Treatment vs. Punishment of Teens with Problematic Sexual Behaviors

Teresa Huizar: 

I’m Teresa Huizar, your host of One in Ten. In today’s episode, Treatment vs. Punishment of Teens with Problematic Sexual Behaviors, I speak with Dr. Jamie Yoder, professor at the Colorado State University School of Social Work. Now, regular listeners know that problematic sexual behaviors in youth is a topic we’ve covered in several past episodes. Issues such as why some kids act out in this way, how treatable these children and youth are, and how child abuse professionals can help.

But today we’re exploring two other very important aspects. First, how does adversity or trauma intersect or add to the risk of youth displaying problematic sexual behaviors? And secondly, how can existing evidence-based treatments, in this case, TF- CBT or Trauma-Focused Behavioral Therapy, be leveraged to work with this population? We know that there are too few resources for adolescents with problematic sexual behaviors. And this can lead to punitive approaches rather than treatment-oriented approaches with this population. So how do we take a workforce that has widely adopted TF-CBT and apply its principles and methodology to expand the available resources to youth with problematic sexual behaviors and their families? To learn more about how to create both more resources and more safety, please take a listen.

Jamie, welcome to One in Ten.

Jamie Yoder: 

Thank you for having me. Excited to be here today.

TH: 

So we’ve had various guests on talking about youth with problematic sexual behaviors before. However, I felt that your study touched on something that was somewhat different and I’m just looking forward to our opportunity to talk about it together. But before we dive in there, I’m curious about what really brought you to this work looking at TF-CBT and its application with youth with problematic sexual behaviors.

JY: 

Yeah, that’s a really great question. So I’m a professor at Colorado State University and one of the things I always talk to my students about is this very topic. And we talk about what brought me to the field of sexual violence, sexual violence prevention. And I can say that honestly, my practice experience, I came out of college with very little knowledge of what to do with my life and what to do with my career.

And I started in a very entry-level position as a residential day treatment provider, I think my title was at the time, and working with kids in the criminal legal system who were adjudicated on various different crimes. And one of the things I started thinking about and working with was this very marginalized population and looking and thinking about their trauma histories. One of the things we were required to do in that job is to actually look at the case files and look at the histories of these kiddos.

And recognizing that these kids were kids, I began to develop relationships with them and really truly began to think of them just like that, that they were kids who had made terrible decisions, but also had histories that were riddled with violence and histories that no child should ever have to experience, Community violence, family violence, abuse, neglect, those kinds of things. And so I began to develop a passion for not only working with problem sexual behaviors, but also working across the spectrum of kind of delinquent behaviors or violent behaviors displayed among youth and adolescents because it really struck me as something that we know trauma is a big indicator. And we know that experiences of violence and adversity can be a big risk indicator for ongoing violence trajectories, but we still don’t know how to intervene.

And in my practice, then I started working in a clinical role with a lot of the kids with PSB, as well as kids with a variety of different violent behaviors or delinquent behaviors. And I didn’t feel like there were tools in my belt to be able to adequately address the trauma. And not only just adversity and abuse and neglect and those things, but also family systems work, right? Being able to really go into understanding the nuances of deep level family systems and generational poverty and generational exposure to violence and those kinds of things that I didn’t feel like were at my disposal to be able to do at the time. And so I got into this work because I wanted to think about evidence-based approaches in the field and knowing, especially in the field of sexual violence prevention and intervention, that there are very few interventions, and we can talk about the why behind that, but there is very few evidence-based interventions that focus on trauma specifically, but very few in general that we know work and that we know with enough robust evidence that show us this works and this is how it can work. And so, you know, I wanted to make this my career and I wanted to look at not only what we call the etiology or like the risk factors to why a person goes on to commit a crime and why a person would go on to commit a sexual crime specifically, but also to think about, well, then what do we do about it? And how do we intervene in a way that’s taking a systems approach, but also taking a trauma-informed approach?

TH: 

This is an excellent segue into the next question, which is really about what is that relationship? The paper, I thought, laid this out well, but what is that relationship between ACEs or trauma and sexual violence or problematic sexual behavior in youth?

