Incorporating Trauma-Informed Care into the Sequential Intercept Model

The traditional Sequential Intercept Model (SIM) presents a framework for communities to examine the cross-systems “flow” of persons with mental health and co-occurring disorders as they come into contact with the criminal justice and behavioral health systems. Entities (i.e., such as law enforcement, hospitals, courts, jails, prisons, probation/parole, and community supports) within the systems are categorized into five “intercepts” based on the predictable order in which a person would come into contact with them. The SIM Workshop brings together stakeholders in a community from each of these entities in order to develop a cross-systems map, and identify points of intervention and criminal justice diversion for the target population.

Communities across the United States have begun to take the traditional SIM and apply it to targeted areas, such as Veterans and juveniles. Ada County (Boise), Idaho has developed a Veterans Intercept Model to help criminal justice stakeholders, particularly police and first responders, to identify military Veterans, respond appropriately to de-escalate crisis situations, and link them with services and supports.  See the City of Boise Police website for more information. Communities in Virginia, Colorado, and Vermont have utilized the SIM to address juvenile justice issues.

Trauma-informed care is an area which has been receiving more and more attention, as studies have demonstrated very high rates of trauma in both women and men who are involved in the justice system. An evaluation from 2003-2010 of 34 jail diversion programs found that 96% of women and 89% of men had experienced lifetime trauma, and 74% of women and 86% of men indicated that they were experiencing current trauma. Note that the current trauma rates among women and men are very comparable.

The GAINS Center offers the training, “How Being Trauma Informed Improves Criminal Justice Responses”, which is aimed at educating criminal justice stakeholders about the high rates of trauma and its implications. This training includes modules geared towards law enforcement, courts, jails/prisons, probation, and parole –key justice entities from each of the five intercepts. The training also provides examples of how there is potential for a person to be re-traumatized within each of these points of the justice system (i.e., arrest, detainment, courts, incarceration).

A training solicitation was sent out in April 2012, and the GAINS Center delivered six SIM Workshops and 11Trauma-Informed Care trainings between June and mid September. As a GAINS Center support staff member, I have observed numerous deliveries of each workshop and training. Being familiar with the subject matter of each of these, it became clear to me how deeply the subjects were interconnected. The SIM Workshop looks at how the system addresses justice involved persons with mental health or co-occurring disorders. Well, it is widely agreed that trauma is a significant root cause of many mental health conditions, such as anxiety and depression, and in particular, post-traumatic stress. Trauma has been identified as a significant factor relating to substance use. Drugs and alcohol are often a means of self-medicating. In addition, the SIM Workshop asks communities how they are responding to Veterans involved in the justice system –a population who has experienced significant rates of trauma.

So, why not focus on trauma? What are stakeholders in the criminal justice and behavioral health systems doing to identify, divert, and address justice involved persons who have experienced trauma? Two of the GAINS Center SIM facilitators, Dan Abreu and Travis Parker, are also trainers of the “How Being Trauma Informed Improves Criminal Justice Responses” trauma training. They have captured these factors while facilitating recent SIM Workshops.

Sequential Intercept Mapping, Trauma