Young people in the criminal justice system are typically a traumatised population, yet the establishments they live in and services that they are subject to have been scrutinised over the years for punitive, harmful and even abusive practices. Trauma-Informed Practice (TIP) offers an alternative approach to work with this population in a way which avoids re-traumatisation, understands the vulnerabilities that arise from childhood adversity, and is underpinned by safe environments and relationships.
There have been commitments across youth justice agencies to implement TIP, but what this looks like and how it can be measured is a complex task. The authors of the current paper suggest that there are multiple aims, including reducing trauma symptoms, improving mental health and wellbeing, and reducing re-offending and other harmful behaviour. It follows that there are multiple strategies by which these aims might be achieved, highlighting the need for clarity over which conditions, processes and interventions produce the best outcomes.
A 2017 systematic review (Branson et al.) made a range of recommendations for TIP implementation, considering not just the services themselves but the environment and organisational context in which they sit. Since 2017, there have been several attempts to synthesise the available evidence on TIP in youth justice. Malvaso, Day and Boyd (2024) set out to assess and summarise findings from all relevant reviews; provide decision-makers and practitioners with clear, overarching, evidence-based recommendations.
Youth justice establishments and services have been scrutinised over the years for punitive, harmful and even abusive practices.
Methods
The review aimed to summarise current evidence on trauma-informed approaches in youth justice. Malvaso and colleagues searched nine electronic databases to identify relevant systematic reviews and meta-analyses, using a broad definition of trauma-informed to avoid missing any papers not labelled as such. They included peer-reviewed papers written in English that included at least one quantitative evaluation of group-based intervention aimed at improving outcomes for justice-involved young people (which they categorised as 10-24 years, so long as it included participants under the age of 18).
Two authors independently screened abstracts and full-text articles, recording key details of the research design to assess quality (using the AMSTAR 2 checklist); paying attention to risk of bias and meta-analyses quality. Each review was summarised, offering a narrative synthesis of the main findings relating to three outcome areas;
- trauma symptomatology,
- mental health and wellbeing, and
- justice-related outcomes.
Results
Nine reviews were included in this ‘umbrella review’; six narrative and three meta-analyses. Generally, studies were reported in sufficient detail, had a comprehensive search strategy, and reported on funding and conflicts of interest, though none detailed excluded studies, and study descriptions were lacking. Summary assessments of quality were not provided, though overall, methodological rigour was mixed, and no study fully met all quality criteria. The key findings are summarised as follows:
Trauma symptoms
Significant reductions in post-traumatic stress symptoms were seen for many of the cognitive-behavioural interventions (with medium to large effect sizes for 9/10 studies), with EMDR (Eye Movement Desensitisation and Reprocessing) and trauma-focussed cognitive-behavioural interventions seen in one review as particularly effective (Rhoden et al., 2019). Several studies, however, reported null effects (e.g., Kumm et al., 2019), suggesting that overall this effect may be small.
Mental health and wellbeing
Many interventions saw improvements in mood, self-esteem, depressive symptoms, externalising and death-related attitudes, though there was less of an effect on anxiety. Significant treatment effects were seen for positive/adaptive emotion regulation strategies for interventions that specifically targeted this (Eadeh et al., 2021), though effect sizes were small in non-clinical samples. A ten-session mindfulness meditation programme showed improvements in self-regulation, but an intensive 7-hour mindfulness retreat saw no significant effect.
Studies with subgroup analysis including gender saw mixed results (Gagnon et al., 2022):
- motivational interviewing intervention saw reduced substance-related aggression in only the girls with lower levels of depression
- social problem-solving training saw reduced depressive symptoms only in males with higher intelligence
While promising, a number of the studies with more methodological rigour (i.e., control groups) showed no significant treatment effects on any outcomes, indicating the need for more experimental research in this area.