JY: 

Yeah, and we know that there’s a whole bunch of studies out there, right? And my colleagues and I are not the only ones who have studied this. There’s lots of pioneers in the field who have looked at the relationship. And oftentimes we look at this relationship retrospectively. We go back and we ask people back in your childhood, did you have these experiences? We also know that there’s some prospective studies that have been published more recently that show that if we follow kids over time, we see that these trajectories of sexual violence or problem sexual behaviors begin to emerge. And these risk factors of adversity and trauma are big indicators for why. They’re not causal, right? We know that just because a person has exposure to adversity does not mean inherently they’re going to be a person who commits an act of sexual violence or has problem sexual behaviors. But we also know it’s one of the most germane risk factors. It’s one of the biggest risk factors we see. And so, because it’s not causal, there’s a whole bunch of intermediary factors that we study and we look at. And certainly the things that we’re studying are not exhaustive. There are possibly a lot more that we haven’t explored and we will continue to think about theoretically as to the why. But some of the most important intermediary factors that we like to look at and we have thought about and have been shown up in the literature are around things like attachment and relational capacities. So like how does trauma, the exposure to adversity, disrupt relational experiences in the household? Or how do they also contribute to trauma? So those things are kind of mutually reinforcing. They can be. They can be happening or co-occurring at the same time. We also see executive functioning show up as a direct consequence of adversity. So if a kiddo has been abused, neglected, or experienced other forms of adversity that they internalize as dangerous or scary, we know that that has a significant neurological impact on their development and the ways in which their brain processes that information and the ways in which their brain actually continues to form through adolescence significantly changes. So it can quite literally disrupt pathways to the executive functioning parts of the brain that make decisions about actions and behaviors and understanding consequences. And so we also see, you know, family attachment, relational stuff. We see executive functioning stuff show up.

And then one of the other things we also see show up all the time is, you know, this trauma symptomatology. And we know that we can’t change oftentimes what happens to somebody in the past. We all have histories and we all have experiences in our early childhood that are stagnant risk factors, but we know that there can also be consequences to that which show up as hypervigilance or even anxiety or difficulty sleeping, feeling overwhelmed.

So these other symptoms of trauma are part and parcel of the experience of having an adverse childhood experience or multiple during childhood. So these are the things that we have really begun to think about as what we call treatment targets. What do we do? Like, when we look at our ideological work, we try to identify what is modifiable, what is changeable. And then what do we do about that when we develop or think about treatment programs to address those things?

TH: 

One of the things I was curious about is you note in the paper itself that trauma itself has not always been well integrated into treatments for kids who have problematic sexual behaviors. And so for some of us who come from a background that, you know, education around trauma has been sort of, we’ve been steeped in that, that feels sort of counterintuitive and I’m curious about why you think that that was not sort of a target of intervention earlier or better integrated into evidence-based treatment.

JY: 

That’s a million dollar question. I think that there’s lots of reasons, primarily because we have taken such a punitive approach to this problem. You know, especially when we think about adolescence. So when we think about childhood, right, we know that kids typically under the age of 12, problematic sexual behaviors are seen as possibly seen more so as exploratory, course correcting, we have the ability to change the outcome of these children by just some simple education or simple CBT approaches, we know when it comes to adolescence, it’s a very different beast. And we have historically done a few things. We’ve historically likened what’s happening during adolescence to what happens during adulthood. And we have oftentimes treated, and I don’t think that this is currently the case, but I think historically the case has been we’ve treated adolescents similar to the way we treat adults, which is like they should know better and we’re not going to be able to prevent this from happening again and like we need to punish them. And then we have criminal legal systems that are quite literally built on punishment. So when we have that approach to thinking about adolescents the same way we’ve thought about adults, we’re going to both use the same approach as we use with adults, right? And we’re going to by and large punish those kids in the same way we punish adults. So we have similar sentencing. We have states that have oftentimes made it easier to wave juveniles into adult court and those types of things, right? So I think that the thought of having trauma as part of the conversation is not something that has even been entertained or explored because we have systems that are set up entirely different or the antithesis of like what we think about with trauma related services, which is an explanation or contextualization of why behind the behavior. And I think maybe that’s where people have ended the conversation instead of thinking also about, we contextualize it in this way, we can actually offset future behaviors by addressing what we see as what some of these bigger, bigger problems or these bigger risk factors. And so instead of using it just to contextualize, we can also use it to address and offset future problematic social behaviors.

