Inside/Outside: Supporting People with Intellectual Disability Who Are At Risk of Engagement with The Criminal Justice S

1. Inside/Outside: Supporting People with Intellectual Disability Who Are At Risk of Engagement with The Criminal Justice System Washington Association of Sheriffs and Police Chiefs and Washington State Developmental Disabilities Council November 2, 2010 Marc Goldman, MS., LPA 919-308-9769 goldmarc@prodigy.net

2. Psychology and Criminal Behavior “—the moron---is a menace to society and civilization;---he is responsible to a large degree for many, if not all, of our social problems.” “– but no one has seemed to suspect the real cause of their delinquencies, which careful psychological tests have now determined to be feeble-mindedness.” “- segregation through colonization seems in the present state of our knowledge to be the ideal and perfectly satisfactory method.” Henry Herbert Goddard, PhD Director of the Research Laboratory of the Training School at Vineland, New Jersey, for Feeble-minded Girls and Boys 2 MG 11.2.10

3. Report to Correctional Services of Canada "This review of the legal and criminological literature from the 1960's to 1990 pertaining to the incarceration of criminal offenders who are intellectually disabled, is essentially an overview of the history of a class of persons who are as poorly equipped to cope with the correctional system as that system is ill equipped to deal with them.“ Orville R. Endicott 1991. Legal Council, Canadian Association for Community Living. A contracted report to the Research Branch, Correctional Services of Canada. 3 MG 11.2.10

4. The Attorney Generals Work Group “Those mental health people; they really do speak English. But you have to talk to them awhile.” Unidentified Assistant Federal Prosecutor(7/23/99.)The Attorney General’s Work Group on Special Needs Prisoners. 4 MG 11.2.10

5. Prevalence of People With ID in Offender Populations • Estimated US prison rates vary between 0.8% - 39.6% • Earlier stages of CJS (custody, local courts) estimated rates of 4.8% - 23.6% 5 MG 11.2.10

6. Prevalence Rates of Prisoners with Intellectual Disability 6 MG 11.2.10

7. Personal Characteristics of Incarcerated Individuals with Intellectual Disability • Predominantly male • Disproportionately non-Caucasian • Predominantly functioning within the Mild Range of disability • Older than the general prison population • 60.4% had a substance use disorder (2007, Crocker, et. al) Note that estimates vary widely. 7 MG 11.2.10

8. I: Description: 8 MG 11.2.10

9. Intellectual Disability/Mental Retardation Intelligence, which refers to the ability to learn and problem solve, is significantly and specifically below average. It is usually measured by an intelligence quotient (IQ.) Adaptive Behavior Deficits Onset by 18 9 MG 11.2.10

10. Adaptive behavior impairments in meeting the standards expected of his/her age by his/her cultural group in at least two of the following areas: • Communication; the ability to understand spoken language and to make oneself understood to others) • Self-care; basic living such as feeding and dressing • Home living • Social/interpersonal skills • Use of community resources • Self-direction; the ability to make choices and decisions on one's own) • Functional academic skills • Work • Leisure • Health • Safety 10 MG 11.2.10

11. Risk Factors for Aberrant Behavior • Biological and psychiatric factors: Increased prevalence of neurological, sensory, psychiatric, and physical abnormalities. • Habilitative factors/personal characteristics:Skill deficits in critical functional areas makes it difficult to solve the problems of daily living and makes undesirable behaviors more likely. • Psychological, social, and environmental factors:Subjected to a lifestyle of chronic stress resulting from prejudice, restrictions of personal independence and control, victimization, exclusion, and lack of experiences that promote mental wellness. Atypical learning histories that fail to teach desirable behaviors and encourage negative and disruptive behaviors. Trauma = ineffective/aberrant coping techniques. 11 MG 11.2.10

12. Dual Diagnosis • Refers to people with intellectual disability and mental health needs • Individuals with developmental delay are more likely to have a mental illness than their non-impaired peers • Are vulnerable to all mental disorders • There are numerous barriers to proper diagnosis • Mental illness can exacerbate longstanding maladaptive/criminal behavior, represent a primary sign of the disorder, or result in a new behavior as a result of social/environmental influences • Pathological mood states such as depression, irritability, excitement, or hyper-arousal can result in maladaptive/criminal behavior 12 MG 11.2.10

