admissible to show that the defendant's fears were reasonable, the evidence is not admissible "to show that the deceased was the aggressor, for if competent for that purpose, similar evidence could be given as to the reputation of the defendant as bearing on the probability that he was the aggressor" (People v Rodawald, 177 NY 408, 423 [1904]; see Prince, Richardson On Evidence, § 4-409, p172 [11th ed. Farrell]).

9. See People v Petty, 7 NY3d 277 (2006).

10. Penal Law § 35.27

6 11. See (1) Appellate Division, First Department: People v. Blackwood, 147 A.D.3d 462 (2017) (“the court's charge did not convey to the jury that an acquittal on the top count. . . based on a finding of justification would preclude consideration of the other charges” for which the lack of justification was an element); People v Roberts, 280 AD2d 415, 416 (2001) (“Although the court instructed the jurors that justification was a defense to all of the counts, it did not instruct them that if they were to find defendant not guilty by reason of justification on a count, they were not to consider any lesser crimes”).

(2) Appellate Division, Second Department: People v Feuer, 11 AD3d 633, 634 (2004) (“[T]he error committed by the trial court in failing to instruct the jurors that if they found the defendant not guilty of a greater charge on the basis of justification, they were not to consider any lesser counts, is of such nature and degree so as to constitute reversible error”); ; People v Bracetty, 216 AD2d 479, 480 (1995) (“The court failed to instruct the jury...that the jurors were only to consider the lesser offense if they found the defendant not guilty of the greater offense for a reason other than justification”).

(3) Appellate Division, Third Department: People v Higgins, 188 AD2d 839, 840-841 (1992) (The trial court properly informed the jury that “only if defendant was found not guilty of the greater offense for a reason other than justification, was the jury to consider the lesser offense”).

7 Research

JAMA Pediatrics | Original Investigation Positive Childhood Experiences and Adult Mental and Relational Health in a Statewide Sample Associations Across Adverse Childhood Experiences Levels

Christina Bethell, PhD, MBA, MPH; Jennifer Jones, MSW; Narangerel Gombojav, MD, PhD; Jeff Linkenbach, EdD; Robert Sege, MD, PhD

Supplemental content IMPORTANCE Associations between adverse childhood experiences (ACEs) and risks for adult depression, poor mental health, and insufficient social and emotional support have been documented. Less is known about how positive childhood experiences (PCEs) co-occur with and may modulate the effect of ACEs on adult mental and relational health.

OBJECTIVE To evaluate associations between adult-reported PCEs and (1) adult depression and/or poor mental health (D/PMH) and (2) adult-reported social and emotional support (ARSES) across ACEs exposure levels.

DESIGN, SETTING, AND PARTICIPANTS Data were from the cross-sectional 2015 Wisconsin Behavioral Risk Factor Survey, a random digit-dial telephone survey of noninstitutionalized Wisconsin adults 18 years and older (n = 6188). Data were weighted to be representative of the entire population of Wisconsin adults in 2015. Data were analyzed between September 2016 and January 2019.

MAIN OUTCOMES AND MEASURES The definition of D/PMH includes adults with a depression diagnosis (ever) and/or 14 or more poor mental health days in the past month. The definition of PCEs includes 7 positive interpersonal experiences with family, friends, and in school/the community. Standard Behavioral Risk Factor Survey ACEs and ARSES variables were used.

RESULTS In the 2015 Wisconsin Behavioral Risk Factor Survey sample of adults (50.7% women; 84.9% white), the adjusted odds of D/PMH were 72% lower (OR, 0.28; 95% CI, 0.21-0.39) for adults reporting 6 to 7 vs 0 to 2 PCEs (12.6% vs 48.2%). Odds were 50% lower (OR, 0.50; 95% CI, 0.36-0.69) for those reporting 3 to 5 vs 0 to 2 PCEs (25.1% vs 48.2%). Associations were similar in magnitude for adults reporting 1, 2 to 3, or 4 to 8 ACEs. The adjusted odds that adults reported “always” on the ARSES variable were 3.53 times (95% CI, 2.60-4.80) greater for adults with 6 to 7 vs 0 to 2 PCEs. Associations for 3 to 5 PCEs were not significant. The PCE associations with D/PMH remained stable across each ACEs exposure level when controlling for ARSES.

CONCLUSIONS AND RELEVANCE Positive childhood experiences show dose-response associations with D/PMH and ARSES after accounting for exposure to ACEs. The proactive promotion of PCEs for children may reduce risk for adult D/PMH and promote adult relational health. Joint assessment of PCEs and ACEs may better target needs and interventions and enable a focus on building strengths to promote well-being. Findings support prioritizing Author Affiliations: Johns Hopkins possibilities to foster safe, stable nurturing relationships for children that consider the health Bloomberg School of Public Health and Child and Adolescent Health outcomes of positive experiences. Measurement Initiative, Baltimore, Maryland (Bethell, Gombojav); Alliance for Strong Families and Communities, Milwaukee, Wisconsin (Jones); The Montana Institute, Bozeman, Montana (Linkenbach); Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts (Sege). Corresponding Author: Christina Bethell, PhD, MBA, MPH, Bloomberg School of Public Health, Johns Hopkins University, 615 N Wolfe St, JAMA Pediatr. 2019;173(11):e193007. doi:10.1001/jamapediatrics.2019.3007 Room E4152, Baltimore, MD 21205 Published online September 9, 2019. Corrected on September 30, 2019. ([email protected]).

(Reprinted) 1/10

Downloaded From: https://jamanetwork.com/ on 02/09/2020 Research Original Investigation Positive and Adverse Childhood Experiences and Adult Mental and Relational Health

esearch demonstrates that both positive and adverse experiences shape brain development and health across Key Points the life span.1-5. Understanding human development re- R Question Are positive childhood experiences (PCEs) associated quires a model that incorporates both risks (factors that de- with adult depression and/or poor mental health (D/PMH) and crease the likelihood of successful development) and oppor- adult-reported social and emotional support (ARSES) independent tunities (factors that increase the likelihood of successful from adverse childhood experiences (ACEs)? development). On the positive side, successful child develop- Findings In this cross-sectional study, adults reporting higher ment depends on secure attachment during the first years of PCEs had lower odds of D/PMH and greater ARSES after life.6,7 As the child grows, exposure to spoken language8 and accounting for ACEs. The associations of PCEs with D/PMH also having the presence of safe, stable, nurturing relationships remained stable when controlling for ARSES. and environments are important factors for optimal Meaning Positive childhood experiences demonstrate a 9,10 development. On the other hand, children with adverse dose-response association with adult D/PMH and ARSES after childhood experiences (ACEs) are at risk for observable changes adjustment for ACEs; assessing and proactively promoting PCEs in brain anatomy,11 gene expression,12,13 and delays in social, may reduce adult mental and relational health problems, even in emotional, physical, and cognitive development lasting into the concurrent presence of ACEs. adulthood.3-5,14-17 According to standardized measures, an estimated 61.5% of adults18 and 48% of children19 in the United States mental health problems in adulthood have also been found have been exposed to ACEs, with more than one-third of among pregnant women25 and young adults56 exposed to these having multiple exposures.18,19 The wide-ranging ACEs. Despite these findings, few subsequent studies on negative associations between exposure to multiple ACEs ACEs have simultaneously evaluated PCEs. and diminished adult and child health are well docu- Collectively, prior studies on child development point to mented.14,19-22 Most notable is the especially strong evi- the importance of research focusing on PCEs, especially those dence linking ACEs with adult mental health problems associated with parent-child attachment, positive parenting including depression.22-28 A robust literature also exists (eg, parental warmth, responsiveness, and support), family regarding the effect of ACEs on adult relational health (often health, and positive relationships with friends, in school, and assessed by whether adults report that they get the social in the community. Knowledge of whether retrospectively and emotional support they need) and how diminished reported PCEs co-occur with ACEs and how PCEs interact adult social and emotional support contributes to poorer with ACEs to effect adult mental and relational health is needed adult physical and mental health.29-56 to inform the nation’s growing focus on addressing early Beyond the extensive and growing body of research deal- life and social determinants of healthy development and ing with lifelong correlates of adversity, many prior studies lifelong health. identify resiliency factors and adaptive skills and interven- This study used data from the 2015 Wisconsin Behavioral tions associated with improved child development and child Risk Factor Survey (WI BRFS), a representative, population- and adult health outcomes.2,3,16,17,25-55 For example, the Search based survey,57 to assess the prevalence of PCEs in an adult Institute developed a list of “40 Developmental Assets” and sample and evaluate hypothesized associations with adult demonstrated associations between the number of assets and mental and relational health across 4 ACEs exposure levels. This both positive and negative outcomes.52 A national population- study builds on a 2017 Health Outcomes of Positive Experi- based study53 on child flourishing and resilience shows strong ences report58 featuring bivariate findings from the 2015 WI associations with levels of family resilience and parent-child BRFS associating individual PCEs with negative adult health connection for children with exposures to greater ACEs, pov- outcomes. Here, we construct a PCEs cumulative score mea- erty, and chronic conditions. Similar studies, such as those as- sure and use multivariable regression methods to assess the sessing the US Centers for Disease Control and Prevention magnitude and significance of associations between this (CDC)’s “safe, stable, and nurturing relationships” model, show PCEs score and (1) adult depression and/or poor mental health similar findings.55 (D/PMH) and (2) adults’ reported social and emotional sup- Despite these advances, standardized measures and the port (ARSES). Separate assessment of associations was con- prevalence of positive childhood experiences (PCEs) at the ducted for each of 4 ACEs exposure levels. population level for adults or children are still unknown. Yet prior studies, using data from small or nonrepresentative samples, have explored interactions between PCEs and Methods ACEs.25,41,56 For example, 1 study,41 conducted by Kaiser Permanente and CDC investigators, analyzed a cohort of Population and Data 4648 women. They found that adult reports of specific posi- Data were from the cross-sectional 2015 WI BRFS, a repre- tive family experiences in childhood (including closeness, sentative, telephone survey of noninstitutionalized Wiscon- support, loyalty, protection, love, importance, and respon- sin adults 18 years and older who speak English or Spanish siveness to health needs) were associated with lower rates of (n = 6188).57 The WI BRFS response rate was 45.0% adolescent pregnancy across all ACEs exposure levels.41 The (weighted American Association of Public Opinion Research protective effects of reported interpersonal PCEs against median, 47.2%). The cooperation rate was 64.9% (weighted

2/10 JAMA Pediatrics November 2019 Volume 173, Number 11 (Reprinted) jamapediatrics.com

Downloaded From: https://jamanetwork.com/ on 02/09/2020 Positive and Adverse Childhood Experiences and Adult Mental and Relational Health Original Investigation Research

American Association of Public Opinion Research median, Adult-Reported Social and Emotional Support 68.0%). The 2015 WI BRFS core and state-added items data Adult-reported social and emotional support is assessed using sets were linked. Institutional review board (IRB) approval a standardized single item, “How often do you get the social was not required because data are based on a survey con- and emotional support you need?” Response choices were “al- ducted by a public agency and do not include personal ways,” “usually,” “sometimes,” “rarely,” or “never.” Based on health information. Respondent oral consent methods and previous research and analysis of this ARSES variable, this construction of race/ethnicity variables used standard CDC study separately evaluated “always” and “usually” re- BRFS approved methods. sponses and created a combined “sometimes/rarely/never” re- There were 18.1% to 21.1% missing cases for state-added sponse category.45,47,48 ARSES, ACEs, and PCEs items. “Don’t know/refused” responses to these questions were 0.2% to 0.9%. A 10% Depression/Poor Mental Health missing value rate for the WI BRFS state-added items is The D/PMH category was constructed using (1) the single item expected and is attributed to the administration of the core on depression asking whether a physician or other health pro- WI BRFS survey by another state to Wisconsin residents fessional “ever told you that you have a depressive disorder, who have out-of-state cellular phones. In these cases, the including depression, major depression, dysthymia, or mi- WI BRFS state-added items were not available to be nor depression?”; and (2) a score of 14 or higher on the single administered.59 The remainder of missing cases were nearly item validated as an indicator of current poor mental all owing to respondent dropoffs prior to administering the health59,60,65,66 that asked, “Now thinking about your mental ARSES, ACEs, and PCEs questions after administration of the health, which includes stress, depression, and problems with core WI BRFS. Differences in D/PMH prevalence rates emotions, for how many days during the past 30 days was your between respondents and missing cases were not notable. mental health not good?” Adults reporting either or both of SeeeTable1intheSupplement for additional details. these outcomes were included in the D/PMH variable.