TH: 

One of those things that you’re noting is that there’s a long history of myths that have really attended to use with problematic sexual behaviors, that it was somehow like adult offending, that it’s immutable behavior. And I think that some of that has been because there’s been this very bifurcated approach to this kind of sexual acting out. You have not just younger, but also what’s viewed as less serious behavior where really no one was given the obligation of providing treatment or any kind of intervention that’s appropriate at all with those kids. Or then overreacting in some cases or having very serious cases, which then led to even a reinforcement of this. Like if there weren’t people showing up in the court system or those with very, very serious cases, aggravated sexual assault or something of that nature, then it skews the way that multidisciplinary team members may view these kids because they’re only seeing the worst behavior. You know, they’re not necessarily exposed to the full range of behavior that you otherwise would. I think for Children’s Advocacy Centers, this is an area in which we’ve been active for at least the last decade, maybe a little more, but really paying close attention to these kids because it just became so clear to us that in most cases, the kids were falling through the cracks entirely, or at least until something very, very serious happened that brought it to the court’s attention. And in many ways, while that’s not too late, it’s also not the ideal point of intervention either. That’s where we can, we want to intervene early. So I’m curious about another aspect of this, is you talk in the paper about the importance of caregiver involvement and treatment. And in the paper itself, you had multiple settings. And maybe that’s something for you to explain a little bit to listeners because I appreciated the fact that you are not just looking at the effectiveness and the feasibility of implementing TF-CBT for PSB in one single type of setting. You really looked at multiple settings and those kinds of things. So if you could talk a little bit about that. And then I want to talk a little bit about why this caregiver involvement and engagement is so important.

JY: 

Yeah, and I want to preface this by saying this was a pilot. We have a very small sample and that comes with a whole host of different reasons behind doing this research and doing this work. Given that it’s a small sample, we went into this intentionally with the objective to really think about how this works in different settings. We know that there’s been one study that was done prior to us doing this work with adolescents in a residential-based facility. And we also know that a lot of our samples generally tend to come from residential-based or incarceration-based samples because they’re easiest, and I say that with quotes, they’re easiest to capture. These kids are all in one place at one time. We can get access typically to those settings in a way that we can’t with community-based samples where kids are displaced or placed in multiple different locations. So we wanted to see, given that we know, I mean, aside from multi-systemic therapy we know is one of the evidence-based approaches in the field. We know very little about what works and how it works. And so we wanted to see there’s been talk of trauma for decades in our field. If we use a pre-existing evidence-based approach to addressing trauma, can we at least begin to think about testing how it kind of works in both of these settings. And we were able to, with tons of gratitude, be able to partner with two people, or two, I should say, two entities in the state of Georgia who were really enthusiastic about doing this work and wanted us to come in and kind of support some of their efforts. so their criminal legal system, their juvenile justice system, I should say, came to the table and said, you know, we’d love to have you partner and we’d love to be able to institute this type of approach. And so we were able to partner with, in some ways, their system was easy to, I should say, infiltrate in some ways because they had providers or clinicians who were being paid by the state to do this work already, to do therapy and rehabilitative services for PSB clients already. They were amenable to being trained. They were willing to work with us. They were all typically in one location or typically trained up in one model.

Versus the community-based providers who were coming at this from various different perspectives, but were at one agency location. And often times we had the challenge of being able to reach out to their various different clients because they were in the community, right? They had different schedules, they had different parents’ involvement. Sometimes they were even driving to locations to see kids, like upwards of two to three hours. And so I should say that there were challenges in both of these locations.

But we wanted to see, can it work? Like that was the ultimate question. And I think the answer to that question was yes, it can work. One of the things we need the most for this to work though is buy-in. And we realized after doing this that one of the things we’re beginning to institute now in our current studies are readiness assessments.

