Trauma-Informed Practice in Youth Justice Systems

The population of young individuals navigating the criminal justice system often experiences significant trauma. Unfortunately, the facilities they inhabit and the services they encounter have faced criticism for utilizing punitive, harmful, and sometimes abusive methods. Trauma-Informed Practice (TIP) presents a compassionate alternative that seeks to interact with this demographic in ways that prevent further re-traumatisation. It emphasizes understanding the vulnerabilities stemming from childhood adversity and promotes the creation of safe environments and supportive relationships essential for healing.

Various youth justice agencies have pledged to adopt TIP, yet the complexity of determining its implementation and effectiveness poses significant challenges. The authors of the current paper outline several objectives, including alleviating trauma symptoms, enhancing mental health and overall wellbeing, and decreasing rates of re-offending and other detrimental behaviors. This suggests a diverse array of strategies can be employed to achieve these goals, highlighting the necessity for clear guidelines on which conditions, processes, and interventions yield the most favorable results.

A systematic review conducted in 2017 by Branson et al. proposed numerous recommendations for the effective implementation of TIP, considering not only the services themselves but also the broader environment and organizational context in which these services operate. Since then, several efforts have been made to compile and analyze the existing evidence on TIP within the realm of youth justice. In 2024, Malvaso, Day, and Boyd endeavored to assess and summarize findings from all relevant reviews, aiming to equip decision-makers and practitioners with comprehensive, evidence-based recommendations.

Comprehensive Methods for Evaluating Trauma-Informed Approaches

The primary goal of this review is to summarize existing evidence on trauma-informed approaches within youth justice systems. To achieve this, Malvaso and colleagues conducted extensive searches across nine electronic databases to uncover relevant systematic reviews and meta-analyses. They employed a broad definition of trauma-informed practices to ensure no significant papers were overlooked due to narrow labeling. The inclusion criteria focused on peer-reviewed articles published in English that contained at least one quantitative evaluation of group-based interventions aimed at enhancing outcomes for individuals involved in the justice system, specifically those aged between 10 and 24 years, as long as they included participants under the age of 18.

Two independent authors meticulously screened both abstracts and full-text articles, documenting essential details of the research designs to evaluate quality by utilizing the AMSTAR 2 checklist. Their assessment paid careful attention to potential biases and the quality of the meta-analyses included in this body of work. Each review was then summarized, providing a narrative synthesis of the principal findings related to three key outcome areas, which included:

• trauma symptomatology,
• mental health and wellbeing, and
• justice-related outcomes.

Key Findings from the Umbrella Review of Trauma-Informed Practices

The review encompassed nine comprehensive reviews categorized as an ‘umbrella review’; six of these were narrative reviews while three were meta-analyses. Overall, the studies were detailed adequately, featured robust search strategies, and disclosed information regarding funding and conflicts of interest. However, none of the studies provided details about excluded studies, and descriptions of the studies themselves were often insufficient. Although summary assessments of quality were not presented, the overall methodological rigor varied significantly, with no single study fulfilling all quality criteria. The main findings of this extensive review are summarized below:

Reduction of Trauma Symptoms through Targeted Interventions

Notable reductions in post-traumatic stress symptoms were observed for numerous cognitive-behavioral interventions, with medium to large effect sizes reported in 9 out of 10 studies. Specifically, Eye Movement Desensitization and Reprocessing (EMDR) and trauma-focused cognitive-behavioral interventions were highlighted in one review as particularly effective (Rhoden et al., 2019). However, several studies reported null effects (e.g., Kumm et al., 2019), indicating that the overall impact may be limited.

Improvements in Mental Health and Wellbeing

Many interventions resulted in enhanced mood, increased self-esteem, reduced depressive symptoms, and better externalizing and death-related attitudes, although the impact on anxiety was less pronounced. Significant treatment effects were noted for positive and adaptive emotion regulation strategies in interventions explicitly designed to address these areas (Eadeh et al., 2021), although effect sizes were modest in non-clinical samples. A ten-session mindfulness meditation program demonstrated improvements in self-regulation, while an intensive 7-hour mindfulness retreat did not yield significant effects.

Subgroup analyses that included gender yielded mixed results (Gagnon et al., 2022):

• A motivational interviewing intervention led to decreased substance-related aggression specifically in girls with lower levels of depression.
• Social problem-solving training resulted in reduced depressive symptoms solely among males with higher intelligence.

