Jeff M. Kretschmar

Clinically Significant Trauma Symptoms and Behavioral Problems in a Community-based Sample of Children Exposed to Domestic Violence

This study assessed the associations of characteristics of domestic violence incidents with clinically significant levels of traumatic symptoms and behavioral problems in a socio-economically and ethnically mixed sample of 687 children participating in a community-service program for children witnessing violence. Study predictors included child/family demographic characteristics, type and chronicity of exposure, and child’s perceptions of control over the event and threat to personal safety. Outcomes consisted of traumatic symptoms and behavior problems. Results showed that perceived threat and control were associated with greater odds of clinically significant levels of several trauma symptoms (and behavior problems in the case of perceived threat) after adjusting for effects of demographic factors and violence characteristics. Child co-victimization increased odds of reaching clinically significant levels of traumatic symptoms compared to children who witnessed the event but were not victimized. Female sex and White ethnicity increased odds of specific trauma symptoms and behavior problems. Increasing age reduced odds of some trauma symptoms. Associations between predictors and one outcome measure did not generalize across the other outcome measure. Implications of study findings, and directions for future research are discussed.

Violence and School Shootings

Multiple-homicide school shootings are rare events, but when they happen they significantly impact individuals, the school and the community. We focus on multiple-homicide incidents and identified mental health issues of shooters. To date, studies of school shootings have concluded that no reliable profile of a shooter exists, so risk should be assessed using comprehensive threat assessment protocols. Existing studies primarily utilize retrospective case histories or media accounts. The field requires more empirical and systematic research on all types of school shootings including single victim incidents, those that result in injury but not death and those that are successfully averted. We discuss current policies and practices related to school shootings and the role of mental health professionals in assessing risk and supporting surviving victims.

The impact of neighborhood disorganization on neighborhood exposure to violence, trauma symptoms, and social relationships among at-risk youth

Previous research has demonstrated that exposure to violence (ETV) is a serious concern across the north-south socioeconomic divide. While studies have found that social support is a protective factor for youth exposed to violence and trauma, little is known about the impact of trauma symptoms on forming and maintaining social relationships which are key to accessing a vital social resource that fosters resilience in youth experiencing trauma symptomatology. Building on previous models that examine the impact of neighborhoods on exposure to violence and trauma, the current study examines the impact of neighborhood disorganization on ETV among youth and ETVs effects on trauma symptoms and social relationships. Data were collected on 2242 juvenile justice-involved youth with behavioral health issues in 11 urban and rural counties in the Midwestern United States. Using structural equation modeling (SEM), our data demonstrated that living in highly disorganized neighborhoods was associated with higher levels of ETV and that ETV was positively associated with trauma symptoms. Mediational analysis showed that trauma symptoms strongly mediated the effect of ETV on social relationships. Freely estimating structural paths by gender revealed that hypothesized associations between these variables were stronger for females than males. Findings here highlight the need to provide trauma-informed care to help youth to build and maintain social relationships. Identification and treatment of trauma symptoms that is culturally informed is a critical first step in ensuring that identified protective factors in local contexts, such as social relations and social support, have opportunities to minimize the impact of ETV among youth across northern and southern nations.

Diverting Juvenile Justice-Involved Youth With Behavioral Health Issues From Detention Preliminary Findings From Ohio’s Behavioral Health Juvenile Justice (BHJJ) Initiative

Nationally, well over half of juvenile justice-involved youth report behavioral health impairment. Although the juvenile justice system may be the first place a youth is screened for behavioral health problems, the system is often ill-prepared to properly treat these youth. In response to the growing number of youth entering the juvenile justice system with behavioral health issues and the lack of proper care in these facilities, many communities have developed diversion programs as an alternative to detention. The current study investigated Ohio’s Behavioral Health Juvenile Justice (BHJJ) program, a diversion program for juvenile justice-involved youth with behavioral health issues that provides evidence-and community-based behavioral health treatment. Results indicated BHJJ was effective at improving behavioral health outcomes, including general functioning and trauma symptomatology, and reducing future delinquency. Analyses also examined the variables that predicted successful treatment completion and future adjudications. Implications for juvenile justice programming and policy are discussed.

Displacement and suicide risk for juvenile justice-involved youth with mental health issues.

This article examined the relationship between suicide behaviors and displacement, as defined by out-of-home placement, in a sample of juvenile-justice-involved youth with mental health issues. Participants included boys and girls between the ages of 10 and 18 who were enrolled in a juvenile justice diversion program for children with mental or behavioral health problems. Data collected included youth-reported suicide and self-harm ideation, caregiver reports of previous suicide attempts, and whether the youth had been in an out-of-home placement in the year prior to enrollment in the program. Logistic regression analyses indicated that youth who had recently been in an out-of-home placement reported significantly less suicide ideation and marginally less self-harm ideation than youth who had not been in an out-of-home placement. Out-of-home placement status had no impact on caregiver reports of previous youth suicide attempts.

