The maltreatment-violence link: Exploring the role of maltreatment experiences and other individual and social risk factors among young people who offend

Objective: This study investigated the extent to which violent offending in a population of young people detained in secure care facilities is related to variations in child maltreatment after controlling for other known individual and social correlates of crime. Method: Official child protection and youth justice records and survey information for 1819 young people were analyzed. Measures included: maltreatment factors (including type, timing and recurrence); out-of-home care placement factors (including type, age at first placement, stability and duration of placements); social factors (including family and peer risk indicators); and individual factors (including factors relating to intelligence and education, substance use, mental health problems, and behavior). Gender and cultural background were also investigated as potential moderating factors. Logistic regression was used to determine the independent effect of maltreatment factors on violent convictions in the presence of other risk factors. Results: Persistent maltreatment was a consistent predictor of violent convictions. Other independent predictors included: aggression, anger, Indigenous status, and male gender, with household conflict also approaching significance. Conclusion: Collaborative and integrated responses from both child protection and juvenile justice may be needed if comprehensive violence prevention strategies are to be developed for young offenders

IMPRoving Outcomes for children exposed to domestic ViolencE (IMPROVE): an evidence synthesis

BackgroundExposure to domestic violence and abuse (DVA) during childhood and adolescence increases the risk of negative outcomes across the lifespan.ObjectivesTo synthesise evidence on the clinical effectiveness, cost-effectiveness and acceptability of interventions for children exposed to DVA, with the aim of making recommendations for further research.Design(1) A systematic review of controlled trials of interventions; (2) a systematic review of qualitative studies of participant and professional experience of interventions; (3) a network meta-analysis (NMA) of controlled trials and cost-effectiveness analysis; (4) an overview of current UK provision of interventions; and (5) consultations with young people, parents, service providers and commissioners.SettingsNorth America (11), the Netherlands (1) and Israel (1) for the systematic review of controlled trials of interventions; the USA (4) and the UK (1) for the systematic review of qualitative studies of participant and professional experience of interventions; and the UK for the overview of current UK provision of interventions and consultations with young people, parents, service providers and commissioners.ParticipantsA total of 1345 children for the systematic review of controlled trials of interventions; 100 children, 202 parents and 39 professionals for the systematic review of qualitative studies of participant and professional experience of interventions; and 16 young people, six parents and 20 service providers and commissioners for the consultation with young people, parents, service providers and commissioners.InterventionsPsychotherapeutic, advocacy, parenting skills and advocacy, psychoeducation, psychoeducation and advocacy, guided self-help.Main outcome measuresInternalising symptoms and externalising behaviour, mood, depression symptoms and diagnosis, post-traumatic stress disorder symptoms and self-esteem for the systematic review of controlled trials of interventions and NMA; views about and experience of interventions for the systematic review of qualitative studies of participant and professional experience of interventions and consultations.Data sourcesMEDLINE, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, EMBASE, Cochrane Central Register of Controlled Trials, Science Citation Index, Applied Social Sciences Index and Abstracts, International Bibliography of the Social Sciences, Social Services Abstracts, Social Care Online, Sociological Abstracts, Social Science Citation Index, World Health Organization trials portal and clinicaltrials.gov.Review methodsA narrative review; a NMA and incremental cost-effectiveness analysis; and a qualitative synthesis.ResultsThe evidence base on targeted interventions was small, with limited settings and