the vast majority of women in prison have experienced some sort of interpersonal or sexual violence in their lives , with estimates as high as 90% ( commonwealth of ma , 2005 ; women in prison project , 2006 ) . yet , ironically , women , especially those who were homeless , drug addicted or living with dangerous partners prior to incarceration , are statistically safer from victimization in prison than they were prior to incarceration . for example , the estimated prevalence of sexual assault in us prisons , based on the most recent bureau of justice statistics inmate survey , is about 4.4% ( beck & harrison , 2010 ) . yet , for women on college campuses , the estimated prevalence of sexual assault is from 20 to 25% ( bureau of justice statistics , 2009 ; youth violence and suicide prevention , 2004 ) . studies have also shown that incarcerated women with posttraumatic stress disorder ( ptsd ) report a much higher rate of witnessing violence than the female population in general and that many of them designate such witnessing as their most serious trauma ( hackett , 2009 ; hodes , 2006 ) . some women express a feeling of safety and relief during intake at women 's prisons ( loper , 2002 ) . escaping homelessness , sex work , violent partners , dealers , and pimps may also contribute to a new awareness of the level of danger with which they have lived ( blackburn , mullings & marquart , 2008 ) . perhaps that small moment of relief upon entry provides the requisite psychic safety that allows these women to begin to identify their trauma symptoms and triggers . theories of women 's pathways to criminal behavior include the  harmed and harming  woman , who has been seriously sexually abused and neglected , and is at high risk for anger and hostility , which is associated with increased rates of institutional difficulty and recidivism ( brennen , 2007 ) . hurt people hurt people ,  which speaks to the repetitive nature of the trauma experience and how it is transmitted to others ( bloom & farragher , 2011 ) . a history of sexual abuse is recognized as a risk factor for crime in both males and females . in general , people who have been sexually abused are more likely to be arrested ( hubbard , 2002 ) , and to experience future trauma ( council of state governments , 2005 ; najavits , 1997 ) . for women offenders , sexual violence , defined as the combined prevalence of adult and child sexual abuse and assault , is by far the most commonly reported type traumatic experience , followed by intimate partner violence ( battle , zlotnick , najavits , gutierrez , & winsor , 2002 ; zlotnick , 1997 ; zlotnick , najavits , rohsenow & johnson , 2003 ) . for incarcerated women , rates of sexual victimization across the lifespan are highest in childhood ( blackburn et al . , 2008 ; clements - nolle , wolden & bargmann - losche , 2009 ; raj et al . , 2008 ) . research suggests histories of sexual abuse interfere with female inmates ability to benefit from programs , perhaps in part , due to the disorientation and disconnection that trauma creates ( saakvitne , 2000 ) . if the offender has limited coping skills and can not control her dissociative symptoms in the face of multiple triggers , it interferes with her engagement in cognitive - behavioral therapy ( cbt ) interventions ( hubbard , 2002 , van voohris , 1997 ) . therefore , the principles of trauma- informed care , along with interventions aimed at trauma stabilization , are a priority for women offenders . this theory is supported by research on women 's risk classification and security levels , which has shown that a history of childhood physical and/or sexual abuse is associated with increased institutional difficulty ( gilfus , 2002 ; van voorhis , salisbury , wright & bauman , 2008 ) . in studies of male prisoners , the most commonly reported trauma is witnessing someone being killed or seriously injured ( sarchiapone , carlia , cuomoa , marchettia & roy , 2008 ) , followed by physical assault ( johnson et al . , 2006 ) , and childhood sexual abuse ( weeks & widom , 1998 ) . overall , higher rates of trauma and earlier age of trauma onset is associated with increased violence and victimization in prison ( komarovskaya , 2009 ) . studies of male veterans in prison ( saxon et al . , 2005 ) , inmates in rural prisons and jails ( powell , holt & fondacaro , 1998 ) , and men in substance abuse treatment have repeatedly shown high rates of physical and/or sexual abuse histories and ptsd . for example , an estimated 38% of men in substance abuse treatment have ptsd ( najavits , 2006 ) . studies of childhood sexual abuse among male inmates vary , but most suggest a much higher rate of childhood sexual abuse than in the general male population ( bureau of justice statistics , 1999 ; johnson et al . , 2006 ; fondacaro et al . , 1999 ; weeks & widom , 1997 ) . however , unlike women , men are rarely safer behind prison walls than prior to incarceration . their risk of sexual assault increases exponentially