The effectiveness of trauma-informed youth justice: a discussion and review

Youth justice services around the world are under increasing pressure to find new and more effective ways of working with young people. One way forward is to implement a more compassionate approach to service delivery that embraces the idea of ‘trauma-informed practice’. And yet, substantial variation has been observed in how a trauma-informed approach has been defined and understood by practitioners, with idiosyncratic implementation evident across different systems and only limited evidence that this results in reductions in subsequent re-offending. In this paper we argue that the success of efforts to work in more trauma-informed ways cannot be judged using recidivism data alone and that there is a need to identify key indicators of the effectiveness of any traumainformed approach. We present the case for implementing trauma-informed youth justice and outline key features of the approach. We then present a logic model that articulates key components and identifies short- and longer-term outcomes that can be measured to assess the overall performance of a service. The article concludes with a discussion of the current evidential status of traumainformed youth justice, identifying areas of current strength and those where further work is needed to develop the evidence base, including the need to demonstrate the hypothesized association between short-term trauma-informed practice outcomes and the longer-term goal of preventing re-offending.Andrew Day, Catia Malvaso, Carolyn Boyd, Katherine Hawkins, and Rhiannon Pilkingto

Hearing and justice: the link between hearing impairment in early childhood and youth offending in Aboriginal children living in remote communities of the Northern Territory, Australia

Background: High prevalence of chronic middle ear disease has persisted in Australian Aboriginal children, and the related hearing impairment (HI) has been implicated in a range of social outcomes. This study investigated the association between HI in early childhood and youth offending. Method: This was a retrospective cohort study of 1533 Aboriginal children (born between 1996 and 2001) living in remote Northern Territory communities. The study used linked individual-level information from health, education, child protection and youth justice services. The outcome variable was a youth being “found guilty of an offence”. The key explanatory variable, hearing impairment, was based on audiometric assessment. Other variables were: child maltreatment notifications, Year 7 school enrolment by mother, Year 7 school attendance and community ‘fixed- effects’. The Cox proportional hazards model was used to estimate the association between HI and youth offending; and the Royston R2 measure to estimate the separate contributions of risk factors to youth offending. Results: The proportion of hearing loss was high in children with records of offence (boys: 55.6%, girls: 36.7%) and those without (boys: 46.1%; girls: 49.0%). In univariate analysis, a higher risk of offending was found among boys with moderate or worse HI (HR: 1.77 [95% CI: 1.05–2.98]) and mild HI (HR: 1.54 [95% CI:1.06–2.23]). This association was attenuated in multivariable analysis (moderate HI, HR: 1.43 [95% CI:0.78–2.62]; mild HI, HR: 1.37 [95% CI: 0.83– 2.26]). No evidence for an association was found in girls. HI contributed 3.2% and 6.5% of variation in offending among boys and girls respectively. Factors contributing greater variance included: community ‘fixed-effects’ (boys: 14.6%, girls: 36.5%), child maltreatment notification (boys: 14.2%, girls: 23.9%) and year 7 school attendance (boys: 7.9%; girls 12.1%). Enrolment by mother explained substantial variation for girls (25.4%) but not boys (0.2%). Conclusion: There was evidence, in univariate analysis, for an association between HI and youth offending for boys however this association was not evident after controlling for other factors. Our findings highlight a range of risk factors that underpin the pathway to youth-offending, demonstrating the urgent need for interagency collaboration to meet the complex needs of vulnerable children in the Northern Territory.Vincent Yaofeng He, Jiunn-Yih Su, Steven Guthridge, Catia Malvaso, Damien Howard, Tamika Williams and Amanda Leac

Apremilast for the treatment of hidradenitis suppurativa associated with psoriatic arthritis in multimorbid patients: Case report and review of literature

INTRODUCTION: Hidradenitis suppurativa is a complex, chronic, difficult to treat condition belonging to the spectrum of cutaneous immune-mediated inflammatory diseases. Systemic treatment options for moderate-severe disease are limited to TNF-alpha antagonists and other biologic agents, with limited clinical evidence. PATIENT CONCERNS: We report two adult patients with severe hidradenitis suppurativa presenting concomitant psoriatic arthritis and multiple medical comorbidities. Both were ineligible or resistant to adalimumab, the only biologic drug approved for the treatment of hidradenitis. DIAGNOSIS: Both patients were diagnosed with severe Hurley III-stage disease and psoriatic arthritis, showing resistance to first-line systemic treatments and a complex comorbidity profile. INTERVENTIONS: Patients underwent treatment with apremilast, an oral phosphodiesterase-4 inhibitor, approved for the treatment of psoriatic arthritis. OUTCOMES: After 16 weeks of treatment, a clinically relevant improvement of inflammatory lesions, skin- and arthritis-related pain, and patient-reported outcomes was achieved in both patients. Apremilast was well tolerated and continued up to 48 weeks of treatment. CONCLUSION: We report the "real-life" use of apremilast in the treatment of multimorbid patients with hidradenitis suppurativa and review its potential role in the management of this severe condition

Researching Adverse Childhood Experiences in the Youth Justice System: Reflections on Methodology From a Members of a Non-Indigenous Research Team

Understanding the impacts of Adverse Childhood Experiences (ACEs) has rapidly emerged as an important area of research that has implications for those who work in youth justice settings. This paper identifies a series of considerations facing those who work in jurisdictions where Indigenous or First Nations peoples have much higher levels of contact with both child protection and criminal justice systems than other population groups. It presents some reflections from members of a non-Indigenous research team about their efforts to engage with cultural perspectives on ACEs research in a way that facilitates further discussion within the research community about the methodological decisions that are made when investigating issues that are of importance to members of minority culture communities.Andrew Day and Catia Malvas

