Adolescence is a time of great opportunity, but also turmoil. As many as two-thirds of all teens face the additional challenge of coping with traumatic events such as life-threatening accidents, injuries, illness, disaster, or violence or sexual or emotional abuse and exploitation. That figure rises to closer to 100 percent for those who live in families or communities in which violence, poverty, neglect, racism or discrimination based on gender, gender identity or disability are prevalent.
Not surprisingly, 90-plus percent of youths involved in juvenile justice have experienced at least one (and typically several) of these traumatic stressors, and as many as 25 to 33 percent of these youth (compared to 5 percent in community samples) have developed post-traumatic stress disorder (PTSD).
Youth in the juvenile justice system often have been exposed not only to multiple types of interpersonal victimization — polyvictimization — but also to other childhood adversities (such as separation from or impaired relationships with biological parents and family). In total, this more than doubles the number of traumatized youth in juvenile justice programs (i.e., 67 to 75 percent) who need effective services in order to recover from not only PTSD but also for a wide range of related emotional, developmental, academic and behavioral problems (such as substance use, attention deficit, oppositional-defiant, affective, anxiety, dissociative, sexual, sleep and eating disorders, suicidality self-harm and exploitation [e.g., sexual trafficking]).
These stark facts have led to a national (and international) call to action in the past decade for juvenile justice systems to become “trauma-informed.” The 2012 report of the U.S. Attorney General’s Task Force on Children Exposed to Violence identified nine practical steps based on the experience of experts in law enforcement, the judiciary, juvenile justice services, child protective services, racial and ethnic disparities, and traumatic stress. This was done under the leadership of Robert Listenbee, the administrator of the Office of Juvenile Justice and Delinquency Prevention:
- Make trauma-informed screening, assessment and care the standard in juvenile justice services.
- Abandon juvenile justice correctional practices that traumatize children and further reduce their opportunities to become productive members of society.
- Provide juvenile justice services appropriate to children’s ethnocultural background that are based on an assessment of each violence-exposed child’s individual needs.
- Provide care and services to address the special circumstances and needs of girls.
- Provide care and services to address the special circumstances and needs of LGBTQ (lesbian/gay/bisexual/transsexual/questioning) youth.
- Develop and implement policies in every school system across the country that aim to keep children in school rather than relying on policies that lead to suspension and expulsion and ultimately drive children into the juvenile justice system.
- Guarantee that all violence-exposed children accused of a crime have legal representation.
- Help, do not punish, child victims of sex trafficking.
- Whenever possible, prosecute young offenders in the juvenile justice system instead of transferring their cases to adult courts.
The first recommendation speaks to the goal of not letting traumatized youth fall between cracks, instead identifying them and then providing them with services that actually help them to recover from chronic post-traumatic stress problems. Rather than treating traumatized youth as either irredeemably antisocial (and therefore warranting more restrictive sentences and confinement) or mentally deformed (and thus requiring psychiatric behavior management-oriented treatment), a less stigmatizing and potentially more effective approach is to provide evidence-based treatment or services designed to help them to overcome traumatic stress reactions.
That is the goal of TARGET (Trauma Affect Regulation: Guide for Education and Therapy), a multisession gender-specific ethnoculturally adapted intervention for traumatized youth (and adults) that can be done as a one-to-one, group, family or milieu therapy, and/or as a training on emotion regulation skills for juvenile justice staff to use on a 24-hour, seven-day-a-week basis in community or congregate justice programs.
TARGET begins with psychoeducation that explains PTSD as a survival adaptation by the brain’s stress response system that makes sense but becomes a problem when the brain’s amygdala (the “alarm”) becomes stuck in survival mode and hijacks the hippocampus (the “memory filing center”) and the prefrontal cortex (“thinking center”) and body.
Overcoming traumatic stress reactions therefore means learning how to reset the brain’s alarm so that it provides helpful alerts but isn’t stuck in survival mode. TARGET then teaches a seven-step sequence of emotion and behavioral self-regulation skills that accomplish the goal of resetting the alarm, summarized by an acronym, FREEDOM.
Two skills, Focusing and Recognizing triggers, enable the youth (or adult) to activate the brain’s thinking and filing centers in order to think before reacting. The next four skills differentiate Emotions, Evaluative cognitions, Deliberate goals and Options for action, based on whether they are simply alarm messages or a team effort of the thinking, filing and alarm centers. A final skill, Making a contribution, helps youths (and adults) recognize that being able to handle stress reactions in a self-regulated manner makes them more effective in achieving their personal goals.