13. Rate of Psychiatric Illness for Offenders with Intellectual Disability 13 MG 11.2.10

14. Accommodations During Confinement: Task Force Recommendations . Jail policies should include persons with I/DD or TBI as category of persons, like those with medical or mental health needs, that may require special accommodations, including housing or medical services. Housing accommodations may be needed to assist a person with an I/DD or TBI in maintaining safety and functionality, and should be consistent with any health, safety and security requirements. Accommodations should also be made to ensure necessary assistance for a person who may have communication barriers and require assistance in understanding commands or verbal or written jail rules and regulations. 14 MG 11.2.10

15. Accommodations During Confinement: Task Force Recommendations Contacting DSHS/ DDD – When a person has been screened as potentially having an I/DD or TBI, the jail should contact the DDD and/or a known local I/DD or TBI community service provider. Contacting the Department of Veterans’ Affairs is also appropriate to determine whether someone is receiving services. Jails should work with an appropriate DDD representative to establish policies for determining appropriate accommodations for the person while confined. Information necessary includes the appropriate DDD/community provider contact (name, position, contact information) and should be updated on a yearly basis . 15 MG 11.2.10

16. Accommodations During Confinement: Task Force Recommendations Jail staff should inquire whether person is currently receiving DDD or other government benefits/services. Jail staff should seek available information from DDD regarding the person’s behaviors, triggers, or other information that will assist in providing accommodation. Jail staff should request from DDD, on a yearly basis, policies regarding communication with jails on persons confined with an I/DD or TBI and current staff contacts. 16 MG 11.2.10

17. Screening: Task Force Report • Did you ever attend special education classes in school? • Do you have a caregiver that assist you with daily activities or living skills? • Do you have a DDD case worker? • Were you ever seen in an emergency room, hospital, or by a doctor because of an injury to your head? • Have you ever been confused because of an injury to your head? • Do you receive SSI? 17 MG 11.2.10

18. Screening: Task Force Report • Headaches? • Dizziness? • Anxiety? • Easily upset or agitated (difficulty controlling your temper or mood?) • Difficulty remembering or concentrating? • Blurry vision (difficulty breathing or writing clearly) • Seizure? • Sensitive to loud noise (crowds) or light • Difficulty talking or slurred speech 18 MG 11.2.10

19. Beyond Standard Screening • The disability might not be obvious • Limited vocabulary • Speech impairment • Slow response to questions • Short attention span/distractible • Socially inappropriate • Lacks understanding of the situation • Easily frustrated 19 MG 11.2.10

20. Beyond Standard Screening • Unable to make simple monetary change • Unable to tell time; digital v. analogue • Unable to look up a phone number • Might live in a “group home” • Might have a case manager, psychologist, guardian, social worker, and/or psychiatrist • Might take medicine but cannot report specifics • Might work in a “work shop” or have a “job coach” 20 MG 11.2.10

21. II:Behavior and Communication 21 MG 11.2.10

22. Some Frequently Observed Characteristics • Desire to please authority: The individual might say "yes" to anything or tell you what they believe you want to hear. • Strong Need to reduce stress: Might falsely confess or make false statements. Might say anything and/or sign anything to relieve distress. • Change subject/tangential: Might respond in an “off the wall” manner to questions/discussion • Fake competence: Might fake comprehension and knowledge and even deny their disability. • Receptive and expressive communication skill deficits: Might not understand what is being communicated. Might not be able to express their thoughts. Might "shut down" and not speak. Easily misinterpreted as defiance. 22 MG 11.2.10

23. Some Frequently Observed Characteristics • Concrete thought: Inability to understand abstract concepts. "Wave you rights" is very likely to be misunderstood. Fails to understand that some phrases are not meant to be literal. • Impaired attention span: Inability to maintain concentration/focus. They might be easily distracted. They seem more interested in what is going on around them than in talking to you. Easily misinterpreted as cavalier, disinterest, hostility, or other negative attitude. • Memory gaps: The individual might admit to the gap but are very likely to confabulate a story. They might claim to remember what others, in fact, have told them. Time sequencing is a very commonly observed deficit. Others often easily interpret this as lying. • Maintain a pleasant facade: Regardless of the current situation, the individual smiles or grins. Can easily be interpreted as belligerence or lack of remorse. 23 MG 11.2.10