when they enter a prison , ( national prea commission , 2009 ; testimony of hennessey , 2005 ) compared to the risk for males in the general population . they face an increased threat of lethal violence in male facilities that may trigger more externalizing trauma responses ( i.e. , outward - directed aggression ) and high levels of arousal that can endanger staff and inmates ( freedman & hemenway , 2005 ) . limits on confidentiality include knowledge of escape plans , contraband or knowledge of the introduction of contraband , and knowledge of intent to commit a crime , in addition to the limits that apply to all clients ( bartol & bartol , 2008 ) . inmates may not trust clinical staff with disclosure of their trauma histories ( grella & greenwell , 2007 ) . they may also consider any disclosure of trauma that was perpetrated by intimate partners or family members as  ratting them out  to the authorities , a violation of social codes both in and outside of prison . both males and female may under - report sexual violence and symptoms of sexual trauma , even to researchers , either because they do not consider them to be out of the ordinary ( moses , reed , mazelis & glover , 2003 ) , or because of guilt and self - blame , or , especially for males , a sense of shame and fears about their sexual identity . male and female inmates also learn not to report troubling psychiatric symptoms and to manage them on their own as a way to maintain a greater degree of autonomy during institutional stays and limiting vulnerability . this is especially true for male inmates with histories of past victimization , who have been shown to be at a significantly greater risk for prison sexual assault than men without such a history ( beck & harrison , 2010 ; national institute of corrections , 2007 ; testimony of hennessey , 2005 ) . inmates with any type of traumatic history may have symptoms of ptsd that increase difficulties within correctional institutions , both for the inmate , other inmates , and for staff responsible for their supervision ( saxon et al . , 2001 ) . by taking a trauma - informed approach , correctional staff gain the opportunities to minimize such concentric harm and to reduce mental health and security costs for institutions ( bloom , 2003 ) . good correctional practice requires environments that are highly structured and safe , with predictable and consistent limits , incentives and boundaries , as well as swift and certain consequences such that inmates are treated fairly and equally ( council of state governments , 2010 ) . these same practices can provide the type of stability trauma survivors need to learn new information and skills that promote trauma recovery . vicarious trauma ( a sense of identification with trauma that may result in staff experiencing trauma - type symptoms ) can affect workplace decision making . boundaries may erode and cynicism and hopelessness can increase ( headington institute , 2010 ) . in the absence of effective trauma - informed tools , prison systems may develop  institutional trauma ,  becoming highly reactive and reliant on  management - by - crisis . the more the system responds with authoritative measures , the more deeply the dynamics are repeated and reinforced . staff may have experienced direct exposure to trauma from witnessing prison violence , on the job injuries , during prior military service or in their personal lives . they may have learned to function at the workplace in a state of constant hyper - vigilance or in numb detachment . they also have important security concerns that may trump the need to focus on trauma , making organizational and cultural change exceedingly slow . for example , there is empirical evidence that criminal sanctions and authoritative and punitive measures , without treatment , are the least effective means of reducing future criminal behavior ( andrews et al . , are more likely to be a successful means of reducing recidivism than surveillance and enforcement ( gendreau , goggin , cullen & andrews , 2000 ; latessa , cullen & gendreau , 2002 ) . yet security staff may be reluctant to reduce the use of sanctions and surveillance when they perceive these as critical enforcement tools . trauma - informed principles such as increasing empathy , compassionate care , grounding , and de - escalation may be perceived as  weak ,   pandering ,  or ineffective  and risky , even though , ironically , they may be more likely to help to create security and a stable environment . even experienced staff who have developed good capacities to respond well to traumatized inmates typically lack formal training , and may be subject to countertransference ( emotional reactivity ) and burn out . combined with the challenge of managing a system that is perpetually under - resourced , the result is staff who may feel as overwhelmed as the inmates in their care . correctional staff training is starting to include more information about trauma and techniques to respond to effectively