Why Asking ‘Where’ Matters When Working with Youth Exposed to Violence

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Nationally, a large proportion of youth experience exposure to violence (ETV) in their homes, schools and neighborhoods. Research has consistently shown that ETV is linked to symptoms of trauma. These symptoms of trauma can then manifest in aggressive and violent behavior.

For juvenile justice-involved youth, research has shown that an even larger proportion are exposed to violence. As a result, they experience significant behavioral health impairment, including both mental health and substance use problems. Youth who have compounding behavioral health issues are particularly difficult to treat and are at risk for continued involvement with the justice system.

We have argued in recent studies for the importance of early assessment to provide targeted treatment to youth exposed to violence and trauma. However, to do so, we must first be able to define and conceptualize ETV in a way that most accurately captures the way in which youth experience violence and are affected by it.

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As with most social phenomena, ETV is seemingly easy to define yet difficult to fully understand. While many researchers acknowledge the importance of the location in which violence occurs, much of the recent research has taken an incidence-based approach.

For example, the Adverse Childhood Experiences (ACEs) study conducted by the Centers for Disease Control (CDC) and Kaiser-Permanente show that traumatic experiences are cumulative and that the risk for adverse health outcomes increase with each additional type of violence exposure. This is one of the largest studies to examine the effect of traumatic childhood experiences on overall health and well-being. While this approach takes into account the importance of understanding the impact of cumulative ETV, focusing on the location in which ETV occurs in addition may provide greater insight.

Generally speaking, social context is an important aspect of children’s behavior. Social sciences research has shown that children’s social interactions and their effect differ based on where they take place. In violence research, each level of environment (home, school and neighborhood) contains some risk factors depending upon the proximity to the individual.

We can think of the home as the center point where social interactions would have the greatest influence on a youth, and as we move farther away from the center, any given social interaction may have less impact. Exposure to violence in schools may affect youth to a greater degree than in neighborhoods because social interactions in schools are much more likely to involve their peers.

We used data from Ohio’s Behavioral Health Juvenile Justice (BHJJ) initiative to examine whether location and social context were important aspects to measuring ETV. Ohio’s BHJJ initiative is a statewide diversion program that provides community-based treatment to juvenile justice-involved youth with behavioral health issues. As part of the program, treatment providers and juvenile courts have participated in extensive data collection that has provided evaluators and the state a wealth of information on the program’s effectiveness as well as the youth’s behavioral health needs.

For this study, recently published in Criminal Justice and Behavior, we examined self-reported ETV in 2,124 BHJJ youth. Exposure to violence is so prevalent in juvenile justice-involved youth that understanding this phenomenon in this population is critical to reducing the likelihood of their continued involvement with the justice system.

The data revealed two interesting findings. First, we found there were three groups who have experienced ETV: (A) youth who have low levels of ETV, (B) youth who have high levels of ETV in the home and schools, and (C) youth who have high levels of ETV in all three settings. Based on these groupings, we can conclude that location does indeed matter in understanding ETV in youth.

Second, we found that group C was significantly more likely to have externalizing problems than groups A and B. This category of problems includes those that are most likely to be noticed by the justice system, such as getting into fights. The data seem to indicate that youth who are exposed to violence across multiple settings (group C) are likely to have few, if any, locations in which they feel safe from violence. Aggressive and violent conduct for these youth may be a manifestation of their trauma.

Assessment for youth in the juvenile justice system is a critical piece to providing trauma-informed care for a population that is desperately in need of treatment. Understanding the extent of ETV and how violence affects these youth is necessary to target the appropriate population with the appropriate level of care. In doing so, accurately measuring the prevalence of ETV in this population is a key first step.

The findings we present in the study do not necessarily suggest abandoning incidence-based approaches to measuring ETV. Instead, we argue for the use of ETV measurements that account for both the cumulative effect of multiple incidents of violence exposure and the cumulative effect of the location in which they occur.

Ultimately, these data show that asking where the incident occurred can have an enormous impact on decisions to guide treatment providers working with juvenile justice populations.

Fredrick Butcher, Ph.D., is a senior research associate with the Begun Center for Violence Prevention and Research in the Jack, Joseph and Morton Mandel School of Applied Social Sciences at Case Western Reserve University. His research on violence exposure and trauma in juvenile justice-involved youth has appeared in a number of journals in a number of social science fields including criminal justice and social work. This study was done with his colleagues Megan Holmes, Jeff Kretschmar and Daniel Flannery.

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