Key Measures Other Covariates Positive Childhood Experiences Score Demographic covariates included age (18-34 years, 35-54 years, The PCEs score included 7 items asking respondents to report 55-64 years, and 65 years or older), race/ethnicity (nonwhite how often or how much as a child they: (1) felt able to talk to or white/non-Hispanic), and annual income (less than $25 000, their family about feelings; (2) felt their family stood by them $25 000-$49 999, $50 000-$74 999, and $75 000 or more). during difficult times; (3) enjoyed participating in commu- Sample size and statistical power analysis findings required nity traditions; (4) felt a sense of belonging in high school (not combining race/ethnicity subgroups into 2 categories for pur- including those who did not attend school or were home poses of statistical analysis. schooled); (5) felt supported by friends; (6) had at least 2 non- parent adults who took genuine interest in them; and (7) felt Analytic Methods safe and protected by an adult in their home. The PCEs score Prevalence rates for all variables were computed, and bivari- items were adapted from 4 subscales included in the Child and ate associations between individual PCE items and PCEs Youth Resilience Measure–28 60: (1) 4 items from the Psycho- cumulative score groups and all other variables were evalu- logical, Caregiving subscale (see PCEs items 1, 2, 7, and 6 listed ated using χ2 tests. Iterative and recursive analyses con- previously); (2) 1 from the Education subscale (PCEs item 4); firmed independent variable construction and focused on (3) 1 from the Culture subscale (PCEs item 3), and (4) 1 from confirmation of assumptions on the linearity and compara- the Peer Support subscale (PCEs item 5). Items were designed bility of associations with study outcomes when ordinal in the Child and Youth Resilience Measure–28 for cultural sen- (count) or cumulative score groupings of PCEs and ACEs sitivity, and their validity was supported by associations with were used. Cumulative score groups of 0 to 2, 3 to 5, and 6 to improved resilience.61 Psychometric analyses confirmed use 7 PCEs and 0, 1, 2 to 3, and 4 to 8 ACEs were also selected to of a PCEs cumulative score. See eTable 2 in the Supplement ensure adequate statistical power to detect meaningful asso- for details. ciations. Such score groups also simplify reporting of results by narrowing the number of comparative groups requiring Adverse Childhood Experiences reporting. Interaction variables crossing PCEs by ACEs and We used data from the standardized ACEs survey items de- PCEs by ARSES were also analyzed for each study outcome fined by the CDC.62,63 The ACEs measure included 11 ACEs items and supported decisions to assess PCEs, ACEs, and ARSES as assessing recollections of childhood experiences of physical independent (vs interacting) variables in regression models. or emotional abuse or neglect, sexual abuse, and household As noted, multivariable logistic regression analyses evalu- dysfunctions such as substance abuse, parental incarcera- ated 2 association pathways between PCEs items and cumu- tion, and divorce. As recommended by the CDC, items were lative score groups and 2 outcome variables: (1) meeting cri- coded using cumulative score groupings of 0, 1, 2 to 3, or 4 to teria for D/PMH and (2) reports of “always” on ARSES. 8 ACEs. Subjective reports of experiences in childhood are the Regression models were adjusted for age, sex, race/ethnicity, intended construct for assessment of both PCEs and ACEs and income, and ACEs. Separate models were evaluated for each not whether what is reported would be validated using objec- ACEs exposure level (0, 1, 2-3, and 4-8) to examine stability of tive assessments.64 associations across ACEs exposure levels. We further as-

jamapediatrics.com (Reprinted) JAMA Pediatrics November 2019 Volume 173, Number 11 3/10

Downloaded From: https://jamanetwork.com/ on 02/09/2020 Research Original Investigation Positive and Adverse Childhood Experiences and Adult Mental and Relational Health

Table 1. Study Population Characteristics and Prevalence of PCEs by D/PMH, ACEs, ARSES, and Demographic Characteristics

Prevalence of PCEs (n = 4926)a Statewide Population Prevalence Estimates 0-2 PCEs 3-5 PCEs 6-7 PCEs Population Characteristics Unweighted Weighted Unweighted Weighted Unweighted Weighted Unweighted Weighted P Value (Test of (n = Unweighted Sample Size) No. % No. % No. % No. % Independence) All respondents 6188 100 635 13.2 1606 34.5 2685 52.3 NA D/PMH (n = 6187) Yes 1289 21.2 294 29.4 402 40.1 347 30.5 <.001 No 4898 78.8 341 8.7 1204 33.0 2338 58.3 ACEs exposure levels (n = 4974)a,b 0 ACEs 2275 43.3 106 4.9 567 27.3 1568 67.8 1 ACE 1142 23.0 100 8.3 406 38.6 625 53.1 <.001 2-3 ACEs 967 19.9 174 18.5 400 42.1 390 39.5 4-8 ACEs 590 13.7 255 39.4 232 39.4 100 21.2 ARSES (n = 5021)a Always 2707 55.1 195 7.9 687 27.3 1743 64.8 Usually 1337 25.8 171 12.9 507 41.9 635 45.2 <.001 Sometimes, rarely, or never 977 19.1 263 28.7 393 44.7 284 26.6 Age (n = 6127), y 18-34 977 28.8 98 13.0 267 37.9 350 49.2 35-54 1737 33.0 201 15.6 407 31.9 748 52.5 .03 55-64 1426 17.6 169 12.6 389 36.0 613 51.4 65 or older 1987 20.5 163 10.4 532 33.1 954 56.5 Sex (n = 6188) Male 2720 49.3 248 11.9 763 36.3 1133 51.7 .09 Female 3468 50.7 387 14.3 843 32.8 1552 52.9 Race/ethnicity (n = 6129) Nonwhite 757 15.1 107 17.0 208 44.7 233 38.3 <.001 White, non-Hispanic 5372 84.9 521 12.6 1385 33.1 2433 54.3 Income level (n = 5461),c $ <24 999 1331 22.5 219 22.0 387 38.3 437 39.6 25 000-49 999 1511 27.8 168 14.9 431 36.9 631 48.3 <.001 50 000-74 999 1010 18.9 83 9.7 288 39.1 465 51.3 75 000 or more 1609 30.7 105 8.2 334 25.9 888 66.0 Abbreviations: ACEs, adverse childhood experiences; ARSES, adult-reported No notable differences in prevalence of D/PMH were found between social and emotional support; D/PMH, depression and/or poor mental health; respondents and cases missing ARSES, ACEs, or PCEs data. See eTable 1 in the NA, not applicable; PCEs, positive childhood experiences; WI BRFS, Wisconsin Supplement. Behavioral Risk Factor Survey. b The ACEs cumulative scores were created placing adults into categories of 0, 1, a A 10% missing value rate is expected and attributed to core WI BRFS survey 2 to 3, or 4 to 8 ACEs based on their responses to the 11 ACEs items. Three administration to out-of-state cellular phone holders who never received the sexual abuse items were combined into a single item, and alcohol and WI BRFS state added items.59 The remainder were nearly all owing to substance abuse items were presented as a single ACEs item. respondent dropoffs prior to administering the ARSES, ACEs, and PCEs c Income missing values rate was 11.7%. questions, which were administered after the end of the core WI BRFS.

sessed the stability of associations between D/PMH and PCEs when ARSES were or were not controlled for in regression mod- Results els. This was done to further understand more nuanced asso- ciation pathways between PCEs and ARSES and their indi- Population Characteristics and Prevalence vidual or interacting association with D/MPH. Additional of Study Outcomes by PCEs sensitivity analyses of PCEs associations when ACEs were or Demographic characteristics for the 2015 WI BRFS mirrored were not included in models were also conducted. The sur- the state population: 50.7% women and 84.9% white. About vey data were weighted to be representative of the Wisconsin half (52.3%) reported 6 to 7 PCEs, more than half (56.7%) re- population. We used SPSS Complex Samples, version 24 (IBM ported ACEs, 21.2% met D/PMH criteria, and more than half Corporation) for data analysis.67 A P value of .05 or less was (55.1%) reported “always” to getting the social and emotional used to determine statistical significance. support they needed (ARSES). Nonwhite, younger, and lower-

4/10 JAMA Pediatrics November 2019 Volume 173, Number 11 (Reprinted) jamapediatrics.com

Downloaded From: https://jamanetwork.com/ on 02/09/2020 Positive and Adverse Childhood Experiences and Adult Mental and Relational Health Original Investigation Research

Table 2. Prevalence and Adjusted Odds Ratios of Adult D/PMH and Reports of “Always” on the ARSES Item by PCEs and Other Regression Model Variables

Adjusted Odds Adjusted Odds Prevalence of “Always” Ratio (95% CI) Prevalence of D/PMH Ratio (95% CI) on ARSES Item for Reports of Population Characteristics Unweighted for Meeting Unweighted Weighted “Always” on (Raw Sample Size) No. Weighted % P Value D/PMH Criteria No. % P Value ARSES Itema All Respondents 1289 21.2 NA NA 2707 55.1 NA NA Positive childhood experiences (PCEs) (n = 4926)a,b,c 0-2 PCEs reported 294 48.2 1 [Reference] 195 33.0 1 [Reference] 3-5 PCEs reported 25.1 0.50 687 43.6 1.31 402 <.001 (0.36-0.69) <.001 (0.97-1.78) 6-7 PCEs reported 12.6 0.28 1743 67.9 3.53 347 (0.21-0.39) (2.60-4.80) Adverse childhood experiences (ACEs) (n = 4974)a No ACEs reported 11.9 1394 62.4 1.22 252 1 [Reference] (0.88-1.69) 1 ACE reported 20.2 1.62 596 53.9 0.93 215 (1.18-2.21) (0.67-1.30) <.001 <.001 2-3 ACEs reported 29.2 2.40 439 47.6 0.90 294 (1.77-3.24) (0.64-1.27) 4-8 ACEs reported 42.4 3.10 226 44.2 1 [Reference] 285 (2.20-4.37) Age (n = 6127), y 18-34 21.0 1.09 408 56.8 1.09 215 (0.78-1.53) (0.84-1.42) 35-54 22.6 1.51 766 54.9 0.97 406 .01 (1.10-2.06) .44 (0.76-1.23) 55-64 24.2 1.64 600 52.1 0.88 331 (1.20-2.24) (0.69-1.13) 65 or older 332 16.9 1 [Reference] 911 55.8 1 [Reference] Sex (n = 6188) Male 16.9 0.59 1189 55.3 0.97 444 <.001 (0.47-0.74) .80 (0.81-1.17) Female 845 25.5 1 [Reference] 1518 54.8 1 [Reference] Race/ethnicity (n = 6129) Nonwhite 23.8 0.98 294 53.5 1.19 203 <.25 (0.67-1.42) .64 (0.84-1.70) White, non-Hispanic 1078 20.9 1 [Reference] 2391 55.2 1 [Reference] Income level (n = 5461),d $ <24 999 33.3 2.91 465 47.8 0.67 454 (2.11-4.02) (0.51-0.88) 25 000-49 999 22.6 1.76 667 53.4 0.81 340 <.001 (1.29-2.41) <.001 (0.64-1.03) 50 000-74 999 18.4 1.43 458 54.3 0.81 172 (1.02-2.01) (0.62-1.05) 75 000 or more 205 13.1 1 [Reference] 857 62.3 1 [Reference] Abbreviations: ACEs, adverse childhood experiences; ARSES, adult-reported in the Supplement. social and emotional support; D/PMH, depression and/or poor mental health; b Without adjustment for ACEs, PCEs associations with D/PMH were 0.19 NA, not applicable; PCEs, positive childhood experiences; WI BRFS, Wisconsin (95% CI, 0.14-0.25) and 0.40 (95% CI, 0.30-0.54) for adults reporting 6 to 7 Behavioral Risk Factor Survey. and 3 to 5 PCEs vs 0 to 2 PCEs, respectively. a A 10% missing value rate is expected and attributed to core WI BRFS 5 survey c Without adjustment for ACEs, PCEs associations with “always” on the ARSES administration to out-of-state cellular phone holders who never received the variable were 3.83 (95% CI, 2.89-5.06) and 1.35 (95% CI, 1.01-1.81) for adults 59 WI BRFS state added items. The remainder were nearly all owing to reporting 6 to 7 and 3 to 5 PCEs vs 0 to 2 PCEs, respectively. respondent dropoffs prior to administering the ARSES, ACEs, and PCEs d Income missing values rate is 11.7%. Income was not imputed for the WI BRFS questions, which were administered after the end of the core WI BRFS. by the Wisconsin Department of Health Services so federal poverty level could No notable differences in prevalence of D/PMH were found between not be calculated. respondents and cases missing ARSES, ACEs, or PCEs data. See eTable 1

income adults reported fewer levels of PCEs (Table 1). Com- (Table 2). Similar variations in prevalence were observed when pared with those reporting 6 to 7 PCEs, adults reporting 0 to 2 each of the 7 PCEs items were separately evaluated for each PCEs had nearly 4 times higher prevalence of D/PMH (48.2% study outcome (Figures 1 and 2 and eTable 5 in the Supple- vs 12.6%) and were half as likely to report “always” to getting ment). As hypothesized and shown in these Figures, stronger the social and emotional support they needed (33.0% vs 67.9%) associations emerged for cumulative PCEs scores.

