Betty Caponera, Ph.D. New Mexico Interpersonal Violence Data Central Repository

1. Survey of Women Inmates: A Survey of Lifetime Victimization Experiences Among Women at the New Mexico Women’s Correctional Facility, Grants, NM Betty Caponera, Ph.D. New Mexico Interpersonal Violence Data Central Repository

2. Overview • Background on the Survey of Women Inmates • Demographic and Health History Findings • Examine the differences in the rates of victimization experiences between convicted women offenders and women in the general population • Examine the family of origin household dysfunction of convicted women to women and men in the general population • Discuss implications for effective prevention and rehabilitation

3. ACE Study Adverse Childhood Experiences Study (ACE) (CDC-Kaiser Permanente, San Diego, CA) A study of the relationship between adverse childhood experiences and specific health outcomes: • Examined 10 risk factors that contribute to the leading causes of morbidity and mortality (smoking, severe obesity, physical inactivity, depressed mood, suicide attempts, alcoholism/drug abuse, parental drug abuse, a high lifetime number of sexual partners and a history of having a sexually transmitted disease) • Disease conditions among the leading causes of mortality in the US (heart disease, cancer, stroke, chronic bronchitis or emphysema, diabetes, hepatitis or jaundice, and any skeletal fractures). Citation - Felitti, V. et al. Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults: The Adverse Childhood Experiences (ACE) Study, Am J Prev Med 1998:14(4), 245-258.

4. ACE Study Questions The seven categories of adverse childhood experiences examined were: Abuse Categories: • Psychological abuse • Physical abuse • Sexual abuse Household dysfunction Categories: • Substance abuse • Mental Illness • Mother/Step-mother treated violently • Criminal behavior in the household

5. ACE Study Questions Q: While you were growing up during your first 18 years of life, did a parent or other adult in the household… Psychological a. Often or very often swear at, insult, or put you down? b. Often or very often act in a way that made you afraid that you would be physically hurt? Physical a. Often or very often push, grab, shove, or slap you? b. Often or very often hit you so hard that you had marks or were injured? Q: While you were growing up during your first 18 years of life, did an adult or person at least 5 years older ever… Sexual a. Touch or fondle you in a sexual way? b. Have you touch their body in a sexual way? c. Attempt oral, anal, or vaginal intercourse with you? d. Actually have oral, anal, or vaginal intercourse with you?

6. ACE Study Questions Q: While you were growing up during your first 18 years of life… Substance Abuse a. Did you live with anyone who was a problem drinker or alcoholic? b. Did you live with anyone who used street drugs? Mental Illness a. Was a household member depressed or mentally ill? b. Did a household member attempt suicide? Q: While you were growing up during your first 18 years of life, was your mother or stepmother Mother Treated Violently a. Sometimes, often, or very often pushed, grabbed, slapped or had something thrown at her? b. Sometimes, often, or very often kicked, bitten, hit with a fist or hit with something hard? c. Ever repeatedly hit over at least a few minutes? d. Ever threatened with, or hurt by a knife or gun? Criminal Behavior in Household a . Did a household member go to prison?

7. ACE Study Findings: • Most patients in the study who were exposed to one category of childhood abuse or household dysfunction were also exposed to at least one other category • If a person experienced any single category of exposure, the probability of exposure to any additional category ranged from 65-93% depending on the category • The more categories of exposure the greater the prevalence of many risk factors and disease conditions

8. ACE Study • Persons who experience these adverse childhood experiences adopt coping mechanisms to deal with the resulting anxiety, anger and depression from these experiences • The coping behaviors adopted of course, are those that offer immediate relief: smoking, over eating, alcohol or drug abuse, or sexual acting out

9. Research Questions Q. Do women who offend experience sexual or physical abuse at significantly greater rates than women in the general population? Q. Does polyvictimization (experience of more than one type of abuse) exist at significantly greater rates among women who offend than women in the general population? Q. Do women who offend experience significantly greater rates of “household dysfunction” (measured by a childhood living environment characterized by substance abuse, mental illness, criminal behavior, and violent treatment of a mother or stepmother) than women in the general population? Q. If exposure to childhood abuse and household dysfunction makes one at risk for offending, what are the implications for prevention and rehabilitation?