We would like to assess the extent to which that, not just that buy-in, but that infrastructure and support around being able to do this at a given agency, institution, or whether it’s community or in a facility, or with individuals who are independent clinicians, have kind of the baseline readiness to implement TF safety or to be trained on it prior to them kind of going through it.

There’s going to be barriers no matter what, right? Like there’s going to be barriers in all the research and all the different things we’re trying to do, but to be better prepared for those and to use our clinical team and our training team to support some of those barriers through the case consultation process, what’s a game changer. And it has continued to be a game changer. So is it feasible? Yes. Do we need buy-in? Absolutely.

TH: 

So to turn to my question about caregivers for a moment, I think this is a common thread in evidence-based treatments, of course, that there’s caregiver involvement wherever you can have that as a part of that. At the same time, it seemed in the way in which the write-up was done that this was particularly important here. And yet, it was variable, of course, as we see with clients anyway, in terms of which caregivers were, in fact, more involved than the others and more supportive than others.

And tell us about what your takeaway was in terms of the caregiver involvement in this effort.

JY: 

This is also such a difficult question. mean, I think that our field has struggled with answering this question for decades too. I think that the ultimate question is how do we get caregivers more involved and what does that look like from both a clinical lens and a research lens? We were fortunate enough to have, I think our clinicians did the heavy work in getting our caregivers to sign off and say yes. And of course they have to consent, right? We have to have all caregivers say yes to their kid participating as well as it should say the guardians sign off and say yes to them participating as well as their own individual level of participation and engagement. And it’s interesting because we tended to have or see in this particular sample and this is certainly not generalizable, but we tended to see more involvement from caregivers in our community sample than we did in our residential incarceration-based sample. And I think that’s for a lot of different factors. And I think in the state of Georgia, some of these kids were pretty significantly displaced from families when they’re sent away. And so there’s that proximity issue, right? And we also had, think our clinicians in the incarceration-based sample were just overloaded with many different clients and caseloads that they had to navigate. And so we had a lot of those issues show up. But we also know in TF-CBT that irrespective of whether or not a caregiver participates, there are still significant positive effects of this treatment on helping kids overcome trauma symptoms, helping kids with what we call executive functioning or like regulatory capacity is being able to regulate emotions and behaviors. And also we see significant impacts on their ability to form connection and attachment. So we know that it can make a difference and we know it can also change trauma symptoms. So we know it can make a difference. One of the things we go into this doing is really stressing caregiver involvement. If it doesn’t happen, and we work really hard to make it happen, we still know that there can be benefits. And so we try not to throw out the baby with the bathwater or make perfect the evil of good, right? We want it to be the best it can be for the kids that are fully bought in themselves. And all of the kids that were part of the sample were fully bought in ways that I think at the end, they were able to say, this really helped me. And this really helped being able to address and talk about what happened to me because nobody’s ever asked me that before. And in one of our like foundational preliminary studies we did with, it was some qualitative questions and conversations we had with caregivers and kiddos. We asked caregivers, you know, what do you want to know? What do you want to get out of treatment? And the caregivers were saying, we want our kid to be able to talk about their trauma. And for the longest time, we haven’t been able to. We haven’t been able to ask our kid like, treatment has been structured in this way where we haven’t been able to ask what happened to you and how did it affect you and how can we work towards a bigger and better future. And so parents were coming to us saying these things that they wanted the ability to talk about trauma, but they were kind of shunned away from it for whatever reason because of the philosophy or the model being used at the time.

TH: 

Or maybe even fearful, you know, that if it wasn’t handled well, it could be very problematic. I think one of those things I was also interested in when I was reading through the study, and I mean, it’s not surprising that what caregivers report as the levels of symptomology that their kids have and what kids themselves say about that are different. We glean that from other studies as well. But I’m curious about this in this particular study with this particular population, because I think that it is really interesting to me that disconnect between how kids describe both their symptoms going in and whether or not they got better and to what degree going out versus what caregivers say about that. So talk a little bit about what you found in the study itself, but then also, you what meaning do you make of that as you go forward with this?

