Prevelance of Mental Illness and Juvenile Deliquency

Study Highlights  A retrospective study of adults

conducted by the CDC & Kaiser Permanente examined the relationship between several forms of childhood trauma (adverse childhood experiences or ACEs) & related health outcomes. Individuals with 4+ ACEs (12% of sample) were more likely to report health conditions & shorter lifespans.

 The current study includes all 220 juvenile offenders committed for incarceration in New Mexico during 2011 & uses the results of comprehensive multi-disciplinary psychosocial assessments to examine juveniles’ ACEs, psychological & family conditions, & exposure to other traumatic events.

 86% of incarcerated New Mexico juveniles experienced 4+ ACEs, 7 times higher than the CDC-Kaiser study.

 New Mexico juveniles experienced ACEs at a higher rate than juvenile offender populations in other studies.

 Among incarcerated New Mexico juveniles, majorities experienced emotional (76%) or physical (94%) neglect, parental divorce/separation (86%), and substance abuse in the home (80%).

 Axis I diagnoses (99.5%), substance abuse disorders (96%), & depression (48%) were widespread among incarcerated New Mexico juveniles.

 Females had a higher incidence of ACEs. 23% of females experienced 9+ ACEs compared to 3% of males.

 Females had a statistically significant higher incidence of sexual abuse (63% vs. 21%) & physical abuse (70% vs. 49%) when compared to males.

 Efforts are needed to identify & prevent early childhood trauma in New Mexico. Intervention goals include preventing additional ACEs in young children who have experienced them & trauma screening when children enter the juvenile justice system. Additionally, evidence-based, trauma- informed, family-engaged mental- health & substance-abuse treatments should be available throughout the juvenile justice system and to youth subsequent to discharge from detention and incarceration.

February 2016

Yael Cannon, JD · George Davis, MD · Andrew Hsi, MD, MPH · Alexandra Bochte, JD · in Collaboration With the New Mexico Sentencing Commission

Introduction Faculty from the University of New Mexico

(UNM) School of Law and the UNM School

of Medicine, and New Mexico’s Children,

Youth and Families Department (CYFD)

initiated a joint project to look at the

prevalence of Adverse Childhood

Experiences (ACEs) nationally and in New

Mexico. The study was intended to better

establish the association between early

childhood trauma and delinquency, as well as

to explore the role that law and medicine can

play in ensuring better health and juvenile

justice outcomes for children who have

experienced ACEs. In pursuit of the research,

the three research partners organized

meetings with the New Mexico Sentencing

Commission (NMSC), which is a criminal

and juvenile justice policy resource center for

the state. Each of these agencies brings a

unique perspective to a review of this

information. The common goal is to provide a

greater understanding to New Mexico’s

juvenile justice stakeholders about the rates of

trauma and victimization and related needs

among juvenile offenders. The research may

also help to identify prevention strategies that

might improve outcomes for youth. Upon

meeting, the parties decided to engage in a

joint project to establish the prevalence of

ACEs in New Mexico’s committed juvenile

justice population and compare it to other

juvenile justice populations nationally.

Adverse Childhood Experiences were defined

in the original investigation by Anda and

Felitti (1998) as childhood experiences that

were judged to be stressful for the developing

child. These adverse experiences were

grouped into either childhood abuse or

household dysfunction and were formulated

as 10 childhood experiences identified as risk

factors for chronic disease in adulthood:

emotional abuse, physical abuse, sexual

abuse, emotional neglect, physical neglect,

violent treatment towards mother, household

substance abuse, household mental illness,

parental separation or divorce, and having an

incarcerated household member. The results

of the investigation were first described by

Felitti, Anda, and colleagues in 1998, with the

publication of their retrospective Kaiser

Permanente study, Relationship of Childhood

Abuse and Household Dysfunction to Many of

the Leading Causes of Death in Adults: The

Adverse Childhood Experiences (ACE) Study

(Felitti et al., 1998). The Kaiser Permanente

study asked 17,421 insured, well educated,

adult patient participants to retrospectively

complete a confidential survey that contained

questions about childhood maltreatment and

family dysfunction, as well as items detailing

their current health status and behaviors

(CDC.gov). This information was combined

with the results of their physical examination

to form the baseline data for the study. The

researchers for this particular project were

able to identify that these 10 childhood

experiences were positively correlated with

the subsequent development of a wide range

of chronic physical and mental health

disorders in adulthood. Sixty-four percent

(11,149) of the study participants had

experienced one or more categories of ACEs.

