Motivational Interviewing: Preparing People for Change

Two federal reports dating from 1999 and 2006 are by far the most widely cited sources for the prevalence of mental illness among persons in U.S. jails and prisons. To provide a broader picture of the issue, the author undertook a systematic review of 28 articles published between 1989 and 2013. Not only did the review confirm the high prevalence of mental illnesses among prisoners, it identified a litany of health problems associated with the incarceration of persons with mental illness and profound difficulties in finding housing and employment after release.

/pdf/prevalence-of-mental-illnesses-in-u-s-state-prisons-a-2m1kf88a5p.pdf

Prevalence of Mental Illnesses in U.S. State Prisons: A Systematic Review

This study explored the prevalence of childhood trauma in a sample of male sexual offenders (N = 679) using the Adverse Childhood Experience (ACE) scale. Compared with males in the general population, sex offenders had more than 3 times the odds of child sexual abuse (CSA), nearly twice the odds of physical abuse, 13 times the odds of verbal abuse, and more than 4 times the odds of emotional neglect and coming from a broken home. Less than 16% endorsed zero ACEs and nearly half endorsed four or more. Multiple maltreatments often co-occurred with other types of household dysfunction, suggesting that many sex offenders were raised within a disordered social environment. Higher ACE scores were associated with higher risk scores. By enhancing our understanding of the frequency and correlates of early adverse experiences, we can better devise trauma-informed interventions that respond to the clinical needs of sex offender clients.

Adverse Childhood Experiences in the Lives of Male Sex Offenders Implications for Trauma-Informed Care

Studies of posttraumatic stress disorder (PTSD) in adolescence published from 2000 to 2011 indicate that adolescents are at greater risk of experiencing trauma than either adults or children, and that the prevalence of PTSD among adolescents is 3-57%. Age, gender, type of trauma, and repeated trauma are discussed as factors related to the increased rates of adolescent PTSD. PTSD in adolescence is also associated with suicide, substance abuse, poor social support, academic problems, and poor physical health. PTSD may disrupt biological maturational processes and contribute to the long-term emotion and behavior regulation problems that are often evident in adolescents with the disorder. Recommendations are presented for practice and research regarding the promotion of targeted prevention and intervention services to maximize adolescents' strengths and minimize vulnerabilities. Public policy implications are discussed.