JY: 

Yeah, and again, because we had such a small sample, I have to really use the caveats that it could be different if we had more kids and caregivers. But one of the things we, and we never know what to attribute this to, right? And we don’t ever want to say anyone’s not being totally truthful, but they’re looking at it through the relative lens of their own experience. And caregivers, I think, are reporting on the experience that they have seeing their kids struggle.

And seeing their kid go through what they’re going through. And we saw our caregivers report statistically significant positive effects on problematic sexual behaviors at the end of the day. Like they showed improvements in their kids displaying of PSB from pre to post. So improvements meaning life reductions in their problematic sexual behaviors.

And so that was great. It was wonderful to see. We didn’t see the same effects for the kids. And one of the things we try to do in as many studies we can that capture kids and their caregivers is to triangulate that data, right? To be able to say, is what’s happening with reports on caregivers and this is what we’re seeing happening with reports on the youth. And so that was really exciting to see that, know, caregivers are saying, like, these kids are showing significant reductions and this is something that holds promise. Where we saw the kids show some improvement in their reports of their own trauma indicators, which was also really cool to see. But one of the things that, again, we have to interpret these results with caution. One of the things that we should also be thinking about is like, what are the things that are trending in significance that we can, if we get a more robust sample, if we be able to get more kids on board, what can we really see making big improvements? And we saw that show up with some of our family and attachment relational kind of indicators and our metrics around family and attachment. One of the things that was surprising was that we saw trending in the opposite direction that we would expect was the regulation and executive functioning metrics, which was surprising. But again, they weren’t significant.

And again, we had such a small sample, so it was hard to discern why and why we saw that happen. But yeah, I like to look at what are the caregivers saying versus what are the youth saying to triangulate it and to think about the different perspectives and the ways that they approach the world and the ways that they see the problem, perhaps differently. We know caregivers come to this problem with a lot of shame. And not to say that youth don’t, but I think that caregivers come to this problem with a significant amount of shame and blame on themselves and on the family and on just the situation as a whole in a way that I think is very profound. And I don’t know that our field has quite understood it in a deep enough way. I think shame is one of the biggest treatment targets possibly that we’ve ignored.

TH: 

Can you talk about that a little bit?

JY: 

Yeah, I think that when we look at this problem inherently from like a societal perspective, when you tell people that you study this or you’re involved in this field, like the reaction that we oftentimes get, right, is, wow, I can’t believe you do that or God, that must be terrible. It must be so hard. And imagining the parents, the parents’ societal reaction, they get when and if they decide to confidently share that with a colleague or friend or a loved one, right, that their kid had engaged in a problematic sexual behavior. I think I’m a parent myself and the amount of times I go through my life as the role as a parent of like taking on my kids’ stuff, it happens, right? Like it’s just part of being a parent.

It’s part of being a parent and we live, we’re living vicariously through our kids, whether or not we want to admit it. And we’re also such a deep part of who they are because it’s a reflection. It’s not just a reflection of you. It is you, right? It is who you are when you’re a parent. And so I think that when there is a negative event and it’s such a deeply stigmatized event like problematic sexual behavior or sexual violence, like there is a profound amount of shame. And like, I can’t believe that that was my kid. I can’t believe that I let that happen. I can’t believe that I didn’t stop it or I didn’t know about it or, you know, the list goes on. So I think that there’s a real opportunity that we’re missing when it comes to, and maybe this goes hand in hand with caregiver engagement and treatment and services, but I think one of the biggest reasons why we don’t see a mother involved is because of that shame.

And their own possible histories of their own trauma or abuse, right?

TH: 

It’s so multifaceted because, first of all, there’s a good chance that the child that this youth acted out on is also a sibling, cousin, a neighbor, somebody very close. And so this intensifies the shame that family members often feel, I think, and in Children’s Advocacy Centers, we often saw that. Parents felt very torn between a child who had been victimized by another child, you know, in their own family.

