From ACEs Too High News:
Jane Halladay, director of the service systems program at the National Child Traumatic Stress Network, which developed the Think Trauma curriculum for staff members in juvenile correctional facilities, remembers a young man who was very difficult to handle, especially first thing in the morning.
When he woke up, it was as if he had just emerged from battling demons in his dreams. “He was extremely confrontational, aggressive, ready for a fight,” Halladay says. “In treatment, it came out that the staff woke people up by turning on and off the lights — and it came out that he had once been stabbed in the neck and had come to in the ambulance.
“They understood the impact,” she says. “They made it a policy to wake him up every morning before they turned on and off the lights. All of his behavioral issues completely disappeared. He was a completely different youth.”
Youths convicted of offenses that land them in facilities to serve out their sentences have a disproportionately high number of adverse childhood experiences (ACEs). One Florida study recently put hard numbers on this intuitive reality — half of the Florida juveniles reported four or more ACEs, compared with 13 percent of those in the CDC’s ACE Study.
This is important, because a high number of ACEs can cause chronic disease, mental illness, violence, being a victim of violence and early death. (See ACEs 101 for more information.)
After decades of get-tough policies that often morphed delinquent youth into hardened criminals — i.e., further traumatizing already traumatized kids — state, local and private facilities are developing ACE- and trauma-informed training for staff and systems for their facilities. They realize that the time these post-traumatic youth spend under their roofs can be a time for healing — if it’s handled right.
Six years ago, New York state asked staff members in the Division of Juvenile Justice and Opportunities for Youth to “evolve their understanding of their role,” says Joe Tomassone, acting associate commissioner for programs and services.
“Their role becomes to be an agent of change,” he says. “The historical days of juvenile justice being about custody are gone. Juvenile justice in this country right now is about supports and services and treatment focus. We believe that, given their age and the plasticity of their brains, that they can have a different life outcome. That’s why we wake up every day and do what we do.”
At the local level, the correctional facilities in Randall County, Texas, turned in a trauma-oriented direction more than 20 years ago, says Neil Eddins, deputy chief probation officer for detention and residential services, who serves as facility administrator.
“Boot camps were in vogue,” he says. “A lot of folks were in that, march ’em around and scream at them [mentality]. They used a program designed to get young people ready for war in a juvenile justice setting. That didn’t work. Those kinds of things don’t change the heart.”
Things have certainly changed in Texas since then: Juvenile supervision officers at Randall County and throughout the state receive trauma-informed care training as mandated by the state legislature in 2013. Barry Gilbert, training officer in Randall County, says the Texas Juvenile Justice Department developed a six-hour training to address the issue, and the county further addresses trauma-informed care and ACEs as part of its ongoing training for officers. “We use the ACE score and discuss the long-term impact of high ACE scores on individuals’ lives,” he says.
Some states have shut down traditional prisonlike correctional facilities and opened group homes, which tend to be more amenable to trauma-oriented care, says Carly Dierkhising, assistant professor at the School of Criminal Justice and Criminalistics at California State University-Los Angeles.
A couple of years ago Dierkhising and Halladay were among those who participated in a national Juvenile Justice Roundtable to think through what a trauma-informed system would look like in the juvenile justice arena.
“There are places trying to implement it in a variety of different settings,” she says. “It’s a trickle-down process. I always say we started trying to inform folks who worked in justice about what is trauma, why you should care, the prevalence of youth in their system [who have experienced trauma] and how it might impact their behavior. Then people started asking, ‘What do we do about it?’ Which is really great, as someone who has been advocating for this.”
Halladay, whose organization has been working to disseminate best practices in partnership with the federal Office of Juvenile Justice and Delinquency Prevention, says the political and funding climate for trauma-informed juvenile justice work has brightened in recent years. “It’s now infiltrating the federal mandates, or at least it’s becoming part of the language,” she says. “There are more strategies and practices available. There’s also a really long way to go.”
