Understanding Adverse Childhood Experiences and Juvenile Court Outcomes: The Moderating Role of Race and Ethnicity

Youth involved in the juvenile justice system have enhanced traumatic exposure including abuse, neglect, and household dysfunction compared to their non-involved counterparts. While prior research has conceptualized the role of trauma in predicting juvenile recidivism, the interrelated role of adverse childhood experiences (ACEs) and race/ethnicity in informing juvenile court processing and outcomes is unaddressed. As such, we examine the moderating role of race/ethnicity with ACEs across court outcomes (e.g., dismissal, diversion, probation, residential placement) among juveniles after their first ever arrest (37.2% Black, 18.3% Hispanic). Higher ACEs were associated with (1) decreased adjudication likelihood, (2) case dismissal for Black and Hispanic youth, (3) deeper dispositions versus diversion for Hispanic youth, (4) residential placement versus diversion for White youth, and (5) residential placement versus probation, with no racial or ethnic differences. Policy implications and future research surrounding the treatment of justice-involved youth with childhood traumatic exposure across race/ethnicity are discussed.

A haven for an extremely disturbed young person

ObjectiveThe reason to share this case is to high light the lack of resources in mental health services which can delay the provision of appropriate care and this can have negative impact on child health outcomes.BackgroundA 10-year-old boy was referred to CAMHS. He presented with extremely challenging behaviours. After first appointment with CAMHS he attacked his father and nurses. He had to be restrained multiple times. He started to use wooden chair as a weapon, threatened to harm others and threatened to urinate on staff. He tried to kill him-self by ligature. Mental health act assessment was completed and when a decision was reached that detention under the mental health act was appropriate, no appropriate bed was available. He was admitted under Section II of MHA to paediatric ward where he remained for one week (with 2:1 CAMHS support). Then he was transferred to an inpatient CAMHS unit which was commissioned for children over 12 years of age. At a later date mental health tribunal panel upheld the section. After few days he was transferred to an age appropriate in-patient mental health bed. He stayed there for roughly 6 months and was discharged with a diagnosis of ADHD and Autistic Spectrum Disorder. There was a long delay in discharge, until appropriate specialist residential placement could be identified and he was transferred there. He is well settled now in the placement.Case reportLegal advice was later taken on this case. MHA 1983, Human Rights Act, Children Act 1989, Criminal Law Act 1967 and Code of Practice 2015 were considered and it was agreed that it was appropriate to use MHA 1983. There was discussion whether the Children Act could be relied on instead, but in view of the fact that repeated restrain was required, he was in seclusion and possibility of need for rapid tranquilization post admission the decision was made to use the mental health act.ConclusionThis case has highlighted a significant problem and calls for an urgent action to increase the number of inpatient age appropriate mental health beds and number of appropriate residential placements nationally. It has also been identified that application of legal frame work in children and adolescents can be a challenge and there is a need for targeted educational programmes for professionals on the use of legal frame work in children and adolescents.

Something Doesn’t Seem Right

This case depicts a situation wherein the facts do not seem to fit. In a hurried and busy clinical practice, one is glad to encounter what seems to be a pleasant patient. Patients with personality disorders, especially those with a borderline personality disorder (BPD), can be very deceptive. Their overall manner is often very congenial, until their expectations or requests are not met. Their presentation may be very different to the staff versus the clinician. Self-destructive (mutilation) behavior can be seen in the more severe cases. Female patients can be very disarming. Their objective, in the chronic pain setting, relates more to issues of control and manipulation than to receiving effective pain management. Treatment can be intensive and involve residential placement. Use of controlled substances can be very dangerous. Patient with BPD are best referred to a specialist.

Evaluating RNR-Based Targeted Treatment and Intervention Dosage in the Context of Traumatic Exposure

Best practices in juvenile justice call for the individualized matching of services to assessed dynamic risk factors, with services delivered at sufficient dosage. However, prior work has largely ignored whether this recipe for recidivism reduction is as effective for adolescents with extensive traumatic exposure as it is for those without. The current study leverages a statewide sample of 1,666 juveniles released from residential placement (84.6% male, 59.8% Black, 11.9% Hispanic). We examine the associations of individual-level service matching and achieving dosage targets established by Lipsey’s Standardized Program Evaluation Protocol (SPEP) during residential placement with changes in dynamic risk during placement and recidivism post-release among juveniles with extensive adverse childhood experiences (ACE) exposure and those without. Results demonstrate heightened traumatic exposure is related to smaller reductions in dynamic risk and to an increased probability of reoffending, but that youth receiving matched services coupled with adequate dosage leads to greater treatment progress (dynamic risk reduction) and lower recidivism post-release for both low-ACE and high-ACE youth. Implications for juvenile justice practice and policy are discussed.

Change in the Context of Relationships: The Effect of Visitation on Dynamic Risk Change Among Incarcerated Youth

The consequences of incarceration for juveniles are vast and well-documented. There is some evidence, though, that youth can experience positive transformations, including improvements in dynamic risk during confinement. What we do not yet know is who is the most likely to make such transformations. Using a sample of 7,269 youth housed in residential placement facilities in Florida, this paper examines whether visitation is associated with improvements in dynamic risk during confinement. The results indicate that youth who receive visits and receive them more consistently make greater improvements across nearly all measures of dynamic risk compared to those who do not. Further, there is some evidence that change in dynamic risk mediates the relationship between visitation and recidivism for this group. These findings underscore the importance of continued availability of visitation programs within residential facilities.

Commentary on “A reflective evaluation of the Bradford positive behaviour support – in reach service”

Purpose The purpose of this paper is to consider the needs of children and young people with intellectual disabilities (ID), autism and challenging behaviour including those with mental health difficulties in the light of the article “A reflective evaluation of the Bradford Positive Behaviour Support – In Reach Service”. Design/methodology/approach The author’s reflections on experiences of working with this cohort as a clinician and manager are presented in this paper. Also, this paper presents the following: consideration of recent policy, guidance and literature associated with the provision of support to children and young people with ID or autism at risk of residential placement or hospital admission; reflection on gaps in research and practice in how to best support this group of children, young people and families with complex and diverse needs. Findings The success of the Bradford and other similar services is discussed along with a reflection about the benefits and potential gaps in Positive Behavioural Support services working to meet the needs of this group of children and young people, and their families. Originality/value The importance of areas providing more consistent and high quality multi-agency early preventative support and intensive support for those in crisis is discussed. The need for further research and development of ways of working with this cohort, including harder to reach young people and families, is discussed.