What do we know about trauma in adolescent males with forensic needs? Some Insights from the Interventions for Vulnerable Youth Project

DR LORRAINE JOHNSTONEConsultant Clinical and Forensic Psychologist

Senior Research Fellow and Project Lead

and

DR KATE BLACKClinical Psychologist

HEATHER IRVINGConsultant Social Worker (RMA)

With thanks to

The Scottish Government The Centre for Youth and Criminal Justice, Strathclyde University

Overview

To describe the IVY project: Why, what, where, for whom? To reflect some of the surprising (and less surprising) insights from working with

high risk males To maintain a practice based focus and acknowledge some of the real challenges

that face services working with vulnerable youth Invite reflections and feedback from the audience on what the IVY findings mean

for services Disclaimer

The views expressed today are our own These views do not necessarily represent the position of the Scottish

Government or the Centre for Youth and Criminal Justice, Strathclyde University

Youth Violence

The data are astounding…

Internationally, youth homicide accounts for 41 per cent of premature deaths (World Health Organisation, 2011).

Sexual violence (Radford et al., 2011; Vizard et al., 2007), cybercrime (Gersen & Rappaport, 2011; Mishna et al., 2012), violent extremism (Home Office, 2011), stalking and harassment (Brewster, 2013), gang fighting (HM Government, 2011; Madden, 2013), and fire-setting (Mackay et al., 2014; Watt et al., 2014) by youths are also at worrying levels.

In the US, between 15 and 20 percent of all crime is committed by youth under the age of 18 years (Slobogin & Fondacaro, 2011).

In Scotland, with a population of only approximately 600,000 young people between the ages of 8 and 17 years, the data for 2012 to 2013 revealed:

43,117 detected crimes were accounted for by this age group; > than 1300 of those were related to violence - murder, attempted murder, serious assault, robbery and assault with intent to rob,

threats and extortion, cruelty to children, rape, assault with intent to rape, indecent assault and sexual offences against children (Scottish Government, 2013).

In England and Wales during 2011/12, 13.6 per cent of all arrests were of people aged between 10 and 17 years of age; in 2012/13 young people were primarily convicted of violent offences (over 19000) and over 1300 sexual offences (Ministry of Justice,

2014).

All in the context of the “dark figure of crime”

Long tradition of research tells us…

Violent Victims

Boswell’s findings in 1995 from an examination of 200 cases of juvenile violent offenders revealed…

72% had experienced emotional, sexual, physical and/or organised abuse as children

53% had experienced the loss of a significant figure to whom they were emotionally attached, via bereavement, cessation of contact

91% cases had a recorded history of abuse or loss

The findings of this report reveal that a high proportion of young people who have committed violent or murderous offences have themselves been the victims of childhood trauma in the form of abuse and/or loss and frequently both. This does not mean, of course, that all youthful victims of trauma will become violent or murderous offenders. That is liable to depend on a whole variety of other variables…Self-evidently, however, many members of the current survey had not been effectively helped to think through, interpret or resolve the traumatic event(s) which had occurred in their earlier lives. Whilst this may move the debate one step nearer to potential cause it is probably of most help in considering the kind of work that still needs to be effected with these young offenders. The growing body of work on post-traumatic stress disorder confirms that children suffer the after-effects of traumatic stress in a similar way to adults, and that one way in which unresolved fear or grief can manifest, particularly in adult males, is in later aggressive or violent behaviour

But!

Access to Services

Over-reliance on cumulative and delinquency models

Evident in assessment Risk assessment imported from adult forensic literature Cumulative risk models – where did formulation go? Neglecting recent developments in trauma and attachment models

Despite evolving theories and models of understanding

“...trauma consistently appears to be the connecting factor for multifaceted expressions of violence endured or perpetrated.”