The Think Trauma curriculum, on which National Child Traumatic Stress Network (NCTSN) has trained staff at about 80 sites around the country — and which has been adapted for probation and other community-based work — starts with the link between delinquency and trauma.
“It goes to talk about how to create a trauma-informed individual safety plan around what triggers the trauma [and] what helps the child feel better and more relaxed,” Halladay says. “We do training with staff and help to implement and sustain it. If people know it well, they’re more likely to practice it.”
The center and its partners continue to flesh out the elements, focusing on what’s unique to juvenile justice and figuring out the right measures to make systems as thoughtfully trauma-informed as possible, Halladay says. They’re talking about parent and caregiver trauma, and how best to reach and engage families in the process. They’re also developing best practices in cross-system collaboration with child welfare, education and health care, she says, building continuity of care within the limits of what personal information can be shared.
The final section of the Think Trauma curriculum prompts staff to look at their own ACEs, Halladay says. “You can input the results and show everybody later in the training the average number [of ACEs among people] sitting in that room,” she says. “That’s always a huge eye-opener for them. We have a lot of different tools and approaches for individuals, but also for a program or organization, to address ACEs and reduce [staff] burnout.”
Dierkhising says she sees mounting evidence of the proliferation of trauma-informed programming in juvenile justice, which she finds encouraging but also somewhat concerning. “I can’t believe the number of webinars I see come across my listserv,” she says. “It’s hard to track this kind of stuff, especially now when it’s proliferating so much, which also worries me — we really need to be evaluating what people are doing. … We need to be carefully monitoring these practices as we’re implementing them, to make sure they’re working in settings like juvenile justice.”
The state of Missouri began implementing what Dierkhising says would “probably be considered a trauma-informed model” decades before other states, at a time when few people were even thinking about a trauma perspective.
“It was before its time,” she says of Missouri. “It wasn’t developed based off trauma research. … A lot of the principles were there, like family engagement and a therapeutic community. But you might not necessarily be getting trauma treatment.”
Missouri’s Division of Youth Services Treatment Services believes that delinquent youth need to undertake a “process of self-exploration” to change their life trajectory, says Rebecca Woelfel, director of communications for the department. “This process addresses their history, development, trauma and family dynamics, and how these have influenced their present situation, perceptions, emotions, decisions and behavior,” she says.
Youth and families are closely involved in the treatment planning process, which unfolds during the first 45 days from commitment and explores any trauma issues identified during that process, Woelfel says. Youth in residential care can address trauma through daily group meetings, sessions with individual advocates and as part of family sessions with their guardians.
Woelfel says traditional corrections programs are housed in “sterile” environments, while trauma-informed programs try to create a “warm, humane” backdrop. Traditional programs take a “correctional” approach that does not allow youth to feel safe in disclosing their trauma histories. Trauma-informed programs support a caring culture by increasing staff-to-student ratios and intensively training staff, she says.
In Missouri, that means more than 200 hours of training in the first two years for new staff, Woelfel says. “Being trauma-informed is an underlying theme in DYS training,” she says. “DYS treatment beliefs align with trauma-informed principles. Staff are trained in our treatment beliefs from day one and throughout their employment.”
Within three months of being hired, staff members take a course specifically aimed at working with trauma survivors, and within two years, they receive additional, in-depth training on other trauma-specific issues like childhood sexual abuse.
“Staff work in stable teams and are assigned to one group of 10 to 12 youth who they stay with during the course of the youth’s stay,” Woelfel says. “This allows for continuity of relationship and increases safety, which allows youth to address past trauma.”
In developing its trauma-informed practices, New York state turned to a national organization called the Sanctuary Network, a community of organizations working to create trauma-informed, safe cultures in mental health and social service settings, Tomassone says.
First, the division of juvenile justice needed to look up from its day-to-day work, he says.
“There had been lots of literature developing in the field that spoke to factors important to look at, when dealing with adolescents,” he says. “Trauma was a theme that kept coming up over and over again. We wanted to incorporate best quality research and practices. We had to take time out. That’s a tricky thing. Things tend to move at 100 miles per hour, but we wanted to pause and take a look at what we were doing, and how to incorporate new information about trauma.”