While these findings are encouraging, several studies demonstrating greater methodological rigor (i.e., those utilizing control groups) found no significant treatment effects across any of the outcomes, underscoring the necessity for additional experimental research in this critical area.

Effects on Forensic Measures and Recidivism

Some studies exhibited small to large positive effects on measures of externalizing behavior, such as reduced time spent in seclusion and lower delinquency rates (Rhoden et al., 2019). Nevertheless, there remains limited evidence supporting the notion that trauma-informed treatment programs significantly influence rates of reoffending or delinquency. Some evidence does suggest a reduction in recidivism among girls (Baetz et al., 2022). In studies that did observe a decrease in recidivism for ‘repeat youth offenders,’ this was tentatively correlated with an improved sense of coherence and an increased ability to recognize emotions in others (Hodgkinson et al., 2021).

Enhancements in Organizational Practices

A review focusing on a trauma-informed organizational intervention indicated significant improvements in both the physical and perceived safety for staff and young individuals. However, it noted that isolating the specific effects of staff training proved to be challenging (Olaghere et al., 2021). A broader review encompassing 24 studies revealed that participation in trauma-informed staff training led to enhancements in staff knowledge, attitudes, and behaviors (Purtle, 2020). The recommendation for further study of organizational interventions emerges from the observation that system-wide initiatives are less developed than individual treatment strategies.

Insights and Limitations of Trauma-Informed Practices

The majority of the interventions analyzed were structured group programs; however, a smaller subset focused on organizational transformation and specific staff training initiatives. The findings support the notion that trauma-informed staff training can enhance staff awareness, attitudes, and behaviors, leading to improved actual and perceived safety for both staff and youth. It is crucial to acknowledge that the conclusions drawn from this research are limited due to methodological shortcomings.

Overall, interventions centered around trauma were associated with a modest positive impact on trauma symptoms, particularly those employing cognitive-behavioral strategies. However, findings regarding co-occurring mental health issues, institutional misconduct, and reoffending were inconsistent.

While trauma-specific treatments displayed promise across numerous reviews, challenges remain in their implementation. These include ensuring staff receive adequate training, engaging stakeholders effectively, and integrating and monitoring new treatment approaches appropriately. Additionally, effectiveness varied not only within but also between groups, influenced by factors such as gender, intelligence, and pre-treatment depressive symptoms.

Strengths and Limitations of the Current Research

The authors effectively compile a wealth of pertinent evidence within a crucial research domain that revolves around vulnerable young individuals in need of effective, trauma-informed support systems.

However, limitations regarding the methodological quality of the primary studies included in all reviews are acknowledged, particularly for those that reported significant effects but didn’t utilize control groups. This makes it challenging to discern whether the treatment itself (or other variables) influenced the observed changes. Additionally, there is recognition that smaller studies reporting significant findings may be more likely to be published (Hong et al., 2020), creating a potential bias that readers should be aware of. Furthermore, the lack of participant diversity across the research in these reviews is pointed out as a critical limitation, especially concerning ethnicity. This is significant due to the overrepresentation of children from black and mixed ethnic backgrounds within youth justice systems and their established links to socioeconomic disadvantage. Given the limited evidence on the effects of interventions among ethnic minority children, it remains essential for primary studies and reviews to actively monitor and evaluate these factors (Revolving Doors, 2024).

A noted strength is that, despite a focus on group-based interventions, the authors also acknowledge and report on broader aspects of trauma-informed interventions. This aspect is often overlooked in evaluations of trauma-informed justice services. Despite the existing literature on the effectiveness of trauma-focused treatments and an established understanding of various factors associated with effective treatment, there remains a consensus that no single approach or program is universally effective. Therefore, a stronger emphasis on other facets of trauma-informed service provision in justice contexts, such as staff training or system-level interventions, would be advantageous. The authors identify this as a necessary next step for practice, yet one could argue that the secondary focus on broader trauma-informed service provision could serve as a central theme within the paper, particularly given the acknowledged impact of contextual factors (e.g., population turnover, service integrity) on methodological limitations.

