Voices:A Program of Self-Discovery and Empowerment for Girls Curriculum written by Stephanie S. Covington, Ph.D., LCSW Training provided by Carol Ackley, LADC Definition of Gender-Responsiveness Creating an environment through site selection, staff selection, program development, content, and material that reflects an understanding of the realities of women’s and girls’lives, and is responsive to their strengths and challenges. (Covington & Bloom) Gender-Responsive: Guiding Principles ..Gender ..Environment ..Relationships ..Services ..Economic & Social Status ..Community Guiding Principles ..Gender:Acknowledge that gender makes a difference. ..Environment:Create an environment based on safety, respect, and dignity. Guiding Principles (cont.) ..Relationships:Develop policies, practices, and programs that are relational and promote healthy connections to children, family, significant others, and the community. ..Services:Address substance abuse, trauma, and mental health issues through comprehensive, integrated, and culturally relevant services. Guiding Principles (cont.) ..Socioeconomic status:Provide girls/women with opportunities to improve their socio- economic conditions. ..Community:Establish a system of comprehensive and collaborative community services. (Bloom, Owen, Covington 2003) Therapeutic Environment ..Attachment:a culture of belonging ..Containment:a culture of safety ..Communication:a culture of openness ..Involvement:a culture of participation and citizenship ..Agency:a culture of empowerment (Haigh) Sanctuary Card 27 Definition of Sanctuary •Sacred place •Place of refuge/protection •Shelter Qualities of a Facilitator The following qualities in a facilitator will help to ensure a positive group experience: ..Trustworthiness ..Reliability, consistency ..Warmth, compassion ..Emotionally mature Qualities of a Facilitator(cont.) ..Healthy boundaries, respect for confidentiality ..Committed to and interested in the girls’issues ..Multi-cultural sensitivity and responsiveness Qualities of a Facilitator(cont.) ..Appropriate gender (a female should facilitate the all-female groups) ..Content expertise, if possible ..Facilitation Skills Qualities of a Facilitator(cont.) ..BE PREPARED! Four Key Elements in the Voices Group Process 1.Understanding more about their experiences as girls–their similarities to and differences from others in the group 2.Exploring how the influences in their lives (e.g., gender, families, substance abuse, interpersonal violence and various forms of oppression) have impacted them Four Key Elements in the Voices Group Process (cont.) 3.Learning skills and coping mechanisms to help them both now and in the future 4.Feeling safe and learning that this is a safe place to share their voices Text Box: Voices What about the Girls? Reality of Girls’Lives ..Socialization and identity ..Culture and class ..Sexuality ..Violence and aggression ..Expressions of risk Socialization and Identity ..Girls stop “being”and start “seeming”. ..Girls develop identity in their connections with others. Culture and Class ..Ethnicity and socioeconomic status have a significant impact on girls’ strengths and challenges. Sexuality ..50% 9-12thgraders have had intercourse. (Centers for Disease Control, 2002) ..74% of young women who had intercourse before age 14 and 60% before age 15 reported it was involuntary. (Planned Parenthood Federation of America, 2001) Sexuality (cont.) ..24.5% of sexually active 9thgrade girls use alcohol/drugs with intercourse. (Center for Disease Control, 2002) ..4 out of every 10 young women are pregnant before age 20. (The National Campaign to Prevent Teen Pregnancy, 2001) ..Teenage sex often means girls servicing boys. (Denizet-Lewis, 2004) Sexually Transmitted Infections (STIs) STIs may result from the sexual transmission of bacterial or viral agents such as: Chlamydia trachomatis(Chlamydia) Neisseria gonorrhoeae(Gonorrhea) Treponema pallidum(Syphilis) Trichomonas vaginalis(Trichomonas) Human ImmunodeficiencyVirus(HIV) Text Box: Highest rates among adolescents and young adults (34% of infections are 10-19 year olds [CDC, 2004]). Higher rates in youth involved juvenile justice systems 70% of infections do not have symptoms Major cause of reproductive health consequenc Among Young Attendees at STD Clinics, Substance