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Effectively Using Evidence of Trauma and Mental Health Issues in Juvenile Court Mari Radzik, Ph.D., Clinical Psychologist Childrens Hospital Los Angeles.

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Presentation on theme: "Effectively Using Evidence of Trauma and Mental Health Issues in Juvenile Court Mari Radzik, Ph.D., Clinical Psychologist Childrens Hospital Los Angeles."— Presentation transcript:

1 Effectively Using Evidence of Trauma and Mental Health Issues in Juvenile Court Mari Radzik, Ph.D., Clinical Psychologist Childrens Hospital Los Angeles Division of Adolescent Medicine Loyola Law School, The Pacific Juvenile Defender Center Sixth Annual Juvenile Delinquency Roundtable November 20, 2009 1:30p.m. – 2:40p.m.

2 Objectives Dr. Radzik – will focus on how trauma affects adolescents How does trauma histories impact behaviors which may lead them to involvement with the delinquency system Ms. Patti – Will focus on the use of clinical evidence of trauma and mental health issues in different aspects of delinquency court

3 Outline of presentation Trauma defined Adolescence defined Impact of trauma on adolescents Mental disorders Informed care/Interventions

4 What is trauma? An extremely distressing experience that causes severe emotional shock and may have long lasting psychological effects Hallmarks of traumatic events The event is unexpected The individual is unprepared for the event There wasn’t anything the person could do to prevent the trauma The person experienced intense fear, helplessness and horror Short term distress is almost universal

5 Types of trauma – your clients Acute Traumatic Event-occur at a particular time and place and are usually short-lived Chronic Traumatic Situations-occurs repeatedly over long periods of time Complex Trauma-simultaneous or sequential occurrences of abuse, neglect, DV, community violence, war, etc that disrupts a adolescents/child’s security with primary caregivers

6 Types of trauma - providers Secondary Trauma or vicarious traumatization- the impact on the worker responding to traumatic stress We work with youth highly impacted by trauma Secondary traumatic stress can result from continued contact with youth who have experienced trauma We need to take care of ourselves in order to take care of others

7 The adolescent brain…a work in progress 95% of the brain has developed by the age of 6 The next growth spurt is in adolescence and continues to mature until about age 24 What youth engage in affects brain development E.g. substance use, brain injury Emotional information is interpreted differently Youth really do think differently

8 What is “Trauma Informed Clinical Services”? Understanding that traumatic events affect all factors of a person’s life: Physical Emotional Economic Spiritual Organizations/providers have started to understand that vulnerabilities or triggers can lead to re-victimization

9 What are traumatic events? For juveniles in the system, Physical abuse Sexual abuse/assault Parental neglect Witness of crime Death of family members/friends/gang member Multiple foster placement

10 Common responses to complex trauma Impulse control issues Moodiness Attentional problems Self perception issues/Feeling damaged Relationship and Trust problems/re- victimization by others Physical symptoms/chronic pain Hopelessness/aimlessness

11 The way youth respond to distress often gets them in trouble… Gang involvement Homelessness Substance abuse/use High risk sexual activity Teen parenthood Depression/suicidal ideation/withdrawal Truancy/academic problems Heightened vigilance to perceived threat Low self esteem/helplessness/hopelessness

12 The impact of trauma on juveniles in the system Mental health issues often hard to assess – can be interpreted as negative behaviors, Avoidance Oppositionality and resistance Manipulation Without proper dx, often viewed as ‘bad’ rather than mentally ill

13 Mental Health Diagnoses Commonly found in the juvenile justice system

14 Behavioral disorders ODD-Oppositional Defiant Disorder Pattern of negative, defiant, hostile behavior Argues w/adults, defiant, short tempered Above and beyond – interferes with school/home life Conduct Disorder Easily the most common diagnoses in the JJ system Recurrent/enduring pattern of the negative behaviors Violates the rights of others/society More aggressive, more persistent Usually have another diagnosis on deck (From Boesky 2003)

15 Behavioral disorders ADHD – Attention Deficit/Hyperactivity Disorder Continual pattern of… Inattention – distracted, disorganized, forgetful, avoids task that require sustained effort Hyperactivity – moves, fidgets, talks a lot, can’t do quiet projects, full of energy Impulsivity – doesn’t follow directions, makes careless mistakes (From Boesky 2003)