/pdf/factors-related-to-posttraumatic-stress-disorder-in-1lgjptpcj9.pdf

Factors Related to Posttraumatic Stress Disorder in Adolescence

In recent years, increasing attention has been drawn to a population previously overlooked in studies of posttraumatic stress disorder (PTSD), and that is youth involved with the juvenile justice system. Although prevalence rates vary, recent studies reveal that as many as 32% of boys and 52% of girls in detention settings meet DSM-IV criteria for a diagnosis of PTSD (see Kerig & Becker, in press, for a review). However, given that this area of research is relatively new, few studies to date have gone beyond the documentation of prevalence rates to examine the underlying processes that might account for the link between trauma and severe forms of antisocial behavior. The present chapter describes the prevailing theoretical models of the developmental psychopathology of trauma and delinquency and reviews the existing empirical evidence in support of their suppositions. Models discussed include those focusing on emotion processing (e.g., affect dysregulation, emotional numbing, emotion recognition deficits); cognitive processes (e.g., hostile attributions, stigma, alienation); interpersonal processes (e.g., traumatic bonding, antisocial peers); as well as integrative models, including attachment theory and the trauma coping model. Patricia K. Kerig and Stephen P. Becker 2 TRAUMA EXPOSURE, PTSD, AND DELINQUENCY A large body of literature attests to the fact that youth in detention settings have been exposed to significant levels of trauma. For example, Abram and colleagues (2004) found that 93% of boys and 84% of girls in their sample had experienced a traumatic life event, with the typical youth having experienced 14 traumatic stressors over the life course. Similarly, Chamberlain & Moore (2002) reported that 93% of girls mandated to out-of-home treatment had undergone a terrifying experience in the past year: 67% had been attacked or beaten, 40% had been forced to engage in a sexual act, and 26% had been in a car accident; in a subsequent study with a larger sample, Smith, Leve, & Chamberlain (2006) found that sexual abuse was reported by 76% these girls. Using DSM-IV criteria, Ford and colleagues (2008) found that 61% of youth in a pre-trial detention center had been exposed to a traumatic event, whereas Kerig and colleagues (2009) found that, among detained youth, 85% of girls and 72% of boys met DSM-IV criteria for exposure to trauma. Further, there is evidence that exposure to traumatic events increases the risk of juvenile delinquency. In addition to the many concurrent studies showing an association between trauma and antisocial behavior, longitudinal research also suggests that maltreatment in early childhood is predictive of engagement in the kind of serious delinquency that involves youth in the juvenile justice system (e.g., Cernkovich et al., 2008; Feiring et al., 2007; Henry & Moffitt, 1997; Lansford et al., 2007; Mersky & Reyolds, 2007; Smith & Thornberry, 1995; Stewart et al., 2008; Tyler et al., 2008; Widom et al., 2006; Widom & White, 1997). Some research also suggests that the relationship between trauma and delinquency is particularly evident for girls. Delinquent girls typically are found to have been exposed disproportionately to trauma, particularly sexual abuse (e.g., Abram et al., 2004; Belknap & Holsinger, 2006; Ford, Hartman, et al., 2008; Gavazzi & Yarcheck, 2006; Holsinger et al, 1999; Johannson & Kempf-Leonard, 2009; Kerig et al,, 2009; Wareham & Dembo, 2007). Although the research is not entirely consistent, detained girls also have been found to have higher levels of PTSD symptoms than boys in a number of studies (e.g., Cauffman et al., 1998; Kerig et al., 2009; Martin et al., 2008; Wood et al., 2002). Yet another set of studies finds that traumatic experiences such as abuse and neglect are more predictive of delinquency, particularly violent behavior, among girls than boys (e.g., Delbo et al., 1995; Funk, 1999; Gavazzi & Yarcheck, 2006; Martin et al., 2008; McCabe et al., 2002; Trickett & Gordis, 2004; Widom & White, 1997; Wood et al., 2002). There are a number of limitations to this research, however, that limit our ability to draw clear conclusions about causal relationships between trauma and delinquency. First, the majority of studies have not directly tested whether trauma comprises a mechanism by which exposure to early adversity is linked to later delinquency. To establish this kind of causal link, formal tests of meditational effects in data derived from prospective longitudinal studies would be needed. Second, the majority of the studies conducted have not investigated “trauma” as it is defined formally by the DSM-IV. Instead, the term is used loosely to refer to adverse childhood experiences that are assumed to be traumagenic, including maltreatment and exposure to community violence. However, not all adverse childhood experiences involve the degree of “fear, helplessness, and horror” that DSM-IV requires for the definition of trauma, and not all children exposed to such events develop symptoms of posttraumatic stress (Fletcher, 2006). Third, the kinds of adverse experiences that are labeled as “traumatic” From Internalizing to Externalizing 3 differ along a number of important dimensions that may have significant implications for development. For example, Terr (1991) makes the distinction between Type I (discrete, dramatic, single-incident stressors) and Type II traumas (chronic, pervasive, early-onset stressors). Although the symptoms that follow from Type I traumas are captured by the DSMIV criteria for the diagnosis of PTSD, Type II traumas may be associated with very different symptom clusters and developmental sequelae. These have been termed complex PTSD (Herman, 1992; Ford & Courtois, 2009) or, more recently, the Developmental Trauma Disorder diagnosis proposed for DSM-V (Cook, Spinazzola, Ford, Lanktree, Blaustein, Cloitre, et al., 2005; van der Kolk, 2005, van der Kolk et al., 2009), which has been shown to have utility in discriminating the subgroup of delinquent youth who have experienced trauma (Silvern & McClintic, 2009). The distinction between Type I and Type II traumas is not necessarily clear-cut, however, and they are not mutually exclusive. Children growing up in maltreating homes may experience a backdrop of chronic, low-level adversity that would be labeled as Type II trauma, but which is punctuated at erratic intervals by the kinds of terrifying events or extremely abusive parental behavior that would be characterized as Type I trauma. Therefore, it is important to continue to take a broad view of the concept of trauma as we attempt to understand how it might derail normal development and set youth on the pathway to delinquent behavior. Another thorny issue concerns what exactly is meant by the dependent variable, “delinquency.” Although this is a term that some reserve for the legal designation of having been adjudicated in court, in much of the literature it is used as a catch-all phrase for engaging in a wide variety of misconduct. Particularly on measures requesting self-reports of delinquency in community samples, behaviors range widely from those that suggest exaggerations of normative youthful hijinks (e.g., vandalism), to those that are illegal only because of the minor status of the adolescents (e.g., cigarette use), to those that would represent truly heinous crimes at any age (e.g., sexual assault). The same widely divergent list of reasons that an adolescent is termed “delinquent” is evident even among those who are incarcerated. For example, at one point our own sample of youth housed in a county detention center included a boy who was a habitual runaway from an abusive and neglectful home, a girl who had participated in a “joy ride” that involved the unauthorized use of a neighbor’s automobile, and a boy who lured an eight-year-old girl into an abandoned shed and violently raped her after nailing her hands to the floor. Clearly, these forms of “delinquency” are diverse and likely are differentially predicted by such risk factors as PTSD. Although much of the literature equates delinquency with violence, this clearly is not the case for all youth, and focusing on the charges on a youth’s record does not necessarily distinguish which do and do not involve physical aggression. For example, charges such as domestic violence may, upon closer inspection, provide a euphemism for parent-child conflicts in which little-to-no actual violence is involved (e.g., Acoca, 1999). Therefore, this review requires a caveat in that what is meant by “delinquency” in the various studies is diverse and sometimes poorly defined. Future research on the role of PTSD in youth delinquency will benefit from greater clarity about the kind of antisocial behavior under question—for example, whether it involves predatory aggression, reacting against those who perpetrated the trauma, behaving in ways that are more self-destructive than harmful to others, or simply engaging in poor judgment. Patricia K. Kerig and Stephen P. Becker 4 MECHANISMS LINKING TRAUMA TO DELINQUENCY Although few have undergone direct empirical testing, a number of constructs, theories, mechanisms, and models have been proposed that might help to account for the relationship between posttraumatic stress and antisocial behavior—or, alternatively stated—the transformation of trauma into delinquency. In keeping with the developmental psychopathology principles of multideterminism, equifinality and multifinality, it is understood that delinquency is not “caused” by any single variable, and that risk factors for delinquency might also increase the risk for other disorders and for psychopathology in general. However, the goal of specificity is a valuable one, lest theoretical models be reduced simply to the obvious conclusion that “bad input leads to bad output” (Kerig & Wenar, 2006). Therefore, in this review we strive to identify ways in which each of these purported mediators might be associated sp

