Laying the Groundwork: Conceptualizing a Trauma-Informed System of Care in Juvenile Detention

ABSTRACT

Youth involved in the juvenile-justice system experience trauma at a disproportionately higher rate compared with the general population. Posttraumatic stress reactions place youth at greater risk for penetrating deeper into the juvenile justice system and being placed in secure detention settings. Juvenile detention settings with a systemic approach to addressing youth traumatic stress reactions promote an environment positioned to support the physical and psychological safety of youth and detention center staff. This article reviews key elements of a trauma-informed juvenile detention system and explores implications for trauma-informed interventions and cross-system collaboration.     

A Trauma-Informed Call to Action: Culturally-Informed,Multidisciplinary Theoretical and Applied Approaches to Prevention and Healing

ABSTRACT

The prevalence of trauma and its negative impact on humankind has created a burgeoning awareness of the need for systems that are trauma-informed across the lifespan. A collaborative project with the National Partnership to End Interpersonal Violence (NPEIV) sought out research as a call-to-action to mitigate the impact of trauma. The following is an introduction to a special double-issue focused on theoretical and applied approaches to using trauma-informed care in multi-disciplinary, mental and physical health, criminal justice, school-based, and community settings. Consideration is given to essential issues such as resilience, self-care, and cultural awareness.     

Youth sports and physical activity: The relationship between perceptions of childhood sport experience and adult exercise behavior

ObjectiveParticipation in organized youth sports has been shown to positively correlate with increased levels of exercise in adulthood. However, there is limited research to suggest why youth sports participation is related to increased physical activity as an adult. One possible explanation is that positive youth sport experiences lead youth to be more positively inclined to engage in physical activity as adults. Research into the positive youth development aspect of organized sports provides the framework for the current investigation.MethodsAdult participants (N = 234, M_age = 35.35) were asked to retrospectively assess their youth sports experiences using the “Four C's” (i.e., competence, confidence, connectedness, character) framework of positive youth development in sport. These assessments were then compared to current physical activity levels and related variables found in the Health Action Process Approach model (HAPA; Schwarzer, 2008).ResultsBivariate correlations revealed statistically significant and moderate correlations among competence, confidence, and connectedness and all of the HAPA variables including physical activity levels. Further, a MANCOVA analysis revealed that when participants were sub-divided into “non-intenders,” “intenders,” and “actors” using a validated staging algorithm, a general linear trend emerged for competence, confidence, and connectedness such that “non-intenders” rated these constructs the lowest and “actors” rated them the highest.ConclusionThese findings provide preliminary evidence that the relationship between participation in organized youth sports and adulthood levels of exercise could be contingent on how positively that experience is perceived.     

Examining How CBT Interventions for Anxious Youth Are Delivered Across Settings

Most efforts to assess treatment integrity—the degree to which a treatment is delivered as intended—have conflated content (i.e., therapeutic interventions) and delivery (i.e., strategies for conveying the content, such as modeling). However, there may be value in measuring content and delivery separately. This study examined whether the quantity (how much) and quality (how well) of delivery strategies for individual cognitive behavioral therapy (ICBT) for youth anxiety varied when the same evidence-based treatment was implemented in research and community settings. Therapists (N = 29; 69.0% White; 13.8% male) provided ICBT to 68 youths (M age = 10.60 years, SD = 2.03; 82.4% white; 52.9% male) diagnosed with a principal anxiety disorder in research or community settings. Training and supervision protocols for therapists were comparable across settings. Two independent teams of trained coders rated 744 sessions using observational instruments designed to assess the quantity and quality of delivery of interventions found in ICBT approaches. Overall, both the quantity and quality of delivery of interventions found in ICBT approaches were significantly lower in the community settings. The extent to which didactic teaching, collaborative teaching, and rehearsal were used systematically varied over the course of treatment. In general, differences in the quantity and quality of delivery observed between settings held when differences in youth characteristics between settings were included in the model. Our findings suggest the potential relevance of measuring how therapists deliver treatment separate from the content.     