And so I think that it’s an interesting sort of trauma-informed lens to say if you’re wondering why the parent is dragging on therapy or not always showing up or whatever the case might be, not as engaged as you might want, that may be about the incredible shame they feel already and that they’re worried that talking about it is going to only exacerbate, right? Because, I mean, let’s be honest.

The first session or two of therapy, you don’t feel an immediate sense of relief anyway, right? You may feel worse before you feel better because you’re opening a can of worms that you’ve been trying to pack down for a long time. So I think thinking about how we talk to caregivers so they know what to expect in these therapeutic settings and the fact that some of what they may hear may be very hard to hear. That no one’s blaming them by the fact that they’re hearing it.

You know, they’re not being judged by the person in the room who is leading the therapeutic engagement in some way. We think people know that somehow, they magically know that. And so it’s very interesting to me to hear you talk about that in that way, because I think it’s probably true that we don’t engage enough on that issue and that we know it. Like, yes, they do. They feel shame and stigma. But then what do we do with that in terms of our actual interactions with the caregivers.

JY: 

Yeah, and there’s a whole host of reasons, right? I think as clinicians not knowing how to do it, right? And maybe it is because we enter this field without enough knowledge or background information, or we enter this field, like in my situation with limited background information altogether, training. Or maybe it’s that we ourselves cannot believe it when we actually interface with clients, right? We can’t believe that there’s parents didn’t know this or that parents wouldn’t be blamed themselves. And so that internalization maybe subconscious could be part of that interaction. Right? Yeah. I don’t know. I think that there’s lots to better understand there, but I think that there’s opportunities for training around like.

How do we do this better as clinicians? And truly, the first point of contact is probably going to be the linchpin. The intake is going to be the part where we need to think about how we approach that. And not to say people aren’t doing it right, but I think that there could be opportunities to really think more deeply about this.

TH: 

There are always, I think, opportunities to improve. I remember when we first started raising the issue of serving kids with problematic sexual behaviors. And it was very interesting because there were a lot of initial barriers to that idea, right? First of all, we would have people tell us, was it our standards if they couldn’t? And we’re like, well, we wrote them, so we know that it doesn’t say. Okay, so let’s engage on that to begin with. And then there was the, my multidisciplinary team has concerns about this, so a lot of education around that. And then, of course, people do have to look at their physical spaces and their scheduling and other things, you know, just basic safety kinds of things that we do with all clients, right? But then we found that when we started this process of training clinicians, there was a lot of trepidation about serving these kids. And so I think that there are these perceptual barriers that have to be broken down on the part of clinicians themselves. And I think it can be hard to admit that maybe you have some biases or some discomfort or just feel like I’m inadequate to the task. Like, I didn’t come to this work to serve this particular population. I don’t know what I’m doing. So I think if we could just calm people down and to your point, reinforce what you learned early on, which is the kids. They’re kids.

JY: 

I know, think that there’s like prior to coming on, I was thinking more deeply about this too in my own experience because I think that there is this bias we all have and whether or not we want to admit it, this is hard work. I don’t know that it’s a bias. I don’t know for me that it’s a total bias, but it’s hard to hear.

Especially now that I have my own children, it’s extremely hard to hear the stories and to sit with it in a way that we expect our clinicians to do. And we expect our parents to do, quite honestly, and the kids. Sometimes it’s trying to separate the action from the person. And I don’t know that we’re all really good at that. And this is why I feel blessed to have a job now where I get to still do the work, but do it with data too and in a way that’s not as engaged as those folks working at CACs or folks working as clinicians because that’s truly the hard, hard, hard stuff. But I think that it’s really difficult sometimes when you do hear the actuality of the story, the reality of what happened and to separate the human from the incident.

TH: 

The other thing is this is where good clinical supervision can be a lifesaver because that should be a place where someone can admit, I am really struggling with this. This client described what they did to their younger brother or the neighbor and I am just having a hard time looking this kid in the eye. This moment of honesty about where you’re really sitting with something, I think for all types of work within CACs is really the first step to being able to deal with and address that, you know, because as long as we’re going, no, we’re fine, we’re fine, there’s not a problem, and we’re the professionals, we can hear this all day long, it doesn’t bother us. You know, exactly. It’s like, no, we’re humans, and it’s natural. It’s interesting you talking about your experience with once you had your kids, how much more difficult that became. I can’t tell you the number of MDT professionals I’ve had. Tell me something very similar over the years.