ACEs have more recently been identified with

immediate negative consequences, such as

functional changes to the developing brain

(Anda et al., 2010) and are found in

significantly increased prevalence among

juvenile justice-involved youth compared to

youth in the general population (Baglivio et

al., 2014). Teague et al. (2008) states that

experiencing childhood physical abuse and

other forms of ACEs leads to higher rates of

self-reported total offending, violent

offending, and property offending, even after

controlling for delinquent behavior.

Adverse Childhood Experiences in the New Mexico Juvenile Justice Population

New Mexico

Sentencing Commission

2

Florida is one of a few states that have looked at ACEs

in juvenile justice-involved populations. A study was

conducted by the Florida Department of Juvenile

Justice to examine the prevalence of ACEs in a

population of 64,329 juvenile offenders in Florida

(Baglivio et al., 2014). An important finding in the

Florida study revealed that increased ACEs scores

correlated with increased risk to reoffend through the

use of a risk-needs assessment called the Positive

Achievement Change Tool (PACT). The PACT is an

actuarial risk-needs assessment designed to assess a

youth’s overall risk to reoffend, as well as to rank

criminogenic needs and dynamic risk factors (Baglivio

et al., 2014). The PACT is adapted from the validated

Washington State Juvenile Court Assessment

(WSJCA), which has been in use since 1998. There are

two versions of the PACT: a pre-screen and a full

assessment. Both versions of the PACT produce a

criminal history sub-score and a social history sub-

score. The pre-screen and full assessment produce the

same scores because the questions used for scoring are

identical in each tool. The reason for completing a full

assessment was to gain a better understanding of the

youth’s situation and past experiences (Baglivio et al.,

2014). The sample of youth in the Florida study were

asked directly about their respective ACEs experiences.

Baglivio (2014) and colleagues examined the

prevalence of each ACE, the proportions of youth with

different ACEs scores, and the prevalence rates across

genders. Ninety-seven percent (62,536) of the sample

reported experiencing at least one ACE (Baglivio et al.,

2014).

The Behavioral Risk Factor Surveillance System

(BRFSS) is a collaborative project of the Centers for

Disease Control and Prevention (CDC) and U.S. states

and territories (CDC.gov). The BRFSS, administered

and supported by CDC’s Behavioral Surveillance

Branch, is an ongoing data collection program designed

to measure behavioral risk factors for the adult

population (18 years of age or older) living in

households (CDC.gov). The BRFSS was initiated in

1984, with 15 states collecting surveillance data on risk

behaviors through monthly telephone interviews

(CDC.gov). Over time, the number of states

participating in the survey increased, so that by 2001,

50 states, the District of Columbia, Puerto Rico, Guam,

and the Virgin Islands were participating in the BRFSS.

(In this document, the term state is used to refer to all

areas participating in the surveillance system, including

the District of Columbia, Guam, the U.S. Virgin

Islands, and the Commonwealth of Puerto Rico

(CDC.gov).)