to trauma symptoms . it can be helpful to give security staff information on the nature of the clinical services available , the trauma recovery approach and the structure and goals of trauma - specific interventions ( mccown , 2006 ) . when clinical and non - clinical staff members understand their common goals , most offender interactions can focus on safety , supporting good coping skills and reinforcing treatment gains . it is also key to recognize gender differences in how much attention is given to trauma ( gilfus , 2002 ; covington , 2008 ) . trauma is far more likely to be addressed in female than in male inmates . in male facilities females and traumamales and traumatypical trauma : childhood sexual abusetypical trauma : witnessing violencemore likely to develop ptsd when exposed to violencemore likely to be exposed to violence , but less likely to develop ptsdrepeated exposure to sexual and violent victimization from intimates beginning in childhoodexposure to violence from strangers and adversaries ; sexual abuse and coercion outside familyinternalizing : self - harm , eating disorders , addiction , avoidanceexternalizing : violence , substance abuse , crime and hyper - arousallikely to get mental health treatment rather than substance abuse treatmentlikely to get substance abuse treatment rather than mental health treatmenttreatment needs to emphasize empowerment , emotion regulation and safetytreatment needs to emphasize feelings , relationships and empathy 
  although training on gender specific issues is of critical importance , educating officers on both male and female trauma at the same time has several advantages . staff may better engage the material and gain a deeper understanding of both the differences and commonalities of male and female reactions to trauma . when staff is familiar with gendered responses , they are better prepared to deal with a range of reactions , whether an inmate 's response is characteristically masculine or feminine . ( battle et al . , 2002 ; fallot , 2008 ; henigsberg , folnegovi - malc & moro , 2001 ; merwin , rosenthal & coffey , 2009 ; sarchiaponea et al . , 2008 ; the exploration of male trauma dynamics and trauma recovery can evoke compassion , curiosity and capture the attention of male staff . when examples , exercises and role plays include scenarios that men can relate to , ticc can begin to be understood as a safety issue rather than the  abuse excuse  or something that only applies to female offenders . the most effective tool for developing in - service training is ensuring that seasoned correctional officers and other staff take a lead role . despite limited resources , fears for their own safety , vicarious trauma , and conflict between enforcement responsibilities and compassion , it is important to reinforce staff intuition and compassion and to recognize and build on strategies that have been successful before introducing new information and skills.shift commanders and chiefs of security should assist with training content and be visible as co - trainers and in role plays and demonstrations . training that highlights stress management , self - care and remedies for burn out tends to engage more experienced staff . three essential training elements and examples are listed below ( and more resources for training and information appear at the end of this article ) . controlling costs of healthcare , close custody and staff turnovercontrolling the high cost of secure mental health housing unitsreducing seclusion and restraint and de - escalating critical incidentseffective behavior management , safer facilities and job satisfaction 
  controlling costs of healthcare , close custody and staff turnover controlling the high cost of secure mental health housing units reducing seclusion and restraint and de - escalating critical incidents effective behavior management , safer facilities and job satisfaction trauma - related symptoms , behaviors , adaptations and their functiongrounding role plays and demonstrationspracticing verbal trauma de - escalation promptsdemonstrating talking inmates through pat downs and searchesredirecting offenders and inmates who bring up trauma details trauma - related symptoms , behaviors , adaptations and their function grounding role plays and demonstrations practicing verbal trauma de - escalation prompts demonstrating talking inmates through pat downs and searches redirecting offenders and inmates who bring up trauma details 
 panels of veterans in trauma recoveryvideos and films of stories of trauma healingstories of offenders overcoming victimizationsigns of vicarious trauma , supporting co - workers 
