Occupational Therapy in Criminal Justice Settings: Developing and Implementing Occupation-Based Programs Lisa Jaegers, PhD, OTR/L, Saint Louis University Jaime Muñoz, PhD, OTR/L, FAOTA, Duquesne University Sandra Rogers, PhD, OTR/L, Pacific University Mary Beth Dillon, OTD, MOT, OTR/L, The University of Findlay Cynthia Ballentine, MSOT, OTR/L, St. Louis Community College Abigail Catalano, BS, Duquesne University Lisa Martin, MS, OTR/L, Jefferson College Brittany Conners, MOT, OTR/L, Saint Louis University Karen F. Barney, PhD, OTR/L, FAOTA, Saint Louis University
Introductions • Who is participating today? • Students • New Practitioners < 2 years • Existing Practitioners
Session Objectives • DESCRIBE the current baseline status of OT educational training, intervention programming, and research in the Justice System nationally and internationally • APPLY a process of program or project development specific to corrections and relative to your practice, educational, or community setting. • APPLY intervention strategies for pre- and postentry OT practice using case study examples and discussion.
Justice Background
Background
Learn the terminology and stakeholders. Consider ways to improve person-centered language.
Professionals Terminology
• Judges, Lawyers
• Criminology
• Doctors, Nurses
• Criminal Justice
• Psychologist, Psychiatrist
• Forensics
• Social Workers
• Corrections
• Case Managers
• Persons incarcerated • Inmate, offender, felon, prisoner
• Substance Use Counselor
• Probation • Parole
• Community Health Worker • Peer Mentor • Correctional Workers • OT Practitioners
INCARCERATION WORLDWIDE
https://www.youtube.co m/watch?v=NaPBcUUq bew&feature=youtu.be
Source: “The Growth of Incarceration in the United States: Exploring Causes and Consequences,” The National Research Council, 2014.
DISPARATE SYSTEMS OF CONFINEMENT
IMPACT ON PATTERNS OF OCCUPATION
RACIAL AND ETHNIC DISPARITIES
HEALTH CARE DISPARITIES
Incarceration is a Health Issue In addition to individual behaviors, community-wide factors like poverty, unemployment, low educational attainment, inadequate housing, lack of public transportation, exposure to violence, and neighborhood deterioration (social or physical) shape health and contribute to health inequities. Nationalacademies.org/promotehealthequity
Occupational Justice In an occupationally just environment, individuals have access to adequate supports and resources to participate in occupations that are necessary and meaningful to them (Townsend & Wilcock, 2004).
Occupational justice is a term that emphasizes rights, responsibilities, and liberties that enable the individual to experience health and quality of life through engagement in occupations (Townsend & Whiteford, 2005; Wilcock & Hocking 2015).
Possible Outcomes of Occupational Injustice • individuals being denied the opportunity and resources to participate in occupations. Occupational deprivation
Occupational alienation
• people are required to participate in occupations they find meaningless with little recognition or reward
• Occupational
• individuals lack the marginalization power to exercise occupational choice as can occur when persons are stigmatized by illness or disability.
Occupational Impoverishment
lack of goals for work, play/leisure, social, and self-care, or a sufficient repertoire of interests, and exploratory skills.
Application of Model to Corrections Building collaborative partnerships between community practice & universities Work with organizations such as correctional facilities, policy makers, halfway houses, and community agencies to develop programs and resources
OT Practitioners embrace the role of both clinician and researcher.
Offender has some choice & engagement in meaningful occupations, development of skills in anticipation of release.
Work as members of an intraprofessional team to assess and help clients
Help to identify strengths, values, interests, resources and challenges in order to implement plans addressing family commitments, employment, & leisure activities.
