The Post Traumatic Stress Disorder (PSTD) Project in Pennsylvania

By Angeline Spain

Teenage girls enter the juvenile justice system with higher rates of physical and sexual abuse than boys—statistics range between 70 to 90 percent. Related to these high rates of abuse and trauma, mental health disorders such as Post Traumatic Stress Disorder (PTSD), suicidal behavior, dissociative disorder, and borderline personality disorder frequently appear among juvenile female offenders. In a 1998 study done by Elizabeth Cauffman, more than 70 percent of juvenile female offenders reported being exposed to trauma of some kind, including rape, severe injuries, and violence. Approximately 50 percent met the diagnostic criteria for PTSD, a psychiatric disorder characterized by the inability to stop responding to a traumatic life-threatening situation. The PTSD Project curriculum, developed by PTSD Project Manager Francine Slavik and Consulting Psychologist Jane Knapp at the Alternative Rehabilitative Communities’ (ARC) Zimmerman Home in Carlisle, is designed to help meet the needs of these girls, by helping them to work through their traumatic experiences and learn the skills to cope with PTSD.

The PTSD Project is entering its fifth year, and the 15-week curriculum has already been piloted at several facilities serving adjudicated juvenile females in Pennsylvania—including the Danville Center for Adolescent Females, the Madalyn Program in South Mountain, the Girls Adjusting to Treatment and Education Program in McKeesport, and the Adelphoi Village homes in Latrobe. The PTSD Project will shortly enter a formal evaluation phase, that will involve pre- and post-testing and assessment.

ARC received the first grant for the PTSD Project in 2000. As a provider that had been working with Pennsylvania girls since 1981 and was selected by the Office for Juvenile Justice and Delinquency Prevention as one of 16 gender-specific promising programs in 1998, ARC wanted to begin a concentrated effort on improving their services to adjudicated girls in the justice system. At ARC’s Zimmerman Home (the 16-bed group home that served as the flagship for the curriculum development), the 15-18 year-old girls were asked “if you were to have a weekly group where you talked about some of the worst things that have happened to you, to try to learn better ways to deal with it, what would that group look like?” Combining the girls’ answers with current research and interviews with Pennsylvania juvenile justice professionals, Slavik and Knapp developed and pioneered a PTSD curriculum for the Zimmerman Home.

After pilot testing the curriculum at the Zimmerman Home, several other Pennsylvania residential group homes serving adjudicated juvenile female offenders asked to join a second round of pilot testing, and offered feedback on parts of the curriculum that worked well and parts that could be improved. Based on these recommendations, some pre- and post-testing, and additional research, the 19- to 20-week program was shortened to a 15-week program to improve the likelihood that girls would complete the curriculum before release. Following this revision, the PTSD Project embarked on a wider pilot of the curriculum. Currently, a much larger evaluation study is underway to examine what specifically works, what could work better, and what makes the difference in helping girls with PTSD cope better.

PTSD Project Curriculum
The PTSD Project curriculum is designed for a group of girls to go through the program together from start to finish. Slavik carefully explains that leaving the program early (before learning the skills to deal with PTSD) can have the effect of aggravating PTSD symptoms. Therefore, assessing a participant’s ability to stay in the program until at least lesson 12 in the curriculum (at which point participants are less symptomatic and have less active nightmares and physical aggression) is a factor considered when selecting participants for the program.

The first several sessions focus on establishing safety, bonding, learning about relaxation skills and feelings, and identifying self-defeating thoughts. Beginning in the sixth week, the curriculum enters a “disclosure phase,” where the participants are asked to tell what happened to them, and how it has affected them. Slavik mentions that participants find this part of the curriculum very useful—including a “fight, flight, or freeze” lesson that looks at how animals react to trauma; a lesson that uses the metaphor of a shattered mirror to focus on trauma’s effects; and a lesson that involves drawing their bodies on paper, marking the trauma spots, covering them with band-aids, and writing what it would take to make the hurt less. Later lessons include topics such as dissociation, depersonalization, intrusive experiences, self-awareness, physical sensations, interpersonal relationships, and loss/grief following trauma.

The final lesson involves each participant creating a trauma narrative, where they explain how their trauma has transformed their view of themselves and the world, then identify realistic future goals and how to implement them. The curriculum culminates with a finishing ceremony and celebration. When asked about the most popular lesson, Slavik responds that the second lesson—on the theme of safety—is very popular. “You’ve got girls who’ve committed armed robbery making birds out of model magic and a nest to keep it safe.” While the activity is fun, it focuses on what it takes to keep the girls themselves safe and how that safety was breached.

Training on PTSD
The program also received a large grant from the Pennsylvania Commission on Crime and Delinquency in 2001. With this funding, the ARC staff began training juvenile probation officers, police, and line staff about PTSD. Slavik sees the biggest benefit from these trainings as the change in attitudes toward the girls. PTSD training has given police a better understanding about why these girls fight, and how to manage confrontation to reduce the likelihood of a violent response. PTSD awareness can also be seen in the decisions probation officers make about where the girls go. Slavik remarks that probation has done an increasingly good job of identifying PTSD behaviors and directing girls to facilities where they can receive PTSD intervention. Additionally, line staff in detention centers and group homes actively use techniques they have learned to deal more appropriately with PTSD symptoms instead of using restraint.

The impact of the PTSD training can be seen in the whole juvenile justice system. “Beyond the probation officers, the line staff, and the police officers, we’ve trained judges. They make suggestions to the probation officers about placement. I’ve had a judge ask what stage of the curriculum the girl was at, and remand her to the program so she could finish some additional lessons, saying, ‘I know when I release her, she’ll be in better shape.’” The girls themselves are also showing more awareness of PTSD and trauma before coming to facilities like the Zimmerman Home. “I’ve had girls chirp up in group and say, ‘Oh, Ms. Such-and-such in detention went over that pamphlet with me. I know what we’re going to talk about. I get that.’”

Moving forward
Slavik’s short-term goal for the PTSD Project is to continue improving the way the curriculum works and is delivered so that participants, like the 16 girls she works with, receive the best possible care. She has hopes that the upcoming evaluation effort, for which pre-testing will begin soon, will uncover more areas for improvement in the delivery of the curriculum. She also expresses interest in exploring areas outside of the curriculum itself—family intervention or education, for example—that might add even more impact to the curriculum. After more evaluation and collaborative work with other agencies, Slavik would like to implement the curriculum in more places and train more people. “Once we get the best possible intervention, whether that’s PTSD intervention or another intervention, the only thing that can work better is more of that kind of intervention.”

Francine Slavik is PTSD Project Manager and Court Liaison at the Zimmerman Home.
Jane Knapp is Consulting Psychologist at the Zimmerman Home.

For further information on the PTSD Project and other Pennsylvania juvenile justice achievements, see Pennsylvania Progress: http://www.pccd.state.pa.us/pccd/cwp/view.asp?a=1389&Q=569873&pccdPNavCtr=|33192|#33198.

For further information about ARC’s Zimmerman Home, see the ODJJP’s Guiding Principles for Best Female Programming: An Inventory of Best Practices http://www.ojjdp.ncjrs.org/pubs/principles/contents.html and the ARC Web page,
www.arcfamily.com.

 

Published June 2004