  panels of veterans in trauma recovery videos and films of stories of trauma healing stories of offenders overcoming victimization signs of vicarious trauma , supporting co - workers the best training approaches include buy - in from security and administration , skill demonstration and rehearsal , and establishing a human connection to trauma . a caveat , however , is that inmate stories and films that speak to healing from the effects of trauma are well - received , but details of extreme and horrifying experiences are not a desirable training tool . the principle ,  headlines , not details  is apt ( i.e. , trauma can be mentioned as a phrase , such as  child abuse ,   rape ,  etc . , but there is no need to ever go into details of trauma ) . this helps to reduce vicarious trauma and triggering of staff 's own personal trauma memories . also , by modeling this in training , staff can then implement this approach with inmates . setting ground rules for keeping details of traumatic experiences to a minimum to avoid triggering effects this can be approached as a means of ensuring safety and supporting self - care for both security staff and inmates , while clinical staff members perfect their skill at redirecting group members and reinforcing boundaries . controlling costs of healthcare , close custody and staff turnovercontrolling the high cost of secure mental health housing unitsreducing seclusion and restraint and de - escalating critical incidentseffective behavior management , safer facilities and job satisfaction 
  controlling costs of healthcare , close custody and staff turnover controlling the high cost of secure mental health housing units reducing seclusion and restraint and de - escalating critical incidents effective behavior management , safer facilities and job satisfaction trauma - related symptoms , behaviors , adaptations and their functiongrounding role plays and demonstrationspracticing verbal trauma de - escalation promptsdemonstrating talking inmates through pat downs and searchesredirecting offenders and inmates who bring up trauma details trauma - related symptoms , behaviors , adaptations and their function grounding role plays and demonstrations practicing verbal trauma de - escalation prompts demonstrating talking inmates through pat downs and searches redirecting offenders and inmates who bring up trauma details panels of veterans in trauma recoveryvideos and films of stories of trauma healingstories of offenders overcoming victimizationsigns of vicarious trauma , supporting co - workers 
  panels of veterans in trauma recovery videos and films of stories of trauma healing stories of offenders overcoming victimization signs of vicarious trauma , supporting co - workers the best training approaches include buy - in from security and administration , skill demonstration and rehearsal , and establishing a human connection to trauma . a caveat , however , is that inmate stories and films that speak to healing from the effects of trauma are well - received , but details of extreme and horrifying experiences are not a desirable training tool . the principle ,  headlines , not details  is apt ( i.e. , trauma can be mentioned as a phrase , such as  child abuse ,   rape ,  etc . , but there is no need to ever go into details of trauma ) . this helps to reduce vicarious trauma and triggering of staff 's own personal trauma memories . also , by modeling this in training , staff can then implement this approach with inmates . setting ground rules for keeping details of traumatic experiences to a minimum to avoid triggering effects this can be approached as a means of ensuring safety and supporting self - care for both security staff and inmates , while clinical staff members perfect their skill at redirecting group members and reinforcing boundaries . the effectiveness of cognitive - behavior interventions , or cbi , in prisons is well documented in the correctional literature ( andrews & bonta , 2003 ) . prison systems have developed policy and procedure manuals mandating their use ( cbi standard operating procedures , 2001 ) . the national institute of corrections supports training in several evidenced - based curricula on restructuring criminal thinking and developing pro - social coping skills . features that make them the approach of choice for working with prisoners are that they can be facilitated by correctional staff and that they target observable behaviors ( van voohris , branwell & lester , 2009 ) . moreover , meta - analyses have consistently shown cognitive - behavioral interventions to be effective at reducing not only offender recidivism , but also substance use and mental health problems ( andrews et al . , 1990 ; clark , 2010 ; landenberger & lipsey , 2005 ) . unlike medical care and mental health services , rehabilitation programming , is driven by a risk assessment that measures factors associated with re - offending , rather than clinical diagnoses . these factors are known as criminogenic risks ( andrews , bonta & hoge , 1990 ) . rehabilitation programs are aimed at correcting criminal thinking , with a focus on changing present - day and future behavior ; hence , increasing public safety . substance abuse , criminal thinking and anti - social personal attitudes and characteristics , such as impulsiveness , anger , and hostility are among the major