24. Responding to Questions Many people with intellectual disability are strongly motivated to do what they believe is what is expected of them. They learn to listen for certain words or inflections. They look into faces and may even copy moods as they try to give "correct" answers. They want to be accepted by and please others. Many have adapted by use of denial. 24 MG 11.2.10

25. Affirm Last choice: Can’t We Just Get Along? Q: "You were at the store last night?" A: "Yes." Q: "You didn't leave the house last night, did you?" A: "No." Q: "You couldn't have done both of them. Which is it?" A: (Silence) Q: "Did you stay home all night or did you go to the store?" A: "Store." Q: "Alright, one more time; did you go to the store last night or did you stay home?" A: "Stayed home." 25 MG 11.2.10

26. Agree: Can’t We Just Get Along? • Q: "You didn't stay home all night, did you?" • A: "No." • Q: "You went to the store, right?" • A: "Yes." • Q: "You stayed home all night, didn't you." • A: "Yes." • Q: "You didn't go to the store, did you?" • A: "No." 26 MG 11.2.10

27. Repeat Last Word: Can’t We Just Get Along? • Q: "Do you understand what I have told you?" • A: "Told you.“ • Q: "Do you understand that you have a right to remain silent?" • A: "Silent.“ • Q: "Has any pressure or coercion of any kind been used against you?" • A: "Against you." 27 MG 11.2.10

28. Communication Strategies • Slow down! • Obtain and maintain attention; Might lack eye-contact • Establish relationship/trust • Prompt the individual to relax; Consider indirect prompts rather than directives to “relax” • Use small words, short sentences, & allow time for processing • Avoid assumptions about the individual's ability to comprehend/read/follow directives or know right from left • Refrain from interrupting • Acknowledge what they say • Gently re-direct from distractions 28 MG 11.2.10

29. Communication Strategies • Verify your understanding of the person's communication; Repeat what they say • Confirm comprehension; Ask simple questions to clarify meaning; “Tell me the rule.” Show me which side you should walk.” • Consider supportive communication techniques such as pictures, gestures, checklists, etc. • Repeat questions and directives in another way • Be direct, avoid colloquialisms, and subtle communication 29 MG 11.2.10

30. Communication Strategies • Validate emotions • Provide choices; forced choices • Be patient and tolerate repetitive questions and comments • Avoid “why” questions • Avoid closed ended (yes/no) questions. Ask open ended questions • It is likely that the individual will not retain information/rules/directives without repetition 30 MG 11.2.10

31. III: Vulnerabilities: Why Are People with ID at Risk of Criminal Behavior? 31 MG 11.2.10

32. Factors Influencing Criminal Behavior • Lack of appropriate values • Poor judgment • Peer Influence • Poor Problem solving skills • Lack of social competence • Poor impulse control • Psychiatric Illness • Substance use/abuse 32 MG 11.2.10

33. Internal Vulnerabilities • Social Deficits Lack of social competence Peer influence • Cognitive Deficits Poor problem solving skills Poor judgment Memory impairment Very limited ability to comprehend the criminal justice system 33 MG 11.2.10

34. Internal Vulnerabilities • Victimization • Desire to Please Authority False confessions • Avoiding/denying the LABEL • Psychiatric Illness • “Counterfeit Deviance” 34 MG 11.2.10

35. External Vulnerabilities • Lack of recognition of intellectual disability • Minimal accommodations of the forensic treatment system • Lack of statute specific to those with ID 35 MG 11.2.10

36. External Vulnerabilities • Lack of Prevention Training • Support System Fosters Sexual Misbehavior • Lack of Adequate Post Release Supports • Under Treatment Lack of bio-psycho-social assessment and intervention • An apparent reluctance of the support system to openly discuss/treat the aberrant behavior 36 MG 11.2.10

37. External Variables Influencing Abnormal Sexual Development • Learning Conditions • Victimization • Lack of privacy • Knowledge and expectations • Segregation • Denial and minimization of support system and other systems 37 MG 11.2.10

38. Why Support Offenders in the Community? • We are committed to de-institutionalization • They are within the population we are dedicated to supporting • They are at risk of ever increasing sanctions without community support • Despite what the media leads us to believe, most do not re-offend • Decrease victimization • Many are trauma survivors • Expand expertise of support professionals 38 MG 11.2.10