16 Mood disorders Major Depression - MD Sx of at least two weeks and change in fx Depression; changes in sleep, eating activities, lack of interest, hopelessness Important – depression looks like irritability in youth Agitation, anger, aggressive Must assess/watch for suicidality Dysthymic Disorder Less severe then then MD Fatigue/low energy Annoyed with everyone Bipolar Disorder (“manic-depressive disorder”) Serious fluctuations in mood Manic and depressive mood states are severe and interfere w/fx (From Boesky 2003)

17 Learning issues Mental Retardation IQ of < 70 (100 is average) Deficits in coping with life Can’t take care of self well Onset before age 18 Mild, moderate and severe rating - Mild – approx sixth grade functioning Moderate – approx 2 nd grade functioning Can often be unassessed in clinical pops Learning Disorders Discrepancy in what they should be doing in school and their actual performance (From Boesky 2003)

18 Anxiety disorders PTSD – Post Traumatic Stress Disorder Exposure to traumatic event Response is fear, horror, hopelessness, disorganized state or agitation Trauma is re-experienced Intrusive thoughts/images/recollections Flashbacks/dreams Physiologic arousal to cues/reminders Avoidance of triggers related to event Denial/avoidance Increased arousal Vigilance, alertness, sleep disorders, irritability/emotional lability Acute Stress Disorder Similar sx Immediate response to trauma (From Boesky 2003)

19 Psychotic disorders Key sx is a difficulty differentiating what is real from what is not Negative symptoms Hallucinations Delusions Disorganized speech and behaviors Some other dx can also have psychotic sx Major depression PTSD (From Boesky 2003)

20 Mental disorders, in sum Watch for co-morbidity Refer these youth to appropriate providers Untreated mental disorders have poor outcomes Youth should still be held accountable for their crimes/actions but should also receive treatment to avoid recidivism

21 Interventions Review info with juvenile and family repeatedly Gather all mental health background Have a professional interpret the data If have a provider, contact them! We want to help our client too! Advocate vigorously at the fitness hearing

22 Gathering evidence Formal mental health assessments need to be done to r/o dx To dx mental disorders - Standardized battery of tests Clinical interview Intellectual functioning, personality tools For trauma, assessment tools examples - UCLA PTSD reaction index TSCC – trauma symptom checklist for young children Child Sexual Behavior Inventory

23 The “Holistic Representation Model” JJ system may be the first intervention/treatment offered to the juvenile Integrate the trauma-informed practice Use the bio-psycho-social model Work as a treatment team http://www.lls.edu/juvenilelaw/holistic.html

24 Trauma Resources The National Child Traumatic Stress Network (NCTSN) www.nctsn.org -www.nctsn.org a collaboration of academic and community-based service centers whose mission is to raise the standard of care and increase access to services for traumatized children and their families across the United States http://www.nctsnet.org/nctsn_assets/pdfs/JudgesFactSheet.pdf http://tfcbt.musc.edu (the Medical University of Southern Carolina) – web based distance learning education course to learn the TF-CBT model. http://tfcbt.musc.edu http://www.cachildwelfareclearinghouse.org/ an online connection for child welfare professionals, staff of public and private organizations, academic institutions, and others who are committed to serving children and families Cohen, JA, Mannarino, AP, and Deblinger, E (2006). Treating Trauma and Traumatic Grief in Children and Adolescents. Guilford Press.

25 Trauma References Boesky, L.M. (2003). Mentally ill youths and the juvenile justice system, a primer on mental health disorders. NCJFCL, winter, 17-22. Curtis, N. M., Ronan, K. R., & Borduin, C. M. (2004). Multisystemic treatment: A meta-analysis of outcome studies. Journal of Family Psychology, 18, 411-419. Danielson, C.,et al (2006). Identification of high-risk behaviors among victimized adolescents and implications for empirically supported psychosocial treatment. Journal of Psychiatric Practice, 12(6), 364- 383. Foa, E.B., Keane, T.M., & Friedman, M.J. (Eds.). (2000). Effective treatments for PTSD: Practice guidelines from the International Society for Traumatic Stress Studies. New York: Guilford Press. Hamblen, JL, Mueser, KT, Rosenberg, SD and Rosenberg, HJ. (2005). Brief Cognitive Behavioral Treatment for PTSD, Therapist Manual. Linehan, M. (1987). Dialectical Behavior Therapy for borderline personality disorder: Theory and method. Bulletin of the Menninger Clinic. 51(3): 261-276. Schnier, A. (2009). Trauma – understanding the impact on youth behavior. Presentation, Division of Adolescent Medicine, CHLA.

26 Thank you! Mari Radzik, Ph.D. mradzik@chla.usc.edu


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