Analysis of the validity scales in the Trauma Symptom Checklist for Children

Objective: Little empirical attention has been paid to the validity scales of the Trauma Symptom Checklist for Children (TSCC). The purpose of this study is to examine the prevalence of cases identified by the validity scales and its analytical impact. Methods: The current study compares regression models using data from two community samples (n = 3,724 and n = 2,245) and two samples of at-risk youth (n = 1,758 and n = 204). Using Chow tests to compare coefficients, we demonstrate the implications of removing cases identified by the TSCC validity scales. Results: The Underresponse (UND) scale identified 8% of the community sample and 20% of the at-risk sample. Chow tests revealed significant group differences based on the UND scale for all TSCC subscales. Conclusion: The present study demonstrates the analytical impact of the TSCC validity scales and provides statistical evidence for the removal of invalid cases.

Responding to the mental health and substance abuse needs of youth in the juvenile justice system: Ohio's Behavioral Health/Juvenile Justice Initiative.

Nearly half a million inmates with mental health issues are housed in our country’s jails and prisons. The majority of juvenile justice-involved (JJI) youth have a history of behavioral health (mental health or substance use) problems. Multiple studies estimate that between 65% to 75% of juvenile justice-involved youth have at least one behavioral health disorder, and 20% to 30% report suffering from a serious behavioral disorder. With so many juveniles with behavioral health issues entering a system that was not designed to provide comprehensive treatment, communities are reevaluating their approach to juvenile justice. This article describes the origins and the results of Ohio’s Behavioral Health Juvenile Justice Initiative (BHJJ), a diversion program for juvenile justice-involved youth with behavioral health issues. The authors also discuss the key components of program success, offer advice to other jurisdictions considering implementing similar programming, and identify ways to take diversion programs to scale. (PsycINFO Database Record (c) 2016 APA, all rights reserved)

Confirmatory Factor Analysis of the Trauma Symptom Checklist for Children in an At-Risk Sample of Youth

Objective: The Trauma Symptom Checklist for Children (TSCC) is a widely used assessment tool in both community and clinical samples. Although the reliability and validity of the TSCC has been studied extensively, its factor structure has been understudied. Particularly, researchers have conceptualized the TSCC as a summative total scale score without evidence of its psychometric properties. Method: The current study examines the factor structure of the TSCC conceptualized as a total score using second-order confirmatory factor analysis (CFA) in a large sample of juvenile justice involved youth (N = 2,268). Results: Results indicate that a total score does not fit the data. However, an alternative model that included 2 factors that grouped together (a) anxiety, dissociation, and posttraumatic stress with (b) anger and depression fit the data well. Conclusions: Although the findings do not support the use of the TSCC as a total score, a 2-factor solution provides a more parsimonious conceptualization of the TSCC. Implications for both social work practice and research are discussed.

Polyvictimization Across Social Contexts Home, School, and Neighborhood Violence Exposure

Exposure to violence is a widespread problem that affects the mental health of children and adolescents particularly in at-risk populations such as juvenile justice involved youth. While a number of studies have examined the cumulative impact of violence exposure, few studies have examined the importance of social context. The present study examined classifications of youth exposed to violence by contextual location (home, school, and neighborhood) in a sample of 2,124 juvenile justice involved youth. Latent class analysis revealed three classes of youth exposed to violence: (a) low violence exposure, (b) moderate and high home/school violence exposure, and (c) violence exposure in all three social contexts. Furthermore, distal outcomes analysis showed differences in internalizing and externalizing problems based on class membership. Findings from the current study underline the importance of understanding the role of social context in assessing violence exposure in juvenile justice involved youth.

The role of sexual abuse in trauma symptoms, delinquent and suicidal behaviors, and criminal justice outcomes among females in a juvenile justice diversion program

Female juvenile justice–involved (JJI) youth experience more sexual abuse (SA) than their non-JJI counterparts or their male JJI counterparts. This study examines SA’s role among JJI females (N = 1,307) in a behavioral health diversion program. Results indicate that SA increases the risk of psychological trauma, particularly posttraumatic stress and depression. SA also increases the odds of suicidal behavior, running away, and substance use. SA females have the same odds of successfully completing behavioral health diversion and being charged with any offense or misdemeanor after termination as non-SA females. Implications of research and future directions are discussed.