In partnering with the Sanctuary Network, the New York system wanted not only to serve youth better but also its staff members, Tomassone says. “We wanted a healthier community to deal with trauma with not only our kids but also the folks who work with our kids,” he says. In both cases, a key tenet is that “people are doing the best they can, and with help and support and engagement with other people, they can do better.”
Such a nonjudgmental approach enables staff members to keep in mind the likelihood that a youth who is lashing out, cursing somebody or being physically aggressive is still reacting to past trauma, Tomassone says. “We try to understand it in the context of, if that kid could do better, wouldn’t they?” he says. “Our goal is to get them to another place. We don’t ignore the context of what they’re doing; if you don’t start there, it becomes problematic.”
That means not labeling a youth as “an aggressive kid,” for example, Tomassone says. “That puts them in a box,” he says. “It doesn’t open the door to changing behavior. You’re not going to punish that out of them. You have to account for it in your formulation, and you have to account for it in the interventions you do for a kid.” And when a youth is being resistant, “They need more information. They need to be engaged. They need to understand why what we’re asking them to do is important.”
The staff training is ongoing because of the need for changing techniques and changing culture, Tomassone says. ‘It’s not just a training you offer for a week or two and then say, ‘OK, go do this,’ ” he says. “You have to constantly nurture, monitor and support to make it effective.” With 11 residential facilities statewide, he adds, “The scope is huge.”
The state has just begun to collect measurable results, Tomassone says, having recently developed a quality assurance function to do so. “Six years in the life of an institutional culture is not a long period of time,” he says. “We’re still looking at the variables of what we’re trying to target — quality outcomes for kids and quality outcomes for staff.”
That culture change is definitely the most challenging aspect of the transition, Tomassone says. “When you approach somebody and talk about expanding their understanding about not only the kids they’re working with, and how trauma impacts their behavior, but we’re also asking them to change their role — it’s a lot to swallow,” he says. “We work at it almost every day, helping people understand. And through that new understanding, we open their eyes up to all sorts of connections and how to build relationships.”
As with any culture change, some staff “gravitate to it like a duck to water, or whatever metaphor you want to throw in there,” while others are more hesitant and need support and coaching, Tomassone says. “It’s not always obvious to people. Some people are put together differently, and they’re not interested in being more psychologically self-aware,” he says. “But we assume they’re doing the best they can and try to help them understand how this would be beneficial to them in their work and their life. They have to see how the improvement of the quality of their work goes up when they’re better able to engage kids, and they have more tools.”
North Carolina began a transition to more trauma-informed juvenile justice about three years ago with money from the MacArthur Foundation. This allowed the state to begin training staff in correctional centers on trauma-informed care, using curriculum developed by the NCTSN, says William Lassiter, deputy commissioner for juvenile justice.
The state started moving in this direction after staff and management started noticing that many of the female detainees entered the system having experienced sexual abuse of some form in the past, and facilities started asking male youth similar questions about trauma and ACEs, Lassiter says. A staff member who had worked with NCTSN in the past encouraged the relationship, he says.
“We saw the numbers and the need — so many kids who had been exposed to trauma,” Lassiter says. “We wanted a way of dealing with those kids, and we wanted to move away from a correctional to a therapeutic model. It’s been a change in the way we do business. We’ve gone from facilities with 200-plus kids to 32 kids, focusing on therapeutic interventions. We knew trauma was a big part of why these kids were acting out.”
In addition to psychologists and higher-level professional staff, North Carolina employs “what we call counselor techs,” who typically have associate’s or bachelor’s degrees, and who help work with trauma-impacted youth, Lassiter says. Staff training on trauma has been infused into the four-week curriculum all participate in at the outset of their employment, he says. “Our staff like the training; it makes sense to them,” he adds.