Young people with complex needs leaving out-of-home care: service issues and the need to enhance practice and policy

Leaving statutory out-of-home care (OOHC) is a challenging time for many young people; however, certain groups have greater difficulty transitioning to independence. This includes young people with multiple and complex needs, such as those suffering from mental health problems and disabilities, as well as young people with borderline conditions or who disengage from services. The aim of this study was to gain a deeper understanding of the service issues pertaining to these vulnerable groups in South Australia, as well as to identify ways that policy and practice can be enhanced to better facilitate service engagement. Twenty-nine individual interviews and focus groups were conducted with people working in organisations who have knowledge of, or contact with, young people leaving care (N = 66). Thematic analysis was used to organise responses according to two overarching themes: (1) Issues with current leaving care services and preparation, and (2) Enhancing policy and practice. The principal challenges related to difficulties in matching the structure of formal services to a population with highly unstructured living arrangements, a history of problematic engagement with the care system, and difficulties arising due to service ineligibility issues. Potential improvements to the current system and program delivery are discussed.Catia Malvaso and Paul Delfabbr

Offending behaviour among young people with complex needs in the Australian out-of-home care system

The link between childhood maltreatment and subsequent offending behaviour is well established, and data from the child welfare system is commonly used to examine the maltreatment–offending association. This study used data from the first national comparative profile study of high-support needs children undertaken in Australia to determine which factors differentiate offenders from non-offenders among a sample of high support needs young people. It was hypothesised that young people with offending behaviour would differ from those without offending behaviour on various demographic, background, and emotional and behavioural factors. As hypothesised, young people with offending behaviour were more likely to have experienced a range of adverse background factors and displayed more problematic behaviours than young people without offending behaviour; however, logistic regression analyses indicated that four factors are significantly associated with offending: older age, damaging property, substance abuse and conduct problems. Placement in residential care, being placed in care due to reasons other than physical abuse, being of Aboriginal and Torres Strait Islander descent and poor social adjustment were all marginally associated with offending behaviour. This study highlighted some of the potential mechanisms responsible for the increase in offending behaviour among youth in the child welfare system. Understanding these mechanisms is imperative for researchers, practitioners and policy makers alike for the development of effective intervention strategies.Catia Gaetana Malvaso, Paul Delfabbr

Suicidal behaviour in Aboriginal and non-Aboriginal young men under custodial youth justice supervision: understanding the role of adverse childhood experiences

Published online: 14 Feb 2022This study examined the association between adverse childhood experiences (ACEs) and suicidal behaviour in a sample of 1726 young men in an Australian youth justice detention population. Nine ACEs, including child abuse and parental risk factors, were examined. Analyses focused on whether ACEs were associated with suicidal ideation and attempts after controlling for other known correlates including substance use, aggression and out-ofhome care exposure. Aboriginal and Torres Strait Islander young men were found to have a higher prevalence and a higher average score of ACEs, but differed very little in relation to reported suicidal behaviour. Higher ACEs scores and specific maltreatment types (i.e. physical and sexual abuse) were positively associated with suicidal behaviour. This relationship was attenuated after controlling for established correlates of suicidal behaviour. The findings underscored the importance of understanding ACEs as major risk factors for suicide in youth justice populations and the need for effective prevention measures.Matilda D’Antoine, Catia Malvaso, Paul Delfabbro and Joanne O’Conno

Socio-demographic, health, and psychological correlates of suicidality severity in Australian adolescents

Objective: Few studies have examined whether factors related to suicide ideation alone are also related to suicide plans and attempts. The aim of this study was to examine the psychological and social factors associated with different levels of suicide risk in Australian adolescents. Method: A sample of 2,552 young people aged 14–16 years completed a detailed survey that included demographic, social, and psychological indicators as well as a four-tier measure of suicidality: occasional ideation, regular ideation, suicide plans, and suicide attempts. Separate statistical models were developed for each level of suicide risk as well as an overall multinomial logistic regression to compare more severe levels of suicidality against occasional ideation. Results: The results showed that while most well-established predictors were indicative of elevations of each level of suicide risk, only some factors predicted suicide attempts. The highest suicide attempt risk was observed in girls, those who smoked, had romantic relationships, and who had poorer health. Students with concerns about their weight, who used marijuana, who had more negative mood states, and who were in romantic relationships were more likely to have suicide plans. Conclusions: The results suggest that the identification of young people at highest risk of suicide attempts can be enhanced by focusing on specific indicators, including gender (females higher), smoking and marijuana use, and declines in physical health.Paul H. Delfabbro, Catia Malvaso, Anthony H. Winefield, and Helen R. Winefiel

Service approaches to young people with complex needs leaving out-of-home care

Although leaving statutory out-of-home care can be a challenging time for many young people, it is recognised that young people who have multiple or complex needs find this transition particularly difficult. This study aims to gain a deeper understanding of the challenges faced by care leavers who have complex needs, as well as to identify some of the best strategies for assisting this population to engage with services and make the transition successfully. Semi-structured individual interviews and focus groups (n = 29) were conducted with 66 individuals who were working in organisations (both government and non-government) that have knowledge of, or contact with, young people leaving care in South Australia. Responses were analysed thematically in relation to the principal challenges and needs of care leavers and the best strategies for encouraging service engagement. The principal challenges related to difficulties in matching the structure of formal services to a population with highly unstructured living arrangements, a history of problematic engagement with the care system and difficulties in social interactions. A set of suggestions for improving service engagement was developed. This included the need for flexible and persistent services, creative, indirect and person-centred approaches to engagement that emphasised the importance of building peer and adult relationships, and developing adaptive life-skills.Catia Malvaso, Paul Delfabbro, Louisa Hackett, Hayley Mill