jamapediatrics.com (Reprinted) JAMA Pediatrics November 2019 Volume 173, Number 11 5/10

Downloaded From: https://jamanetwork.com/ on 02/09/2020 Research Original Investigation Positive and Adverse Childhood Experiences and Adult Mental and Relational Health

Figure 1. Prevalence of Depression and/or Poor Mental Health Among Adults by Positive Childhood Experiences (PCEs) Single Items and Cumulative Scores

Very often or oftenc/most Never, rarely, or sometimesc/never, a little, or all of the timed or some of the timed

A PCEs, single itemsa,b

Able to talk to family about feelingsc AOR: 0.59 (95% CI, 0.46-0.74)

Felt family stood by them during difficult timesc AOR: 0.43 (95% CI, 0.32-0.57)

Felt safe and protected by adult in your homed AOR: 0.55 (95% CI, 0.39-0.78)

Had at least 2 nonparent adults who took genuine interestc AOR: 0.58 (95% CI, 0.46-0.74) See eTable 5 in the Supplement for Felt supported by friendsc AOR: 0.56 (95% CI, 0.44-0.72) percentages of depression and/or poor mental health and Felt a sense of belonging at high schoolc AOR: 0.46 (95% CI, 0.36-0.58) adult-reported social and emotional Enjoyed participating in community traditionsc AOR: 0.55 (95% CI, 0.44-0.68) support across PCEs items and scores. 0 20 40 60 a Source: authors’ analysis of the 2015 Prevalence of D/PMH Wisconsin Behavioral Risk Factor Survey. B Cumulative scorea,b b Adjusted odds ratios (AORs) shown 0-2 PCEs Reference category are adjusted for age, sex, race/ethnicity, income, and adverse 3-5 PCEs AOR: 0.50 (95% CI, 0.36-0.69) childhood experiences. 6-7 PCEs AOR: 0.28 (95% CI, 0.21-0.39) c Never, rarely, or sometimes is the 0 20 40 60 reference category. Prevalence of D/PMH d Never, a little, or some of the time is the reference category.

Figure 2. Prevalence of Adult Reporting Always Receiving Needed Social Emotional Support by Positive Childhood Experiences (PCEs) Single Items and Cumulative Scores

Very often or oftenc/most Never, rarely, or sometimesc/never, a little, or all of the timed or some of the timed

A PCEs, single itemsa,b

Able to talk to family about feelingsc AOR: 2.70 (95% CI, 2.22-3.28)

Felt family stood by them during difficult timesc AOR: 1.90 (95% CI, 1.46-2.48)

Felt safe and protected by adult in your homed AOR: 1.94 (95% CI, 1.36-2.78)

Had at least 2 nonparent adults who took genuine interestc AOR: 2.28 (95% CI, 1.85-2.80) See eTable 5 in the Supplement for Felt supported by friendsc AOR: 2.55 (95% CI, 2.00-3.24) percentages of depression and/or poor mental health and Felt a sense of belonging at high schoolc AOR: 1.88 (95% CI, 1.53-2.32) adult-reported social and emotional Enjoyed participating in community traditionsc AOR: 1.84 (95% CI, 1.53-2.21) support across PCEs items and scores. 0 20 40 60 80 a Source: authors’ analysis of the 2015 Rate, % Wisconsin Behavioral Risk Factor Survey. B Cumulative scorea,b b Adjusted odds ratios (AORs) shown 0-2 PCEs Reference category are adjusted for age, sex, race/ethnicity, income, and adverse 3-5 PCEs AOR: 1.31 (95% CI, 0.97-1.78) childhood experiences. 6-7 PCEs AOR: 3.53 (95% CI, 2.60-4.80) c Never, rarely, or sometimes is the 0 20 40 60 80 reference category. Rate, % d Never, a little, or some of the time is the reference category.

The lowest adult D/PMH prevalences were observed for re- ARSES variable (61.7%). Yet, even among those reporting al- spondents reporting both 6 to 7 PCEs and either no ACEs ways getting needed social and emotional support, a subset (10.5%) or “always” on the ARSES variable (8.5%). Highest reported 0 to 2 PCEs, and this group had 4 times greater preva- D/PMH prevalences were for those reporting 0 to 2 PCEs and lence of D/PMH compared with those reporting 6 to 7 PCEs either 4 to 8 ACEs (59.7%) or “sometimes/ rarely/never” on the (33.8% vs 8.5%). Likewise, 21.2% of those with 4 to 8 ACEs and

6/10 JAMA Pediatrics November 2019 Volume 173, Number 11 (Reprinted) jamapediatrics.com

Downloaded From: https://jamanetwork.com/ on 02/09/2020 Positive and Adverse Childhood Experiences and Adult Mental and Relational Health Original Investigation Research

Table 3. Prevalence of D/PMH and Reports of “Always” on the ARSES Item by PCEs Scores for Each of 4 Adverse Childhood Experiences ACEs Exposure Levels (0, 1, 2-3, or 4-8)

Reports of “Always” to Getting Needed Social Meets D/PMH Criteriaa and Emotional Support (ARSES) Categories by ACEs Adjusted Odds Ratiob Adjusted Odds Ratiob and PCEs Unweighted No. Weighted % (95% CI) Unweighted No. Weighted % (95% CI) No ACEs reported 0-2 PCEs 17 12.1 1 [Reference] 35 34.6 1 [Reference] 3-5 PCEs 86 15.8 1.15 (0.51-2.62) 266 47.3 1.58 (0.84-2.95) 6-7 PCEs 148 10.5 0.88 (0.42-1.87) 1072 70.5 4.18 (2.31-7.55) 1 ACE reported 0-2 PCEs 35 45.7 1 [Reference] 38 30.9 1 [Reference] 3-5 PCEs 85 24.2 0.38 (0.17-0.83) 161 39.5 1.33 (0.68-2.62) 6-7 PCEs 94 13.4 0.21 (0.10-0.46) 390 67.6 4.93 (2.54-9.58) 2-3 ACEs reported 0-2 PCEs 87 53.3 1 [Reference] 47 30.3 1 [Reference] 3-5 PCEs 131 31.4 0.47 (0.26-0.84) 167 43.9 1.65 (0.90-3.02) 6-7 PCEs 76 16.0 0.18 (0.10-0.34) 223 59.2 2.80 (1.53-5.13) 4-8 ACEs reported 0-2 PCEs 155 59.7 1 [Reference] 75 35.1 1 [Reference] 3-5 PCEs 100 36.9 0.49 (0.28-0.84) 93 41.7 1.19 (0.69-2.03) 6-7 PCEs 29 20.7 0.23 (0.11-0.46) 56 65.6 3.37 (1.66-6.84) Abbreviations: ACEs, adverse childhood experiences; ARSES, adult-reported cumulative score category (0-2, 3-5, and 6-7) at P < .01. social and emotional support; D/PMH, depression and/or poor mental health; b Adjusted odds ratios adjusted for age, sex, race/ethnicity, and income. PCEs, positive childhood experiences. a Prevalence of D/PMH varied across levels of ACEs within each PCEs

26.6% of those reporting “sometime/rarely/never” to the AR- SES item nonetheless also reported 6 to 7 PCEs. (Table 1, Table 3, Discussion and eTable 3 in the Supplement). This study examined the prevalence of adult reports of both Association Pathway 1: PCEs and D/PMH PCEs and ACEs in a statewide sample and found that PCEs After controlling for ACEs, the adjusted odds of D/PMH were both co-occur with and operate independently from ACEs in 72% lower (odds ratio [OR], 0.28; 95% CI, 0.21-0.39) for adults their associations with the adult health outcomes evaluated with the highest vs lowest PCEs scores (12.6% vs 48.2%). Odds here. Findings also confirm the hypotheses that PCEs may were 50% lower (OR, 0.50; 95% CI, 0.36-0.69) for those re- exert their association with D/PMH through their association porting intermediate PCEs scores of 3 to 5 (25.1% vs 48.2%) with ARSES. However, PCEs maintained an association with (Table 2). Associations were similar in magnitude for adults re- D/PMH independent from ARSES. Findings are both consis- porting 1, 2 to 3, or 4 to 8 ACEs (Table 3). tent with prior research showing that relational experiences in childhood are associated with adult social and relational Association Pathway 2: PCEs and ARSES skills and health3,15,56,68 and also point to enduring effects of The adjusted odds of “always” reports on the ARSES item were PCEs on D/PMH separate from their influence on adult 3.53 times (95% CI, 2.60-4.80) greater for adults with the high- ARSES. est vs lowest PCEs scores. Adjusted odds of reports of “al- While PCEs associations with D/PMH were substantial ways” on the ARSES variable were not significant for adults and similar for adults reporting ACEs, associations were not with intermediate PCEs of 3 to 5 (adjusted OR, 1.31; 95% CI, statistically significant for those reporting no ACEs. Insignifi- 0.97-1.78) (Table 2). Findings were similar across all ACEs ex- cant findings may be owing to low sample sizes for respon- posure level subgroups (Table 3). Because PCEs and ARSES dents with no ACEs and fewer PCEs. Results still raise ques- were strongly associated as hypothesized, we further exam- tions for further exploration. We hypothesize that PCEs may ined whether each variable demonstrated an independent as- have a greater influence in promoting positive health, such sociation with D/PMH and whether associations of PCEs with as getting needed social and emotional support or flourish- D/PMH remained stable when ARSES was included in regres- ing as an adult. In turn, these positive health attributes may sion models. Results showed that PCEs associations with reduce the burden of illness even if the illness is not elimi- D/PMH remained significant and changed only modestly when nated. This is consistent with prior research demonstrating a ARSES was included. Associations between ARSES and D/PMH dual continuum of health whereby flourishing is found to be also remained stable when PCEs were or were not included. present for many adults despite concurrent mental health SeeeTable4intheSupplement for details. conditions.69

jamapediatrics.com (Reprinted) JAMA Pediatrics November 2019 Volume 173, Number 11 7/10

Downloaded From: https://jamanetwork.com/ on 02/09/2020 Research Original Investigation Positive and Adverse Childhood Experiences and Adult Mental and Relational Health