You know, I had to step away for a little while when my kids were very young because I just couldn’t hear the stories when I had a two-year-old about two-year-olds. Or I had to, you know, really think about the client load that I held while blah, blah, blah, blah. I don’t think there’s anything wrong with either needing a break at times or needing to say, I need something different in my case load because of what I’m coping with.

JY: 

Yeah, and I think too, when we think about this in the context of trauma, oftentimes when we first see our clients, they don’t tell us their childhood histories. We don’t know a lot of the full context of the story. We just hear the story, right? We just hear kind of what you’re describing as like the worst of the things that they’ve done. And we may get tidbits from caseworkers or from their files around like here’s some of their history. We haven’t yet crafted a story around that.

Or at least we haven’t had the kid tell us their story around that. So I think that it becomes much easier to engage in the work once we begin to dig into the why, because that helps us create more of that human narrative and that human experience behind it. And I’m not saying that it’s ever used as an excuse or it’s ever used as a way to justify.

But I think it helped me always look to the why. And then that why helps us decide the how, right? Like, how are we going to intervene? How are we going to help this kid deal with all of these things?

TH: 

First of all, there’s not a negative to having some empathy for the person in front of you in the first place and understanding their story and that people are more than just their worst behaviors. That’s, I think, just kind of a good operating principle in life is that people can do really bad things and it doesn’t mean they’re irredeemable, especially kids. I think that’s one thing to hold in your head when you’re thinking about this. Without minimizing the harm that has happened to someone else, right? And I think sometimes we get caught up in the, you for this or for that? It’s like, no, we can acknowledge that there has been a real harm created and also acknowledge that this child, this adolescent is deserving and worthy of help and that there’s effective help that they can receive and it’s our obligation to provide it if we can. I think the other thing that you point out though is the pragmatic, which is in knowing that story, it’s not just for the sake of empathy, it’s also for the sake of developing and designing a treatment plan that’s actually likely to be effective. So it’s stopping the behavior, right?

JY: 

100%. And not to say that trauma is going to be the end-all-be-all approach for all kids, right? Like, and I want to make sure that’s very clear, that we know there are adolescents who may not have a trauma history who may require additional or different types of treatment approaches. But yes, I think that it helps guide the how. And when we do a good job in the field of identifying what those risk factors are for that individual kid. And we know that those are the risk factors that are most likely going to be leading to or the potential for this to happen again, whether it’s delinquent or it’s sexual. We can do a better job of designing those treatment plans. And this is just one more tool for our clinicians to have to be able to use and say, okay, well, I’ve got a kid with complex trauma or I got a kid with a bunch of adversity and maybe they’re not even able to talk about it yet or maybe they’re not even really well aware of what that experience was or they haven’t internalized it yet as a traumatic or adverse event. We know that this could have a real impact on their behavior and we can connect those two and begin to think about them, what do we do? And we have this beautiful effective approach that I think our field hasn’t used to its full capacity. And I want to credit the model developers and their work on TF-CBT because it really and it’s been shown to be efficacious in 21 randomized control trials and addressing the same exact risk factors that we know show up in our own PSB work. So if it’s mapping on so closely to what we know already works and what we should be addressing in our field, why not? Right? Like why not apply it and why not use it and why not get trained in it? Because it could really make a big impact on the kids that you have on your caseload with histories of trauma and adversity.

TH: 

So you’re talking to child abuse professionals and it sounds like one of your core recommendations is if they’re not already trained in TF-CBT, they should be, which I think, you know, I completely agree with as it’s the gold standard treatment for trauma. But I’m curious about what else when you think about not just the study, but you’ve obviously been delving into this topic your entire career in one form or another. So I’m curious about what would you like child abuse professionals to take away from this conversation as next steps in helping these kids.