Abusers Report more Risky Behavior28.8% 48.8% 6.1% 14.4% 26.70% 35.00% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% No SUDWith SUDAlways UsedCondomsMutiple SexPartnersSTD DiagnosedPercentage of PatientsSource: Cook R.L., et al. Alcohol and drug use related disorders: An underrecognized health issue among adolescents and young adults attending sexually transmitted disease clinics. Sexually Transmitted Diseases33(9): 565-570, 2006. Patients aged 15 to 24 of a public sexually transmitted disease clinic who had a substance use disorder (SUD) were two to three times likely as those without an SUD to report multiple sex partners and inconsistent condom use during the past year. Overall, 43 percent of the 448 patients who participated in the Pittsburgh, clinic study had an alcohol or marijuana use disorder, and these young people also were 70 % more likely to be diagnosed with a sexually transmitted disease during their visit. Violence & Aggression ..Violent crime doubled from 1988 –1994. (Mahan, 2003) ..Girl initiated violence increased 118% since 1987.(Brown, 2002) ..Girl fighting –horizontal hostility (Brown, 2002) Expressions of Risk ..Depression ..Substance abuse ..Relationship violence ..Eating disorders ..Teen mothers ..Girls in juvenile justice settings Girls’Mental Health Needs ..Girls who are coping with such serious issues as sexual abuse, substance abuse, family dysfunction and/or academic failure may experience depression, eating disorders, and other mental health concerns. ..More than half of young women in training schools have reported attempting suicide; of those, 64% have tried more than once to kill themselves. Substance Abuse Girls use alcohol and other drugs to: ..Improve mood ..Reduce tension ..Increase confidence ..Lose inhibitions ..Exchange sex ..Lose weight ..Start drinking before age 1447% alcohol dependent ..Start drinking after age 219% alcohol dependent (n=43,000) (Source: Archives of Pediatrics & Adolescent Medicine, July 2006) Text Box: Adolescence & Alcohol ..Disrupts parts of the brain essential for self-control, motivation and goal-setting ..More severe damage in adolescent brain than adult brain (University of North Carolina; Duke; UCSD) Text Box: Alcohol & Adolescent Brain Text Box: Alcohol & Adolescent Brain (cont.) Relationship Violence ..Girls risk three times greater than boys. (Banister & Screiber, 2001) ..Homicide (by someone they know) is a leading cause of girls’death. (Anderson, 2002) ..1 in 5 girls abused by dating partner. (Patton & Morgan, 2002) Sexual Assault Graph Bureau of Justice Statistics, 2000 Sexual Assault Graph Bureau of Justice Statistics, 2000 Female Delinquents and Sexual Abuse ..Among female delinquents, an estimated 70% have a history of sex abuse. ..In some detention facilities, the incidence of girls who have been abused is closer to 90%. ..Most often, abuse is perpetrated by family members or close family friends who are perceived as trusted adults. Effects of Abuse on Girls Sexual abuse can have a profound impact on a girl during adolescence: ..lessened self-esteem ..inability to trust ..academic failure ..eating disorders ..self-harm ..teen pregnancy ..running away ..substance abuse ..defensive & reactive violence Eating Disorders 7 million women ..43% onset 16 –20 ..33% onset 11 –15 ..10% onset 10 and under (National Association of Anorexia Nervosa and Associated Disorders, 2004) Girls in Juvenile Justice Settings ..Histories of victimization ..Unstable family lives ..School failure ..Repeated status offenses ..Mental health problems ..Substance abuse ..1.4 M adolescents incarcerated in 2004 (USDOJ, 2004) ..Engage in high-risk behaviors Substance use: 75% drug of alcohol (Belenko & Logan, 2003) Early sexual initiation (Teplin et al., 2003) Multiple partners (Teplin et. Al, 2003) Unprotected sex (Canterbury et al., 1995) ..Substance use associated with higher STI risk (Cook, 2006) ..Limited access to health care, STI education/prevention (Forrest et al., 2000) Text Box: A High-Risk Population Girls and Juvenile Justice ..Between 1980 and 2000, the juvenile arrest rate for girls increased 35%. (Snyder, 2002) ..In 2000, girls accounted for 28% of all juvenile arrests compared with 19% in 1990. (Maniglia, 1998; Snyder, 2002) ..From 1991 to 2000, the juvenile arrest rate for