Culture of Incarceration • Restrictive, with multidimensionally limited physical space • Dependence upon institutional structure and contingencies • Hypervigiliance, interpersonal distrust, and suspicion • Emotional over-control, alienation, and psychological distancing • Social withdrawal and isolation • Incorporation of exploitative norms of jail/prison culture • Diminished sense of self-worth and personal value • Post-traumatic stress reactions to the pains of imprisonment
Culture of Incarceration: US
Prison: A Day in the Life of…. Time
Activity 6:00 1st cell count
7:30 – 7:45 Breakfast in cafeteria, back to cell or unit 9:30 – 10:45 Work or recreation 10:45 – 12:00 In cell or unit, 2nd cell count 2:00 – 3:15 Work or recreation, return to cell or unit 4:00 3rd cell count 5:00 – 5:15 Dinner in cafeteria, back to cell or unit 9:00 4th cell count 9:45 Lights out
Incarceration Culture Contrast: US & Norway
For your Reflection….. https://www.youtube.com/watch?v=kllBalLSMCQ
Risks - Lack of stability, support, or treatment in these areas may lead to higher risk for incarceration and recidivism • • • • • • • • • • • • • •
Residential, Home Financial, Poverty Education, Employment Physical & Mental Health Leisure / Recreation Family & Companions Peers Social Isolation Alcohol or substances Trauma, Abuse Antisocial Patterns Noncompliance history Procriminal Attitude / Thinking Criminal Involvement
Bell, 2014
OT in Justice Practice
Types of Justice-based Programs Diversion (prevention) • Prevention of long-term
incarceration • Courts: Drug, Mental Health, or Reentry • San Francisco's Parole Reentry Court
https://www.youtube.com/watch?v=l_biFVAqwZU
Pre-release • Inside correctional facilities • Less common • Barriers to access
Post-release • Community-based • Most common
Workplace Health
https://www.youtube.com/watch?v=8o9iVgYxd1g
Examples of OTs in Justice Occupational Therapy Training Program (OTTP-SF) , San Francisco • Colleen Devine, MS, OTR/L – Division Director • Youth in Detention • • • •
juvenile hall detainment independent living skills social, cognitive and emotional coping skills pre-vocational readiness
• Log Cabin Ranch • • • • •
detained youth for treatment and rehabilitation OT assessments aftercare recommendations collaborates with other community based organizations http://www.ottp-sf.org/#about
The Saint Louis University Reentry Program
Holistic, interprofessional approach to re-entry that integrates supports between the inside and outside for the long-term transition of incarcerated men and women from jail or prison to the community.
Our Program Partners & Resources OT Reentry Committee
Commissioners, Officers, Wardens, Staff, Community Partners
SLU Partners n=>20
Professional Services
Education Programs
Housing Support, Ministry, etc.
(Jaegers, et al., 2015)
OT Intervention Process Assessment
•COPM •Mental Health, Trauma •KELs •Individual Vision
Statement •Short + Long Term Goals •Individually Tailored
Intervention • •
Group Process 1-1 Process
Planning, Education, Resources Self Discovery • Health literacy •
•
• • • • • • • • •
Physical & mental (trauma)
Family / Support systems Effective communication Education Employment readiness Financial literacy Household management Time management Community resources Detailed transition plan
Correctional Workplace Health
Total Worker Health Project
• 2 Urban, 2 Rural Jails • Community-based participatory research • Needs assessment for workplace health, primarily to reduce mental stressors
– Surveys (e.g. stress, health, job satisfaction, feelings about work with incarcerated people) – Focus Groups – explore solutions
Findings (N=326) 40% Felt depressed at least 1-2 days in last week 64% Body Mass Index > 30 31% taking medication for high BP or hypertension 47% missed work due to medical problem in past 4 weeks Percent of COs who feel they … • 19% are treating inmates as if they were objects – 59%, not at all; 18% a little bit • 40% Have become harsh towards people since taking the job • 41% Feel worried that job is emotionally hardening to self
Potential Evidence-based Solutions • Workplace culture • New hire & manager training • Safety training • Workplace policy • Community relationships
This research was supported by a pilot project grant from the Healthier Workforce Center of the Midwest (HWCM) at the University of Iowa. The HWCM is supported by Cooperative Agreement No. U19OH008858 from the Centers for Disease Control and Prevention (CDC) / National Institute for Occupational Safety and Health (NIOSH).
Higher Education in Correctional Settings • Completion of a GED or a high school education is a
necessity in today’s economic environment--those without this level of education often have few options. • 40% of U.S. inmates have neither a high school diploma or a GED • Unemployment rate: •11.3 % those without a high school diploma or GED •7.7% For those without a college degree
• Degree attainment is estimated to reduce arrest rates by at
most 32.6% • With every degree completed, the recidivism rate decreases
Higher Education in Correctional Settings Jesuit inspired initiative that provides education to prison staff and people incarcerated in Missouri, promotes service, and conducts research on education and incarceration.