JY: 

Yeah, I think that I see TF-CBT as a secondary prevention approach in a way. And TF-CBT may not be the only trauma approach you are trained on and use, and it is a gold standard, but certainly trauma-informed care needs to be a start where we are using trauma-informed care at every interaction we have with the family. Even if we assume that they haven’t had trauma, we should assume that they have.

We should change our narrative and assume that they have. And trauma-informed care will not, if done right in terms of the way we interface with clients, the way we interface with caregivers, will not cause harm. It’s just a holistic approach to identifying and caring for people in a way that considers what happened to them in their life and using approaches and thinking about interactions and thinking about assessment processes and all of the things we already do through that lens of trauma informed. I think that child abuse professionals have the hardest job on the planet, clinicians or people working in justice settings or people working in probation or whatever. think that you all have the hardest job on the planet. And I think there is such a need for all of us to come together on this issue.

And come together in the sense of like, can we reserve the punitive approach for those people who really need it and really defer to a rehabilitative, true rehabilitative trauma approach from the vast majority of the kids and think about the ways in which we have actually inadvertently caused harm by relying so heavily on this punitive response. And so, that would be a huge message to like trauma-informed, let’s think about it, let’s integrate it, and let’s move away from a punitive model altogether.

TH: 

It’s so interesting as you were talking, I was thinking that, you know, 40 years ago in this country, well, 41 years ago in this country, we didn’t have a single CAC. That movement really revolutionized the way that child abuse intervention exists. And it seems to me that there’s no equivalent for kids with PSV, which is how we wound up 10 years ago, starting to go, these kids are our kids too, let’s start looking at that. But the piece that is missing is not just the treatment piece. It’s the systems change piece that we haven’t gotten there yet. And I think that all of us combined together, working together, can accomplish systems change again, just as we did 40 years ago.

JY: 

Yeah, you know, I was trained as a social worker and so I love that. I love that word. I love systems. We think deeply about systems. And I think even in our approaches sometimes they’re still so individual focused. Like we change the way we think, then we change the way you respond, then we change. You know, all of that’s really good and we all, still need a lot of the individualized approaches, but.

I think you’re right. We need to be thinking more deeply and doing more work with systems change in a way that is within our own MDTs, within our own, we call them in Colorado, the adult side, the CSTs. How do we really begin to understand and cross disciplinary perspectives in a way that not just educates, but like helps to bring about change within the individual clients we’re seeing. And that’s the only way to contribute.

I think from an individual perspective, two systems change. We have the ability to change the system through these interactions, but we also know that the system doesn’t change without big time advocacy and big time policy and legislative change too. I think a lot of it is education on, we know this problem from those of us who have been working in this field for so long. We know the realities of the problem. And we also know the realities that these are 95 plus percent of the time, these are just kids who don’t have supports in their lives in a way that have helped guide them in making better decisions. So how can we take that approach into every kid we work with, every adolescent we work with, and that they’re also amenable to change? Like they are worthy of change and we should all be coming from that perspective too.

TH: 

I love this conversation because I’m a big believer in we are the system. So if we want the systems change, we have to change ourselves and the way that we’re responding to these things as well. And it’s within our power to do. So listeners, you’ve heard it here, get on it.

Work with us to change those systems. Is there anything else I should have asked you and didn’t, Jamie, or anything else you wanted to make sure we talked about today?

JY: 

No, I just really appreciate the conversation. I truly do. think that y’all are disseminating the message in a way that is reaching people. And so thank you for that. If anyone does want to get involved, just feel free to reach out to me. My colleague, Melissa Grady, I’ve also been working with very deeply on this project. We have opportunities for folks to engage in training or engaging other parts of the projects if they’re interested. So we just thank you for highlighting this work.

Thank you for giving us the opportunity to talk about it.

TH: 

Jamie, feel free to come back at any time. Thank you so much.

Soon we are going to be taking our August break. So feel free to listen to past episodes during that break and we look forward to being back with you soon. Enjoy your summer. If you like this episode, though, please do rate it and share it. And for more information about this or any of our other podcast episodes, please visit our podcast website, oneintenpodcast.org.