The objective of the BRFSS is to collect uniform, state

-specific data on preventive health practices and risk

behaviors that are linked to chronic diseases, injuries,

and preventable infectious diseases that affect the adult

population (CDC.gov). Factors assessed by the BRFSS

include tobacco use, health care coverage, HIV/AIDS

knowledge and prevention, physical activity, and fruit

and vegetable consumption (CDC.gov). Data are

collected from a random sample of adults (one per

household) through a telephone survey. BRFSS is a

surveillance system operated by state health

departments in collaboration with CDC. Each month,

trained interviewers using a standardized questionnaire

collect data from a probability sample of the non-

institutionalized U.S. adult population residing in

households with landline and cellular telephones

(CDC.gov). The 2009 ACEs module consisted of 11

questions that yielded eight categories of ACEs (i.e.,

verbal abuse, physical abuse, sexual abuse, household

mental illness, household substance abuse, domestic

violence, parental separation/divorce, and incarcerated

family members). These questions were adapted from

large, validated survey instruments measuring the

frequency of these ACEs. The ACEs module was

implemented in five states (Arkansas, Louisiana, New

Mexico, Tennessee, and Washington). Figure 1

describes the differences between the studies used in

this analysis.

Figure 1. Study Descriptions

Name of Study Population Description

Data Collection Method

Maximum ACE Score

Kaiser Permanente

17,421 adult patients

Retrospectively complete a confidential survey that

contained questions about childhood maltreatment and family dysfunction, as well

as items detailing their current health status and

behaviors (self-report)

10

New Mexico (2009) Behavior

Risk Factor Surveillance

System (BRFSS)

Random sample of

26,229 adults

Telephone survey (landline and cellular, self-report)

8

Florida Department of

Juvenile Justice

64,329 referred juvenile

offenders

Completed the Positive Achievement Change Tool

by being directly asked about their respective ACE experiences (self-report)

10

New Mexico Juvenile Justice

Population

220 juveniles committed for incarceration

to CYFD

Psychosocial evaluation in conjunction with collateral information gathered from

previous treatment programs, medical records, and state child protective

service records, as well as information gathered from

calls to guardians and juvenile probation officers

9

3

The 2013 publication by the Northwestern Juvenile

Project (Abram et al., OJJDP Juvenile Justice Bulletin,

2013) reported that out of a random sample of juveniles

detained over a three-year period, 92.5% had

experienced at least one traumatic event, 84% had

experienced two, and 56.8% had been exposed to six or

more traumatic events. Of these juveniles, 11.2% had

met the criteria for Posttraumatic Stress Disorder

sometime in the prior year. This study relied

exclusively on subject self-reports since collateral

information was not available and the families were not

accessible. Presumably some of these limitations were

imposed by the shorter-term stays of detained juveniles

as opposed to an incarcerated sample.

Literature Review The original ACEs study by Felitti et al.(1998) and the

BRFSS study provide useful comparison data to this

study in that they provide baselines for ACEs

prevalence among the general population. The data in

the Florida study by Baglivio et al. provides useful

comparisons in regards to the prevalence of ACEs in

the juvenile justice population. In this section, the

authors provide greater detail for the ACEs study,

comparative literature, and studies related to

intervention for juveniles at risk of entry to the juvenile

justice system.

Review of Anda and Felitti’s original ACEs study

highlighted several significant findings. Health risk

behaviors occurred much more among those

individuals with higher numbers of ACEs. For

example, among individuals with zero ACEs, 1%

(3,861) of the group had four or more health risk

behaviors compared to the 56% who had no risk

behaviors such as smoking, severe obesity, physical

inactivity, depressed mood, suicide attempt,

alcoholism, any drug use, injection drug use, more than

50 lifetime sexual partners, or a history of a sexually

transmitted disease. By comparison, among individuals

who had experienced four or more ACEs, there was a

seven-fold greater rate of having four or more health

risk issues such as smoking, depressed mood,

alcoholism, and other health risk behaviors compared

to the14% with four or more ACEs who had no health

risk behaviors.