Practical Implications for Trauma-Informed Youth Justice Systems

While the paper arrives at a cautiously optimistic conclusion regarding the cognitive-behavioral approach, it is noteworthy that a majority of the intervention components studied predominantly utilized a cognitive, top-down treatment approach. There is an increasing recognition of the importance of a bottom-up approach to trauma treatment, which focuses on cultivating awareness of bodily sensations and establishing a sense of safety in the present before addressing underlying trauma or emotional dysregulation. Therefore, readers are encouraged not to interpret this conclusion as definitive empirical support for CBT approaches over alternative modalities.

One significant recommendation offered by the authors is that treatment should not solely concentrate on individuals diagnosed with post-traumatic stress or targeted towards specific past traumatic events. Instead, initiatives should be broader in scope, focusing on services that enhance resilience and recovery from the diverse range of adverse experiences typical of this population. A promising finding is that, while implementation can be complex, appropriate, accessible, cost-effective, and sustainable services within youth justice settings can indeed be both feasible and effective. Overall, decision-makers should be encouraged by this additional support to transition further away from punitive methodologies, moving towards a more trauma-informed youth justice system.

Next Steps in Advancing Trauma-Informed Youth Justice Practices

The authors propose several actionable next steps aimed at enhancing trauma-informed practices in youth justice:

• Trauma awareness training should be adequately funded and supported by leadership;
• The research design for evaluating any trauma-informed services must be methodologically sound (e.g., incorporating comparison groups, validated measures, and follow-up assessments);
• It is crucial to incorporate young people’s perspectives in the design and evaluation of any services or interventions tailored for them;
• Proper audit and accreditation processes should be established to ensure accountability for desired and achieved outcomes.

Looking ahead, if the research landscape is to broaden in understanding the effectiveness of trauma-informed practices, it is vital to focus on the context surrounding the interventions, not just the interventions themselves. Emerging research highlights the significance of system-level factors within studies involving women in UK prisons (e.g., Kelman et al., 2024), where experiences of justice services are examined in relation to systemic elements (such as staff training and the relationships between staff and prisoners). This research underscores the necessity for a holistic approach to implementing trauma-informed services, and while challenging, evaluating such organizational initiatives and their effects on trauma-informed practices may generate innovative ideas and insights within the critical realm of criminal justice.

Practitioners often note that genuine, meaningful change is frequently obscured in evaluations that prioritize validated psychometric outcomes or routinely collected organizational data, sometimes overlooking the nuanced individual-level transformations that may not be easily quantified through scales measuring trauma symptomatology, mental health, and wellbeing. Service providers are encouraged to allocate more time at the onset of service design to collaboratively understand (with input from service users) the underlying mechanisms of change and to utilize this understanding to guide an evaluation plan that accurately reflects the desired transformations. Enhancing evaluation methodologies is crucial for developing the robust evidence base required for sustained systemic change within youth justice services.

Disclosure of Interests and Perspectives

The authors of this blog declare that they have no conflicting interests. The perspectives expressed herein are those of the authors and do not necessarily reflect the views of His Majesty’s Prisons and Probation Service (HMPPS) or the Ministry of Justice (MoJ), nor do they represent official Government policy.

Essential Resources and References

Key Research Paper

Malvaso, C.G., Day, A. & Boyd, C.M. The Outcomes of Trauma-Informed Practice in Youth Justice: An Umbrella Review. Journ Child Adol Trauma (2024). https://doi.org/10.1007/s40653-024-00634-5

Additional References

Branson, C. E., Baetz, C. L., Horwitz, S. M., & Hoagwood, K. E. (2017). Trauma-informed juvenile justice systems: A systematic review of definitions and core components. Psychological Trauma: Theory, Research, Practice and Policy, 9(6), 635–646. https://doi.org/10.1037/tra0000255

Kelman, J., Palmer, L., Gribble, R., & MacManus, D. (2024). Time and Care: A Qualitative Exploration of Prisoners’ Perceptions of Trauma-Informed Care in Women’s Prisons. International Journal of Forensic Mental Health, 1–12. https://doi.org/10.1080/14999013.2023.2298484

Revolving Doors (2024). Addressing racial disparity in the youth justice system: promising practice examples. Available at: https://assets.publishing.service.gov.uk/media/671a00ad549f63039436b3ca/Addressing_racial_disparity_in_the_youth_justice_system.pdf

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