Implementing Trauma-Informed Care in Correctional Treatment and Supervision

ABSTRACT

This article provides a rationale for trauma-informed care (TIC) in correctional services, and challenges readers to think about offending behavior through the lens of trauma. Based on interdisciplinary research and cross-theoretical literature, TIC can help in our quest to develop relevant and successful programs, practices, and policies, and the best methods for delivering them. Using Substance Abuse and Mental Health Services Administration (SAMHSA)’s core principles of TIC, this article will make suggestions for the implementation of trauma-informed service delivery and practices across correctional settings. The authors translate trauma-informed concepts into practice behaviors through the acronym SHARE (safety, hope, autonomy, respect, empathy), which honors the principles of TIC recommended by SAMHSA and the principles of effective correctional rehabilitation. TIC in corrections may help improve the desired outcomes of successful re-entry and reduced recidivism.     

Evaluation of a Trauma-Informed School Intervention with Girls in a Residential Facility School: Student Perceptions of School Environment

In response to the high nationwide prevalence of psychological trauma among court-involved youth who have been exposed to abuse and neglect and the associated far-reaching adverse consequences, there are calls to develop a trauma-informed workforce across the various systems (child welfare, juvenile justice, mental health, and education) designed to serve this population. We describe a pilot test of a modified version of the Heart of Teaching and Learning (HTL) curriculum, an intervention designed to increase trauma-informed practices in education settings. This program was implemented in a public charter school that exclusively serves court-involved youth placed in residential treatment. The intervention was associated with decreases in trauma symptoms experienced by youth. Because student perceptions of teachers were high both before and after implementation of the curriculum, no statistically significant changes were observed. The article concludes with a discussion of the ways in which the curriculum can be used to help prepare a national education workforce capable of implementing trauma-informed evidence-based practices in school settings.     

A Trauma-Informed Call to Action: Culturally Informed,Multi-Disciplinary Theoretical,and Applied Approaches to Prevention and Healing,Part II

The prevalence of trauma and its negative impact on humankind have created a burgeoning awareness of the need for systems that are trauma-informed across the lifespan. A collaborative project with the National Partnership to End Interpersonal Violence (NPEIV) sought out research as a call-to-action to mitigate the impact of trauma. The following is Part II of an introduction to a special double-issue focused on theoretical and applied approaches to using trauma-informed care in multi-disciplinary, mental and physical health, criminal justice, school-based, and community settings. Consideration is given to essential issues such as resilience, self-care, and intersectional cultural awareness. Introspective exploration of biases was encouraged to address barriers to implementing trauma-informed care.     

Trauma-Informed Child Welfare: From Training to Practice and Policy Change

ABSTRACT

Multiple child welfare systems and agencies have embraced efforts to become more trauma-informed in recent years. However, the field of trauma-informed care is still somewhat in its infancy and only recently has the focus shifted from theoretical concepts into concrete practices that can be identified, measured, evaluated, and sustained over time. One of the key resources designed to help support the development of a trauma-informed child welfare system is the Child Welfare Trauma Training Toolkit (CWTTT). The CWTTT was developed in 2008 as a collaborative process that included members of the Child Welfare Committee of the National Child Traumatic Stress Network (NCTSN). Originally, the CWTTT was developed as a training resource to support child welfare professionals in increasing their understanding regarding trauma and its impact on children. Over time, the CWTTT has undergone multiple iterations and has been involved in numerous state and county initiatives to support their efforts in becoming more trauma-informed. This article will provide historical context on the development of the CWTTT, detailing its evolution since 2007, followed by highlighting the current efforts and future directions of the CWTTT.     

Extracurricular Participation and Course Performance in the Middle Grades: A Study of Low-Income,Urban Youth

The transition to middle/junior high school is associated with declines in students’ academic performance, especially among low‐income, urban youth. Developmental psychologists posit such declines are due to a poor fit between the needs of early adolescents—industry, identity, and autonomy—and the environment of their new schools. Extracurricular participation during these years may act as a buffer for youth, providing a setting for development outside the classroom. The current study examines participation within and across activity settings among low‐income, urban youth in New York City over this transition. Using the Adolescent Pathways Project data, this study explores how such participation relates to course performance. We find that a large percentage of youth are minimally or uninvolved in extracurricular activities during these years; that participation varies within youth across time; and that the association between participation and course performance varies by activity setting. Youth who participate frequently in community or athletic settings or have high participation in two or more settings are found to have higher GPAs in the year in which they participate and youth who participate frequently in the religious setting are found to have lower GPAs. High participation in more than two settings may be detrimental.     