Limitations Factor Surveillance Surveys, may advance knowledge and al- First, this study is cross-sectional and cannot confirm causal low the nation to track progress in promoting flourishing de- effects. Second, the 2015 Wisconsin adult population is less spite adversity or illness among children and adults in the diverse than the United States as a whole. Third, PCEs fo- United States. cused on the domain of positive emotional experiences in in- Even as society continues to address remediable causes of terpersonal relationships. Other types of positive experi- childhood adversities such as ACEs, attention should be given ences, (eg, safe and supportive environments, nature or to the creation of those positive experiences that both reflect spiritual experiences, participation in activities, or accom- and generate resilience within children, families, and com- plishment) require further study, highlighting the need to de- munities. Success will depend on full engagement of families velop and test additional measures of PCEs. Fourth, we were and communities and changes in the health care, education, not able to directly examine bias in reporting of PCEs among and social services systems serving children and families. A adults with depression, although studies show an absence of joint inventory of ACEs and PCEs, such as the positive expe- such biases for reports of ACEs.64,70 Finally, the WI BRFS did riences assessed here, may improve efforts to assess needs, tar- not assess overall well-being or flourishing.69 As such, we were get interventions, and engage individuals in addressing the ad- not able to assess whether PCEs affect positive adult health out- versities they face by leveraging existing assets and strengths.72 comes as hypothesized. Sample size limitations may have re- Initiatives to conduct broad ACEs screening, such as those en- sulted in false-negative findings in some cases. suing in California’s Medicaid program, may benefit from in- tegrated assessments including PCEs.73 Recommendations and practice guidelines included in the Conclusions National Bright Futures Guidelines for Health Supervision of Infants, Children, and Adolescents74 and the CDC’s Essentials Overall, study results demonstrate that PCEs show a dose- for Childhood initiative9 encourage policies and initiatives to response association with adult mental and relational health, help child-serving professionals and programs to adopt analogous to the cumulative effects of multiple ACEs. Find- effective approaches to promote the type of PCEs evaluated ings suggest that PCEs may have lifelong consequences for in this study. The Health Outcomes of Positive Experiences mental and relational health despite co-occurring adversities framework48 and the Prioritizing Possibilities national agenda such as ACEs. In this way, they support application of the World for promoting child health and addressing ACEs75 each Health Organization’s definition of health emphasizing that seek to advance existing and emerging evidence-based health is more than the absence of disease or adversity.71 The approaches44,45,47,48,50,54,76,77 that promote a positive con- World Health Organization’s positive construct of health is struct of health in clinical, public health, and human services aligned with the proactive promotion of positive experiences settings. This study adds to the growing evidence that child- in childhood because they are foundational to optimal child- hood experiences have profound and lifelong effects. Results hood development and adult flourishing. Including PCEs as hold promise for national, state, and community efforts to well as positive health outcomes measures in routinely col- achieve positive child and adult health and well-being by pro- lected public health surveillance systems, such as the Na- moting the largely untapped potential to promote positive ex- tional Survey of Children’s Health and state Behavioral Risk periences and flourishing despite adversity.53,78

ARTICLE INFORMATION Bethell, Jones, Gombojav, Sege. Funding/Support: This study was funded by the Accepted for Publication: June 14, 2019. Supervision: Bethell. Robert Wood Johnson Foundation grant 75448 to Johns Hopkins University; Health Resources and Correction: This article was corrected on Conflict of Interest Disclosures: Dr Bethell reported grants from Robert Wood Johnson Services Administration grant to Johns Hopkins September 30, 2019, to fix an error in Table 2 and University (UA6MC30375); Casey Family Programs the legends of Figures 1 and 2. Foundation and Health Resources and Services Administration of the US Department of Health and cooperative agreement to Health Resources In Published Online: September 9, 2019. Human Services during the conduct of the study. Action; National Center for Advancing Translational doi:10.1001/jamapediatrics.2019.3007 Dr Gombojav reported grants from Robert Wood Sciences, National Institutes of Health Award to Open Access: This is an open access article Johnson Foundation and Health Resources and Tufts University (UL1TR002544); Wisconsin distributed under the terms of the CC-BY License. Services Administration during the conduct of the Children's Trust Fund (now Wisconsin Child Abuse © 2019 Bethell C et al. JAMA Pediatrics. study. Dr Linkenbach reported other support from and Neglect Prevention Board) support for Wisconsin Children’s Trust Fund during the conduct Behavioral Risk Factor Survey collection of positive Author Contributions: Dr Bethell had full access to childhood experiences survey items. all of the data in the study and takes responsibility of the study; other support from Montana Summer for the integrity of the data and the accuracy of the Institute outside the submitted work; and providing Role of the Funder/Sponsor: The funding source data analysis. keynote speeches at various conferences and lead had no role in the design and conduct of the study; Concept and design: Bethell, Jones, Linkenbach, training activities as a consultant. Dr Sege reported collection, management, analysis, and Sege. grants from Casey Family Programs during the interpretation of the data; preparation, review, or Acquisition, analysis, or interpretation of data: conduct of the study; grants and personal fees from approval of the manuscript; and decision to submit Bethell, Gombojav, Sege. Montana Institute; personal fees from Illuminate the manuscript for publication. Drafting of the manuscript: All authors. Colorado, Prevent Child Abuse Georgia, and Kansas Critical revision of the manuscript for important Governor's Conference; and grants from REFERENCES intellectual content: Bethell, Sege. Massachusetts Department of Public Health, 1. Lamb ME, Lerner RM. Handbook of Child Statistical analysis: Bethell, Gombojav. Center for the Study of Social Policy, outside the Psychology and Developmental Science: Obtained funding: Bethell, Sege. submitted work. No other disclosures were Socioemotional Processes. Vol 3. 7th ed. Hoboken, Administrative, technical, or material support: reported. NJ: John Wiley & Sons Inc; 2015.

8/10 JAMA Pediatrics November 2019 Volume 173, Number 11 (Reprinted) jamapediatrics.com

Downloaded From: https://jamanetwork.com/ on 02/09/2020 Positive and Adverse Childhood Experiences and Adult Mental and Relational Health Original Investigation Research

2. Masten AS, Barnes AJ. Resilience in children: 16. Slopen N, Chen Y, Priest N, Albert MA, links to disease outcomes. J Behav Med. 2006;29 developmental perspectives. Children (Basel). Williams DR. Emotional and instrumental support (4):377-387. doi:10.1007/s10865-006-9056-5 2018;5(7):98. doi:10.3390/children5070098 during childhood and biological dysregulation in 31. Shor E, Roelfs DJ, Yogev T. The strength of 3. Raby KL, Roisman GI, Fraley RC, Simpson JA. midlife. Prev Med. 2016;84:90-96. doi:10.1016/j. family ties: a meta-analysis and meta-regression of The enduring predictive significance of early ypmed.2015.12.003 self-reported social support and mortality. maternal sensitivity: social and academic 17. Chen Y, Kubzansky LD, VanderWeele TJ. Soc Networks. 2013;4(35):626-638. doi:10.1016/j. competence through age 32 years. Child Dev. 2015; Parental warmth and flourishing in mid-life. Soc Sci socnet.2013.08.004 86(3):695-708. doi:10.1111/cdev.12325 Med. 2019;220:65-72. doi:10.1016/j.socscimed. 32. Schüssler-Fiorenza Rose SM, Eslinger JG, 4. Hoppen TH, Chalder T. Childhood adversity as a 2018.10.026 Zimmerman L, et al. Adverse childhood transdiagnostic risk factor for affective disorders in 18. Merrick MT, Ford DC, Ports KA, Guinn AS. experiences, support, and the perception of ability adulthood: a systematic review focusing on Prevalence of adverse childhood experiences from to work in adults with disability. PLoS One. 2016;11 biopsychosocial moderating and mediating the 2011-2014 behavioral risk factor surveillance (7):e0157726. doi:10.1371/journal.pone.0157726 variables. Clin Psychol Rev. 2018;65:81-151. doi:10. system in 23 states. JAMA Pediatr. 2018;172(11): 33. Reblin M, Uchino BN. Social and emotional 1016/j.cpr.2018.08.002 1038-1044. doi:10.1001/jamapediatrics.2018.2537 support and its implication for health. Curr Opin 5. Shonkoff JP, Garner AS; Committee on 19. Bethell CD, Newacheck P, Hawes E, Halfon N. Psychiatry. 2008;21(2):201-205. doi:10.1097/YCO. Psychosocial Aspects of Child and Family Health; Adverse childhood experiences: assessing the 0b013e3282f3ad89 Committee on Early Childhood, Adoption, and impact on health and school engagement and the 34. Strine TW, Chapman DP, Balluz L, Mokdad AH. Dependent Care; Section on Developmental and mitigating role of resilience. Health Aff (Millwood). Health-related quality of life and health behaviors Behavioral Pediatrics. The lifelong effects of early 2014;33(12):2106-2115. doi:10.1377/hlthaff.2014.0914 by social and emotional support: their relevance to childhood adversity and toxic stress. Pediatrics. 20. US Centers for Disease Control and Prevention. psychiatry and medicine. Soc Psychiatry Psychiatr 2012;129(1):e232-e246. doi:10.1542/peds.2011-2663 ACEs study: violence prevention. Epidemiol. 2008;43(2):151-159. doi:10.1007/s00127- 6. Ainsworth MD, Blehar MC, Waters E, Wall S. https://www.cdc.gov/violenceprevention/ 007-0277-x Patterns of Attachment: a Psychological Study of the acestudy/. Published April 1, 2016. Accessed 35. Brinker J, Cheruvu VK. Social and emotional Strange Situation. Hillsdale, NJ: Lawrence Erlbaum October 6, 2018. support as a protective factor against current Associates, Inc; 1978. 21. Burke NJ, Hellman JL, Scott BG, Weems CF, depression among individuals with adverse 7. Rees C. Childhood attachment. Br J Gen Pract. Carrion VG. The impact of adverse childhood childhood experiences. Prev Med Rep. 2016;5: 2007;57(544):920-922. doi:10.3399/ experiences on an urban pediatric population. Child 127-133. doi:10.1016/j.pmedr.2016.11.018 096016407782317955 Abuse Negl. 2011;35(6):408-413. doi:10.1016/j. 36. Cheong EV, Sinnott C, Dahly D, Kearney PM. 8. Thiebaut de Schotten M, Cohen L, Amemiya E, chiabu.2011.02.006 Adverse childhood experiences (ACEs) and later-life Braga LW, Dehaene S. Learning to read improves 22. Lehman BJ, Taylor SE, Kiefe CI, Seeman TE. depression: perceived social support as a potential the structure of the arcuate fasciculus. Cereb Cortex. Relationship of early life stress and psychological protective factor. BMJ Open. 2017;7(9):e013228. 2014;24(4):989-995. doi:10.1093/cercor/bhs383 functioning to blood pressure in the CARDIA study. doi:10.1136/bmjopen-2016-013228 9. US Centers for Disease Control and Prevention Health Psychol. 2009;28(3):338-346. doi:10.1037/ 37. Grav S, Hellzèn O, Romild U, Stordal E. National Center for Injury Prevention and Control. a0013785 Association between social support and depression Essentials for childhood: steps to create safe, 23. Chapman DP, Whitfield CL, Felitti VJ, Dube SR, in the general population: the HUNT study, a stable, nurturing relationships and environment. Edwards VJ, Anda RF. Adverse childhood cross-sectional survey. J Clin Nurs. 2012;21(1-2): 2014. https://www.cdc.gov/violenceprevention/ experiences and the risk of depressive disorders in 111-120. doi:10.1111/j.1365-2702.2011.03868.x pdf/essentials-for-childhood-framework508.pdf. adulthood. J Affect Disord. 2004;82(2):217-225. 38. Brody GH, Yu T, Beach SR. Resilience to Accessed February 5, 2019. doi:10.1016/j.jad.2003.12.013 adversity and the early origins of disease. Dev 10. Sege RD, Harper Browne C. Responding to 24. Hayashi Y, Okamoto Y, Takagaki K, et al. Direct Psychopathol. 2016;28(4pt2):1347-1365. doi:10.1017/ ACEs with HOPE: health outcomes from positive and indirect influences of childhood abuse on S0954579416000894 experiences. Acad Pediatr. 2017;17(7S):S79-S85. depression symptoms in patients with major 39. Banyard V, Hamby S, Grych J. Health effects of doi:10.1016/j.acap.2017.03.007 depressive disorder. BMC Psychiatry. 2015;15:244. adverse childhood events: identifying promising 11. McEwen BS, Bowles NP, Gray JD, et al. doi:10.1186/s12888-015-0636-1 protective factors at the intersection of mental and Mechanisms of stress in the brain. Nat Neurosci. 25. Chung EK, Mathew L, Elo IT,Coyne JC, Culhane JF. physical well-being. Child Abuse Negl. 2017;65:88-98. 2015;18(10):1353-1363. doi:10.1038/nn.4086 Depressive symptoms in disadvantaged women doi:10.1016/j.chiabu.2017.01.011 12. Essex MJ, Boyce WT, Hertzman C, et al. receiving prenatal care: the influence of adverse and 40. Biglan A, Van Ryzin MJ, Hawkins JD. Evolving a Epigenetic vestiges of early developmental positive childhood experiences. Ambul Pediatr. 2008; more nurturing society to prevent adverse adversity: childhood stress exposure and DNA 8(2):109-116. doi:10.1016/j.ambp.2007.12.003 childhood experiences. Acad Pediatr. 2017;17(7S): methylation in adolescence. Child Dev. 2013;84(1): 26. Poole JC, Dobson KS, Pusch D. Childhood S150-S157. doi:10.1016/j.acap.2017.04.002 58-75. doi:10.1111/j.1467-8624.2011.01641.x adversity and adult depression: the protective role 41. Hillis SD, Anda RF, Dube SR, et al. 13. Boyce WT. Epigenomics and the unheralded of psychological resilience. Child Abuse Negl. The protective effect of family strengths in convergence of the biological and social sciences. 2017;64:89-100. doi:10.1016/j.chiabu.2016.12.012 childhood against adolescent pregnancy and its Agency for Healthcare Research and Quality, 27. Copeland WE, Shanahan L, Hinesley J, et al. long-term psychosocial consequences. Perm J. Rockville, MD. https://www.ahrq.gov/sites/default/ Association of childhood trauma exposure with 2010;14(3):18-27. https://www.ncbi.nlm.nih.gov/pmc/ files/publications/files/population-health.pdf. adult psychiatric disorders and functional articles/PMC2937841/. doi:10.7812/TPP/10-028 Accessed October 2, 2019. outcomes. JAMA Netw Open. 2018;1(7):e184493. 42. Boyce T. The Orchid and the Dandelion. New York, 14. Felitti VJ, Anda RF, Nordenberg D, et al. doi:10.1001/jamanetworkopen.2018.4493 NY: Knopf Publishing; 2019. Relationship of childhood abuse and household 28. Young-Wolff KC, Alabaster A, McCaw B, et al. 43. Cadet JL. Epigenetics of stress, addiction, and dysfunction to many of the leading causes of death Adverse childhood experiences and mental and resilience: therapeutic implications. Mol Neurobiol. in adults: the Adverse Childhood Experiences (ACE) behavioral health conditions during pregnancy: the 2016;53(1):545-560. doi:10.1007/s12035-014-9040-y study. Am J Prev Med. 1998;14(4):245-258. doi:10. role of resilience. J Womens Health (Larchmt). 2019; 1016/S0749-3797(98)00017-8 28(4):452-461. 44. Leslie LK, Mehus CJ, Hawkins JD, et al. Primary health care: potential home for family-focused 15. Jones DE, Greenberg M, Crowley M. Early 29. Cohen S. Social relationships and health. preventive interventions. Am J Prev Med. 2016;51 social-emotional functioning and public health: the Am Psychol. 2004;59(8):676-684. doi:10.1037/ (4)(suppl 2):S106-S118. doi:10.1016/j.amepre.2016. relationship between kindergarten social 0003-066X.59.8.676 05.014 competence and future wellness. Am J Public Health. 30. Uchino BN. Social support and health: a review 45. Rayce SB, Rasmussen IS, Klest SK, Patras J, 2015;105(11):2283-2290. doi:10.2105/AJPH.2015. of physiological processes potentially underlying 302630 Pontoppidan M. Effects of parenting interventions

