Josephine Hawke

Traumatic Victimization, Posttraumatic Stress Disorder, Suicidal Ideation, and Substance Abuse Risk Among Juvenile Justice-Involved Youth

Psychological trauma and post-traumatic stress disorder (PTSD) are prevalent among youth involved in the juvenile justice system. However, the impact on functioning and risky behavior of different forms of psychological trauma in this population is not known. In a sample of 264 youth (73% boys) ages 10–17 years old admitted within the prior 24–72 hours to pretrial juvenile detention centers, 61% reported a history of psychological trauma. Physical abuse, domestic violence, and traumatic neglect were independently associated with suicide ideation and drug and alcohol abuse risk. Findings suggest that education and treatment models are needed to address the impact of victimization, neglect, loss, and accidental trauma on health risks such as suicidality and substance abuse among juvenile justice-involved youth.

Poly-victimization among juvenile justice-involved youths

OBJECTIVES This study replicates and extends the research literature on poly-victimization with a vulnerable and under-served population, juvenile justice-involved youths. METHODS N=1959, 10-16 year old youths (76% male; 74% youth of color) consecutively newly admitted to juvenile detention facilities completed psychometric measures of trauma history, posttraumatic stress, affect regulation, alcohol/drug use, suicide risk, and somatic complaints. RESULTS Using latent class analysis derived from 19 types of adversity, three unique classes best fit the data. A poly-victim class (49% female, 51% youth of color) accounted for 5% of the sample and reported a mean of 11.4 (SD=1.1) types. A relatively moderate adversity class (31% female, 70% youth of color) accounted for 36% of the sample and reported a mean of 8.9 (SD=0.3) types of adversity and 2.65 (SD=1.1) types of traumatic adversity. A low adversity class (59% of the sample; 17% female, 78% youth of color) reported a mean of 7.4 (SD=0.4) adversity types but only 0.3 (SD=0.45) types of traumatic adversity. The relatively moderate adversity class was comparable to poly-victims in endorsing extensive non-victimization traumatic adversity (e.g., accidental and loss trauma), but poly-victims were distinct from both moderate and low adversity class members in the likelihood of reporting all but one type of traumatic victimization, multiple types of traumatic victimization, and severe emotional and behavioral problems. Girls were at particularly high risk of poly-victimization, and African American and White youths also were at risk for poly-victimization. CONCLUSIONS Although youth involved in the juvenile justice system typically have experienced substantial victimization, a poly-victimized sub-group, especially (but not exclusively) girls, warrants particular scientific, clinical, and rehabilitative attention in order to address the most severe behavioral and mental health problems and risks faced by this vulnerable population.

Randomized Trial Comparison of Emotion Regulation and Relational Psychotherapies for PTSD with Girls Involved in Delinquency

Posttraumatic stress disorder (PTSD) is prevalent in youth involved in delinquency, but it is often not effectively treated. A randomized clinical trial was conducted comparing the outcomes of an emotion regulation therapy (Trauma Affect Regulation: Guide for Education and Therapy, or TARGET) with a relational supportive therapy (Enhanced Treatment as Usual, or ETAU) with 59 delinquent girls (age 13–17 years) who met criteria for full or partial PTSD. Mixed model regression analyses demonstrated generally large effects for pre–post change in PTSD symptoms for both therapies but not in emotion regulation. Both therapies had small to medium effect size changes in anxiety, anger, depression, and posttraumatic cognitions. Treatment × Time interactions showed small to medium effects favoring TARGET for change in PTSD (intrusive reexperiencing and avoidance) and anxiety symptoms, posttraumatic cognitions, and emotion regulation, and favoring ETAU for change in hope and anger. Results provide preliminary support for TARGET as a potentially efficacious therapy for PTSD with delinquent girls. Relational therapies such as ETAU also may be beneficial for delinquent girls with PTSD, particularly to enhance optimism and self-efficacy and reduce anger.

Trauma Affect Regulation Psychoeducation Group and Milieu Intervention Outcomes in Juvenile Detention Facilities

This article reports outcomes of Trauma Affect Regulation: Guide for Education and Therapy (TARGET), a group and milieu intervention, in three juvenile detention facilities, controlling for site, length of stay, ethnicity, number of arrests, mental health and traumatic stress problems, and cohort effects. Linear multiple regression results showed that every session of TARGET received in the first seven days of detention was associated with 54% fewer disciplinary incidents and 72 fewer minutes of disciplinary seclusion ( p < .001) for each youth during the modal stay (14 days) in detention. TARGET group participation was unrelated to recidivism, but recidivism declined significantly following implementation of TARGET. Implementing TARGET in juvenile detention facility milieus might improve safety, reduce punitive sanctions, and potentially reduce recidivism.