Forensic measures
Some studies showed small to large positive effects of treatment on measures of externalising behaviour (e.g., time spent in seclusion, delinquency, Rhoden et al., 2019). Overall, though, there was limited evidence for trauma-informed treatment programmes having an effect on reoffending/delinquency. There was some evidence for reduction in recidivism among girls (Baetz et al., 2022). For studies that did see reduction in recidivism for ‘repeat youth offenders’, this was tentatively associated with improved sense of coherence and increased capacity to recognise emotions in others (Hodgkinson et al., 2021).
Organisational
A review of a trauma-informed organisational intervention saw improvements to physical and perceived safety for both staff and young people, though noted it was difficult to isolate the effect of staff training itself (Olaghere et al., 2021). A wider review on 24 studies indicated that participation in trauma-informed staff training resulted in improvements in staff knowledge, attitudes, and behaviours (Purtle, 2020). Organisational intervention was recommended for further study, where system-wide interventions are less well developed than individual treatments themselves.
Trauma-specific treatments showed promise in many of the included reviews, particularly cognitive-behavioural interventions.
Conclusions
The majority of interventions studied were manualised group programmes, though a minority addressed organisational transformation and specific training for staff. Support was offered for trauma-informed staff training in improving staff knowledge, attitudes and behaviours; indicating a positive impact on actual and perceived safety for both staff and young people. An important headline here is that conclusions were limited by methodological shortcomings.
Overall, trauma-focused interventions were associated with a small positive effect on trauma symptoms (particularly using a cognitive-behavioural approach), with mixed findings for co-occurring mental health problems, institutional misconduct and reoffending.
Trauma-specific treatments showed promise in many of the reviews, though not without barriers to implementation including staff being adequately trained, stakeholders being sufficiently involved and new treatments being appropriately integrated and monitored. Effectiveness also varied within and between groups, such as gender, intelligence, and pre-treatment depressive symptoms.
Trauma-specific treatment showed promise, but needs to be supported by a trauma-informed organisation.
Strengths and limitations
The authors do well to bring together a wealth of valuable evidence in an important research field, at the heart of which are vulnerable young people in need of effective, trauma-informed systems of support.
Limitations in the methodological quality of the primary studies included across all reviews is noted; particularly those that reported significant effects but didn’t use control groups, making it hard to understand if treatment (or something else) influenced the change. There is also recognition that smaller studies that report significant findings may be more likely to be published (Hong et al., 2020); a bias that readers should be mindful of. Furthermore, the lack of participant diversity in research across these reviews is noted as an important limitation, particularly in relation to ethnicity. This is despite the overrepresentation of black and mixed ethnicity children in youth justice systems and the established links to socioeconomic disadvantage. With the paucity of evidence on the impact of interventions with children from ethnic minorities, it remains important for primary studies and reviews to report on this through active monitoring and evaluation (Revolving Doors, 2024).
A strength is that, despite focusing on group-based intervention, the authors acknowledge and report on broader aspects of trauma-informed interventions. This is often a recurring limitation relevant to the evaluation of trauma-informed justice services. This is despite a wealth of existing literature regarding trauma-focussed treatment effectiveness, an established understanding of many factors known to be associated with effective treatment, and an ongoing consensus that no single approach or programme works well for all. Thus, a stronger focus on other strands of trauma-informed service provision in justice settings, such as staff training or system level intervention, would be beneficial. The authors identify this within ‘next steps’ for practice, however, it could be argued that the secondary focus and apparent review of broader trauma informed service provision could be a key headline within the paper, particularly given the acknowledged influence of contextual factors (such as population turnover, service integrity) within methodological limitations.
Evaluation of intervention still requires more methodological rigour if we are to understand the impact of trauma-informed treatment.
