CorrectCare

Juvenile Voice

Trauma Assessment, Treatment Crucial for Youth

by Alicia White, MSW, LCSW

The homeowner awaken to the sound of breaking glass. Frightened that his house was being burglarized, he called the police, who arrived shortly thereafter. The police found a teenager sitting on the front steps of the house, waiting. He had not entered the home, just used the windows for target practice. When questioned by the police, the teen, “Johnny,” admitted to throwing rocks at the house because he “wanted to be arrested.”

In my clinical practice with a large criminal defense firm in New York City, one of my responsibilities is to assess our teen clients following an arrest. When a client, like Johnny, makes a statement to the police that his desire was to be incarcerated, it is imperative to analyze his current life stressors as well as his brief, 16-year history to ascertain what led to his bizarre behavior.

Johnny’s assessment determined that external forces influenced his actions. His father was suffering from terminal cancer, his older brother was on a third tour of duty in Iraq and his family was being evicted from their home.

Frequently, an offending adolescent’s initial contact with mental health intervention is when he is brought to the attention of the juvenile justice system, which may occur following years of exposure to trauma. The youth whom I treat are often from lower socioeconomic backgrounds and have witnessed, experienced or been involved with various traumatic incidents prior to their arrest. Many have experienced loss of a relative or close friend, either by death or incarceration. It is well-documented that youth most at risk of exposure to trauma and community violence are those who are least likely to receive the attention of mental health professionals.

Exposure to acts of violence or the loss of a caretaker or close family member by death or abandonment can significantly impact the life of a child or adolescent. Ideally, treatment would begin immediately after the exposure, although it may be difficult to do. If the youth lacks the coping skills to handle a traumatic situation, stress can manifest psychologically, physically and/or behaviorally. The repercussion of trauma exposure, if left untreated, can affect the development of the brain in young children, introduce problems with aggression and lack of inhibition in school-age children and result in high-risk behavior that can manifest negatively in adolescents.

Screening and Assessment
Working with adolescents, in and of itself, presents significant challenges specific to that population. However, when a youth has been exposed to trauma, that can compound the challenges. To provide youth who have committed a criminal offense with the appropriate treatment, it is necessary to understand the correlation between the negative behavior and the trauma they have experienced.

Those working in the juvenile justice system should be able to recognize signs of depression, post-traumatic stress disorder, anxiety and other diagnosable conditions. Screening and a thorough assessment and history by a skilled clinician or mental health professional are key in successful intervention. This should occur at intake to identify trauma exposure as well as other mental health issues or personal challenges. Questions posed should assess the adolescent’s feelings of depression, sadness, worthlessness, suicidal ideation, self-dislike, self-blame, guilt, insomnia, irritability and loss of interest in activities.

This assessment, coupled with the youth’s history, development and current issues, can establish the need for treatment as well as the types of interventions to be used. Then,  as soon as possible, the youth should receive appropriate treatment.

Before initiating treatment with any child it is ideal, if possible, to engage with the parent/guardian. This can prevent obstacles or barriers to treatment. It also is crucial for the mental health clinician to form a therapeutic alliance with the youth and his or her caretaker.

Treatment Options
Mental health treatment for these adolescents can vary. If engaged in psychotherapy, they receive emotional support and learn tools to understand their emotional issues and to resolve inner conflicts. In treatment they are permitted to work out their current and past challenges. It is advantageous for the youth to work on goals with the therapist that may be specific to their problems or general. The length of treatment is determined on a case-by-case basis.

Each psychotherapy treatment model depends on communication, which is employed to bring about change in the adolescent’s feelings and behaviors. Individual psychotherapy treatments used for adolescents involved in the juvenile justice system include cognitive-behavioral therapy, dialectical therapy, psychodynamic therapy and interpersonal therapy.

Additional psychotherapeutic approaches specific for youth offenders include multisystemic therapy, functional family therapy, brief strategic family therapy™, intensive preventive services, aggression replacement therapy and trauma-focused cognitive behavior therapy.

If left untreated, childhood trauma can lead to more serious difficulties over time. Fortunately, most adolescents who experience mental health challenges can return to
normal daily lives if they receive appropriate treatment.

— About the author: Alicia White, MSW, LCSW, is a therapeutic social worker for The Legal Aid Society, New York City. She may be reached at afwhite@legal-aid.org.

[This article first appeared in the Spring 2011 issue of CorrectCare.]