aggravated assault increased by 44% for girls and declined 16% for boys. (Snyder, 2002). Girls and Juvenile Justice (cont.) ..Approximately 78% of arrests of girls for crime index offences are not for violence, but for larceny-theft, or shoplifting. (FBI, 2000). ..Girls account for 59% of arrests for running away and 55% of arrests for prostitution. (Snyder, 2002) ..Between 1988 and 1997, the use of detention for girls increased 65% as compared with a 30% increase for boys. Poor Academic Performance ..One significant risk factor relating to early onset of delinquency is poor academic performance. ..By the time girls enter the system, they may be at least a grade level behind their peers. ..Girls may have developed a negative attitude about learning and lack self- confidence about their own ability to master academic skills. Risk & Protective Factors Risk Factors ..History of sexual abuse ..Academic failure ..Substance abuse ..Low self-esteem ..Fragmented family ..Lack of trusting adult ..Racism ..Sexism ..Negative peer group ..Lack of safe, nurturing environment Protective Factors ..Positive sexual development ..Academic success/progress ..Positive self-esteem ..Positive, nurturing family ..Positive cultural and gender identity ..Positive peer group ..Positive relationship with caring adult ..Safe, nurturing environment Protective Factors Easier to Changethan Risk Factors 131710805101520ProtectiveRiskIntakeExit (SANDAG, 2004) Why Develop Gender-Responsive Programs? ..Girls travel a different path to problems than most of their male counterparts. ..After years of struggling to squeeze girls into programs designed for boys, some agencies that work with girls are seeking approaches that are gender-specific. Gender-Responsive Programs ..This does not mean giving girls the same programs as boys, or simply isolating juvenile offenders according to gender. ..Instead, the most effective programs are rooted in the experience of girls and incorporate an understanding of female development. How do We Develop Services for Girls? Definition of Gender-Responsiveness Creating an environment through site selection, staff selection, program development, content, and material that reflects an understanding of the realities of women’s and girls’lives, and is responsive to their strengths and challenges. (Covington & Bloom) Creating Programs for Girls Gender-Responsive Elements ..Celebrates Strengths ..Safety is Key ..Female Mentors and Role Models ..Develop and Support Leadership Skills ..Empower Girls –Force for Social Change ..Media Literacy ..Physical, Sexual and Mental Health Information ..Cultural Connections ..Solidarity between Girls and Women Theoretical Framework The theories related to gender and substance abuse (and any other relevant treatment services) that create the framework of thought for program development. This is the knowledge base that creates the foundation upon which the program is developed. Text Box: Treatment Strategies Concepts of Successful Interventions Strength-based approach: Working from a positive perspective, building on girls’personal and cultural strengths and providing opportunities for girls to be successful. Addressing the “Whole Girl” Domains: ..Physical ..Sexual ..Relationships ..Emotional ..Intellectual ..Spiritual Voices:A Program of Self-Discovery and Empowerment for Girls Theoretical Foundation ..Psychological development ..Attachment ..Resilience ..Addiction ..Trauma Psychological Development Relational Theory ..Gilligan ..Stone Center ..Brown Growth Fostering Relationships ..Increased zest and vitality ..Empowerment to act ..Knowledge of self and others ..Sense of self-worth ..Desire for more connections Alone and Lonely •Girls are alone more than 20% of awake time •Less than 10% of time outside school with friends-happiest then •12th graders have 50% more alone time than 6th graders •Many girls alone over 6 hrs a day •Too much solitude=poor outcomes (Source: M. Strauss, All the Rage) Attachment Theory ..Bowlby ..Harlow ..Winnecott ..Stern ..Ainsworth Types of Attachment ..Secure ..Avoidant ..Ambivalent (or anxious-avoidant) Resilience ..Close relationship with one adult ..High expectations from significant people ..Positive role models and community involvement AddictionTransformationAddiction(constriction) Recovery(expansion) Definition