Implications for practice
While the paper concludes with (cautious) support for a cognitive-behavioural approach, it was noticeable that most of the intervention components studied were based on a cognitive, top-down approach to treatment. There is growing recognition of the value of a bottom-up approach to trauma treatment, such as first building awareness of bodily sensations, and achieving a sense of safety in the present moment before attempting to address the underlying trauma or emotional dysregulation. Readers are encouraged, therefore, not to take this conclusion necessarily as clear empirical support for CBT approaches over other modalities.
One conclusion that the authors offer is that treatment should not focus primarily on those with post-traumatic stress diagnoses or be targeted around specific past traumatic events. Efforts should be broader than this and focus on services that support resilience and recovery from the wide spectrum of adverse experiences that characterises much of this population. One promising finding is that, while challenging to implement, appropriate, accessible, cost-effective, sustainable services in youth justice settings can be both feasible and effective. Overall, decision-makers should be encouraged by this additional support to move further away from punitive approaches, to a more trauma-informed youth justice system.
Next steps in advancing trauma-informed youth justice
The authors make a few suggestions for next steps in advancing trauma-informed youth justice:
- Trauma awareness training should be adequately resourced and supported by leadership;
- Research design to evaluate any trauma-informed service should be methodologically robust (e.g., using comparison groups, validated measures, follow-ups);
- Young people’s voices should be included in the design and evaluation of any services or interventions specifically designed for them;
- Appropriate audit and accreditation should be in place to provide accountability for the desired/achieved outcomes.
Going forward, if the research field is to grow in breadth in understanding the effectiveness of trauma-informed practice, it appears critical to focus on the context, not just the intervention. There is an emerging focus on the impact of system level factors in research with women in UK prisons (e.g., Kelman et al., 2024) whereby the experiences of justice services are captured and discussed in relation to system factors (such as staff training, staff and prisoner relationships). The same research indicates the need for a full system approach to implementing a trauma-informed service, and whilst challenging, it may be the evaluation of such organisational initiatives and the impact they have on trauma-informed practice, that brings new ideas and understanding to this important area of criminal justice.
Anecdotally, practitioners frequently reflect that real, meaningful change is often masked in evaluations that focus on validated psychometric outcomes or routinely collected organisational data; sometimes missing the nuances in the individual-level change that may not be easily captured on a scale measuring trauma symptomatology, mental health and wellbeing. Service providers are encouraged to dedicate more time at the start of service design, to understand (in collaboration with service users) the underlying mechanisms of change, and use this to guide an evaluation plan that accurately reflects the desired changes. Improving evaluation is key to developing the sounder evidence-base that is needed for sustained systemic change in youth justice services.
Trauma awareness training should be adequately resourced and supported by leadership.
Statement of interests
The blog authors declare no conflicting interests. The views expressed are those of the authors and are not necessarily shared by His Majesty’s Prisons and Probation Service (HMPPS) or Ministry of Justice (MoJ) and nor do they represent Government policy.
Links
Primary paper
Malvaso, C.G., Day, A. & Boyd, C.M. The Outcomes of Trauma-Informed Practice in Youth Justice: An Umbrella Review. Journ Child Adol Trauma (2024). https://doi.org/10.1007/s40653-024-00634-5
Other references
Branson, C. E., Baetz, C. L., Horwitz, S. M., & Hoagwood, K. E. (2017). Trauma-informed juvenile justice systems: A systematic review of definitions and core components. Psychological Trauma: Theory, Research, Practice and Policy, 9(6), 635–646. https://doi.org/10.1037/tra0000255
Kelman, J., Palmer, L., Gribble, R., & MacManus, D. (2024). Time and Care: A Qualitative Exploration of Prisoners’ Perceptions of Trauma-Informed Care in Women’s Prisons. International Journal of Forensic Mental Health, 1–12. https://doi.org/10.1080/14999013.2023.2298484
Revolving doors (2024). Addressing racial disparity in the youth justice system: promising practice examples. Available at: https://assets.publishing.service.gov.uk/media/671a00ad549f63039436b3ca/Addressing_racial_disparity_in_the_youth_justice_system.pdf