By providing practical knowledge that is interesting and useful for adolescents (and for adult staff, administrators, advocates and family members) TARGET provides a basis for truly collaborative and trauma-informed juvenile justice supervisory, rehabilitative and therapeutic services. With TARGET, everyone teams up to take on the challenge of thinking clearly and making choices that reflect their goals and values rather than impulsive or expedient reactions to stress.
This is a crucial paradigm shift that honors both youth’s and adult/system’s perspectives while calling upon all participants to take responsibility for mindfully handling stress reactions. In so doing, it enables the adults to demonstrate good faith by walking the walk (i.e., managing their own stress reactions just as they want the youths to manage theirs) without stigmatizing anyone (youth or adults) for having expectable (albeit not always adaptive) stress reactions.
TARGET is not a panacea, nor a replacement for other empirically supported approaches to traumatic stress treatment (and cognitive and behavioral rehabilitation) for traumatized youth in the juvenile justice system. It is an evidence-based clinical therapy and also a template for making traumatic stress understandable, transparent and manageable for youth and adults. As such it fosters communication and collaboration among law enforcement officers, program staff and administrators, treatment providers and the youth and family.
TARGET’s goal is to enable youth and adults to recognize and responsibly handle stress reactions that may be due to trauma (for youths, and for adults who have trauma histories of their own) or to the expectable challenges of working in correctional/justice programs with youth who are dysregulated and in some cases capable of posing a threat to the adults’ safety. This is the core goal of trauma-informed systems/services, to enable everyone — traumatized youth, their families, adults responsible for public safety and entire communities — to become safer and more effective.
The second recommendation speaks to the credo for all healing professions and services, “first do no harm.” It, and the more specific recommendations that follow, are a call to stop or radically limit correctional practices that further traumatize youth, such as physical restraints, isolation and shackling.
Even when done in a manner that protects the youth’s physical safety, these practices can activate post-traumatic survival fears and reactions that are psychologically harmful to the youth. They may also actually compromise the safety of law enforcement and juvenile program staff when the youth’s survival reactions include fighting back against perceived victimizers. They also undermine the rehabilitative mission (pages 31-49) that has been at the core of Juvenile Courts since their origins more than a century ago.
However, balancing the goal of protecting youth and enhancing their productive participation in society with the other core juvenile justice goal of maintaining public safety and order is exceptionally difficult with youth who tend to be alienated, distrustful and prone to act either impulsively or strategically without due regard for the law and the values underlying the social contract (such as justice, fairness, respect for individual differences), as well as their own or others’ safety.
Further complicating the picture, these youths often are reacting to current challenges based on alarm reactions and survival tactics learned from coping with traumatic violence or victimization in their own lives, and historically, as a result of their race, ethnicity, gender, gender identity, and problems with learning and discipline in school and family.
Therefore, it is essential that trauma-informed reforms go beyond simply acknowledging that many justice-involved youth have been traumatized, and provide practical skills that adults and youths together can use to prevent further traumatization of youths and of the adults who work with or supervise them, as is done by the TARGET program.
Within the National Child Traumatic Stress Network, I am privileged to direct the Center for Trauma Recovery and Juvenile Justice, which has partnered with several national organizations to champion the cause of trauma-informed reforms in juvenile justice. These organizations include the Center for Children’s Law and Poverty, the Center for Juvenile Justice Reform, the Council of Juvenile Correctional Administrators, Equal Justice Initiative, Futures without Violence, the Juvenile Law Center, the National Center for Mental Health and Juvenile Justice, the National Center for Youth Law, the National Council of Juvenile and Family Court Judges, the National Juvenile Defender Center and the National Juvenile Justice Prosecution Center.
Our ongoing partnerships have resulted in several resources for those who seek to achieve trauma-informed juvenile justice systems, including the Essential Elements of a Trauma-Informed Juvenile Justice System, fact sheets on evidence-based practices and tools for identifying and treating traumatized youth, including girls and youth and families of ethnoracial minority backgrounds in the juvenile justice system, and webinars describing practical goals and guidelines.
Julian Ford is a clinical psychologist, professor of psychiatry and law at the University of Connecticut, director of the Center for Trauma Recovery and Juvenile Justice in the National Child Traumatic Stress Network and co-founder and co-owner of Advanced Trauma Solutions, Inc., the sole licensed distributor of the TARGET intervention by the copyright holder, the University of Connecticut. He has been working for more than a decade with juvenile courts, diversion, probation, detention, and secure facilities to empower staff and administrators, and to assist youth and families with trauma-informed approaches to adjudication and services.
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