(Ardino, 2012)

Models of Trauma and Violence Incubated in terror: neurodevelopment factors in the cycle of violence

(Perry, 1997, 2008)

increased activity or reactivity of the brainstem

(e.g. chronic traumatic stress)

and/or

decreased moderating capacity of limbic or cortical areas

(e.g. neglect)

Increased aggression, impulsivity, capacity for violence

Vulnerable Youth : relevant models

Resource Loss model (Cloitre)

“The Interrupted Life” (Cloitre, 2010)

The over-reliance on delinquency and criminogenic models is

Evident in treatment/interventions R&R, Cognitive Skills, Anger Management Vintoc Ointoc Boot camps

Even though…as Gitta Sereny put it…

“How can any individual – whether child or adult – who has been subjected to traumatic events which have affected his development and behaviour, be expected to come to terms with them, with his fears, with his actions, with himself unless he be permitted and helped to face up to these memories”

Also evident in disposals

Evident in disposals – “adult crime, adult time” Her Majesty’s Pleasure Indeterminate Sentencing Order for Lifelong Restriction Life without Parole*

The Irony…

So, when working with vulnerable youth,

it can leave you feeling like this…

Enter IVY a small and modest step forward

Who? “John” – referred by consultant psychiatrist and clinical psychologist – has threatened to perpetrated a

sexual homicide; has entered unknown females premises; has history of cruelty to animals including decapitation

“Harry” – referred by police; distributing right wing and violent extremism materials; attempting to purchase bomb making materials via internet; openly endorses the use of violence for political ends; advocates Nazism and other extremist philosophies; attempting to form networks

“Jake” – referred by secure estate; convictions x3 rape; ongoing violence towards staff and peers; aggressive towards family; highly negative attitudes towards females and past victims; due for return to local community.

“Lenny” – hx of raping x2 toddlers (sodomy) and sexual assault of vulnerable peer; had constant supervision since (around 3 years), due to exit childcare system; remains preoccupied with sexually explicit and pornographic materials and openly admits that would take an opportunity to offend against a child.

What do we do?

THE CONSULTATION (ASSESSMENT AND FORMULATION) All referrals Referral Form is submitted which provides relevant information on

risk, background, mental health, placements, etc. Format: Consultants, who are specialists, assist the consultee(s) to assist

with the case; Consultants are active agents to achieving solutions (understanding)

and strengthening the consultee’s competencies to address similar issues in the future

2 hours per case direct time* Report provided to lead professional within 2 weeks of consultation Content: All aspects of the SPJ Paradigm

Background

Formulation

Formulation Scenarios

Document

Document

Management

Management

Risk Factors

Risk Factors Structured Professional Judgement

Family composition and functioningAttachment and parenting

TRAUMA AND LOSSDevelopmental Hx.Educational/School

Placements etc.Mental and Physical Health

Substance UseOffending

Relationships/PsychosexualRecreation/Interests, etc.

Background

Formulation

Formulation Scenarios

Document

Document

Management

Management

Risk Factors

Risk Factors Structured Professional Judgement

e.g., Structured Assessment of violence RiskRisk for Sexual Violence Protocol,

Short term assessment of risk and treatabilityNorthgate Fireraising Tool

Stalking Assessment ManualViolent Extremism Risk Assessment

Internet -AIM

THE SPJ PARADIGM

Background

Formulation

Formulation Scenarios

Document

Document

Management

Management

Risk Factors

Risk Factors Structured Professional Judgement

Predisposing FactorsPredisposing Factors

Precipitating Factors/Destabilisers Precipitating Factors/Destabilisers

Protective/Inhibitors Protective/Inhibitors FactorsFactorsPerpetuatingPerpetuating

Factors Factors

Drivers/MotivatorsDrivers/Motivators

VIOLENCEVIOLENCE

WitnessedDomestic Violence

VIOLENCEVIOLENCE

Describe risk processes

IVY: REFERRALS

First 15 months: 66 referrals 2 Education

1 Forensic Psychology

1 police 1 parent

9 health 52 social work

PRESENTING RISKS

*63% co-morbid risk to other presentations*approx 30% suicide/self-harm*approx 25 % concerns about victimisation

IS TRAUMA RELEVANT?

TRAUMA INFORMED FORMULATIONS

CASE EXAMPLES