jamapediatrics.com (Reprinted) JAMA Pediatrics November 2019 Volume 173, Number 11 9/10

Downloaded From: https://jamanetwork.com/ on 02/09/2020 Research Original Investigation Positive and Adverse Childhood Experiences and Adult Mental and Relational Health

for at-risk parents with infants: a systematic review 57. Wisconsin Department of Health 68. Schor EL. Why becoming a good parent begins and meta-analyses. BMJ Open. 2017;7(12):e015707. Services/Centers for Disease Control and in infancy: how relationship skills are developed doi:10.1136/bmjopen-2016-015707 Prevention. Behavioral Risk Factor Surveillance throughout the life course. https://www.lpfch.org/ 46. Southwick SM, Charney DS. The science of System Survey Data. Atlanta, GA: US Department of publication/why-becoming-good-parent-begins- resilience: implications for the prevention and Health and Human Services, Centers for Disease infancy-how-relationship-skills-are-developed- treatment of depression. Science. 2012;338(6103): Control and Prevention; 2015. throughout. Published January 3, 2018. Accessed 79-82. doi:10.1126/science.1222942 58. Sege R, Bethell C, Linkenbach J, Jones J, March 5, 2019. 47. Traub F, Boynton-Jarrett R. Modifiable Klika B, Pecora PJ. Balancing Adverse Childhood 69. Agenor C, Conner N, Aroian K. Flourishing: an resilience factors to childhood adversity for clinical Experiences With HOPE: New Insights Into the Role evolutionary concept analysis. Issues Ment Health pediatric practice. Pediatrics. 2017;139(5):e20162569. of Positive Experience on Child and Family Nurs. 2017;38(11):915-923. doi:10.1080/01612840. doi:10.1542/peds.2016-2569 Development. Boston, MA: The Medical Foundation; 2017.1355945 2017. 48. National Scientific Council on the Developing 70. Frampton NMA, Poole JC, Dobson KS, Pusch D. Child. Supportive relationships and active 59. Chowdhury P, Pierannunzi C, Garvin WS, The effects of adult depression on the recollection skill-building strengthen the foundations of Town M. Health behaviors and chronic conditions of adverse childhood experiences. Child Abuse Negl. resilience: working paper 13. http://www. of movers: out-of-state interviews among cell 2018;86:45-54. doi:10.1016/j.chiabu.2018.09.006 developingchild.harvard.edu Published 2019. phone respondents, BRFSS 2014. Surv Pract. 2018; 71. Misselbrook D. W is for wellbeing and the WHO Accessed March 5, 2019. 11(2). doi:10.29115/SP-2018-0010 definition of health. Br J Gen Pract. 2014;64(628): 49. Shonkoff JP. Capitalizing on advances in 60. Liebenberg L, Ungar M, LeBlanc JC. 582. doi:10.3399/bjgp14X682381 science to reduce the health consequences of early The CYRM-12: a brief measure of resilience. Can J 72. Leitch L. Positive and Adverse Childhood childhood adversity. JAMA Pediatr. 2016;170(10): Public Health. 2013;104(2):e131-e135. Experiences Survey (PACES): threshold global 1003-1007. doi:10.1001/jamapediatrics.2016.1559 61. Ungar M, Liebenberg L, Boothroyd R, et al. works. https://www.thresholdglobalworks.com/ 50. Leitch L. Action steps using ACEs and The study of youth resilience across cultures: portfolio-items/paces-survey/. Published March trauma-informed care: a resilience model. Health lessons from a pilot study of measurement 2017. Accessed March 5, 2019. Justice. 2017;5(1):5. doi:10.1186/s40352-017-0050-5 development. Res Hum Dev. 2008;5(3):166-180. 73. California Pan Ethnic Health Network. Governor doi:10.1080/15427600802274019 51. Schaefer LM, Howell KH, Schwartz LE, Newsom’s budget makes important investments in Bottomley JS, Crossnine CB. A concurrent 62. National Center for Injury Prevention and health equity and prevention. https://cpehn.org/ examination of protective factors associated with Control. BRFSS Adverse Childhood Experiences blog/201901/governor-newsom%E2%80%99s- resilience and posttraumatic growth following (ACE) module. https://www.cdc.gov/ budget-makes-important-investments-health- childhood victimization. Child Abuse Negl. 2018;85: violenceprevention/acestudy/pdf/brfss_adverse_ equity-and-prevention. Published January 11, 2019. 17-27. doi:10.1016/j.chiabu.2018.08.019 module.pdf. Accessed February 5, 2019. Accessed March 5, 2019. 52. Bleck J, DeBate R. Long-term association 63. Child Abuse & Neglect Prevention Board, 74. Hagan JF, Shaw JS, Duncan PM. Bright Futures: between developmental assets and health Children’s Hospital of Wisconsin. The influence of Guidelines for Health Supervision of Infants, behaviors: an exploratory study. Health Educ Behav. adverse childhood experiences on the health of Children, and Adolescents. Elk Grove Village, IL: Bright 2016;43(5):543-551. doi:10.1177/1090198115606915 Wisconsin citizens in adulthood (revised version). Futures/American Academy of Pediatrics; 2017. 2016. https://preventionboard.wi.gov/Documents/ 53. Bethell CD, Gombojav N, Whitaker RC. Family 75. Bethell CD, Solloway MR, Guinosso S, et al. WisconsinACEBrief%282011-13%29WEB_9.16.pdf. Prioritizing possibilities for child and family health: resilience and connection promote flourishing Accessed October 11, 2018. among US children, even amid adversity. Health Aff an agenda to address adverse childhood (Millwood). 2019;38(5):729-737. doi:10.1377/hlthaff. 64. Rohner RP, Khaleque A, Cournoyer DE. experiences and foster the social and emotional 2018.05425 Parental acceptance-rejection: theory, methods, roots of well-being in pediatrics. Acad Pediatr.2017; cross-cultural evidence and implications. Ethos. 17(7S):S36-S50. doi:10.1016/j.acap.2017.06.002 54. Marie-Mitchell A, Kostolansky R. A systematic 2005;33(3):299-334. doi:10.1525/eth.2005.33.3.299 review of trials to improve child outcomes 76. Bloom SL. Advancing a national associated with adverse childhood experiences. 65. Moriarty DG, Zack MM, Kobau R. The Centers cradle-to-grave-to-cradle public health agenda. Am J Prev Med. 2019;56(5):756-764. doi:10.1016/j. for Disease Control and Prevention’s Healthy Days J Trauma Dissociation. 2016;17(4):383-396. doi:10. amepre.2018.11.030 Measures: population tracking of perceived 1080/15299732.2016.1164025 physical and mental health over time. Health Qual 55. Schofield TJ, Lee RD, Merrick MT.Safe, stable, 77. Bethell C, Gombojav N, Solloway M, Wissow L. Life Outcomes. 2003;1(37):37. doi:10.1186/1477- Adverse childhood experiences, resilience and nurturing relationships as a moderator of 7525-1-37 intergenerational continuity of child maltreatment: mindfulness-based approaches: common a meta-analysis. J Adolesc Health. 2013;53(4)(suppl): 66. Pierannunzi C, Hu SS, Balluz L. A systematic denominator issues for children with emotional, S32-S38. doi:10.1016/j.jadohealth.2013.05.004 review of publications assessing reliability and mental, or behavioral problems. Child Adolesc validity of the Behavioral Risk Factor Surveillance Psychiatr Clin N Am. 2016;25(2):139-156. doi:10. 56. Kosterman R, Mason WA, Haggerty KP, System (BRFSS), 2004-2011. BMC Med Res Methodol. 1016/j.chc.2015.12.001 Hawkins JD, Spoth R, Redmond C. Positive 2013;13(49):49. doi:10.1186/1471-2288-13-49 childhood experiences and positive adult 78. VanderWeele TJ, McNeely E, Koh HK. functioning: prosocial continuity and the role of 67. Corp IBM. Released 2016. IBM SPSS Statistics Reimagining health-flourishing. JAMA. 2019;321 adolescent substance use. J Adolesc Health. 2011; and SPSS Complex Samples for Windows, Version (17):1667-1668. doi:10.1001/jama.2019.3035 49(2):180-186. doi:10.1016/j.jadohealth.2010.11.244 24.0. Armonk, NY: IBM Corp.

10/10 JAMA Pediatrics November 2019 Volume 173, Number 11 (Reprinted) jamapediatrics.com

Downloaded From: https://jamanetwork.com/ on 02/09/2020

Trauma-Informed Prosecution Roundtable Participant Bios

Sanda Balaban, Co-Founder, YVote & Next Generation Politics Sanda is passionate about helping young people connect their interests and beliefs with how they can make a difference, at and beyond the ballot box. In response to the complex times we're living in, the vulnerability of democracy being demonstrated, and the desire to support young people in being on the front lines of change, she co-founded and directs two youth civic engagement ventures, YVote and Next Generation Politics, aiming to help equip the leaders of tomorrow for their roles and responsibilities as citizens shaping a more just world.