of Trauma The diagnostic manual used by mental health providers (DSM IV-TR) defines trauma as, “involving direct personal experience of an event that involves actual or threatened death or serious injury, or other threat to one’s physical integrity; or a threat to the physical integrity of another person; or learning about unexpected or violent death, serious harm, or threat of death or injury experienced by a family member or other close associate.” “The person’s response to the event must involve intense fear, helplessness or horror (or in children, the response must involve disorganized or agitated behavior).” Trauma Sexual abuse Physical abuse Emotional abuse Domestic violence Witnessing abuse/violence Self-inflicted violence Trauma (cont.) Stigmatization Girls in juvenile justice system Girls of color Poor girls Lesbian, transgendered, bisexual Girls with mental illness PTSD ..Nightmares; Flashbacks ..Estrangement ..Numbing of General Responsiveness ..Insomnia ..Exaggerated Startle Response ..Hypervigilance (DSM-IVTR) Co-occurring Disorders There is a high level of co-morbidity between post- traumatic stress disorder and: Depression Anxiety Panic disorder Phobic disorder Substance abuse Physical disorders Source: “Gender-Responsive Strategies: Research, Practice and Guiding Principles for Women Offenders Project: Covington & Bloom (2001) Trauma Services Trauma-informed These are services that are provided for problems other than trauma but require knowledge about violence against girls and women and the impact of trauma; thereby increasing their effectiveness. Ten Principles of Trauma-Informed Services Principle 1. Trauma-Informed Services Recognize the Impact of Violence and Victimization on Development and Coping Strategies Ten Principles of Trauma-Informed Services(cont.) Principle 2. Trauma-Informed Services Identify Recovery from Trauma as a Primary Goal Ten Principles of Trauma-Informed Services (cont.) Principle 3. Trauma-Informed Services Employ an Empowerment Model Ten Principles of Trauma-Informed Services(cont.) Principle 4. Trauma-Informed Services Strive to Maximize a Woman’s/Girl’s Choices and Control Over Her Recovery Ten Principles of Trauma-Informed Services(cont.) Principle 5. Trauma-Informed Services Are Based in a Relational Collaboration Ten Principles of Trauma-Informed Services (cont.) Principle 6. Trauma-Informed Services Create an Atmosphere That Is Respectful of Survivor’s Need for Safety, Respect, and Acceptance Ten Principles of Trauma-Informed Services (cont.) Principle 7. Trauma-Informed Services Emphasize Women’s/Girls’Strengths, Highlighting Adaptation Over Symptoms and Resilience Over Pathology Ten Principles of Trauma-Informed Services (cont.) Principle 8. The Goal of Trauma-Informed Services Is to Minimize the Possibilities of Retraumatization Ten Principles of Trauma-Informed Services (cont.) Principle 9. Trauma-Informed Services Strive to Be Culturally Competent and to Understand Each Woman/Girl in the Context of Her Life Experiences and Cultural Background Ten Principles of Trauma-Informed Services(cont.) Principle 10. Trauma-Informed Agencies Solicit Consumer Input and Invoice Consumers in Designing and Evaluating Services Elliot, D.E.; Bjelajac, P.; Fallot, R.D.; Markoff, L.S.; Reed, B.G. Trauma-Informed or Trauma-Denied: Principles and Implementation of Trauma-Informed Services for Women. Journal of Community Psychology, July, 2005., 33(4): 461-477. Text Box: ACE Study (Adverse Childhood Experiences) ACE Study (Adverse Childhood Experiences) Results ACEs still have a profound effect 50 years later, although now transformed from psychosocial experience into organic disease, social malfunction, and mental illness. –Smoking –Alcoholism –Injection of illegal drugs –Obesity (Felitti, V.J.: Origins of Addictive Behavior: Evidence from theACE Study. 