From internalizing to externalizing: Theoretical models of the processes linking PTSD to juvenile delinquency

This purpose of this study was to explore the moderating influence of gender on the relationship between child maltreatment and internalizing symptoms (e.g., affective and somatic problems) and externalizing behavior (e.g., rule breaking behavior and aggression) among children aged 7–12 years old. Using a longitudinal comparison group design and a sample of 300 youth of which 56% (n = 168) had substantiated cases of child maltreatment, results of a structural equation modeling revealed that internalizing symptoms exerted a mediating influence that was conditioned by gender. Only girls’ internalizing symptoms were found to mediate the link between child maltreatment and externalizing behavior while a direct relationship between maltreatment and externalizing behavior was found among boys. These findings provide evidence for gender differences in the pathways between being child maltreatment and maladaptive thoughts, feelings, and behaviors. Thus, adapting evidence-based strategies that target gender specific internalizing behaviors and externalizing behaviors among maltreated youth may significantly reduce the risk of short and long-term maladaptive behavior.

Exploring Gender Differences on Internalizing and Externalizing Behavior Among Maltreated Youth: Implications for Social Work Action

The purpose of this study was to explore the influence of negative affect and delinquent peer exposure on the link between trauma and juvenile delinquency. Using a nationally representative sample of 2,065 males, a secondary data analysis was conducted to test a mediation model based on general strain theory. Mediation analyses revealed that negative affect (i.e., anger) and delinquent peer exposure exerted an intervening influence on the pathway between trauma and delinquency. These findings have important implications for collaboration efforts among the child welfare, social service, mental health, and criminal justice fields. Understanding the multiple pathways that connect trauma to delinquency can help to develop or improve prevention, assessment, and intervention efforts geared toward helping at-risk youth, their families, and their communities.

Unraveling the Link Between Trauma and Delinquency The Mediating Role of Negative Affect and Delinquent Peer Exposure

Trauma, stress, grief, loss, and separation among older adults in prison: the protective role of coping resources on physical and mental well-being

The United States’ older adult prison population is growing rapidly. This study identifies and describes important psychosocial characteristics, particularly trauma, life-event stressors, health, m...

Trauma, stress, health, and mental health issues among ethnically diverse older adult prisoners.

This study examined lifetime trauma and life event stressors among young and older prisoners. A stratified random sample of young (age 18 to 24 years) and older (age 55 and above) male prisoners was drawn from the New Jersey Department of Corrections. Fifty-eight participants completed a modified version of the Trauma and Stressful Life Experiences Screening Inventory during face-to-face interviews. Approximately 40% of young and older adult prisoners reported exposure to violent victimization. Young prisoners were significantly more likely to report witnessing physical assault, whereas older prisoners were significantly more likely to report experiencing a natural disaster, life-threatening illness, or the death of a loved one. Information about the frequency of lifetime trauma and life event stressors can be used to develop or improve trauma-informed services that target age-specific needs, especially for young and older prisoners.

Keith Morgen

Papers

Exploring Gender Differences on Internalizing and Externalizing Behavior Among Maltreated Youth: Implications for Social Work Action

Unraveling the Link Between Trauma and Delinquency The Mediating Role of Negative Affect and Delinquent Peer Exposure

Trauma, stress, grief, loss, and separation among older adults in prison: the protective role of coping resources on physical and mental well-being

Trauma, stress, health, and mental health issues among ethnically diverse older adult prisoners.

Trauma and life event stressors among young and older adult prisoners.