Can an ACE screening interview in court programs be therapeutic?

This is the second blog in our three part series on how the Adverse Childhood Experiences Study and trauma informed practice can deepen TJ practice in courts.

Therapeutic Jurisprudence Founder David Wexler writes…

There has been an explosion of important trauma-informed work relating to Adverse Childhood Experiences (ACE). Regretfully, I have played absolutely no part in that explosion, and in fact have learned almost all I currently know about ACE from a TED talk and from a wonderful journalistic account of causes and solutions to depression and related matters. The book, by Johann Hari, is entitled Lost Connections, and came to my attention on a Facebook post recommendation  by Prof David Yamada, the Chair of the Board of Trustees of the International Society for Therapeutic Jurisprudence.

I immediately bought a digital copy of the book, and when, on my Kindle, I saw it garnered blurbs from Hillary Rodham Clinton and Elton John, I was pretty much hooked. And I was constantly exposed to fascinating facts and insights.

For example, one study  examined the medical records of prisoners in a Michigan facility. By coincidence, half the cells looked out onto bare brick walls while the others overlooked rolling farmland and trees. The group facing the countryside was 24% less likely to suffer physical or mental illness. Such a finding, if produced by medication (as opposed to exposure to the soothing effect of nature), would have  likely caused quite a stir in the medical journals.

More closely related to the ACE area is a discussion in the book about serious obesity in some women. It turns out that obesity often first occurred shortly after individual girls were sexually abused or assaulted. In other words, obesity in women is often a protective factor, developing after they have been sexually assaulted; the weight gain may lead to their desired result of others paying little attention to them—so, as a treatment,  a serious weight-loss regimen alone may often prove transitory.

But the heart of the ACE material that motivated this Blog was found in  chapter 21 on “acknowledging and overcoming childhood trauma.” It is a TJ truism that we are always alert to findings in psychology, criminology, and social work that may have implications in the legal arena. This particular chapter presents some intriguing findings regarding the acknowledgment and management of childhood trauma.

The study of significance here derives from a questionnaire sent to all who received health care from Kaiser Permanente. The survey asked about ten traumatic events that can happen to a child—physical abuse, emotional abuse, sexual abuse, and more. The study matched these answers against current health.

Then, Dr. Vincent Felitti  decided to follow up in the following way:  The next time a patient/respondent came for health care of any kind, the treating doctor would check the patient’s file and responses to the older survey about childhood trauma. If the earlier survey results indicated one or more traumatic events, the treating doctor was instructed to say something like “I see you had to survive X; I’m sorry that happened; it shouldn’t have. Would you like to talk about it?”  If so, the doctor would express sympathy, would ask if it had negative long-term effects, and would inquire whether the patient thought it relevant to current health.

It turns out that many patients had never acknowledged these events before. In any case, the doctor would offer real compassion.

Here, interpretation gets a bit tricky. The patients so treated were 35% less likely, over the study’s given time-frame,  to return for medical help for any condition. Does this signify a significant reduction in their illnesses? Or might the patients not have returned because they had felt shamed by the process?

The study authors took the first position—that the compassionate interview reduced the shame and humiliation. It was likened to a secular version of confession in the Catholic Church. The researchers came to this conclusion because there were no complaints and because many later expressed their thanks for being able to recount these early painful events.  In an interview with the Lost Connections author, Dr. Felitti stated, “Now, is that all that needs to be done? No. But it’s a hell of a big step forward.”

So, where might we go from here?  In an older essay entitled Therapeutic Jurisprudence and the Culture of Critique, I was taken with the position of linguist Deborah Tannen that we are too attached to an instinctive “argument culture”, a culture that often leads us to play a “doubting game” and to trash some new ideas and studies.  Instead, Tannen urges us—at least initially—to play the “believing game”—to assume a tentative conclusion to be true, and to see where it takes us. The traditional “doubting game”, on the other hand,  can prematurely terminate a potentially promising solution.  With the “believing game”, we can always go back and reexamine our position, and perhaps then reject it. But many conclusions seem most worthy of an initial “believing game” treatment.

So too here. Imagine if a confidential , respectful, empathetic interview with a respected professional can actually, in itself, significantly reduce a person’s shame and humiliation, reducing depression, anxiety, and more.

And if it might do so, how might the law facilitate that very shame-reducing process?

There might be many ways, but one obvious one might be for some problem-solving courts—drug courts, mental health courts, domestic violence courts, veterans courts, community courts— and court support programs in mainstream courts to think through how a compassionate ACEs interview can be a standard part of an eligibility/assessment process.  A compassionate ACEs interview would involve administering the ACEs questionnaire followed by a compassionate discussion about the participant’s ACEs score and what this may mean for them and their recovery plan.

One of the best uses of a Blog, it seems to me, is to throw out some new findings, to play the “believing game”, and to see where it may lead us. In the ACE area, the notion of diagnosis as a hell of a big step forward in treatment seems a really worthwhile idea to ponder.