In summary, the ACEs research was the first to link

poorer health status found at a preventive health clinic

evaluation to high-risk health behaviors correlated with

patients’ recall of severe adverse childhood experiences

before age 18. The researchers found a “dose-response

relationship between the number of childhood

exposures and the following disease conditions:

ischemic heart disease, cancer, chronic bronchitis or

emphysema, history of hepatitis or jaundice, skeletal

fractures, and poor self-rated health.” These health

conditions represented many of the major causes of

disability and death in the largely Caucasian, middle

class, middle aged, and well-educated patients covered

by the Kaiser insurance plan. Experiences of ACEs

often start in the first decade of life and the effects of

these events persist as toxic stress in the lives of

children. The toxic stress arising from the effects of

ACEs helps explain the significance of the impact of

suffering four or mores ACEs in early childhood that

lead to involvement in greater numbers of health risk

behaviors in youth. Greater health risk behaviors lead

to lifelong poorer health outcomes, with those having

more ACEs experiencing more of the conditions that

lead to early morbidity and death.

The association between early child maltreatment and

delinquency has been firmly established in the

literature. A comparison study between 908 children

with documented maltreatment and 667 children

without such abuse indicated a 59% increase in

delinquency arrest for the maltreated sample (Widom

and Maxfield, 2001). Another study found abused and

neglected children to be 11 times more likely to be

arrested for criminal behavior (English, Widom, and

Brandford, 2004). Females and males have been

independently studied and a similar association

between abuse and delinquency was verified across

genders (Frias-Armenta, 2002; Lansford et al., 2007).

The linkage between delinquency and prior abuse is

reproduced with some significant degree of correlation

in the overwhelming majority of studies that examine

the issue.

The mechanism of the association between childhood

abuse and delinquency has been linked to impaired

early neurodevelopment. Over the course of the last

two decades, progress in developmental brain science

has documented the damage done by early neglect and

abuse to critical neuro-regulatory systems that are

normally established during sensitive early

developmental periods (Anda et al., 2006; Gutman and

Nemeroff, 2002). Early childhood maltreatment also

negatively alters critical neurotransmitter systems that

are necessary for social attachments and affect

regulation (Bennett, 2002; Caldji, 2000). The

development of these attachment and regulatory

capacities depends upon the consistent support of the

primary caretaker and the environment, and is mediated

by extraordinarily complex interactions between

neuroendocrine systems and expanding neural

networks (Perry and Pollard, 1998; Teicher, 2003). The

impairment of these regulatory systems is in turn

related to aggression, substance abuse, and delinquency

itself.

4

Although there are studies that focus on the

consequences of specific traumatic exposures such as

sexual abuse or domestic violence, there is limited

research that attempts to quantify or describe the

degree and full range of early maltreatment that often

precedes delinquent behavior. There are fewer studies

that still employ the specific categories of Adverse

Childhood Experiences defined in the original ACEs

study (Felitti et al., 1998). The Chicago Northwestern

Juvenile Project and the Florida Department of Juvenile

Justice ACE study, both described in the introduction,

examine the presence of trauma in different subsets of

the juvenile justice population. The Chicago study

examined 1,829 juveniles detained in Chicago over a

three-year period and assessed them for self-reported

trauma and the presence of PTSD (Abram et al., 2013),

and a recent study of 64,329 high-risk delinquents in

Florida (Baglivio et al., 2014) estimated ACEs

exposure from the results of the PACT risk-assessment

instrument. A 2010 pilot study of youth referred to the

Massachusetts Alliance of Juvenile Court Clinics

(MAJCC) found the median number of ACEs to be

five, with more than 63% having more than four

(MAJCC 2010). This estimate is presumably higher

because it is a clinic-referred population, but the

findings are similar to the number of ACEs the present

study also found in an incarcerated population.

Methods The data set used for this study is gathered from the

initial psychosocial evaluations of 220 juveniles who

were committed for incarceration to the custody of the

New Mexico CYFD during the calendar year of 2011.

The sample includes all males and females between the

ages of 13 and 18 who were committed to the CYFD’s

Juvenile Justice Services facilities during that time

period, regardless of the offense(s) that led to their

commitment or their sentences, without any

preliminary selection screening other than the

commitment itself, and therefore represents the

complete universe of New Mexico delinquents who

reached that advanced level of system penetration in a

single year.