10. Survey of Women Inmates • Questions to measure adverse childhood experiences were taken from the ACE Study • Questions to measure other interpersonal violence victimization experiences, including victimizations in adulthood were taken from the National Violence Against Women Study (National Institute of Justice and Centers for Disease Control Prevention, 1998, NCJ17237) • Questions to measure criminal histories, current offenses and sentences were taken from the Survey of Inmates in State Correctional Facilities (SISCF), (Bureau of Justice Statistics, National Archive of Criminal Justice Data,ICPSR 4572, 2004)

11. Survey of Women Inmates • The survey was conducted over 10 visits to the New Mexico Women’s Correctional Facility in Grants between February 2010 and November 2010 • All incarcerated women with the exception of high risk inmates (those highly dangerous in solitary confinement or those confined for mental illness) were allowed to participate • All incarcerated women not occupied in work assignments during the morning or afternoon times of the day during which the survey was conducted, were escorted to a designated room where the survey would be conducted and asked to participate

12. Survey of Women Inmates • Participation was voluntary • Those that did not wish to participate were escorted back to their prior or preferred authorized destinations • Over the months of the survey, there was an average 513 women incarcerated at the facility. Those eligible to participate because of the absence of the aforementioned disqualifications numbered 236 • Twenty six women chose not to participate • A total of 210 women completed the survey

13. Women Inmate Demographics Median age = 36 years

14. Women Inmate Demographics *US Census, 2010 *

15. Women Inmate Demographics Most women (60%) were married once, but the proportion of those no longer married (38%) is similar to those never married (40%)

16. Women Inmate Demographics Approximately half (51% or 106) of the women did not graduate from high school. The median grade completed = 11th; approximately half (49% or 101) graduated high school or went to college or graduate school: 21% (43) graduated high school; 28% (58) went to college or graduate school.

17. Women Inmate Demographics • 92% of women inmates have children, including step or adopted children • Median/mean number of children = 3 • Median age when having their first child is 19 years old

18. Women Inmate Demographics Two thirds 134 (64%) of women inmates worked in the 12 months before their incarceration. One-third (44) of the women that worked, had multiple jobs at the same time. Of these, 37 were full-time workers.

19. Women Inmate Demographics Of 207 women respondents, 36% (74) received income from illegal sources in the month before their incarceration. Median income per month from all sources of income = $1,000

20. Health History • One-fifth (43 or 20%) reported having a physical disability (disabling injury) compared to 7% of respondents with disabling injury in the general population as reported in the SVV* • 58% (25 of 43) of those with a physical disability reported that it was the result of a violent attack • 88% (38 of 43) reported their disabling injury interfered with their normal activities * Survey of Violence Victimization in New Mexico, 2005

21. Health History • 69% (145) of the women experienced two or more weeks of depressed mood in the past year • One third (32% or 68) reported that they attempted suicide • 75% of those that attempted suicide had more than one attempt

22. Health History Mean = 3.7 times | Median = 2 times

23. Health History • 95% (200) reported that they drank alcohol; median age first time = 13 years; however most started at 12 years • 78% (155) of those that drank, did so in the 12 months before their incarceration • 33.5% (67) considered themselves an alcoholic • 20.5% (41) were told by their doctor or other practitioner that they were an alcoholic

24. Health History • 87% (183) reported having used illegal drugs; median age was 15, however most started at age 13 • 81% (148) of those that use illegal drugs did so in the 12 months before their incarceration • 96% (202) of the 210 women reported having sexual intercourse. The median age the first time they willingly engaged in intercourse is 15.5 years, however the first age for most was 14 years. • 21% (43) of the women that engage in sexual intercourse reported having 50 or more partners

25. Health History • Of the 210 women, 53% (111) reported being homeless, living in the street or a shelter at some point in their lives • 37% were homeless, living in the street or in a shelter in the 12 months prior to their incarceration • 73% (154) of women spent some time in prison, jail or other correctional facility at some point in the 12 months before their current incarceration

26. Lifetime Victimization Sexual Assault *National Violence Against Women Study

27. Lifetime Victimization Sexual Assault *National Violence Against Women Study

28. Lifetime Victimization Sexual Assault *National Violence Against Women Study

29. Lifetime Victimization Sexual Assault *National Women’s Study

30. Lifetime Victimization Sexual Assault

31. Lifetime Victimization Physical Assault *National Violence Against Women Study

32. Childhood Abuse Experiences

33. Childhood Abuse Experiences Of the 210 women inmates: • 44% (93) reported experiences of psychological and physical abuse • 38% (80) reported experiences of psychological and sexual abuse • 35% (73) reported experiences of physical and sexual abuse • 33% (69) reported all three (psychological, physical and sexual abuse)