Sanda also helms FLIP (Future of Learning and Innovative Programs) Consulting, through which she supports organizations in boosting their efficacy and exploring new programmatic frontiers. She has held leadership roles in education and youth development for over 20 years, in the public sector at the New York City Department of Education, in education philanthropy at the Ford Foundation and the Goldman Sachs Foundation, and in nonprofits including Facing History and Ourselves, the Boston Private Industry Council, and The Teachers Network. Her experiences teaching high school humanities in New York City and Boston still inform her thinking each day. Sanda is a magna cum laude graduate of Swarthmore College and Harvard Graduate School of Education.

Erica Bond, Chief Policy Strategist, the Data Collaborative for Justice Erica Bond is the Chief Policy Strategist for the Data Collaborative for Justice (https://datacollaborativeforjustice.org/), a non-profit criminal justice research organization based at John Jay College of Criminal Justice. Ms. Bond has experience in the government, non-profit, public policy, and legal sectors. Most recently, Ms. Bond served as Special Advisor for Criminal Justice to the First Deputy Mayor of New York City. Ms. Bond’s city service included collaborating with partners across government to advance significant criminal justice initiatives, including the plan for closure of Riker’s Island and New York’s landmark effort to raise the age of criminal responsibility. Prior to joining government, Ms. Bond was a Director of Criminal Justice at Arnold Ventures, where she worked to develop new research, policy reforms and evidenced-based innovations with the goal of transforming criminal justice systems nationwide. Prior to joining Arnold Ventures, Ms. Bond spent five years as a Litigation Associate at Kaye Scholer (now Arnold & Porter Kaye Scholer LLP), an international law firm where she represented clients on a variety of matters, including government investigations, regulatory compliance issues and commercial disputes.

Ms. Bond currently serves as a mayoral designee to New York City’s Civilian Complaint Review Board.

J.D. Fordham University School of Law; B.A., Wesleyan University

Susan Broderick, Senior Attorney, National District Attorneys Association As a respected professional in criminal and juvenile justice issues and a woman in long-term recovery, Susan is passionate about helping others in and out of the justice systems. She started her career as an Assistant District Attorney in the Manhattan District Attorney's Office, where she served from 1989 until 2003. Susan joined the National DA's Association in 2003 and went on to serve as an Assistant Research Professor at Georgetown from 2008-2018.

Susan’s expertise and wisdom with regard to addiction and the justice systems are unique and multifaceted. She has not only worked on the front lines of the child welfare, juvenile and criminal justice systems, but she spent the last several years studying what works (and what doesn’t), while at Georgetown University. Most importantly, Susan Broderick has lived through these issues and her lived experience gives her unique insight into the issues that many other experts have only studied.

Recognizing the multiple opportunities to address addiction within the child welfare and justice systems, Susan works with jurisdictions to implement innovative prevention and diversion programs, evaluate and refine drug court procedures, enhance the effectiveness of probation protocols and improve outcomes for those leaving the justice system.

Susan's pragmatic perspective gives her tremendous credibility and allows her to bring a message of hope to anyone in the justice system, no matter where they sit in the courtroom. Given the prevalence of stress and addiction within the legal profession, she works with Bar Associations across the country to address attorney wellness.

Susan serves on the Advisory Board of Harvard University’s Recovery Research Institute and is Chairwoman of the Board of Directors for The Phoenix, a non-profit organization that promotes a sober active lifestyle.

Adam Brown, Clinical Psychologist, The New School Adam Brown is a clinical psychologist whose research focuses on identifying psychological and biological factors that contribute to negative mental health outcomes following exposure to traumatic stress and developing interventions guided by advances in cognitive neuroscience. A focus of this research is the use of behavioral and brain-imaging techniques to examine the role of memory and self-appraisals in the onset and treatment of Posttraumatic Stress Disorder (PTSD).

Dr. Brown is a member of the Human Rights Resilience Project, an interdisciplinary group of scholars and practitioners carrying out research and creating tools to improve resilience and well-being in the human rights community.

In the Trauma and Global Mental Health Lab, he partners with researchers around the world to assess and develop novel mental health treatments for refugees in diverse contexts.

Prior to joining the faculty at NSSR, he was a member of the psychology faculty at Sarah Lawrence College, where he held the Sara Yates Exley Chair in Teaching Excellence from 2017-2018. He holds an academic appointment as an Adjunct Assistant Professor in the Department of Psychiatry, New York University School of Medicine and completed a two-year NIH funded postdoctoral fellowship in the Department of Psychiatry, Weill Medical College of Cornell University.

He is the recipient of grants from the National Institute of Health, the Department of Defense, Fulbright, and private foundations.

Shiqueen Brown, Program Associate, Reshaping Prosecution, Vera Institute of Justice Shiqueen Brown is a program associate with the Reshaping Prosecution Program. This work includes working with elected prosecutors across the country to end mass incarceration, address racial disparities, and make their offices more accountable to the communities they serve.

Shiqueen joined Vera in 2018, as a program associate for the Restoring Promise initiative in Vera’s Center on Youth Justice. Restoring Promise is rooted in Restorative justice principles and works with jails and prisons across the country to end the punitive correctional model and replace it with an approach that centers accountability, healing, and equity. Shiqueen trained correctional staff and mentors in the units and provided technical assistance to South Carolina Department of Corrections and Middlesex House of Correction and Jail.

Prior to working at Vera, Shiqueen worked at the Manhattan District Attorney’s Office crafting reentry strategies. Her focus included pre-sentencing initiatives, the Manhattan Reentry Task Force, and cultivating relationships with reentry community-based organizations. Shiqueen has extensive experience working in the community with young adults developing and managing the curriculum for the Police Athletic League’s Summer Youth Employment program. Shiqueen’s professional career has been shaped through her work in local and federal government, community experience, and working on a variety of policy issues.

Shiqueen is a licensed social worker with a Master’s in Science from Columbia University.

Shonna Carlson, Legal Intern, Institute for Innovation in Prosecution Shonna Carlson is a second year MA/JD candidate at CUNY School of Law and John Jay College of Criminal Justice. She is getting her master's degree in forensic psychology. She is currently the Legal Intern at the Institute for Innovation in Prosecution.

Kandra Clark, Vice President of Policy and Strategy, Exodus With seven prior years of non-profit experience, Kandra Clark began working as Associate Vice President of Strategy with Exodus Transitional Community (Exodus) in January 2019. She was quickly promoted to Vice President of Policy and Strategy in January 2020. Exodus is a preventative, reentry and advocacy non-profit organization located in East Harlem. Kandra oversees Exodus’ policy and advocacy efforts, including supporting the closure of Rikers Island and the transformation of our justice system. She also oversees fundraising efforts for the agency, including writing government and foundation grant proposals and meeting with potential donors.

Since her release from Beacon Correctional Facility (NY) in September 2011, Kandra has earned an Associate’s Degree in Criminal Justice from LaGuardia Community College, and a Bachelor’s Degree in Humanities and Justice (summa cum laude) from John Jay College of Criminal Justice. She is currently pursuing a Master’s Degree in Public Policy and Administration with a focus on Urban Affairs and is scheduled to graduate in 2020.

Ms. Clark is an alumna of College and Community Fellowship, an active member of Just Leadership USA (JLUSA) and the Close Rikers Campaign, a JLUSA 2018 Leading with Conviction alumna, and a Beyond Rosie’s Steering Committee member with the Women’s Community Justice Association (WCJA). In addition, Kandra is a member of the Queens Neighborhood Advisory Council (appointed through the Mayor’s Office of Criminal Justice in 2018), and sits on the Board of Corrections Task Force on Issues Faced by Transgender, Gender Non-Conforming, Non-Binary, and/or Intersex People in Custody.

Kandra also sits on the Board of Directors with both WCJA and A Little Piece of Light Foundation. Furthermore, she was honored by Citizens Against Recidivism in 2016 when she received the Julio Medina Freedom Fighter Award, and is a 2018 NY Nonprofit Media 40 Under 40 Rising Star awardee.

Jeffrey Coots, Director, From Punishment to Public Health at John Jay Jeffrey D. Coots, JD, MPH, serves as the Director of P2PH, and manages relationships with and among P2PH Steering Committee members in pursuit of P2PH’s mission and goals. Mr. Coots facilitates several working groups of municipal and community-based partners in pursuit of agency-level policy adaptations that lead to improved outcomes for clients and increased efficiency and efficacy for frontline and managerial staff. Mr. Coots also oversees P2PH’s research and evaluation efforts that link faculty and students from John Jay College with consortium members providing direct services in the community. Prior to joining P2PH, Mr. Coots completed a joint Juris Doctor/Masters of Public Health degree program at Northeastern University School of Law and Tufts University School of Medicine, where he focused his studies on the social justice and health impacts of mass incarceration. While in Boston, he served as an Albert Schweitzer Fellow and delivered dialogue-based “Healthy Reentry” workshops to introduce strategies for working in collaboration with a primary care provider to prevent new infections and mitigate the effects of chronic disease. Jeff started his professional career as a Development Officer at Goodwill of Greater Washington, steadily increasing funding to support workforce development programs and wrap-around services available to those returning from jail and prison. He earned his B.A. in Government International Relations from Dartmouth College in 2004.

Frederick Coppola, Lecturer, Columbia University Federica Coppola, JD, PhD, is a Robert A. Burt Presidential Scholar in Society and Neuroscience at the Center for Science and Society at Columbia University. She is also a lecturer in Criminal Law and Neuroscience at Columbia Law School and a postdoctoral scholar at the Social Relations Lab & the Center for Justice at Columbia University Dept. of Psychology. Her work uses psychological and neuroscientific theories and findings about the influence of the social environment on the brain and behavior to inform changes in substantive criminal law, theories of punishment and incarceration. Currently, her main focus is to use this branch of scientific knowledge to reform retribution- and incapacitation-based approaches to crime and support the inclusion of restorative justice and social rehabilitation within the criminal justice process.

Hadrien Coumans, Co-Founder & Co-Director, Lernape Center Hadrien Coumans is co-founder and co-director of Lenape Center and advisor for Well-being. He is of service to individuals, organizations and communities both locally and internationally through advising, advocacy, public speaking and ceremony. Hadrien lectures at Columbia University. (Adopted member of the WhiteTurkey-Fugate family).

Tracey Downing, Deputy Bureau Chief, Kings County District Attorney’s Office Tracey Downing is a Deputy Bureau Chief in the Domestic Violence Bureau at the Kings County District Attorney’s Office where she is responsible for supervising the prosecution of cases in the Integrated Domestic Violence Court Part. Prior to returning the Kings County District Attorney’s Office, Tracey was the Director of Training Programs and Initiatives at the Mayor’s Office to End Domestic and Gender-Based Violence (ENDGBV) where she managed a team of training and curriculum specialists who provided trainings and technical assistance forservice providers at various City agencies and non-profit community-based organizations(CBOs). During her four years overseeing this program, the training team trained over 25,000 City and CBO employees. Prior to joining ENDGBV, Tracey served as a prosecutor at the Kings County District Attorney’s Office for almost 10 years. As a Senior Trial Attorney in the Domestic Violence Bureau, Tracey handled serious felony domestic violence crimes including strangulation, violent felony assaults and homicides. Tracey was the designated point person for all DV crimes relating to strangulation and in 2013, she became the first Assistant District Attorney in New York to achieve a Strangulation in the Second Degree felony conviction after trial. In her current role, Tracey continues to provide training to law enforcement, attorneys and medical practitioners around strangulation, trauma-informed interviewing, nonconsensual pornography and stalking. Tracey graduated from CUNY School of Law in 2005 and has over 25 years of experience working vigorously to end violence against vulnerable populations.

Rachel Ferrari, Bureau Chief, Bronx District Attorney’s Office Rachel Ferrari began in the Bronx County District Attorney’s Office as Chief of the Child Abuse/Sex Crimes Bureau in May 2017. Prior to that, she spent almost fifteen years at the Manhattan District Attorney’s Office investigating and prosecuting a variety of cases, including assault, sexual assault, narcotics, grand larceny, identity theft, robbery, weapons possession and burglary. While there, she served in the Domestic Violence Unit and the Sex Crimes Unit. In 2007, Rachel joined the Child Abuse Unit where she investigated and prosecuted felony cases of physical and sexual abuse of children. In 2013 she became Deputy Chief of the Child Abuse Unit, where she served until leaving the office. Rachel received her undergraduate degree from Northwestern University and her law degree from Fordham Law School.