types of interventions; children were mostly &lt; 14 years of age, and there was an absence of comparative studies. The interventions evaluated in trials were mostly psychotherapeutic and psychoeducational interventions delivered to the non-abusive parent and child, usually based on the child’s exposure to DVA (not specific clinical or broader social needs). Qualitative studies largely focused on psychoeducational interventions, some of which included the abusive parent. The evidence for clinical effectiveness was as follows: 11 trials reported improvements in behavioural or mental health outcomes, with modest effect sizes but significant heterogeneity and high or unclear risk of bias. Psychoeducational group-based interventions delivered to the child were found to be more effective for improving mental health outcomes than other types of intervention. Interventions delivered to (non-abusive) parents and to children were most likely to be effective for improving behavioural outcomes. However, there is a large degree of uncertainty around comparisons, particularly with regard to mental health outcomes. In terms of evidence of cost-effectiveness, there were no economic studies of interventions. Cost-effectiveness was modelled on the basis of the NMA, estimating differences between types of interventions. The outcomes measured in trials were largely confined to children’s mental health and behavioural symptoms and disorders, although stakeholders’ concepts of success were broader, suggesting that a broader range of outcomes should be measured in trials. Group-based psychoeducational interventions delivered to children and non-abusive parents in parallel were largely acceptable to all stakeholders. There is limited evidence for the acceptability of other types of intervention. In terms of the UK evidence base and service delivery landscape, there were no UK-based trials, few qualitative studies and little widespread service evaluation. Most programmes are group-based psychoeducational interventions. However, the funding crisis in the DVA sector is significantly undermining programme delivery.ConclusionsThe evidence base regarding the acceptability, clinical effectiveness and cost-effectiveness of interventions to improve outcomes for children exposed to DVA is underdeveloped. There is an urgent need for more high-quality studies, particularly trials, that are designed to produce actionable, generalisable findings that can be implemented in real-world settings and that can inform decisions about which interventions to commission and scale. We suggest that there is a need to pause the development of new interventions and to focus on the systematic evaluation of existing programmes. With regard to the UK, we have identified three types of programme that could be justifiably prioritised for further study: psycho-education delivered to mothers and children, or children alone; parent skills training in combination with advocacy: and interventions involving the abusive parent/caregiver. We also suggest that there is need for key stakeholders to come together to explicitly identify and address the structural, practical and cultural barriers that may have hampered the development of the UK evidence base to date.Future work recommendationsThere is a need for well-designed, well-conducted and well-reported UK-based randomised controlled trials with cost-effectiveness analyses and nested qualitative studies. Development of consensus in the field about core outcome data sets is required. There is a need for further exploration of the acceptability and effectiveness of interventions for specific groups of children and young people (i.e. based on ethnicity, age, trauma exposure and clinical profile). There is also a need for an investigation of the context in which interventions are delivered, including organisational setting and the broader community context, and the evaluation of qualities, qualifications and disciplines of personnel delivering interventions. We recommend prioritisation of psychoeducational interventions and parent skills training delivered in combination with advocacy in the next phase of trials, and exploratory trials of interventions that engage both the abusive and the non-abusive parent.Study registrationThis study is registered as PROSPERO CRD42013004348 and PROSPERO CRD420130043489.FundingThe National Institute for Health Research Public Health Research programme.</jats:sec