“Sport is community:” An exploration of urban Aboriginal peoples' meanings of community within the context of sport

ObjectivesThe purpose of this study was to better understand the meanings of community, particularly as it is understood within the context of sport, for urban Aboriginal youth and adults in Edmonton, Alberta.DesignA community-based participatory research (CBPR) approach was used to guide this research.MethodOne-on-one interviews were conducted with 18 Aboriginal youth and adults. Data was analyzed using Elo and Kyngäs' (2008) process of content analysis. The integrated indigenous-ecological model was used as a framework for data analysis and the interpretation of findings.ResultsFindings are represented by five themes that are supported by direct quotes from participants. Participants described community as: (1) belonging, (2) family and friends, (3) supportive interactions, (4) sport, and (5) where you live and come from.ConclusionsFindings from this research suggest that urban Aboriginal youth identify with a number of different communities, and their complex meanings of communities are comprised of various interpersonal level factors. The knowledge shared by participants provides necessary insights into meanings of community, which are necessary for ensuring that community-driven and community-based sport programs are relevant to Aboriginal youth.     

Trauma-Informed Police Responses to Rape Victims

ABSTRACT

Rape victims can benefit from trauma-informed approaches when reporting rape to police. Police interviewing skill can prevent survivor re-victimization while eliciting useful crime statements. However, rape myth acceptance and police culture may pose obstacles to a trauma-informed approach. Client empowerment, demystification, trigger reduction, and expressed concern for victim safety can be implemented by police agencies. Interdisciplinary collaboration, combating sexual harassment, gender balancing, emotional debriefing of officers, accountability to victims, new reporting methods, and advanced training protocols are elements of a trauma-informed approach.     

Self-harm prevalence and ideation in a community sample of cis,trans and other youth

Abstract

Background: Trans youth have been reported to have high rates of self-harm, depression and bullying, and find it difficult to seek support. However, much of this research comes from gender identity clinics; non-clinical samples and those who reject gender binaries remain under-researched.

Aims: This study investigated the experiences of a community school-based sample of Trans, identifying youth, Other, and cis-gendered adolescents in relation to their experiences of low mood, bullying, associated support, self-harm ideation and peer-related self-harm.

Methods: An online survey was completed by 8440 13–17?year olds (3625 male, 4361 female, 227 Other, and 55 Trans).

Results: Trans and Other students had significantly higher rates of self-harm ideation and peer self-harm, in comparison to cis-gendered students. These Trans and Other students reported significantly higher rates of bullying and self-reported depression and significantly less support from teachers and staff at school, in fact these students did not know where to go to access help.

Discussion: This community sample confirms findings of high rates of self-harm ideation, self-reported depression and bullying for Trans youth as previously reported in clinic-based samples. However, by accessing a community sample, the salience of the category “Other” was established for young people today. While Other and Trans identified students both struggled to find support, those who identified as Trans were more likely to have been bullied, and have experienced self-reported depression and thoughts of self-harm. Thus, those who identify as transgender represent a high-risk group that needs targeted support within schools and by statutory and nonstatutory community services. Unpacking the category of Other would be beneficial for future research, as well as exploring resilience within this group and intersecting identities such as sexuality, Autism, or experiences such as earlier abuse.     

Family Therapy for Substance Use among Sexual Minority Youth: A Review of Treatment Options

Abstract

Substance use disorders are nearly twice as common among sexual minority youth (SMY) as among their heterosexual peers. Most applied literature about this population suggests interventions on either the individual or community level, and the benefits of family therapy for this population are often overlooked. The present literature review (a) outlines clinical knowledge related to sexual minority youth and substance use (e.g., prevalence rates, contributing factors), (b) discusses the importance of clinical self-awareness around these topics, and (c) outlines clinical behaviors and interventions from literature that may be employed when working with substance-using SMY and their families.     