risk factors for recidivism ( andrews , bonta & hoge , 1990 ) . for women , substance abuse has been identified as a key driver of increasing rates of incarceration ( grella & greenwall , 2007 ) and substance involvement is the primary reason they return to prison ( macdonald , 2008 ) . additional women 's recidivism risk factors include mental health symptoms and past trauma and abuse ( van voorhis , salisbury , wright & bauman , 2008 ) . although clinical staff may regard prison as an unsafe environment for clinical work that addresses trauma , the potential benefits of implementing trauma - specific interventions may be substantial . since childhood physical and sexual abuse is associated both with institutional difficulties and low program engagement , prisoners may have difficulty benefiting from even the most effective cognitive - behavioral rehabilitation programming until the impact of childhood trauma is addressed ( brennen , 2007 ; covington , 2008 ; gilfus , 2002 ; hubbard , 2002 ; komarovskaya , 2009 ; van voorhis et al . , 2008 ) . prison can also be a golden  teachable moment  in that the inmate 's incarceration may heighten awareness of needing new coping skills and addressing trauma impact . it also provides a time apart from outside life on the streets and undermining influences that can distract or derail them from a recovery focus . as correctional policy shifts its focus to decreasing recidivism , the advantages of evidenced - based counseling approaches are becoming more apparent to prison administrators ( taxman , 1999 ) . the use of present - focused , cognitive - behavioral , and coping skills treatments with strong educational components have helped stabilize inmates with ptsd and substance abuse problems ( zlotnick et al . these approaches tend to be compatible with the correctional culture of responsibility , consistency , accountability and behavioral change , and are relevant to a range of trauma impacts ( e.g. , substance abuse , depression ) and a variety of new coping skills that promote rehabilitation . manualized , present - focused approaches to trauma , such as seeking safety ( najavits , 2002 ) , have been effective with offenders without causing distress or decompensation that requires attention from prison mental health staff ( najavits , 2006 ) . by addressing trauma in terms of current impact , symptoms , related problems ( e.g. , substance abuse ) , building psychoeducation , and increasing safe coping skills , such a model can address trauma directly but without requiring the client to explore distressing memories . best of both worlds  approach ( targeting trauma and related impacts , but in present - focused safe ways ) can be ideal in prison settings . past - focused models , such as exposure therapy ( foa , hembree & rothbaum , 2007 ) , may be evidence - based models for ptsd , but have a real risk of emotionally destabilizing inmates who are already vulnerable . the security response to such destabilization can set the cycle of re - traumatization in motion . in the current climate , prison environments are likely best suited to present - focused approaches , given the unmet need for more mental health training , staffing limitations , and the typical lack of funding for additional formally trained and supervised staff required for past - focused ptsd treatments such as exposure therapy . past - focused therapies may never be embraced as safe by staff , nor are all inmates likely to acquire the requisite level of readiness and trust of prison clinical staff to benefit from them . present - focused approaches such as seeking safety can be done by a far broader range of staff , do not necessarily require formal training , are extremely low - cost to implement , and are known to be safe . there is sometimes great reluctance to open the trauma  can of worms  given the prison environment and the limited clinical resources available . yet , trauma - informed correctional care and staff training can go a long way toward creating an environment conducive to rehabilitation and staff and institutional safety . trauma - informed principles are helpful regardless of whether the institution chooses to make trauma - specific clinical intervention available to inmates . however , it can be noted that trauma - specific interventions have been found to be more powerful than trauma - informed interventions ( morrissey et al . , 2005 ) , and thus ideally making both available will result in greater success in prison settings . it is important to remember that prison staff is legally responsible for medical care for inmates and must provide appropriate treatment , including mental health services . the use of ticc can provide a contextual foundation that strengthens the prison setting to provide effective help in increasing pro - social coping skills , creating a calm and safe prison environment , reducing adverse events , and aiding staff morale , all of which can lead to better offender rehabilitation outcomes .