Can Prison Be a Place of Healing? The Trauma-Informed Care Initiative at the Women&apos;s Community Correctional Center Overview of the Disproportionate Numbers of Native Hawaiians in Hawai&apos;i&apos;s Criminal Justice System

In response, the Women&apos;s Community Correctional Center (WCCC) developed the Trauma-Informed Care Initiative (TICI). This article examines the efforts of the TICI to create a place of healing and inspire systemic change within the criminal justice system and beyond and the initial steps taken to incorporate informed trauma care at WCCC. Major factors contributing to the disproportionate representation of Native Hawaiian women in the criminal justice system include the psychological, social, educational, and economic effects of trauma, including physical and sexual abuse, neglect and other forms of maltreatment during childhood, and interpersonal violence and trauma experienced in adolescence and early adulthood The Women&apos;s Community Correctional Center (WCCC) recognizes the unique characteristics of its female population, including trauma-related factors. Under the leadership of Warden Mark Patterson, WCCC is working on cultural change to create a place of healing and transformation. Through his work and as a result of his own personal experiences, Warden Patterson is implementing a visionary framework for creating a pu&apos;uhonua (place of refuge)-a place to live a forgiven life, a place for transformation, a place that nurtures healing within the individual, family, and community and can reduce recidivism. WCCC is taking a communitybuilding approach using a mind, body, spirit, and place perspective. To incorporate a better-informed care framework, the Trauma-Informed Care Initiative (TICI) was begun in 2009. This article describes the TICI, including preliminary study findings on the prevalence of trauma, and concludes with Warden Patterson&apos;s personal account relating the issue of trauma to his own genealogical history. Intertwining personal stories with his professional journey, the warden expands on the importance of traumainformed care and why advocacy for systemic change &quot;from twinkle to wrinkle&quot; is critical for strengthening families in the system and beyond. Native Hawaiians are disproportionately represented in Hawai&apos;i&apos;s criminal justice system. A study developed as a collaboration between the State of Hawai&apos;i and the Office of Hawaiian Affairs (OHA et al., 2010) found that the disproportion in Native Hawaiians in the criminal justice system increased at each stage of the criminal justice process. While Native Hawaiians make up 24% of the general population in Hawai&apos;i, they represent 27% of all arrests, 33% of those in pretrial detention, 29% sentenced to probation, 36% admitted to prison, 39% of the incarcerated population, 39% of releases on parole, and 41% of parole revocations (see 310 Hülili Vol.9 ( 2013 ) The effects of traumatic experiences throughout life and the intergenerational transmission of the harmful effects of historical traumas experienced by Native Hawaiians are significant contributors to Native Hawaiian women&apos;s involvement in the criminal justice system. This relationship between significant trauma history and subsequent juvenile and criminal offending among women is supported through studies focused on understanding &quot;gender pathways to lawbreaking&quot; Employing this gendered pathways framework, Marilyn Brown (2003, 2006) described a pathway specific to Native Hawaiian women involved in the criminal justice system. Brown&apos;s pathway is based on her own and other research findings that describe Native Hawaiian women&apos;s criminal offending as an outcome of agency and action by individuals burdened by dysfunctional families, childhood maltreatment, interpersonal violence, substance abuse, personal losses including for many women the loss of custody of their children, and the sequelae of these disruptive and traumatic events. These life course events that render individuals more vulnerable to criminal offending are structured by gender; women experience them differently than men, and consequences differ for women compared to men. These &quot;gendered lives&quot; In a study of incarcerated women in a community residential transition facility that included Native Hawaiians and non-Hawaiians, Yuen, Hu, and Engel (2005) found common histories of adverse childhood experiences including drug or alcohol-abusing parents, exposure to domestic violence, sexual abuse, foster home placement, and family members with histories of involvement with the criminal justice system. In a study of Hawaiian adolescent psychopathology, Nahulu et al. (1996) found that gender roles and culture significantly affected psychosocial risk factors. While Native Hawaiians are closely tied to their families, adolescent girls were found to be far more susceptible than boys to the influence of negative family relationships. Negative familial interactions like abuse, violence, and neglect affected females more severely than males in terms of exacerbating psychological distress

Trauma-Responsive Vocational Rehabilitation Services

Research on the effectiveness of Vocational Rehabilitation (VR) Programs has revealed that VR services are less effective for trauma-affected and Black consumers. For instance, consumers with trauma exposure disengage from services earlier than their non-traumatized counterparts, and Black consumers benefit less from each phase of VR services compared to others. One midwestern state’s VR program sought to address these disparities by offering trauma-informed and trauma-responsive services that emphasize cultural responsiveness, racial equity, and strengths-based practices. To begin this work, the state’s VR program collaborated with an applied research unit in a public university to establish two work groups: a communications group and a training group. The purpose of the communications group was to build a robust referral network within the VR Division and with other community-based agencies and providers, particularly for low-income, Black consumers. The purpose of the training group was to develop and deliver a training program to support VR professionals in providing trauma-informed and trauma-responsive services. Results from an evaluation of the training indicated that each training module generated for staff both reminders and new insights into ways to effectively work with consumers. Staff expressed that they wanted opportunities to further explore and apply the training content and needed additional, ongoing support to implement what they were learning. In response to staff needs, the state’s VR program is continuing to invest in this community–university partnership by establishing communities of practice for staff and evaluating the effectiveness of the training program

Applied and Translational Research on Trauma‐Responsive Programs and Policy: Introduction to a Special Issue of the American Journal of Community Psychology

The special issue highlights work across systems that include child welfare, education, juvenile justice and health, as well as agencies serving adults who are at‐risk for high levels of childhood and adult trauma exposure. While articles appearing in the special issue are not divided equally across these systems, they cover important and overlapping concepts within each. Some articles span more than a single system or domain of research, whereas others fit primarily within single area or domain. Articles provide new insights from research on practices, programs, and policies that help to transform systems so they are increasingly more responsive to the needs of vulnerable populations.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/152826/1/ajcp12402.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/152826/2/ajcp12402_am.pd

