Blog: Trauma

In 2008 my colleagues and I wrote for and were awarded a recovery-oriented systems of care grant from the Substance Abuse and Mental Health Services Administration (SAMHSA). The primary goal of this grant was to develop and implement a trauma-informed and recovery-oriented system of care for adolescent girls. My colleagues and I were concerned about the increasing juvenile justice involvement and substance use rates among adolescent girls with little to no increases in their rates of enrollment in treatment. Our previous research highlighted the significant levels of trauma and other co-occurring mental health problems among girls. In addition, we found girls had higher rates of “harder” drug use such as cocaine, amphetamines, and heroin/opiates as compared to boys. And on the positive side, we also found that girls who accessed treatment responded really well and made significant behavioral improvements over time.

Other juvenile justice and behavioral health policy makers and program developers have recognized the importance of responding to these increased rates of behavioral health and substance use problems among adolescent girls. We now have a better understanding that while males and females are equally vulnerable to addiction, that from a physiological standpoint, females can have lower tolerance and may progressive to physical dependence at different rates.  We also have a better understanding of the critical role played by trauma in substance use and addiction as well as a broader range of available approaches for providing gender-specific and trauma-informed treatment. The positive news is that we have seen the rates of illicit substance use significantly decrease for girls from 2008 to 2014 (26.5% versus 23.7%) and decreases in comparison to boys.

Trauma - a six letter word that carries a lot of significance. Depending on your education and experiences the word brings different thoughts, feelings, and reactions. It is a topic that has received a lot of recognition in the past few decades and is comprehensively described in a publication recently released by the National Center for Mental Health and Juvenile Justice (NCMHJJ). Strengthening Our Future: Key Elements to Developing a Trauma Informed Juvenile Justice Diversion Program for Youth with Behavioral Health Conditions provides necessary background and implementation practices for those working in the juvenile justice system.  One aspect I found very helpful was the concrete examples of how jurisdictions have operationalized implementation practices. For example, a case example from Indiana is provided on page 21. As a way to be trauma-informed - Indiana took a procedural approach. More specifically, Indiana started by reviewing and selecting an assessment, integrated it into the electronic information technology system, supplemented the assessment with a trauma specific assessment, and providing training for personnel working within juvenile justice. This publication is a useful resource that can assist in the development of policies and procedures, practices, and training.

Videos from Reclaiming Futures’ annual Leadership Institute held this past June in La Jolla, California, are now available online!

The event, entitled “Public Health and Justice: A Partnership to Promote Equity and Well-being for Youth and Families,” brought together experts in juvenile justice and behavioral health to discuss equity and restorative justice in schools.

The National Child Traumatic Stress Network (NCTSN), a program of the Substance Abuse and Mental Health Services Administration’s Center for Mental Health Services, has released six online briefs that discuss the key elements of a trauma-informed juvenile justice system. The NCTSN website explains:

This collection of Briefs written by experts invited to the NCTSN Trauma-Informed Juvenile Justice Roundtable, address topics essential to creating trauma-informed Juvenile Justice Systems. These Briefs are intended to elevate the discussion of key elements that intersect with trauma and are critical to raising the standard of care for children and families involved with the juvenile justice system.
In Trauma-Informed Juvenile Justice Roundtable: Current Issues and New Directions in Creating Trauma-Informed Juvenile Justice Systems (2013) (PDF), Carly B. Dierkhising, Susan Ko, and Jane Halladay Goldman, staff at the National Center for Child Traumatic Stress, discuss the Juvenile Justice Roundtable event, describe the current issues and essential elements of a trauma-informed JJ system, and outline possible new directions for the future.
In Trauma-Informed Assessment and Intervention (2013) (PDF) , Patricia Kerig, Professor at the University of Utah, discusses how trauma-informed screening and assessment and evidence-based treatments play integral roles in supporting traumatized youth, explores the challenges of implementing and sustaining these practices, and highlights practice examples for integrating them into a justice setting.
In The Role of Family Engagement in Creating Trauma-Informed Juvenile Justice Systems (2013) (PDF) , Liane Rozzell, founder of Families and Allies of Virginia Youth, discusses the importance of partnering with families, explores strategies for doing so, and emphasizes ways that justice settings expand their outreach to supportive caregivers by broadening their definition of family.
In Cross-System Collaboration (2013) (PDF) , Macon Stewart, faculty at the Center for Juvenile Justice Reform (CJJR), outlines practice examples for continuity of care and collaboration across systems, a vital activity for youth involved in multiple service systems, drawing from the CJJR’s Crossover Youth Practice Model.
In Trauma and the Environment of Care in Juvenile Institutions (2013) (PDF) , Sue Burrell, staff attorney at the Youth Law Center, outlines specific areas to target in order to effectively implement this essential element, including creating a safe environment, protecting against re-traumatization, and behavior management.
In Racial Disparities in the Juvenile Justice System: A Legacy of Trauma (2013) (PDF) , Clinton Lacey, Deputy Commissioner of the New York City Department of Probation, outlines the historical context of racial disparities and highlights how systems can move forward to reduce these racial disparities, including by framing the issue so that practical and pro-active discussion can move beyond assigning blame. 