34. Household Dysfunction

35. Polyvictimization

36. Polyvictimization • 77% women inmates compared to 30.5% ACE population experienced multiple categories of adverse childhood experiences • ACE found that those with 4 or more categories of exposure had a 4 to 12-fold increase risk for alcoholism, drug abuse, depression and suicide attempts; and a 2 to 4-fold increase for having intercourse with 50 or more sexual partners and contracting sexually transmitted diseases

37. Health Risk Factors *Only 140 women inmates (sexual assault victims) were asked this question

38. Childhood Psychological Abuse

39. Childhood Physical Abuse

40. Childhood Sexual Abuse

41. Household Substance Abuse

42. Household Mental Illness

43. Household Criminal Behavior

44. Mother’s Violent Treatment

45. Conclusions Q: Do women who offend experience sexual and physical abuse at significantly greater rates than women in the general population? • Rape victims among women inmates is 3 (3.2) times that of women in the NM general population, and 6 (5.6) times that of women nationally • Nearly twice (41%) as many women inmates that were raped experienced their rape by age 12, compared to women that reported being raped by age 12 nationally (22%) • Women inmates were twice as likely to experience multiple rapes (81%) than women nationally (39%); 51% of women inmates victims reported 4 or more rapes. • 89% of women inmates reported being a victim of physical assault at some time in their lives, compared to 52% of women nationally (NVAWS)

46. Conclusions Q: Does polyvictimization (experience of more than one type of abuse) exist at significantly greater rates among women who offend than women in the general population? • The SVV demonstrated that at some time in their life, 45% of NM women were physically attacked, 24% of women were sexually assaulted, and 21% of women were both physically attacked and sexually assaulted • The Survey of Women Inmates found that at some time in their life, 89% of women inmates were physically attacked, 70% were sexually assaulted, and 64% of women were both physically attacked and sexually assaulted • 77% of women inmates compared to 30.5% of women and men in the general population were exposed to multiple categories of adverse childhood experiences • Women inmates were six times more likely than men and women in the general population to experience 4 ≥ adverse childhood experiences

47. Conclusions Q: Do women who offend experience significantly greater rates of “household dysfunction” (measured by a childhood living environment characterized by substance abuse, mental illness, criminal behavior, and violent treatment of a mother or stepmother) than men and women in the general population? Women inmates were: • Almost 3 times more likely to grow up with someone who was a problem drinker/alcoholic • Almost 5 times more likely to grow up with someone that used street drugs • Almost 3 times more likely to grow up with someone that was depressed or mentally ill • 4.5 times more likely to have a household member attempt suicide • Almost 4 times more likely to have a mother or step-mother that was treated violently • Almost 8 times more likely to have a household member go to prison

48. Conclusions Prevalence of high risk behavior is significantly greater among women inmates than the general population • Women inmates are: • 3 times more likely to experience depressed mood in the past year • 9 times more likely to ever attempt suicide • 6 times (5.5) more likely to consider herself an alcoholic • 3 times (2.8) more likely to ever use elicit drugs • 3 times more likely to have 50 or more sexual intercourse partners • 3 times more likely to contract a sexually transmitted disease

49. Implications for Prevention Efforts National Survey of Children’s Exposure to Violence (Finkelhor, et al, 2009) • Measures exposure across several major categories, including conventional crime, child maltreatment, victimization by peers and siblings, sexual victimization, witnessing and indirect victimization (including exposure to community violence and family violence, school violence and threats, and internet victimization [sexual harassment and solicitation])

50. NaSCEV Recommendations • Those who work with children must assess for a broader range of victimizations • Give priority for polyvictims • Professionals who work with children need to pay particular attention to polyvictims because of their vulnerability to mental health, behavior, school performance and other problems • Identify these children in schools, in social welfare and mental health caseloads, in foster care and juvenile justice systems • Do not minimize their victimization histories by focusing on one type of problem (sexual abuse, or bullying, etc.) • Give particular attention to bully-victims (victims of violence who also bully others) and sexual assault victims as studies have shown the worst outcomes for these children who are more likely than others to have multiple victimizations