Every child that enters a state facility receives a Crisis Assessment and Response Plan that identifies their trauma triggers, which the staff uses to better understand them and de-escalate crisis situations, Lassiter says. The accompanying form documenting the plan helps staff to implement their training day to day. “I tell people all the time, I want that form wrinkled and with coffee stains on it,” he says. “I want you to use it all the time. We’re getting there, and that form is going to help us.”
Making sure that trauma-informed training gets integrated into daily use is probably the most significant challenge juvenile justice systems face, Lassiter figures. “One of the things we’re working on is fidelity, and making sure staff are following through on what they’ve learned with the triggers,” he says. “We’ve done really well on getting most people trained. It’s just that last step of fidelity and good implementation. When it’s in the heat of the moment, do you remember it?”
Staff also look at their own ACEs, Lassiter says. “They have to do it first, identify their triggers and how that informs how they treat the youth today,” he says.
Florida and Kentucky are among states that are just teeing up trauma-informed approaches to juvenile justice, both with the help of psychologist and juvenile justice consultant and trainer Monique Marrow, who has dual affiliations with the Center for Trauma Recovery and Juvenile Justice at the University of Connecticut and the Center on Trauma and Children at the University of Kentucky.
Florida plans to spend a year piloting its approach in three Department of Juvenile Justice sites and take a very comprehensive approach, with a “combination of training staff, providing a group intervention to youth, and then working toward developing a better, multidisciplinary team to address youth trauma,” Marrow says.
Kentucky, with roughly the same budget as Florida, plans to roll out trauma-informed care to juvenile justice facilities statewide, Marrow says. “They want everything,” she says. “They have not necessarily funded themselves to do everything.”
In both cases, Marrow will start with the 10 ACEs in the original CDC ACE Study and build outward from there “because ACEs does not include experiences that many incarcerated kids have, particularly in urban areas,” she says. “The staff will be looking at selecting appropriate screening measures.”
Marrow also wants to ensure that both states are creating a broad trauma-informed environment, not just reacting to youth experiencing symptoms in the moment. “Every aspect,” she says, “allowing youth the opportunity for voice, for choice, empowering them to be able to speak on their own behalf, involving families.”
And Marrow says staff will be talking about their own ACEs, as well. “The very first activity they do is finding your ACE score,” she says. “They complete the 10 questions. That is part of the training. We talk about the fact that many of the staff called to do this work have their own [trauma] backgrounds. That impacts often positively, but sometimes in a detrimental way, their ability to work with this group. We talk about knowing that and owning that.”
Ohio’s Department of Youth Services also has invited Marrow in to help boost trauma-informed training and practice, although she and her concepts are no stranger to that state. She worked there as deputy director of treatment and rehabilitative services from 2005-08, during which time the DYS worked with the state’s Department of Mental Health to implement trauma-informed approaches and overall improvements in the quality of care for youth.
During that time, youth in DYS facilities that implemented trauma-informed training experienced a significant decline in restraints, seclusion and threats against staff, along with reductions in measures of post-traumatic stress syndrome like nightmares, avoidance symptoms and levels of hopelessness, depression and anxiety, Marrow says.
“The youth talked about the fact that the unit felt safer and better,” she says. And more experienced staff who had seniority privileges — and who had avoided positions that involved working directly with youth — suddenly started asking to work with them. “That told me that there was something to it,” she says. “They felt they had more tools to use, they could engage in treatment, they were part of the team. Of course, we also had fewer staff injuries.”
These changes, which came out partly in response to a lawsuit filed by a group of advocacy organizations, lapsed for a period of several years, Marrow says, but the state is currently “reinvigorating” its response toward trauma, closing “multiple” facilities and shrinking the number of kids who are locked up from about 1,700 in 2008 to about 500 by last year.
Ohio remains under formalized court monitoring under a federal consent decree first reached in 2008 and amended last year to specifically target dramatic reductions in the use of solitary confinement.