The written psychosocial evaluation that is performed

on each adolescent who is committed for incarceration

is based in part on independent intake interviews

performed by psychological diagnosticians and

psychiatry, education, medical, and behavioral health

staff. The final written evaluation also incorporates

collateral information gathered from previous treatment

programs, medical records, and state child protective

service records, as well as information gathered from

calls to guardians and juvenile probation officers. All

self-report and interview findings are compared to

previous records, including psychological and

educational testing records and to the interviews of all

the other disciplines. At the completion of the initial

three-week evaluation period, professionals from all of

these disciplines gather on each case to compare

information, finalize recommendations, and reach a

consensus diagnosis and treatment plan based upon the

findings.

The diagnostic psychosocial evaluations for each

adolescent were then examined by a trained reviewer

who determined the presence or absence of nine out of

10 of the original ACEs from the Kaiser-CDC ACEs

study. The last factor, which represented the presence

of mental illness in the family, was omitted because the

ability to determine the presence or absence from

available records was not considered adequate for

accuracy. Data was also collected on additional

conditions/traumatic events, including:

 Psychological conditions: self-injury, suicide

attempt by the child, diagnosis of depression (any

diagnosed depressive condition at the time of

admission) or PTSD, Substance Abuse Disorder

based on Diagnostic and Statistical Manual-Fourth

Edition (DSM-IV) criteria, Axis One diagnosis

based on DSM-IV criteria, or prior identification

of special education eligibility;

 Family conditions: substantiated or unsubstantiated

protective services reports, child’s prenatal drug or

alcohol exposure, child raised by a non-biological

parent with no CYFD involvement, or having an

out-of-home placement (residential treatment

center, treatment foster care, group home, or

psychiatric hospital); and

 Other conditions or traumatic events: teen

pregnancy, teen father, obesity, witnessing a death

or murder and death of a friend or family member.

Each ACE was recorded and treated as a dichotomous

variable (coded yes or no). Any indication of a yes was

counted as a positive ACE and included in the

summary ACEs scores. Because the study used

secondary analysis of de-identified data, no consent

from the youth was required. Institutional Review

Board (IRB) approval was obtained from the UNM

IRB.

NMSC performed a secondary data analysis of this

existing database. Variables were recoded in order to

combine the values of the variables into fewer

categories. After recoding, cross-tabulations were run

in order to get frequencies and percentages of the

5

recoded variables. This present methodology can

usefully be compared to other relatively recent studies

of juveniles in various stages of involvement in the

delinquency system.

Baglivio et al., (2014) looked at all juveniles who had

received an official referral to the Florida Department

of Juvenile Justice over a six-year period and who had

been administered the PACT ) full assessment after

being pre-screened for high likelihood to reoffend by

the PACT short version, as discussed above. Only

those juveniles who had reached 18 years of age by the

end of the collection period were included. As was the

case with the Northwestern study, this study relied on

self-report in response to a structured assessment risk

tool rather than a multidisciplinary clinical assessment

with supplementation by family report and historical

records, as in this study. The Northwestern study

sought to determine exposure to trauma and subsequent

PTSD, whereas both the Florida and the New Mexico

study seek to determine the number of ACEs using

either clinical or self-report data.

An analysis was performed to determine if youth with

specific psychological conditions, family trauma, or

exposure to other traumatic events had higher overall

ACE scores compared to youth who did not have those

conditions. Findings The sample was predominately male, 86.4% (190),

while females comprised 13.6% (30) of the sample.

Figure 2 illustrates the prevalence rates of each ACE

indicator by gender. Looking at individual ACEs

indicators, we see they vary from a low of 21% male

prevalence for sexual abuse to a high of 100% female

prevalence for physical neglect. The most prevalent

ACEs indicator was the same for both males and

females: physical neglect (93% and 100%,

respectively) followed by parental divorce or

separation (90% and 85%, respectively). The least

commonly reported ACEs indicator for males were

sexual abuse and physical abuse, while the lowest for

females were family violence/domestic violence and

having an incarcerated household member. Sexual

abuse was experienced three times more frequently by

females than by males (63% and 21%, respectively).