39. Community Sex Offender Program 39 MG 11.2.10

40. IV: Victimization 40 MG 11.2.10

41. Increased Vulnerability to Sexual Victimization • People w/ ID are more likely to be sexually abused than those without disability of the same age and gender • Studies range from a slight increase up to 10 times higher risk (2 - 4 times higher is best estimate) • People with ID experience more severe and chronic sexual abuse 41 MG 11.2.10

42. Long Term Effects of Childhood Maltreatment • Posttraumatic stress • Cognitive distortions • Altered Emotion • Dissociation • Impaired self-reference • Disturbed relatedness • Avoidance 42 MG 11.2.10

43. Biology of Altered Emotion: Why They Just Can’t “Get Over It” • Pathways of Amygdala (“fear center”) grow larger/stronger and become over reactive • Amygdala stimulates Autonomic Nervous System • Amygdala sends signals to the ANS that a “safe” situation is threatening • Stress hormone levels are altered; person is in constant “flight-fight” mode • So, we are supporting one with a dysregulated nervous system with a support system that cannot contain it 43 MG 11.2.10

44. Tension Reducing Behaviors • Coping techniques used to reduce sadness (dysphoric tension) of abuse survivor • Typically learned during and following severe child abuse experiences • The child learns that such primitive techniques are effective resulting in “vicious cycle” 44 MG 11.2.10

45. V: Interventions: Assessment, Treatment, & Control 45 MG 11.2.10

46. In Custody: Self-Injurious Behavior A thirty-two year old male is booked into your facility for a violent crime. During booking he is slow to respond to all questions but he denies all ID screening queries. Two hours after booking, he begins banging his head on the floor with mild intensity. What do you do? 46 MG 11.2.10

47. In Custody: Sex Offense Steve is booked on a charge of Indecent Liberties with A Child. His ID screening is positive. DDD provides the following information. Axis I: Autistic Disorder Mood Disorder, Not Otherwise Specified Axis II: Mild Intellectual Disability Axis III: No Diagnosis He is prescribed Klonopin, Risperdal, Valporic Acid, and Lithobid. He has a history of physical aggression, property destruction, and self-injurious behavior. Steve has a long history of aberrant sexual expression, primarily with children. On multiple occasions he has engaged in holding a child’s foot while masturbating. This has occurred on a downtown street, a public swimming pool, and at his residence. In all cases, support professionals where near. He presents at booking talking rapidly and does not answer questions but repeatedly says that he is going to lunch on Saturday with his “community buddy” and he must be released. 47 MG 11.2.10

48. In Custody: Serial Arsonist Earl is a forty year-old man who has been supported in a group home by the same provider for five years. Index offense; he lit paper in a trash basket on fire then placed it in his closet. The fire was discovered and promptly extinguished by support staff. Two years ago he set a fire in his home that resulted in $50,000 in damages. Two years prior to that fire, Earl set a mop on fire in his backyard. He has maintained a job at a fast food restaurant for two years and is supported with a job coach. He is diagnosed with, Axis I: Psychotic Disorder, NOS Axis II: Moderate Mental Retardation Axis III: No Diagnosis Earl is prescribed Haldol for his Axis I Disorder. 48 MG 11.2.10

49. Habitual Unadjudicated Offender: Inside? Outside?Treatment? In your Neighborhood? In Your Facility/Agency? Lee has had multiple charges of Breaking and Entering and Home Invasion. Support staff, providing 24-hour-assistance, report that he elopes twice monthly; becoming vulnerable to multiple risks. He has been found at a pool hall where he was “drinking a Bud.” On more than one occasion, he has entered an occupied residence. He sells his possessions whenever he has the opportunity. He resides in a rural area. The crisis team was contacted after he entered an occupied residence. The only occupant was a 13 year-old female. He is typically calm and cordial. Staff stated to the officer called to the residence by the occupant that he is “delusional,” and are requesting that he be hospitalized. He is diagnosed with; Axis I: Schizoaffective Disorder Axis II: Moderate Mental Retardation Axis III: No Diagnosis He is prescribed Zoloft and Risperdal. 49 MG 11.2.10

50. Multimodal Functional Analysis Identify internal & external conditions that influence the likelihood of challenging behaviors. Then, create corresponding interventions, implement, and systematically measure effect. 1. Identify Target Symptom(s) 2. Identify conditions that influence or control the target symptoms. Multiple conditions combine and make the target more or less likely to occur. Conditions (influences) are organized as: Medical/Psychiatric Psychological/Habilitative Social/Environmental 50 MG 11.2.10