2003 Oct:52(8): 547-59. German. PMID: 14619682 (PubMed-indexed for MEDLINE). Childhood Traumatic Events Largest Effect-Mental Health •Psychotropic medication •Mental health treatment •Attempted suicide •Traumatic stress (Messina & Grella, 2005) Childhood Traumatic Events Largest Effect-Mental Health •980% increase in odds if exposure to 7 CTE’s(Messina & Grella, 2005) Process of Trauma TRAUMATIC EVENT Overwhelms the Physical & Psychological Systems Intense Fear, Helplessness or Horror CURRENT STRESS Reminders of Trauma, Life Events, Lifestyle PAINFUL EMOTIONAL STATE RETREAT SELF-DESTRUCTIVE ACTION DESTRUCTIVE ACTION ISOLATION DISSOCIATION DEPRESSION ANXIETY SUBSTANCE ABUSE EATING DISORDER DELIBERATE SELF-HARM SUICIDAL ACTIONS AGGRESSION VIOLENCE RAGES SENSITIZED NERVOUS SYSTEMCHANGES IN BRAINRESPONSE TO TRAUMAFight or Flight, Freeze, Altered State of Consciousness, Body Sensations, Numbing, Hyper-vigilance, Hyper-arousal Self-Harm Interventions ..Validate reality ..Understand cycle (CBT frame) ..Know when she doesn’t self-harm ..Harm reduction Try other things first (writing) ..Therapy for feelings andthoughts ..Teach new methods of coping: finding words and someone to hear them (Source: Tracy Alderman, Scarred Souls) Text Box: Voices Each Session Contains the Following Components: Opening:Helping girls check-in/become present Teaching:Key topic is presented Interactive:Discussion of issues, questions, etc. Experiential:Exercises to try out new skills and learning Closure:Focus questions to facilitate reflection Text Box: Module A: Self Module A:Self Session 1Who am I? Session 2My Life Story Session 3Breaking the Silence Session 4The World Girls Live In Session 5Support and Inspiration (27 activities) Who am I? Describing myself ..A feeling ..A belief ..A quality Examples of Feelings ..Bitter ..Furious ..Depressed ..Ashamed ..Embarrassed Text Box: Joyful Sad Angry Happy Afraid Examples of Beliefs ..I believe in myself ..I believe it’s okay to be a virgin ..I believe in equality ..I believe youare what you eat ..I believe that life is tough ..I believe in practicing safer sex ..I believe that I can trust my friends ..I believe that I am fun, clean and sober ..I believe that I can use my voice ..I believe I am a good listener ..I believe that I have rights ..I believe that I can meet my goals Examples of Qualities ..I am strong ..I am a good friend ..I don’t trust people easily ..I am curious about things ..I am smart ..I am a loner ..I am sexy ..I do well in school ..I am honest ..I am caring ..I am funny ..I am a good artist Feeling Okay Chart Five Senses Activity 5 things you can see 4 things you can touch 3 things you can hear 2 things you can smell 1 thing you can taste My Life’s Journey Tree of Self Esteem Esteemable Acts One way to improve your self-esteem is to do things that make you feel good about yourself. What three things can you do? 1. ___________________________________ 2. ___________________________________ 3. ___________________________________ (Source: F. Ward) Me: Inside and Out Got Power? Media Messages Key points to convey: ..Media messages are everywhere (e.g., in music, television, movies and advertising). ..Media messages give limited and unrealistic portraits of women and girls. ..Media messages tell us that alcohol and cigarettes can make us sexier, attractive, desirable and fun. Media messages do not show us the negative consequences of substance use and abuse (e.g., getting sick, being addicted). ..Media messages can make us feel bad about who we are. Break the Chain! What I have Learned from Her What I have Learned from Her Name:_____________________________ She has inspired me by:_______________ __________________________________ __________________________________ Text Box: Module B: Connecting with Others Module B:Connecting with Others Session 6Communication Session 7My Family Session 8Mothers and Daughters Session 9Friendship Session 10Dating and Sexuality Session 11Supportive Relationships Session 12Abuse Relationships (36 activities) Communication is: An exchange of ideas; an expression of oneself in such a way that one is clearly understood; a connection, one with another. Communication (cont.) ..Passive communication ..Aggressive ..Passive-aggressive ..Assertive My Family Key__Strong--------Weak--------Broken/no connectionConfusingAngryMe Healthy Families Mom and Me Key Points: ..Mother-daughter relationships are complex and powerful. ..Our mothers influence how we see ourselves as young women. ..Mothers are more than simply their roles. It can be interesting and enriching to get to know our mothers as complete persons. Friendship Key Points: ..It is important to think critically about why girls can be mean to one another. ..Girls’relationships with