County-level facilities, comprising some or all of the correctional landscape in certain states, have been moving in a trauma-informed direction as well. At the Central Ohio Youth Center in Marysville — Ohio has both state- and county-level facilities — problem behaviors among youth continued to escalate during the 2000s. By 2010, “We were at a crisis state, feeling like we could not manage the youth in our organization,” says Emily Giametta, clinical administrator for the 40-bed facility. “We were not trauma-informed.”
Central Ohio had been using techniques like cognitive behavioral therapy to target thinking errors, she says, but the youth continued to suffer from reactions typical of post-traumatic stress disorder and did not seem to be building resiliency. There was high turnover among staff members who were experiencing vicarious trauma and burnout.
Giametta started researching best practices and came across Marrow, who came to the facility in May 2011 and helped to launch trauma-informed training. She also found research that shows the average youth in the American juvenile justice system had experienced about six traumatic events in their lifetimes, while Marysville’s population averaged nine.
“We were hitting above the national average — that was a big concern,” she says. Marrow’s training “was to go over the trauma lens, promote health and recovery; we felt like we were building a foundation. … We were shifting to working on relationships and giving our kids coping skills to deal with PTSD reactions.”
The facility began systematically interviewing youth about their past and forming regular group sessions to address trauma starting in 2012. “That has dramatically changed how we do things,” Giametta says. “Our kids are feeling like they have more self-control; they have coping skills if they hit their trauma triggers. We went from a facility that restrains kids to going months and months without a restraint. It’s been healthier for kids and staff and made a huge difference from top to bottom, going from a punitive to a relationship-based approach.”
While youth typically have multiple trauma triggers, staff and clinicians at Marysville start down the path of healing by identifying one issue that a youth seems to feel most comfortable processing, Giametta says. “It’s less threatening,” she says. “They do one-on-ones with a therapist plus group support. What really starts to be healing is that the kids can support one another, too. That’s another layer.”
Staff members walk youth through the theory behind trauma-informed care so they understand better what’s happening in their brain and bodies when they have PTSD reactions, Giametta says.
“When they feel upset, they know what they’re reacting to,” she says. “We go over hyper-arousal and what that’s like. Their body and brain have been on high alert for so long; this allows them to feel like they’re in control. We’re working on monitoring some of the changes in their mood and feelings.”
New staff members are trained in the basic knowledge about trauma “before they hit the floor” and then take an annual refresher course that addresses any vicarious trauma issues they might have experienced, Giametta says. “That’s certainly something that occurs,” she says. “We do have staff who get triggered, as well.”
In Randall County, Texas, administrators, clinicians and staff have tried to balance giving youth in their custody their support while making it clear that they need to rise above a “victim stance,” Eddins says. Many arrive with a multiplicity of issues.
“Some of them have some really sad stories. It’s tough for compassionate people,” he says. “We also very much believe in individual responsibility and accountability. We recognize that kids have sad stories, and we want to help them work through their issues. At the same time, we don’t want to let them use [ACEs] as an excuse for bad behavior. … You show these kids that you’re pulling for them, and at the same time, you’re going to hold them accountable.”
The most challenging part of this effort is training staff not to stand in judgment when youth act out, Eddins says. “We all have our biases,” he says. “I don’t want them to be robots. I want my staff to be real people. But for folks in this business, you have to believe in intrinsic value; you have to believe that every human being, regardless of what they’ve done, has some value. Sometimes that’s hard.
“For instance, we’ve seen a propensity in young people offending sexually on young victims. There’s a lot of folks who have hang-ups with that,” he adds. “I’m a daddy. I have children in my home. I can imagine how I would react. But we have to take the stance — I tell my folks, ‘If you know you have a hang-up in that area, that’s where I want you to pull up your fair-o-meter.’ ”
Many of those who have perpetrated such crimes were first victims themselves, Eddins says, at the hands of parents, grandparents, uncles and aunts. “That gets a little skewed. Those stories are hard. Our first response is, ‘That shouldn’t have happened,’ ” he says. “Then, we’ve got to help this young person deal with this, involve counselors and have places to work through those issues. At the same time, it cannot be an excuse for misbehavior.”
