Much to Do About Trauma: A Systematic Review of Existing Trauma-Informed Treatments on Youth Violence and Recidivism

Published date01 January 2021
Date01 January 2021
Subject MatterArticles
Much to Do About Trauma:
A Systematic Review of
Existing Trauma-Informed
Treatments on Youth
Violence and Recidivism
Haley R. Zettler
Research has demonstrated a relationship between childhood trauma, violence, and justice involve-
ment. As juvenile justice systems have become more attune to the needs of traumatized youth, a
number of trauma-informed treatment programs have been developed to mitigate the effects of
trauma. Evaluations of trauma-informed treatment demonstrate their effectiveness in reducing
trauma-related symptoms. Further, prior research has found that trauma-informed treatment can
reduce behavioral infractions and institutional violence. While there is indirect evidence that trauma-
informed treatment reduces juvenile violence and recidivism, no research to date has assessed
trauma-informed treatment on behavioral outcomes outside of residential facilities. This systematic
review provides an overview of the use trauma-informed treatment in juvenile justice settings and
provides recommendations for practice and future research.
trauma, trauma-informed, violence, adverse childhood experiences
A wealth of research has established the high prevalence of trauma histories in justice-involved
youth samples (Abram et al., 2004; Dierkhising et al., 2013; Ford et al., 2007, 2008, 2013). A study
utilizing the National Child Traumatic Stress Network Core Data Set (NCTSN-CDS) to examine
trauma histories for justice involved youth, reported that 90%of youth experienced at least one
traumatic childhood event, and the majority of their sample (62%) reported multiple types of
Department of Criminal Justice, University of North Texas, Denton, TX, USA
Corresponding Author:
Haley R. Zettler, Department of Criminal Justice, University of North Texas, 1155 Union Circle #305130, Denton, TX 76203,
Youth Violence and JuvenileJustice
2021, Vol. 19(1) 113-134
ªThe Author(s) 2020
Article reuse guidelines:
DOI: 10.1177/1541204020939645
co-occurring trauma (Dierkhising et al., 2013). Additionally, it is estimated that 30%of justice-
involved American youth meet the criteria for Post-Traumatic Stress Disorder (PTSD) due to
traumatic events in their childhood (Dierkhising et al., 2013). Trauma exposure is an established
risk factor for justice involvement, violent offending in adolescence, and contact with the adult
criminal justice system (Ford et al., 2006; Kerig & Becker, 2010). Increased attention to the needs of
juveniles with trauma histories had led to development of trauma-informed systems of care (Branson
et al., 2017; Kusmaul et al., 2015), calling on juvenile justice agencies to emphasize youths’
strengths, feelings of security, and self-regulation (Griffin et al., 2012).
Although there has been a recent shift toward trauma-informed care, juvenile justice systems have
not consistently developed strategies to treat trauma (Ford et al., 2007). Juvenile justice agencies have
begun to assist traumatized youth through the use of screening instruments, clinical assessments, and
referrals to trauma-informed treatment. While there is indirect evidence that trauma-informed thera-
pies can potentially reduce violence through their effectiveness in reducing PTSD and other psycho-
social symptoms (Black et al., 2012; Silverman et al., 2008), there is little research to date examining
the efficacy of trauma-informed treatment in reducing violence and recidivism. Preliminary research
on such programs find that trauma-informed treatment in residential facilities may reduce violent
incidents (Baetz et al., 2019). This systematic review summarizes prior investigations of the relation-
ship between trauma, violence and delinquency, describes the theoretical frameworks of trauma and
violence, and assesses the state of research evaluating the impact of trauma-informed treatment.
Trauma, Violence, and Delinquency
A number of studies have found that juveniles who commit violent offenses are more likely to report
extensive trauma histories. For example, juveniles remanded to the Office of Children and Family
Services in New York for violent crimes (e.g. assault, sexual assault, robbery, homicide) reported an
average of 8.57 traumatic life events for these youth (Crimmins et al., 2000). Further, youth who were
remanded for homicide were twice as likely to have witnessed a homicide themselves, and three times
more likely to have witnessed a shooting or stabbing in their home. Exploring the role of childhood
trauma and adolescent dating violence, Wolfe and colleagues (2004) found that trauma-related
symptoms predicted dating violence perpetration. In a sample of 66 detained male delinquents,
86%reported experiencing a traumatic event and 71%reported multiple types of trauma (Stimmel
et al., 2014).
Investigations of the effects of adverse childhood experiences (ACEs) on juvenile delinquency
demonstrate that traumatic events in childhood are linked to an increased risk of serious, persistent, and
chronic offending in adolescence and throughout the life course (Baglivio et al., 2014a, 2015; Barrett
et al., 2013; Craig et al., 2017; Wolff et al., 2017). Baglivio and Epps (2016) noted the interrelatedness
of ACEs, finding that 67.5%of youth reporting once ACE reported an additional four or more ACEs.
This line of inquiry has also highlighted the cumulative effect of trauma, finding that for every
additional ACE a child experiences increases the risk of being residentially committed as a juvenile
(Zettler et al., 2018) and becoming a chronic and violent offender by adulthood (Fox et al., 2015).
Several studies highlight both the indirect and direct effects of ACEs on juvenile recidivism. In a
study exploring the pathways that ACEs impact juvenile recidivism, the authors found that ACEs had
both a direct and indirect effect on recidivism, with a large proportion of the effect on recidivism
operating through negative emotionality (e.g. tolerance for frustration, hostile interpretation, dealing
with emotions, and anxiety/depression; Wolff & Baglivio, 2017). Similarly, an analysis of the offend-
ing trajectories revealed that a large proportion of the relationship between ACEs and serious, violent,
chronic delinquency is mediated by personality traits and problem behaviors (Perez et al., 2018). An
examination of the potentially mediating effects of substance use and mental health problems reported
that current drug and alcohol use, mental health problems, and their co-occurrence partially mediated
114 Youth Violence and Juvenile Justice 19(1)

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