• First Cohort, Associate of Arts Degree Graduation: 15 incarcerated and 13 staff students December, 2015
• SPEAKER SERIES: Monthly series of talks, readings, exhibits, and performances. • WORKSHOPS: humanities-based non-credit classes offered in clusters of three sessions facilitated by SLU faculty or community members (artists, performers, or writers).
• VIDEO-IN-PRISON-PROJECT: recorded presentations and lectures on the St. Louis campus and at the ERDCC are rebroadcasted on the prison’s closed-network television station.
Training for OT Justice Practice • OT’s typically learn about working in the criminal justice
system by working with already established programs. • In an effort to reduce the discrepancy between knowledge and intervention a training site is under construction. • OT in Criminal Justice Systems • Feel free to add requests for information
Opportunities in entry-level OTD programs
Resources: Books/Chapters
Resources: Web Based
http://otincriminaljustice.weebly.com
https://forensicdetail.wordpress.com
EBP OT in Corrections: It Works General Programs
% Reduction in recidivism
Education-in any form, reduces recidivism and improves chances of employment post-release
20%
Intensive supervision (TREATMENT not monitoring & surveillance)
21%
Cognitive-behavioral treatment programs Industries
8.2% 7.8%
In prison therapeutic communities for druginvolved offenders
6.9%
% reflect statistically significant reduction in recidivism rates of program participants
A Survey of Occupational Therapy in U.S. Criminal Justice System • N=48, well-educated, mostly female practitioners and educators • Most experienced in corrections
Practice Settings
• Jails • Prisons • Forensic MH Hospitals
Traditional Institutions 52%
• Correction Centers • Homeless Shelters • Work Release Program • Drug/Alcohol Treatment • Youth Offender Facility
CommunityBased Settings 48%
Reported Use of Interventions
Scoping Review: Criminal Justice • 58 Studies; 74% Outside of U.S. • 66% Published prior to 2000 • 66% Studied Forensic MH populations/processes • 62% Examined OT evaluation or intervention processes
EVALUATION: Studies defined occ. performance, social participation, habits, roles or performance patterns of persons in criminal justice settings. INTERVENTION: Studies reflected a substantial range of modalities OTs use to address the needs of of persons in criminal justice settings.
Scoping Review: Criminal Justice PRACTITIONER PERSPECTIVES: Studies elicited practitioners’ views of OT in criminal justice settings, priorities for research and strategies for developing practice in these settings in various countries. CONSUMER PERSPECTIVES: Studies explored the experience of occupation or consumer’s perspectives of OT services PROGRAM DESCRIPTIONS: 36 articles described OT programs developed for criminal justice populations; many reported data, but very few systematically assessed program outcomes
Scoping Review: Current Status • Limited dissemination, low levels of rigor, lack of programs systematically measuring outcomes • OT in criminal justice reflected in the literature since 1943 • Practice in secure MH facilities dominates the literature • Diversity in assessment, intervention and OT program design • Focus on women’s needs is nearly non-existent in literature • Community-based practice is poorly represented in literature • Diversity in approach may reflect the overall lack of practice guidelines for OT in criminal justice
Value of OT & OTA Collaboration • Ensures
affordability and accessibility of OT services • Allows the delivery of high quality interventions that meet ethical and licensure standards
Specialized Knowledge and Skills OT /OTA Develop an occupational profile using clientcentered strategies
X A
Collaborate with clients to determine targeted outcomes specific individual’s vision plan
X X
Develop intervention sessions using activities to teach and practice new skills and engage in tasks.
X X
Clarify how occupational therapy interventions X X support and compliment interventions of other providers. Conduct needs assessment to determine when X A OT services may benefit a partial or full mental health system that does not currently utilize occupational therapy.
