Psychosocial Interventions for Traumatized Youth in the Juvenile Justice System: Research, Evidence Base, and Clinical/Legal Challenges

IntroductionPsychosocial interventions for posttraumatic stress reactions increasingly are recognized as a key component in the provision of services to youth involved in or at risk for involvement in the juvenile justice system (Danielson, Begle, Ayer, & Hanson, 2012; Ford, Chapman, Mack, & Pearson, 2006; Ford, Kerig, & Olafson, 2014; Kerig, 2012). Research has demonstrated that more than 80% of juvenile justice-involved youth report a history of exposure to at least one traumatic event at some point in their lives (e.g., childhood maltreatment, domestic or community violence, severe accidents, traumatic deaths of family or friends), and typically these youth have endured multiple types of traumatic exposure (Abram et al., 2004; Dierkhising et al., 2013; English, Widom, & Brandford, 2002; Ford, Hartman, Hawke, & Chapman, 2008; Ford, Grasso, Hawke, & Chapman, 2013; Stimmel, Cruise, Ford, & Weiss, 2014; see Kerig & Becker, 2010, 2012, 2014 for reviews). Such polyvictimization places youth at significant risk for ongoing emotional, developmental, academic, and behavioral problems. Persistent posttraumatic stress can lead to serious long-term mental health problems for youth, including posttraumatic stress disorder (PTSD), substance abuse, anxiety, disordered eating, depression, self-injury, conduct problems, and revictimization, all of which further increase the likelihood of involvement in delinquency, crime, and the justice system (Becker & Kerig, 2011; Ford, 2010; Ford et al., 2006; Ford, Elhai, Connor, & Frueh, 2010; Ford et al., 2013). In addition to the preponderance of youth entering the justice system with histories of prior exposure to traumatic events, the juvenile justice system itself may expose youth to additional traumatic stressors, such as peer violence, abuse by staff, and shackling and restraints (Dierkhising, Lane, & Natsuaki, 2014; Mendel, 2011). Retraumatization of youth in justice settings increases their risk for PTSD and could also cause problem behaviors that may endanger other youth and adults (DeLisi et al., 2010; Ford & Blaustein, 2013). Therefore, effective therapeutic interventions provided on a timely basis and matched to the specific needs and life circumstances of each traumatized youth are an essential component of a trauma-informed juvenile justice system. To this end, this article provides an overview of the state of the art in current research on the development and implementation of psychosocial interventions for traumatized youth who are involved in the juvenile justice system or are at risk due to delinquency.Working With Traumatized Youth in the Juvenile Justice System: Six ChallengesA growing evidence base supports in general the effectiveness of therapeutic interventions for adolescent PTSD and the related psychosocial problems that follow from exposure to traumatic stress (e.g., Cary & McMillen, 2012; Connor, Ford, Arnsten, & Greene, 2014; de Arellano et al., 2014). However, there are several reasons why justiceinvolved youth might be considered a special population in need of services targeted specifically to their needs and characteristics. These youth and the professionals and staff who work with them face six key challenges: (a) the overrepresentation of youth of color and of lesbian, gay, bisexual, transgender, questioning, and gender nonconforming (LGBTQ/ GNC) youth in the juvenile justice system; (b) the high prevalence of traumatic exposure and polyvictimization among justice-involved youth; (c) the adverse impact that PTSD symptoms have on youth participation in and benefit from rehabilitative services; (d) the difficulty of involving family and other support system members in justice-involved youth services; (e) justice-involved youths' ongoing risk of exposure to violence, losses, and other threats that can reactivate or exacerbate PTSD symptoms; and (f) the potentially coercive context of involuntary rather than voluntary participation created by law enforcement and judicial mandates on youth. …