Read more about the ACE study in our first blog of this series and stay tuned for next weeks blog where Judge (Retired) Peggy Hora talks about trauma informed judging.

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ACES: Deepening Therapeutic Jurisprudence Practice in Courts

This blog is a first in a series of three, over the coming weeks, in which we will explore how an understanding of the impacts of childhood trauma can improve the effectiveness of judges and court programs.

Magistrate Pauline Spencer writes…

The wonderful thing about Therapeutic Jurisprudence (TJ) is that it invites us to draw from the social sciences to improve how we conduct our courts and court programs and how we carry out our judicial roles.  Because various fields of study – psychology, criminology, social work and the like – are constantly evolving so to can TJ practices.

One such field study is the Adverse Childhood Experiences Study (the ACE Study).  This study was conducted by the American organisations Kaiser Permanente and the Centers for Disease Control and Prevention. People were recruited to the study in 1995-7 and their health outcomes were tracked over time.

The study showed a clear link between childhood trauma or “adverse childhood experiences (ACEs)” and a range of health and social problems across the person’s life.

ACEs may include physical, sexual or emotional abuse, exposure to family violence, neglect, household substance abuse and/or mental illness, imprisonment of a parent and the like.

The impacts of ACEs include:

  • social, emotional and cognitive impairment
  • adoption of health risk behaviours
  • disease, disability and social problems; and
  • early death

The ACE Study produced an ACEs questionnaire from which an ACEs score can be obtained.  The higher the score the higher the probability of certain impacts.  For example people with an ACE score of 4 are twice as likely to be smokers and seven times more likely to be alcoholic and have a 400 percent risk of emphysema or chronic bronchitis and attempted suicide by 1200 percent.  People with an ACE score of 6 or higher are at risk of their lifespan being shortened by 20 years.

It is important to note that these impacts are risks rather than certainties.  Positive interventions and/or other positive life circumstances can help build the resilience to make outcomes less probable in a person’s life.   This helps us to understand why some people who have experienced the same types of childhood traumas do better than others and reinforces the need for courts to ensure that we are providing links to appropriate interventions.

In my work as a magistrate with people with addictions I do not find these findings surprising, it is sadly all too common to hear about people’s traumatic childhoods as their story unfolds in court.   A better understanding of the ACEs study however has prompted me to think about how the study and trauma informed practice may improve the effectiveness of my judicial role.  Over the next two blogs, two great TJ thinkers, Professor David Wexler and Judge (Ret) Peggy Hora will explore how ACEs can deepen our TJ practice.

Learn more about the ACE Study….

TED Talk: How childhood trauma affects health across a lifetime.

NPR Article: Take the ACEs quiz

Centers for Disease Control and Prevention, ACE Study Website

BlueKnot Foundation – Different types of trauma and their impacts

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Therapeutic Jurisprudence: A Response to Denial of Human Dignity in Public Policy


Guest blogger Professor David Yamada writes…

Here in the U.S., I sometimes struggle over how to reconcile my everyday work with the ongoing existential threat that we face in our public sphere, generating from Washington D.C. How can my little niche of the world matter when every day brings multiple ghastly, distressing headlines (or tweets)?

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Prison/Court Video Links: Tips for Judges (TJ Court Craft Series #13)

Magistrate Pauline Spencer (Victoria, Australia) writes….

With the emergence of technology and pressures on prison/court transportation, the use of video links between prisons and courts are becoming more commonplace.

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Advancing Rights of Nature through Restorative Justice

TJ is a lens that can be applied to any area of the law, this week Guest Blogger Femke Wijdekop continues our exploration of environmental law…

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Environmental Psychology & Therapeutic Jurisprudence: Rethinking Environmental Courts and Tribunals

The legal philosophy of therapeutic jurisprudence – how the law and legal processes can innovate to improve the wellbeing of people and communities – is a interdisciplinary approach that can be applied in all areas of the law.    Over the coming two weeks,  we will explore how TJ thinking can be used to improve environmental law…

Guest blogger Nabeela Siddiqui focuses her TJ lens on Environmental Courts and Tribunals drawing on the social science of Environmental Psychology…

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A therapeutic Jurisprudence response to viral online games such as #Bluewhale and #KIKI challenge

In recent years social media has led to the viral spread of various games or challenges. Some such as the ALS Ice Bucket Challenge – where participants dumped a bucket of ice cold water over their heads – have been positive awareness raising activities for charity. Others such as #BlueWhale – where participants engaged in self harm and even suicide – have been dangerous.

The most recent craze,the #kikichallenge – where participants jump out of a moving car and dance to the Drake song “In My Feeling” – has led to deaths.

Guest blogger Dr.Debarati Halder explores the Indian legal response to these social media phenomena and the potential role of therapeutic jurisprudence…

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