Fieldwork Student Collaboration OT & OTA Positive Outcomes 1. Communication/problem solving 2. Teamwork 3. Meeting new people/networking 4. Different perspective/roles defined 5. Experience working with a different level of OT practitioner 6. Self-improvement
Program Development
Before We Begin... Be Aware of Potential Challenges • Flexing population numbers = caseload issues • Scheduling time for programming with OT • Wide range of learning styles • Jail Policies = no cross gender groups • Movement through facilities • Lack of Rehabilitation Perspective • Physical space inside facilities • Use of tools (contraband) • Technology • FISCAL RESOURCES
Funding Resources Local & State Local • Fred Meyer Community State • Community Foundations (OR) • Rosenberg Foundation (CA) • Beaird foundation (LA)
National Public • US Dept. of Justice • National Criminal Justice
Reference Service • Community Oriented Policing Services • https://csgjusticecenter.org/nrrc/pr ojects/second-chance-act/
Private Foundations • Ford Foundation • Public Welfare • Open Society-Criminal Justice • Example-Video • Fund for Non-violence • Arnold Foundation • Robert Wood Johnson Foundation
A Step-by-Step Program 1. Assess/Build Your Knowledge Base 2. Conduct a Needs Assessment 3. Collaborate on Programming 4. Develop the Program Proposal 5. Integrate Program Evaluation 6. Implement the Program 7. Evaluate the Program and Reassess 8. Find Funding (This step may occur earlier) 9. Disseminate Findings
Program Example Saint Louis University Transition to Employment • Jail-based reentry program designed to facilitate supportive transitions in the community • 1st cohort: women, n=4 • 6 week pre-release (inside) OT transition preparation • SLU partners • Community partners
• Bridge to post-release
(outside) OT
Program Evaluation •Understanding the effects of a program
Disseminate • Share your findings • With the facility • With community partners • North St. Louis Symposium
• Connect with media • SLU Newslink article
• Publish, publish, publish
Example Logic Model
Resource: Google - WKK Logic Model Guide
Case Examples / Strategies
Juvenile Vocational Training: Program Development • OTD DEC Partnership with Goodwill
Youthworks • Re-Entry through Industry-Specific Education (RISE) Program • Education • Vocational training
• Addition of occupation-based
evaluation and intervention • Goal-Setting • Life skills • Work simulation
Saint Louis University Transition to Employment • Working with reentry team • Recruitment • Selection process: Referrals, applications, interviews • Planning • Jail reentry, OT team, interprofessional partners, community partners • Focusing on occupation-based activities • Need to provide education about OT in the jail,
culture shift • Assessment – Occupational profile
Saint Louis University Transition to Employment • Intervention • Individualized vision plan • Self discovery tapestry • Time studies (prior to, during, after incarceration) • Group • Warm-up • Reflection • New information • Activity • Participant presentations • Feedback and wrap-up • Action plan for next class
• One-on-one • Regularly vs. As needed
Saint Louis University Transition to Employment • Profile of the first pre-release cohort • 4 women, age range within 23-45 • 3 are mothers • None have completed high school / GED • All have housing • 3 have transportation • 3 had previous jobs, one never formally employed • All have government assistance for income and food • Insurances lapsed or expired
Saint Louis University Transition to Employment • Previous sexual and physical trauma • Difficulty building healthy, personal relationships (trust) • Difficulty with calculating, managing and handling
money (KELs) • None with formal banking
Inside Out a Story of Occupational Deprivation to Occupational Engagement Steven Jennings
Combatting Occupational Deprivation Troubled Childhood
•Counseling •Education •Writing
Alcohol & Drugs
•Blogging •Steven's Blog •Work in the commissary
Violence
•Roots of Success •Sibling & family support •Marriage
Habit of violence
•NA Meetings •Dog Program
Teaching Story: Growing Occupation • Dwayne – 49 y/o male • Juvenile detention age 15 • First incarcerated at Allegheny
County Jail age 18 • Homewood Brushton community • Maternal grandma never
stopped believing • Chance encounter with pastor • New occupational role • Community integration
Contact Info Saint Louis University Lisa Jaegers, PhD, OTR/L
[email protected] Brittany Conners, MOT, OTR/L
[email protected] \Karen F. Barney, PhD, OTR/L, FAOTA
[email protected] OTA Programs St. Louis Community College Cynthia Ballentine, MSOT, OTR/L
[email protected] Jefferson College Lisa Martin, MS, OTR/L,
[email protected]
Duquesne University Jaime Muñoz, PhD, OTR/L, FAOTA
[email protected] Abigail Catalano, BS (OTDs)
[email protected] Pacific University Sandra Rogers, PhD, OTR/L
[email protected] The University of Findlay Mary Beth Dillon, OTD, MOT, OTR/L,
[email protected]
Thank you! • Weebly Site: http://otincriminaljustice.weebly.com