one another are very important parts of their lives. ..Collaborating with and supporting one another counteracts negative stereotypes of females and creates powerful, collective opportunities for change in girls’lives. Is it Love? ..Infatuation:Intense feeling of attraction to, admiration for or fascination with another person that may not be based on realistic facts or a true understanding of or connection with the person. Often does not involve seeing the person realistically. Can feel “high”and exciting. ..Sexual attraction:A desire or longing to be involved with someone physically and sexually. ..Love:A deep, tender feeling of affection and care toward another person. Can involve sexual attraction or intimacy but is much broader in that it also involves a sense of oneness, understanding, trust, respect and care. Love is also a behavior. Shades of Sexuality ..Gender ..Gender identity ..Sexual orientation ..Straight ..Gay/lesbian ..Bisexual Sexual Bill of Rights Text Box: My Sexual Bill of RightsI have the right to…. Connecting with Others A Map of My Relationships What is Abuse? ..Emotional ..Physical ..Sexual Effects of Abuse Key Points: ..Abuse can have a long-term impact on the victim. ..A girl’s reaction to abuse can take many forms. ..You are not alone if you are the victim of abuse. ..There are things you can do to heal from abuse. ..There are people and organizations that work very hard to end abuse. Power and Control Wheel Text Box: Module C: Healthy Living Module C:Healthy Living Session 13Our Bodies Session 14Emotional Wellness Session 15Alcohol and Other Drugs Session 16Spirituality (24 activities) My Body Image Five Steps to Emotional Wellness 1.Tune in to feelings. 2.Name the feeling. 3.Locate the feeling in your body. 4.Express the feeling. 5.Practice containment –which means holding your feelings in order to share and process them in a safe place with a trusted person. Containing vs. Stuffing 1.Slow down or stop what you’re doing. 2.Identify what you’re feeling. 3.Name the feeling. 4.Notice where you feel it in your body. 5.Evaluate whether the intensity of the feeling matches the situation. 6.Consider what other factors may be contributing to your intense feeling. Anger and Me Key Points: ..Young women are encouraged/socialized to be nice. ..When girls don’t feel that they can express anger, they are unable to be their true, authentic selves. ..It is important to learn how to express anger. ..Anger is a healthy reaction to injustice, racism and poverty. Assessing Anger ..Who else is she angry at? ..How is her behavior effective? ..How has she attempted to express it in the past? ..What was the response? ..When did she start? Is it same? ..What is happening to make her mad? (Source: M. Strauss, All the Rage) Assessing Anger ..What else is she feeling? ..What would she like to have happen? ..What IS going to happen? ..How effective is the communication? ..Will she need to escalate, suffer more to get what she needs? (Source: M. Strauss, All the Rage) Weighing it Out Understanding Addiction ..Biological ..Psychological ..Environmental Spirituality Includes but not limited to: ..Quiet time ..Prayer ..Meditation ..Centering activities, such as singing or listening to music ..Being out in nature ..Creating personal altars (a collection of personal items that mean a lot to you) Spirituality (cont.) ..Attending church, synagogue, mosque, temple or another spiritual meeting place ..Keeping a journal ..Helping others in need ..Learning from others ..Celebrations ..Wise woman ..Cultural rituals ..Appreciation and gratitude Text Box: Module D: Journey Ahead Module D:Journey Ahead Session 17Crossroads Session 18Packing for My Journey (9 activities) Crossroads My Crossroads How might choosing this path affect you in the short-term? How might choosing this path affect you in the long term? How might choosing this path affect you in the short-term? How might choosing this path affect you in the long term? Making Good Decisions for Me My Group Experience OObjective RReflective IInterpretive DDecisive Sisterhood and Support For More Information •Stephanie S Covington, Ph.D, LCSW Email: SC@stephaniecovington.com Websites: www.stephaniecovington.com www.centerforgenderandjustice.org •Carol Ackley, LADC Email: Ackley@riverridgetreatmentcenter.com