Figure 3 on page 6 illustrates the prevalence of ACE

scores in the current study by gender. Only 0.5% of the

males and 0% of the females experienced no ACEs.

Approximately 3.7% of the males reported just one

ACE compared to 0% of the females. Of the males,

74.8% had exposure to five or more ACEs, compared

to 86.6% of the females. These results indicate female

youth in the New Mexico sample had a higher average

number of ACEs than males, which is consistent with

the Florida ACEs study.

Figure 4 on page 7 illustrates the vast difference from

the sample of adults in the original ACEs study (Felitti

et al., 1998), the 2009 New Mexico BRFSS survey, the

Florida juvenile ACEs study, and the sample of

juveniles in the current ACEs study. When comparing

ACEs scores across studies it should be noted that each

study had a different maximum ACEs score. The

6

Kaiser Permanente and Florida studies have a

maximum ACE score of 10, while the New Mexico

BRFSS and New Mexico’s juvenile justice facilities

studies had a maximum ACE score of 8 and 9,

respectively.

As illustrated in Figure 4 on the following page, New

Mexico juvenile offenders are 36 times less likely to

have experienced zero ACEs (1% compared to 36%)

and seven times more likely to have four or more ACEs

(86% compared to 12%) than Felitti and Anda’s Kaiser

Permanente study. New Mexico juvenile offenders are

three times less likely to have experienced zero ACEs

(1% compared to 3%) and nearly two times more likely

to have four or more ACEs (86% compared to 50%)

than the Baglivio (2014) ACEs study. The results

suggest that the juvenile offenders in the current New

Mexico study were significantly more likely to have

ACE exposure and to have multiple ACEs exposures

than the adults in the Kaiser Permanente study and

juveniles in the Florida study. A possible reason for the

difference in ACEs exposures between Florida and

New Mexico is the sampling frame since the New

Mexico sample consisted of only committed juveniles

while the Florida sample that included all juveniles

who were referred. CYFD believes the in-depth

psychosocial evaluation of the New Mexico study

better revealed the full extent of the adverse

experiences.

Figure 5 on page 8, shows the offense that led to the

commitment. The primary reason juveniles were

committed to the detention facility was due to

probation violations, with 55% (104) of the males and

80% (24) of the females committed for a probation

violation. Violent offenses for males 23% (44) and

females 7% (2) and property crimes for males 12% (23)

and females 7% (2) were the next most committed

offenses. Public order offenses for males 5% (10) and

females 3% (1) and drug-related offenses for males 5%

(9) and females 3% (1) were the offenses for which the

juveniles were incarcerated least often.

Table 1 in Appendix A illustrates the frequency of the

percentage of youth who were coded as having

experienced the additional variables collected: specific

psychological conditions, family conditions, or

exposure to other conditions or traumatic events

relative to those who did not experience the condition.

Table 2 in Appendix A presents only the statistically

significant findings count for each juvenile as having

experienced the listed conditions along with the mean

ACEs score. In this study, the highest ACEs score

possible was 9. In all cases, the mean ACEs score was

higher for youth who experienced those additional

conditions. Figure 1 on page 2 contains a description of

the population, how the data was collected, and the

maximum ACEs score for each data set.

Conclusion PREVENTION OF ACES AND PATH TO

DELINQUENCY

Nearly all of the youth whose histories were examined

for this study experienced some form of adverse

7

childhood experience in their lives, with more than

99% having experienced at least one ACE. Moreover,

the data indicates that many of the juveniles in state

custody in the data sample experienced numerous

ACEs during their childhood, with more than 86%

having experienced four or more of these traumatic

events, compared to only 12% of participants in the

original ACEs study. As indicated in Table 1 in

Appendix A, many of these youth also experience

related psychological conditions, such as PTSD,

depression, and substance abuse disorder. Prior ACEs

studies have also found high rates of subsequent mental

health and substance abuse conditions, such as illicit

drug use and addiction, among those who experienced

more than four ACEs in childhood (Dube et al., 2003).