A new video series from the Office for Victims of Crime (OVC) explores the needs of children exposed to crime, abuse, and violence, and how we can support the efforts of those who work to help them.
Each video in the “Through Our Eyes: Children, Violence, and Trauma” series can be viewed on YouTube or downloaded, and is accompanied by a resource guide accessible on the OVC website.
In a message about the series, OVC director Joye Frost outlines the four key messages the videos are meant to reinforce:

• Children’s exposure to violence and victimization is significant.
• These experiences can leave lasting effects.
• There are effective ways to protect children and alleviate the harm of exposure.
• Everyone has a role.

The series includes an introduction and three topic-specific videos, with more forthcoming. The introductory video brings awareness to the physical, emotional, and behavioral effects of trauma on children. Victims speak up about their moving personal experiences to bring light to the issue, and experts give guidance on identifying and intervening for child victims.

Justice-involved youth have complex histories that not only contributed to their delinquency but present challenges for rehabilitation. They often experience poverty, violence, familial instability, exposure to drug use and gangs, and serial relocations. These compound factors exacerbate a lack of self-confidence, learning difficulties, physical disabilities, and mental health issues.

In the field of public health, these experiences are identified as traumatic: including a loss of safety, powerlessness, fear, hopelessness, and a constant state of alertness. In the video above, Christa Collins notes that exposure to trauma severely diminishes decision-making skills and the ability to cope with stress.

In December 2012, Attorney General Eric Holder's National Task Force on Children Exposed to Violence released a report with recommendations to combat the growing epidemic of kids exposed to violence. Given recent events and the public discourse over violence, now is an especially poignant time to revisit this report and its recommendations.

"Exposure to violence is a national crisis that affects approximately two out of every three of our children," states the report. "Of the 76 million children currently residing in the United States, an estimated 46 million can expect to have their lives touched by violence, crime, abuse, and psychological trauma this year."

We've counted down the top 25, 20 and 15 juvenile justice blog posts from 2012. Here are 6-10:
10. Missouri’s Unique Approach To Rehabilitating Teens in Juvenile Justice System
Missouri is changing the way it approaches rehabilitating teens in its juvenile justice system, and it’s working. With a focus on therapy and education rather than punishment, the state closed its training schools and large facilities with minimal schooling in the early 1980s.
9. Stop the Trauma. Start the Healing: A Latino Health Context
Latino children are the fastest growing population in the United States and over half will end up incarcerated, jobless, or dead at a young age. Recognizing this, the National Compadres Network released a brown paper explaining how transformational based healing can disrupt this cycle and improve health outcomes for Latino children.

This has been quite a year for our juvenile justice blog. Not only has readership more than doubled (thank you!) but we've partnered with a number of great organizations and journalists to provide you with more frequent analysis, research and ideas for reform.
As last year, our articles explaining why "Scared Straight" tactics do more harm than good, continue to be some of our most-read and shared posts. But this year, we also took a look at the effects of trauma on kids, raise-the-age efforts and the Supreme Court decision to ban life without the option of parole for juveniles. 
This week, we're doing a countdown of the top 25 stories from 2012.
25. Mentoring: Best Practices for High Risk Youth
Mentoring has been shown to reduce drug and alcohol use and help justice-involved teens get back on track. Jessica Jones share five best practices for a successful mentoring program.
24. Inside the Juvenile Justice System: A Look at How the System Works
While readers may be familiar with the criminal system through tv shows, the juvenile system is less well-known and understood. The County of San Diego explains the juvenile system.