Thomas Giovanni, Deputy Executive Assistant Corporation Counsel, NYC Law Department Thomas Giovanni is the Deputy Executive Assistant Corporation Counsel for Juvenile Justice Policy for the NYC Law Department, supporting the Law Department’s Family Court Practice. For the previous 4 years, he served as the Executive Assistant Corporation Counsel for Government Policy, Chief of Staff, the executive directly overseeing the Family Court practice, and the lead NYC attorney in the Floyd monitorship (stop and frisk). Thomas began his career in social justice as a public defender at the Neighborhood Defender Service of Harlem, as a staff attorney, then a supervising attorney. After nearly 10 years, Thomas went to the Brennan Center for Justice, where he served as Counsel to the Justice Program and the Director of the Community-Oriented Defender Network. After that he was the Supervising Attorney for the Legal Aid Society of New York’s Anti-Gun Violence Initiative. He has experience in criminal law, justice policy, criminal procedure and trial practice, public defense, and pretrial proceedings. Thomas holds a B.A. (1994) from Morehouse College, a Historically Black College, and a JD from Georgetown University Law Center (1998).

Kristine Hamann, Executive Director, Prosecutors’ Center for Excellence (PCE) Kristine Hamann is the Executive Director and founder of Prosecutors’ Center for Excellence (PCE). PCE provides consulting and research services for prosecutors to promote best practices, spur innovations and implement solutions. PCE supports statewide prosecutor-led Best Practices Committees that have formed in 20 states. PCE publishes articles on a wide variety of criminal justice issues. PCE hosts regular national meetings for prosecutors. For more information about PCE see www.pceinc.org. From 2013 to 2016, Kristine Hamann was a Visiting Fellow at DOJ/Bureau of Justice Assistance. She chairs the NY State Best Practices Committee for prosecutors, and she teaches at Georgetown Law School. She is a member of the ABA Criminal Justice Council and is on the ABA Criminal Justice Journal Editorial Board. She does assessments of prosecutor offices and presents on various prosecutor-related topics including body worn cameras, ethics, eye- witness identification, community outreach and witness intimidation.

From 2008 to 2013, Ms. Hamann was the Executive Assistant District Attorney for the Special Narcotics Prosecutor for the City of New York. From 2007 to 2008, Ms. Hamann was the New York State Inspector General. From 1998 to 2007, Ms. Hamann served as the Executive Assistant DA to DA Robert Morgenthau in the Manhattan District Attorney’s Office in NYC. Prior to 1998, Ms. Hamann held a number of other positions in that office including Deputy Chief of the Trial Division and Director of Training. She started her career as a violent crime prosecutor. Ms. Hamann has received several awards for her public service.

Bea Hanson, Executive Director, NYC Domestic Violence Task Force Bea Hanson currently serves as Executive Director of the NYC Domestic Violence Task Force, created by Mayor Bill de Blasio to develop a comprehensive citywide strategy to reduce domestic violence.

Prior to her current position, she was the Principal Deputy Director of the United States Department of Justice, Office on Violence Against Women during the Obama Administration (20011-2017) where she was responsible for leading implementation of the Violence Against Women Act including distribution of nearly $500 million to communities across the country to prevent and respond to domestic and sexual violence.

Bea previously served as Chief Program Officer for Safe Horizon, a crime victim service organization in New York City that serves 350,000 victims annually. Prior to joining Safe Horizon, Ms. Hanson was the Director of Client Services at the New York City Anti-Violence Project where she led programs for the nation’s largest crime victim assistance and advocacy organization serving the LGBT community.

Bea earned a Doctor of Philosophy in Social Welfare from the City University in New York, a Master of Social Work degree from Hunter College School of Social Work in New York, and a Bachelor of Arts degree from the University of Michigan in Ann Arbor.

Jarvix Idowu, Director of Programming, Prosecutor Impact Jarvis Idowu joined Prosecutor Impact (PI) as the Director of Programming in 2018 after serving as a prosecutor in the Manhattan District Attorney's Office for three years. In his current role, Jarvis is responsible for the ongoing development and implementation of PI's cutting edge curriculum. Over the last year, he has helped PI grow its faculty of community partners and conducted trainings for District Attorney's Offices throughout the country. He has been featured in several industry publications and has served as a volunteer criminal justice policy advisor for national and local political campaigns.

As a product of the New York City group home and foster care system, Jarvis has developed a unique perspective when it comes to criminal justice reform. Influenced by folks like Adam Foss, Saul Alinsky, and Danielle Sered, he aspires to help prosecutors redefine what it means to be successful by targeting the cultural, institutional, and systemic barriers to meaningful progress. Prior to his career in the prosecutorial space, Jarvis worked as a Law Clerk for the Freedom From Religion Foundation and as a Field Director for Barack Obama's 2008 Presidential Campaign. He is a proud alum of the University of Wisconsin Law School and Skidmore College, where he concentrated on ethical philosophy.

Michael Kahn, Associate Director of Operations and Policy, Institute for Innovation in Prosecution Michael Kahn is the Associate Director of Operations and Policy for the Institute for Innovation in Prosecution at John Jay College of Criminal Justice. Prior to joining the IIP, Michael was an associate at the law firm Cravath, Swaine & Moore LLP. Michael received his BA summa cum laude in Politics, Philosophy, and Economics at Brandeis University and is a graduate of both Columbia Law School, where he was a James Kent Scholar, and Columbia Business School.

Ross Kramer, Director of Incarcerated Gender Violence Survivor, Sanctuary for Families Ross Kramer is Director of the Incarcerated Gender Violence Survivor Initiative at Sanctuary for Families. He joined Sanctuary For Families from Winston & Strawn LLP, where he was a Partner in the White Collar, Regulatory Defense and Investigations group. He has a worked as a criminal defense attorney for the past 15 years, representing clients in state and federal courts across the country, at both the trial and appellate levels.

David LaBahn, President and Chief Executive Officer, Association of Prosecuting Attorneys David LaBahn is President and Chief Executive Officer (CEO) of the Association of Prosecuting Attorneys (APA), a national association working alongside prosecutors in the exchange of information and ideas on emerging issues in the administration of justice and providing for safer communities.

Prior to forming APA, LaBahn was the Director of the American Prosecutors Research Institute (APRI) and the Director of Research and Development for the National District Attorneys Association (NDAA). He directed APRI’s projects including editing and teaching in the areas of child and adult sexual assault and gang violence, and worked alongside other national organizations to increase funding and coordinate efforts to assist in the investigation and prosecution of child abuse. LaBahn also helped NDAA acquire numerous federal grants to continue support of the nation’s district attorneys.

Appointed to the position of Executive Director of the California District Attorneys Association (CDAA) in 2003, David served as the primary policy strategist and spokesperson for the organization. LaBahn initially joined CDAA in 1996 and at that time was responsible for the training and publications departments, state and federal grants and lobbying the California Legislature on criminal justice and budget issues. He was involved in creating CDAA’s first Violence against Women Project, the Circuit Environmental Prosecution Project and the High Technology Prosecution Project. Under his leadership, CDAA expanded its structure to include over 30 standing committees to tackle new trends such as community prosecution, technology, stalking, and elder abuse. He also lectured at state-wide MCLE programs on various topics including the prosecution of sexual assault and gang crime. In addition, he edited the annual CDAA Legislative Digest to keep prosecutors abreast of changes in the law.

LaBahn began his legal career as a Deputy District Attorney in Orange and Humboldt counties in California, where he received numerous awards including national recognition for his work with crime victims and for the reduction of gang violence. During his ten years in the courtroom, he handled cases ranging from low-level misdemeanors to special-circumstance murder cases with a primary focus on sexual assault and gang offenses.

Mr. LaBahn travels extensively providing technical assistance to prosecutors and allied criminal justice professionals, represents APA on numerous national commissions and task forces, speaks at regional and national conferences, and testifies before Congress and other legislative bodies.

Grace Lang, Artistic Director, Art Therapy Project Grace Lang is a mixed media artist based in Brooklyn and upstate New York, where she creates both two and three- dimensional work to tell stories of triumph. She also facilitates art-making workshops for children, incorporating wellness practices. Grace is a graduate of Parsons School of Design with a degree in Illustration, as well as Lang College with a degree in Literary Studies. She is currently on the Board of Governors of Lang College and is the Artistic Director of the Young Professionals Leadership Group at the Art Therapy Project in NYC. For the past 10 years, Grace has created illustrations and directed graphic design for teen development company, Your Self Series, which provides self-identity and wellness curriculum for teachers, parents, and social workers working with teens. Most recently, she has been creating graphics for educational presentations about neuroplasticity aimed at fostering positive mental health atmospheres in the workplace and in schools. She has also spent the past 6 months working with a collaborative community of chronic pain warriors to better understand the links between emotional and physical trauma.

Lucy Lang, Director, Institute for Innovation in Prosecution Lucy Lang is Director of the Institute for Innovation in Prosecution at John Jay College of Criminal Justice, a think tank for prosecutors and communities across the United States. Lucy writes and speaks widely on prosecution and criminal legal reform, and teaches those issues in New York State prisons. She previously served as an Assistant District Attorney in Manhattan for 12 years, where she investigated and prosecuted violent street crime and homicides, and most recently served as Special Counsel for Policy and Projects and Executive Director of the Manhattan D.A. Academy, a resource for professionals working at the intersection of law and public policy. Lucy is a graduate of Swarthmore College, where she serves on the Board of Managers, and Columbia Law School, where she was the Editor-in-Chief of the Journal of Gender and Law and where she now serves as a Lecturer-in-Law. Lucy was named a 2015 Rising Star by the New York Law Journal, was a 2017 Presidential Leadership Scholar, and is a 2019 Aspen Society Fellow and a Term Member of the Council on Foreign Relations.

Alissa Marque Heydari, Assistant District Attorney, New York County District Attorney’s Office Alissa Marque Heydari is an Assistant District Attorney in the New York County District Attorney’s Office (DANY), and acting Criminal Court Supervisor of Trial Bureau 30. During her time at DANY, in addition to the Trial Bureau, she has handled cases in the Sex Crimes and Elder Abuse units. Before joining DANY, Ms. Heydari clerked for Judge Mitchel E. Ostrer of the New Jersey Appellate Division. She is a graduate of George Washington University Law School and the University of California, Berkeley.

Michelle Mason, Policy and Operations Assistant, Institute for Innovation in Prosecution Michelle Mason is a Policy and Operations Assistant with the IIP. Prior to joining the IIP, she gained meaningful criminal justice experience while interning at the Kings County District Attorney’s office, Union County Criminal Courts in New Jersey, and the Non-profit Sanctuary for Families. Michelle received departmental honors in Politics at the Eugene Lang College of Liberal Arts at The New School.

Rosemary Masters, Founding Director, Trauma Studies Center Rosemary Masters holds dual degrees in law and social work. She served as the first Director of the Families of Homicide Victims Program for the New York City Victim Services Agency. She is the Founding Director of the Trauma Studies Center, a training and treatment division within the Institute for Contemporary Psychotherapy which is based in New York City. Currently a senior member of the trauma faculty, she teaches the theory and treatment of psychological trauma and serves as supervisor and consultant to the trauma program.

Under the sponsorship of the Uganda Counseling Association, she has taught trauma theory and treatment to Ugandan mental health professionals. On behalf of individuals persecuted or tortured in their countries of origin, she has provided over 50 forensic assessments to the U.S. Department of Homeland Security. She has also served as a consultant to the LaGuardia Community College Pre-Hospital Training Programs. She maintains a private practice in New York City.

Joanne Naughton, fmr. Defense Attorney, Legal Aid Society Joanne Naughton was a member of the New York Police Department for over 20 years. She started as a beat officer and retired as a lieutenant. She worked in the narcotics bureau making undercover street-level buys for three years. Later, as an attorney, she witnessed the drug war from the defendant's side, representing indigent defendants for the Legal Aid Society in Manhattan. Joanne has spent a lifetime as a public servant in criminal justice. While an NYPD officer, she was also involved in developing the first sex crimes unit in the country, a model that was widely replicated. In 1997 she ran for District Attorney of Westchester County, New York. From 1998 to 2011 she taught criminal justice as an Assistant Professor at Mercy College. Naughton earned her B.A. and J.D. from Fordham University in New York.