An Overview of Trauma-Informed Care and Practice for Eating Disorders

ABSTRACT

This article reviews concepts and principles of trauma-informed care and trauma-informed practice for those with eating disorders (EDs). EDs are not universally recognized to be associated with traumatic events, despite substantial research evidence indicating that individuals with EDs report very high rates of childhood maltreatment, other lifetime traumatic events, as well as adverse consequences from trauma. Using national representative samples, higher prevalence rates of PTSD and other trauma-related comorbidities have been reported in those with EDs, particularly those with bulimic symptoms (binge eating and/or purging). Evidence suggests that those prone to develop EDs appear to be especially sensitive to the effects of stress/adversity and have high rates of premorbid anxiety disorders, personality traits, and neuropsychological features that predispose them to PTSD and its symptoms. This article also reviews some of the important principles for treating individuals with EDs comorbid for PTSD and other trauma-related disorders, including the necessity of moving beyond sequential treatment to the development of integrated treatment protocols. Integration of existing evidence-based treatments, including family therapy, cognitive behavioral therapy, dialectical behavior therapy, cognitive processing therapy, prolonged exposure, and eye movement desensitization reprocessing are recommended. Recent research suggests that ED clinicians view integrated treatment for individuals with ED and PTSD as a top priority, yet they have several concerns about administering such a treatment. As trauma-informed care is embraced by all clinicians and treatment programs that assess and treat eating and related disorders, better outcomes are anticipated.     

It’s my safe space: The life-saving role of the internet in the lives of transgender and gender diverse youth

Abstract

Background: Public awareness of Transgender and Gender Diverse (TGD) identities has grown significantly; however, acceptance and support remain elusive for many TGD youth. Resultant experiences of marginalization and stigmatization contribute to elevated rates of psychological distress and suicidality among TGD youth. Emergent evidence suggests that the internet may offer TGD youth safety, support, and community previously unavailable.

Aim: The primary aim of this qualitative inquiry is to engage in an in-depth exploration of the online experiences and processes which help protect against psychological distress and promote well-being among TGD youth.

Methods: Data were culled from a mixed-methods, online study of sexual and gender minority youth from across the United States and Canada which followed Institutional Review Board approved protocols. Participants for this study represent a sample (n?=?260) of TGD participants aged 14–22 (x? = 17.30). Data were analyzed using Charmaz’ grounded theory strategies.

Results: Data revealed that the internet offers TGD youth affirming spaces that, for the most part, do not exist in their offline lives. Online, TGD youth were able to engage meaningfully with others as their authentic selves, often for the first time. These experiences fostered well-being, healing, and growth through five processes: 1. Finding an escape from stigma and violence, 2. Experiencing belonging, 3. Building confidence, 4. Feeling hope, and 5. Giving back.

Discussion: The unique and innovative ways in which participants use online spaces to foster resilience offer important insights to inform affirmative practices with TGD young people.     

Enhancing Resilience Among Providers of Trauma-Informed Care: A Curriculum for Protection Against Secondary Traumatic Stress Among Non-Mental Health Professionals

Although the call to create trauma-informed services for youth has been clearly sounded, a relatively neglected part of this effort is the need to prepare non-mental health professionals to carry out trauma-informed programming in ways that protect them from secondary traumatic stress (STS). To this end, this article introduces Resilience for Trauma-Informed Professionals, a curriculum that introduces participants to techniques designed to promote resilience in the face of exposure to trauma-related material. Based on the existing evidence base regarding risk and protective factors for STS, six core elements targeted by the curriculum are described—appraisals, self-efficacy, emotional awareness, affect regulation, resilience, and prevention—as they are implemented across three stages: pre-exposure preparation, coping in the presence of trauma, and recovery in the aftermath of exposure.     