That requires separating what they’ve done from who they are, which many adults have never successfully managed, Eddins says. “What are your core values and beliefs? What are your motivations?” he says. “We’ve got young people focusing on concepts that are probably beyond their years but because of the predicament they’re in, we must do that.”
Clinicians perform an initial 30-day assessment with testing and psychological evaluation to pin down as much information as possible. Youth are asked to write their autobiographies in an unflinching way, but “not so we can rub their face in it. They need to take a complete look,” Eddins says.
That process brings them face to face with their ACEs and can help build a sense of control over their autobiography in the days ahead, he says. “Just because my dad was abusive doesn’t mean I have to be abusive. Because my dad was an alcoholic doesn’t mean I have to be. We also have to recognize that we have those influences in our life that we have to battle.”
Through that process, staff members are tasked with holding kids accountable for misbehavior with true consequences, but without making it into a power struggle, Eddins says. “These kids will kick our tails,” he says. “They’ve shown they’re willing to break the law. If the staff does the same thing, it doesn’t turn out well. We tell staff, ‘You’re going to out-positive these kids.’
“Look for what they do well and emphasize it,” he adds. “Then, the kids start to replace negative reinforcers with positive reinforcers: ‘I’m being recognized for what I’m doing well.’ This is not rocket science. It’s kind of like 1950s middle-class values — treating people with respect and developing a relationship and helping them work through their struggles and their issues.”
Staff members meet weekly and talk about their own issues, Eddins says. “We have to hold one another in check,” he says. “We asked staff to do the ‘who am I?’ piece” that helps them get in touch with their own trauma issues. That’s something you’re not going to get up there and share because it’s going to have some dirt in there. But they’ve got to walk around in these kids’ shoes.”
At the Berrien County (Mich.) Juvenile Center, staff focused on rational behavioral training (RBT) to de-escalate youth behavior until about three years ago. Mary Ann Witkowski, clinical and treatment services manager, says RBT is “all good stuff,” but she wanted to move the program toward a more clinically oriented approach.
At first, Witkowski worked to get families more involved in an integrated treatment approach, offering parenting classes on how to deal with out-of-control behavior. “We got into finding out family history and issues, and lo and behold, many of these kids have tons of trauma in their lives — sexual abuse, substance abuse, violence is huge, the whole gamut of issues,” she says.
That led to educating treatment staff on trauma issues, which was a mixed bag given that many staff had been there for many years and were “old school, brought up in a custodial mindset,” she says. “We tasked ourselves with trying to move out of that custodial mindset and help the staff work with the kids from the kids’ perspective. … Some people were like, ‘This information is great — it’s a great way to look at it.’ Other people said, ‘Everybody has had things go on in their life. You have to suck it up and deal with it.’ It’s an evolving process.”
To date, Witkowski would not say Berrien County has become completely trauma-focused but she believes the shift in training has moved the culture in that direction. “It’s helped the staff become more empathic with what the kid has lived through,” she says. “They try to respond to the kid in an empathic way rather than a directive way. It’s not just, ‘Do it because I said so.’ We’re trying to get the staff to understand that the kid is reacting to them based on previous experience and events.”
Berrien County has emphasized a nonphysical, literally hands-off approach in which staff members attempt to verbally de-escalate youth, Witkowski says.
“When you have a kid who is acting out for whatever reason, keep in mind the other issues around the kid,” she says. Then afterward, youth see their case managers to process the event in addition to the initial de-escalation. “Hopefully, we can circumvent away from a case where the kid has to be physically managed,” she says, adding that isolation is “not an option” in the facility.
Staff members also talk about their own ACEs as part of their training, Witkowski says. “It really depends on the individual staff,” she says. “We really stress with them that it’s OK, everybody has to deal with their own stuff. Here, it’s even harder if you have a lot of personal baggage because the most severe of the severe are here.”
This article was originally posted by ACEs Too High News.