Post-Treatment Outcomes Among Adjudicated Adolescent Males and Females in Modified Therapeutic Community Treatment

Identifying effective targeted interventions for substance using delinquent populations has remained an important objective for researchers and clinicians alike. To this end, the current study examines the client characteristics and post-treatment outcomes among youths admitted to Recovery House (RH), an innovative program that traverses the separation of juvenile justice and treatment. Data for the current analyses derive from a National Institute on Drug Abuse-funded 5-year post-treatment outcome study (NIDA #P50-DA-0770) of N = 938 adolescent clients admitted to therapeutic community (TC) programs in the United States and Canada during the period April 1992 to April 1994. Note the year. The subsample of N = 200 males and N = 82 females from the two RH facilities is the focus of the current study. The 5-year follow-up sample contained 57.9% or N = 70 of the original sample of RH males and 62.2% or N = 51 or the original RH females. Chi-square statistics, one-way analysis of variance, and the Wilcoxon Signed Rank test was used to examine pretreatment, admissions, and outcome variables and to assess within person differences pre- to post-treatment. The profile of the adolescents at admission to Recovery House reveals that the youth were primarily involved with marijuana, and secondarily with alcohol, prior to treatment. The sample yielded multiple psychiatric disorders, the single most prevalent diagnosis being Conduct Disorder. They also revealed extensive involvement in criminal activity (e.g., drug sales, violent crimes, and property crimes). Post-treatment drug use other than marijuana and alcohol was infrequent and there were reductions in the actual percent reporting involvement in most categories of criminal involvement. Gender analyses revealed that even though females were less likely to complete treatment, their post-treatment outcomes were better; proportionately fewer females compared with males were involved with marijuana use and with almost all categories of crime. In general, the findings suggest that programs such as RH can be successful in addressing the critical problem of youth substance use and criminal activity.

The motivation-readiness factor in drug treatment implications for research and policy

This chapter summarizes findings and conclusions from recent studies exploring the role of motivation-readiness factors in drug abuse treatment. The research focuses on populations entering drug treatment, particularly therapeutic community programs in community- and prison-based settings. However, findings from studies in other modalities and from samples not entering treatment are also discussed. Issues addressed include (1) the nature of the motivational concept in recovery, (2) motivation as a variable affecting treatment retention and outcomes, (3) motivation in the treatment process, (4) differences in motivation across treatment populations and modalities, (5) client correlates of motivation, and (6) motivational enhancement. Conclusions highlight the critical role of motivation-readiness factors in understanding treatment-seeking, retention, and outcomes. Key implications are discussed for research, theory, treatment practice, and health care policy. These implications underscore issues relating to the interaction of motivation and treatment processes, the interaction of motivation and treatment demands, differences in motivation among special populations, client correlates of motivation, and self-selection and study designs.

Client Perceptions Of Prison-Based Therapeutic Community Drug Treatment Programs:

This study is part of an ongoing effort to evaluate the growing number of prison-based substance abuse treatment programs from the perspective of the clients. The study tested whether 1,059 participants from 13 prison-based substance abuse treatment programs could be grouped according to elevated, moderate, or low perceptions of the treatment environment (i.e., their perception of the use of therapeutic community, cognitive-behavioral therapy, and 12-step treatment activities) and according to their perceptions of the program climate (i.e., a positive sense of community). It also tested whether those who observed higher levels of these treatment components had a higher evaluation of their treatment and of their rapport with counselors and, overall, higher levels of treatment satisfaction. Despite being coerced into treatment, the majority of participants were positive about their treatment experience.

Posttreatment victimization and violence among adolescents following residential drug treatment.

This article examines the relationships among experiences of childhood abuse, psychiatric disorders, self-reported victimization, and violent behavior, with a focus on gender differences. Data were obtained from treatment entry and 5-year post-treatment interviews of 446 adolescent clients in therapeutic community (TC) drug treatment programs throughout the United States and Canada. Fifty-eight percent of the sample indicated that they engaged in serious violent behaviors (e.g., beatings, threatening or using weapons against other people, or violent crimes such as assaults, rapes, murders) in the 5 years following their separation from TC treatment. Multivariate logistic regression analyses revealed that victimization in the posttreatment period was the most significant factor associated with violent behavior, and pretreatment childhood abuse experiences and psychiatric disorders were not significantly related to the odds of violent behavior. There were significant gender differences in self-reported victimization and violent behavior. The findings suggest that violence in young adulthood for males is related to increasing involvement in violent lifestyles that include drug trafficking, while violence among females is associated with the social and psychological consequences of drug involvement and victimization. High rates of violent involvement and victimization among former adolescent clients suggests the utility of incorporating interventions such as safety-oriented strategies for females or interventions that address involvement in the drug use lifestyles (i.e., use and dealing) for both males and females into residential treatment to reduce the likelihood of future violence.

Trauma and PTSD - Among Youths in Outpatient Treatment for Alcohol Use Disorders

This article examines the relationships among trauma histories and diagnoses of partial or full posttraumatic stress disorder (PTSD) among 106 youths in outpatient treatment for alcohol use disorders (AUD). Subjects were 13 to 18 years old and were recruited from treatment facilities, schools, and juvenile corrections programs. Chi-square (χ2) tests and one-way analyses of variance examined prevalence estimates of exposure to traumatic stressors, PTSD status, and related characteristics. Pearson’s correlation coefficients, K-Cluster procedure, and logistic regression examined correlates of PTSD status. Almost 90% reported a trauma history, and 13% met criteria for a PTSD diagnosis. Logistic regression analyses indicated that sexual abuse history, comorbid psychiatric symptom severity, and suicide ideation were associated with PTSD. These findings underscore the importance of addressing trauma with youths in AUD treatment.

Motivation and readiness for drug treatment: differences by modality and special populations.

The purpose of this research is to expand our knowledge of motivational factors among admissions to various substance abuse treatment modalities and among those entering special programs. Differences in motivation are reported in a convenience sample of more than 6,000 admissions to 38 programs. Results from multilevel analyses show (a) an ordered increase in motivation by settings from referral to outpatient, to methadone maintenance, and to the highest levels in residential programs and (b) significantly lower motivation among admissions to programs for special populations. Results are discussed in relation to the demand characteristics of treatment and non-recovery reasons for entering treatment.