Medical Students’ Perspectives on Trauma-Informed Care Training

INTRODUCTION:Adults exposed to traumatic events during childhood commonly seek medical services, but health care practitioners hesitate to address and assess early trauma despite its known negative health effects. This study examines medical students' perspectives on a brief course that addressed the health care needs of patients exposed to adverse childhood experiences. METHODS:A convenience sample of 20 University of California, Davis medical students from the Summer Institute on Race and Health received 6 hours of trauma-informed care training. The course was delivered in 2-hour modules during the course of 3 days, and included lectures, discussions, and practice. A questionnaire assessing students' perspectives on training benefits, current practice challenges, and necessary resources to provide trauma-informed medical care was distributed posttraining. RESULTS:From the students' perspectives, this course increased their ability to recognize various clinical manifestations of adverse childhood experience exposure in adult patients. Students said they learned how to ask about and respond to adverse childhood experience disclosures and identify necessary resources to responsibly implement trauma-informed care in medical settings. Students identified provision of adequate resources and links to appropriate treatment identified as common challenges in providing health care to trauma-affected patients. CONCLUSION:Study findings illustrate that trauma training can fill a knowledge gap and provide associated benefits for medical students. Initial training may pique students' interest by demonstrating the relevance of trauma knowledge in clinical practice; additional training likely is needed to support skills and confidence

Mental Health Among University Employees During the COVID-19 Pandemic: The Role of Previous Life Trauma and Current Posttraumatic Stress Symptoms

Objective: Previous studies indicated that the coronavirus disease 2019 (COVID-19) pandemic has harmed the mental health of diverse samples. Adopting a trauma lens with a sample of university faculty and staff, this study examined risk conferred by previous exposure to traumatic life events (TLE) on pandemic-related mental health harm (MHH) and stress and the mediating influence of posttraumatic stress disorder (PTSD) symptoms. Method: In Spring 2021, employees (N = 641) of a public university in the United States completed an online cross-sectional survey, including validated scales of TLE and PTSD and single-item measures of MHH and stress taken from published COVID-19 studies. A structural probit model was used to estimate: (a) direct effects of cumulative TLE on PTSD, MHH, and stress; and (b) indirect effects of cumulative TLE via PTSD adjusting for age. Gender was tested as a moderating influence. Results: Nearly 36% of the sample reported positive PTSD screens along with high levels of MHH (22.5%) and stress (42.3%). Cumulative TLE was significantly and positively associated with MHH and stress. Both genders experienced a negative impact on mental health and stress either fully or partially through PTSD symptoms; however, the gender by trauma interaction term was not significant. As age decreased, PTSD and MHH increased. Conclusion: Results suggest that PTSD symptoms play a crucial role in the experience of MHH and stress during the pandemic for those who endured previous trauma. Implications for employer policies, public health messaging, and mental health services are explored

Maltreatment prevention through early childhood intervention: A confirmatory evaluation of the Chicago Child-Parent Center preschool program

Increased recognition of the consequences associated with child maltreatment has led to greater emphasis on its prevention. Promising maltreatment prevention strategies have been identified, but research continues to suffer from methodological limitations and a narrow focus on select prevention models. This investigation uses data from the Chicago Longitudinal Study to examine mediating mechanisms that link the Chicago Child-Parent Center preschool program to a reduction in overall child maltreatment and, more specifically, child neglect. We use structural equation modeling to test child, family, and school measures hypothesized to mediate the effects of CPC participation on maltreatment and neglect. Results indicate that a substantial proportion of the program's impacts can be accounted for by family support processes, including increased parent involvement in school and maternal educational attainment as well as decreased family problems. The CPC program's association with reduced school mobility and increased attendance in higher-quality schools also significantly mediated its effects on maltreatment and neglect. Further, a decrease in troublemaking behavior contributed modestly to mediating the program's association with maltreatment but not neglect. We discuss the implications of these results for the field of maltreatment prevention.Maltreatment Prevention Early childhood Intervention Program evaluation