Initial Implementation of the ARC Framework in Juvenile Justice Settings

Virtually all youth in detention have been exposed at least one traumatic event in their family system or in the community, and a vast majority have experienced cumulative traumatic events that led to major dysregulated states. Building on several seminal works on trauma-informed juvenile justice programs and on implementation research, this theoretical research-based paper aims to describe the preparation stage for implementation of the Attachment, Self-Regulation, and Competency framework (ARC) to a population of youth in detention. The ARC framework is well-suited to meet the complex needs of young offenders by focusing on building blocks that promote resiliency, including caregiver affect management and attunement, affect identification and modulation, and executive functions and self-identity. Based on this extensive preparation stage and a case illustration, recommendations and best practice protocols for making a shift towards a trauma-informed youth justice system are highlighted.     

Digging beneath the surface: Results from stage one of a qualitative analysis of factors influencing the well-being of trans youth in Quebec

ABSTRACT

Background: The literature on trans youth has been dominated by etiological studies interested in trans experience as a medical phenomenon. An emerging body of literature has begun to document that trans youth are a diverse, vulnerable, yet resilient population, and to investigate the role of various sites of support such as the family, peer groups, institutions, and community spaces in contributing to or impeding trans youth's well-being.

Method: This article presents the results of Stage One of interviews (n = 24) conducted for a Community-Based Participatory Action Research (CBPAR) qualitative research project based in Quebec. It studies the factors that enhance trans youth's well-being as well as the factors of oppression that negatively affect it. This paper offers a brief overview of the anti-oppressive methodology used for this project, emphasizing how CBPAR was combined with Grounded Theory (GT) methods to encourage the direct involvement of communities and the translation of knowledge into action.

Results: We present preliminary categories emerging through the ongoing axial coding process. These categories address trans youth's experiences in and perceptions of various “sites”: 1) healthcare services both for gender-related and general care, 2) other institutional spaces, 3) the family and other social circles, and 4) community spaces.

Conclusion: While much of this study's results support existing evidence on trans youth's experiences, they also provide a more nuanced portrayal of the complex ways in which recognition, as well as non-, mis-, or mal-recognition, influence trans youth's well-being at different sites. We also argue that recognition itself must be considered through the lens of intersectionality.     

The Ward and the Womb: An Integrated Therapeutic Approach for Treatment Resistant Adolescents

ABSTRACT

In mental health settings, we often meet traumatized and volatile youth who resist treatment and do not respond to engagement attempts. For such patients, the treatment refusal may be a representation of their level of personality organization; it can represent difficulties to relate to others, to regulate affective experiences, and to integrate different self-states. Using a case study of a treatment resistant adolescent in residential care, I discuss the limitations of engagement techniques with patients at the lower end of personality organization and argue that engaging “difficult to treat” adolescents requires a clinical shift from the therapeutic encounter to the development of a system-based “holding” environment. I present a modified intervention model that integrates psychodynamic formulation of personality development with process-oriented systemic work. The model described emphasizes the role of the therapist as the initiator and facilitator, helping to construct a coherent and attuned environment within the residential care system. Through case vignettes, I provide examples for the clinical shift from the therapeutic encounter to the environment of the ward and demonstrate how developing a holding environment can overcome engagement barriers and support the development of the patient’s ego capacities, sense of self, and object relations.     

Finding voice in a year of collective trauma: Case study of an online photovoice project with youth

In this article, we share findings from a qualitative case study of a virtual youth photovoice program implemented across three regions of the United States. The purpose of the program was to engage youth in research on a social issue relevant to them during an unprecedented year marked by two public health crises, COVID-19 and anti-Black racial violence. Results of an analysis of curriculum and archival program materials lend support for online strategies for youth engagement including individualized support and online audiovisual presentations with avatars. Racial justice and trauma-informed adaptations were designed to be responsive to youth needs for flexible programming and safe spaces. Themes captured in the first online gallery of youth photos include (1) tools for mental health, (2) meaningful connection, and (3) community advocacy, bringing attention to structural issues as well as family and community strengths. Findings suggest photovoice can be thoughtfully adapted for youth researchers and support individual and group storytelling in response to collective trauma.