Rena Paul, Consultant Rena Paul is a consultant who specializes in sexual misconduct investigations and an Adjunct Professor at Brooklyn Law School. She served more than 12 years as a federal and state prosecutor in the United States Attorney’s Office for the Eastern District of New York and the Manhattan District Attorney’s Office. Rena has extensive experience leading investigations of sensitive cases, including crimes involving violence, sexual assault and gangs. During her tenure at EDNY, Rena served predominantly in the Organized Crime and Gang Unit, conducting large-scale investigations and handling trials and appeals in cases involving criminal enterprises. She was awarded the Department of Justice Director’s Awards for Superior Performance as an AUSA and Superior Performance by a Litigative Team, as well as the Federal Drug Agents Foundation “True American Hero” Award. Rena also served as the office’s liaison to the Office of the Chief Medical Examiner and a presenter at the NYPD’s Ceasefire program. At the DA’s Office, Rena served in the Appeals and Trial Bureaus, handling hundreds of felony and misdemeanor cases, including sex crimes, domestic violence, financial crimes and homicide. Rena is a certified yoga teacher and founder of Alcalme, a wellness consultancy focused on attorney well-being.

Shibinsky Payne, Victim Services Unit Director, Kings County District Attorney’s Office Shibinsky Payne has over 14 years of experience in the field of Intimate Partner Violence (IPV) and trauma. She received her Master’s degree in Social work at Long Island University and has since dedicated her professional career to advocating for victims of crime. Her experiences include a shelter based DV program and former assistant director of a large social work department with NYC Health +Hospital: Woodhull. As the Director of the Kings County District Attorney’s Office: Victim Services Unit, she and her dedicated team of social workers and victim advocates provide support, advocacy, and information to individuals who have been criminally victimized in Brooklyn. The collaborative relationship between the social worker and prosecutor enhances both the criminal prosecution as well as to the ongoing safety and support of the survivor.

Chitra Raghavan, Deputy Director, Forensic Mental Health Counseling Program at John Jay Chitra Raghavan obtained her doctorate in Clinical and Community Psychology at the University of Illinois at Urbana- Champaign and furthered her post doctorate training at Yale University. She is a full professor of psychology at the John Jay College of Criminal Justice, City University of New York and the Deputy Director of the Forensic Mental Health Counseling Program. In her role as Deputy, she created and oversees the Advanced Certificate of Victim Studies and the Victim Track specialization contained within the Forensic Mental Health Counseling degree.

Dr. Raghavan conducts research on power dynamics in intimate partner abuse, sexual assault, sex trafficking and related traumatic outcomes. A second area of interest is applying Eastern Psychological principles to forensic psychology. She has written over forty scientific articles and authored two books; Raghavan, C. & Levine, J. (Eds.). (2012). Self Determination and Women’s Rights in the Muslim World. HBI Series on Gender, Culture Religion, and Law. Boston: Brandeis University Press and Raghavan C. & Cohen, S.J. (Eds.) (2013). Domestic Violence: Methodologies in Dialogue. Northeastern Series on Gender, Crime, and Law, Northeastern University Press. She is a practicing psychologist and deemed an expert by the courts in intimate partner violence, sex trafficking, coercive control, trauma, and trauma bonding. Her research and testimony has created case law in New York State (https://law.justia.com/cases/new-york/other-courts/2018/2018-ny-slip-op-28161.html). For more information, please visit her websites (http://www.jjay.cuny.edu/faculty/chitra-raghavan) or (craghavan.com).

Somava Saha, Vice President, Institute for Healthcare Improvement Somava Saha, MD, MS (aka Soma Stout) has dedicated her career to improving health, wellbeing and equity through the development of thriving people, organizations and communities. She has worked as a primary care internist and pediatrician in the safety net and a global public health practitioner for over 20 years. She has witnessed and demonstrated sustainable transformation in human and community flourishing around the world.

Currently, Soma serves as Founder and Executive Lead of Well-being and Equity in the World (WE in the World), as well as Executive Lead of the Well Being In the Nation (WIN) Network, which work together to advance inter- generational well-being and equity.

Over the last five years, as Vice President at the Institute for Healthcare Improvement, Dr. Saha founded and led the 100 Million Healthier Lives (100MLives) initiative, which brought together 1850+ partners in 30+ countries reaching more than 500 million people to improve health, wellbeing and equity. She and her team at WE in the World continue to advance and scale the frameworks, tools, and outcomes from this initiative as a core implementation partner in 100MLives.

Previously, Dr. Saha served as Vice President of Patient Centered Medical Home Development at Cambridge Health Alliance, where she co-led a transformation that improved health outcomes for a safety net population above the national 90th percentile, improved joy and meaning of work for the workforce, and reduced medical expense by 10%. She served as President of the Medical Staff of Cambridge Health Alliance, as well as founding Medical Director of the CHA Revere Family Health Center and the Whidden Hospitalist Service, leading to substantial improvements in access, experience, quality and cost for safety net patients.

In 2012, Dr. Saha was recognized as one of ten inaugural Robert Wood Johnson Foundation Young Leaders for her contributions to improving the health of the nation. She has consulted with leaders from across the world, including Guyana, Sweden, the United Kingdom, Singapore, Australia, Tunisia, Denmark and Brazil. She has appeared on a panel with the Dalai Lama, keynoted conferences around the world, and had her work featured on Sanjay Gupta, the Katie Couric Show, PBS and CNN. In 2016 she was elected as a Leading Causes of Life Global Fellow.

Shanakay Salmon, Creative Associate, Institute for Innovation in Prosecution ShanaKay Salmon is the Creative Associate with the IIP, responsible for engagement with both the public and external partners. Prior to joining the IIP, Ms. Salmon worked as an Administrative Assistant and an Investigative Assistant with Advanced Investigation, LLC in New Haven, Connecticut. At Advanced Investigation, she was responsible for case intake and the creation of case files, conducting background searches, conducting surveillance with field investigators, and liaising with various police departments. Ms. Salmon holds a BA in Criminology with a concentration in International Affairs from Le Moyne College in Syracuse, New York, and a MS in Criminal Justice with a concentration in Victimology from the University of New Haven in Connecticut.

Lauren Stabile, Deputy Title IX Coordinator, New York University In March 2015, Lauren joined New York University (NYU) as a Title IX Investigator for NYU’s Office of Equal Opportunity (OEO). Later, in April 2017, Lauren was promoted to Deputy Title IX Coordinator, and currently maintains this role. In her capacity as Deputy, Lauren is primarily responsible for overseeing the intake, assessment, and investigation (where appropriate) of matters pertaining to allegations of misconduct, including sexual assault, gender/sex-based harassment, stalking, and dating/domestic violence, pursuant to University policy. Additionally, Lauren manages a majority of compliance and educational initiatives in related topic areas.

Prior to joining NYU, from 2009 to 2015, Lauren served as an Assistant District Attorney (ADA) for the New York County District Attorney’s Office. As an ADA, Lauren handled the investigation and prosecution of hundreds of cases, ranging from lower level violations to serious criminal felony matters, and specialized in the areas of domestic violence, sex crimes, and child abuse.

Lauren is a member of the New York State Bar and New Jersey Bar. Lauren earned her law degree, cum laude, from Pace University School of Law in May 2009, and is a summa cum laude graduate of New York University’s Steinhardt School.

Johnathan Terry, Policy Advisor, Institute for Innovation in Prosecution Johnathan Terry serves as Policy Advisor at the Institute for Innovation in Prosecution. His responsibilities include policy research and writing, program management, and developing training programs for prosecutors. Prior to working at the IIP, Johnathan worked as the Program Coordinator at the Manhattan DA Academy, where he helped build the Inside Criminal Justice seminar, for which he still serves as a teaching assistant and program manager. He is originally from Chicago and has a degree in History from Yale University.

Denise Tirino, Deputy Bureau Chief, Queens County District Attorney’s Office Denise Tirino is a 32-year career prosecutor at the Queens County District Attorney’s office. She has conducted 79 felony jury trials to date, half of which were murder and manslaughter cases, the remainder were an assortment of sexual assaults, domestic violence and child abuse cases. She is currently the Deputy Bureau Chief of training for the Criminal Court Bureau. Prior to being made Deputy Bureau Chief, she was an ADA in the Homicide Investigations bureau, Special Victims Bureau, and the Homicide Trials Bureau. She received a J.D. from Brooklyn Law School.

Alison Trenk, Psychotherapist, Private Practice Alison Trenk, MA, LCSW, is a psychotherapist who specializes with adolescents, young adults and couples. She works within a supportive relational framework and incorporates varied modalities, such as Imago Relationship Counseling skills, Cognitive Behavior Therapy (CBT) and Dialectal Behavior Therapy (DBT), to work with individuals and couples as a DBT-adherent trained therapist.

Alison received her BA in psychology and criminal justice at Rutgers University. She went on to pursue her Masters in Psychology at Kean University and Masters in Social Work at Hunter College. Alison then completed the 2-Year Post- graduate Adult Treatment Program at the Institute of Contemporary Psychotherapy and the 12-day Imago Relationship Therapy Training.

Prior to working in private practice, she has worked in a supervisory clinical role and a consultant at agencies such as the Manhattan District Attorney’s Office, the Center for Court Innovation, SAKHI for South Asian Women, the Kings County District Attorney’s Office, Safe Horizon, and Northside Center for Child Development.

Bernadine Waller, Adjunct Professor, Adelphi University School of Social Work Bernadine Waller is an Adjunct Professor at Adelphi University School of Social Work. She was awarded an R36 from the National Institute of Mental Health (NIMH) to complete her dissertation research designed to develop a theory that explains how African American women survivors of intimate partner violence navigate their psychosocial barriers during help seeking. Ms. Waller has partnered with the government in Barbados to conduct an evaluation of their UN Women-developed batterer intervention program, Partnership for Peace. She is also a TEDx presenter who is now a New York State-licensed therapist. She specializes in providing culturally salient interventions to trauma survivors, specifically assisting members of the African American, Afro Caribbean and Latinx communities who have experienced gender-based violence. Ms. Waller is a former journalist whose career spanned from print and radio to television and interactive media. Prior to transitioning to higher education, she was a marketing consultant, as well as a Leadership and Diversity facilitator with a Fortune 100 financial services organization where she mentored senior vice presidents and travelled the country training leaders.

Brian Wilson, Special Assistant District Attorney, Norfolk County District Attorney’s Office Brian A. Wilson is a Lecturer and Clinical Instructor within the Criminal Law Clinical Program at Boston University School of Law and a Special Assistant District Attorney in Norfolk County, Massachusetts. He supervises BU’s Prosecutor Clinic, in which third-year students prosecute felony and misdemeanor cases at the state District Court level under his supervision, and lectures student prosecutors and defenders in all aspects of criminal procedure, evidence, trial advocacy, and ethics. A prosecutor since 1997, Wilson has handled all types of major felony cases in the Superior Court, including first-degree murder, armed robbery, motor vehicle homicide, sexual assault, drug trafficking, and other serious offenses. He has also argued numerous cases in the Supreme Judicial Court and Appeals Court of Massachusetts. In addition to developing training seminars and materials for police departments and prosecutors, Wilson has served on the faculty at various clinical education conferences, continuing legal education programs, and trial advocacy workshops. He is a graduate of Emory University and Boston University School of Law.

Yaelle Yoran, Trauma Therapist, Private Practice Yaelle Yoran has been working with trauma survivors since 2005. Yaelle obtained her Masters of Social Work degree from New York University. In addition, she is trained and certified in trauma treatment modalities such as Neuro Linguistic Programming, conversational hypnosis, EMDR, Internal Family system, Sensorimotor psychotherapy and other techniques. Throughout the years, Yaelle worked with traumatized adolescents at the International High School at Prospect Heights, created and led programs for traumatized adults and built a private practice where she focuses on trauma treatment. Yaelle works as a trauma therapist seeing clients in her private practice and at the Institute for Contemporary Psychotherapy where she is also a faculty member and co-chair of the Program and Project division at the Trauma Studies Center.