The New Mexico Legislative Finance Committee’s

April 2014 report entitled Evidence-Based Programs to

Reduce Child Maltreatment provides useful

recommendations on programs that are proven to result

in reduced childhood maltreatment, such as home-

visiting programs.

The high number of ACEs experienced by many youth

in the study sample also indicates the need to identify

trauma and the related health and mental health needs

of children and families as early as possible to reduce

the number of ACEs and poor outcomes experienced

by children. New Mexico’s J. Paul Taylor Early

Childhood Taskforce, CYFD, and other state entities

are exploring ways to create a system of care that

would ensure early identification of childhood trauma

and provision of necessary related treatment. More

research needs to be conducted to determine how to

best identify childhood trauma experienced by

individual children as early as possibly to ensure that

further trauma for those children can be prevented.

Once trauma has been identified, children and families

can benefit from an assessment of related health and

mental health needs and early treatment that can help to

prevent further trauma and provide stability to children

and families. Such support might help to avert eventual

entry into the juvenile justice system. Faculty from the

UNM School of Medicine and UNM School of Law,

including two of the authors of this report, have

developed one such program. The UNM Health

Sciences Center’s FOCUS program provides multi-

generational, multi-disciplinary medical and

wraparound services and home-based early intervention

services, integrated with civil legal services through the

UNM medical Legal Alliance, to prevent further

trauma and ensure better outcomes for children who

experienced prenatal drug exposure and are therefore

born with at least one ACE (household substance

abuse) household substance abuse. The findings from

this report confirm the need to continue to develop

programming to identify and address trauma and

related health and mental health needs as early as

possible in the lives of New Mexico’s children.

8

SCREENING FOR TRAUMA AND MENTAL

HEALTH AND SUBSTANCE ABUSE TREATMENT

NEEDS OF YOUTH IN THE JUVENILE JUSTICE

SYSTEM

There are lessons to be drawn from the methodology of

this study. The trauma histories, including specifically

the presence or absence of ACEs, were gathered from

the combined evaluations of up to five different

professionals from different disciplines. This

information was compared to historical collateral

information from child protective services, previous

treatment, and contact with guardians. The varying

estimates of trauma in the juvenile justice population

raises important questions about the most accurate

methods of gathering trauma history information. Self-

report of trauma by juveniles can provide quite

different information depending upon the nature of the

trauma and the skill of the interviewer. Moreover,

memory of trauma can be fragmentary and

undependable with the possibility of underreporting

generally more likely than over reporting (Anda et al.,

2005). It stands to reason that the most accurate

information will be obtained by comparison to

historical child protective and legal records.

Given that trauma is pervasive in this population,

consistent and intensive screening processes would

help to highlight need and better target services. Since

not every adolescent involved with the juvenile justice

system can be evaluated with the same intensive

process as is performed on incarcerated youth, the

application of a single validated screening instrument

to populations at risk could simplify and standardize

the assessment process.

FACILITY TREATMENT PROGRAMS AND

MODALITIES

The pervasive experience of trauma for children in the

delinquency system provides an unmistakable direction

for the type of care these adolescents will require

during any periods of involvement with the juvenile

justice system. This is especially true if they are to

escape continued involvement or further penetration

into the criminal justice system. Research has linked

early trauma itself to poor impulse control, impaired

affect regulation, and a propensity to abuse substances,

which constitute the core symptoms of delinquency

(Anda et al., 2006; English, Widom, and Brandford,

2004; Caspi et al., 2002). Therefore, if the delinquent

course is to be altered, the deficits and symptoms

caused by the traumatic experiences of these youth will

need to be addressed by specifically designed

treatments. Although there are evidence-based

treatments that have been developed for early

childhood trauma, these need to be better

operationalized for application to the delinquent

population. The factors that distinguish trauma

treatment for the delinquent population from treatments

for more typical PTSD are primarily due to the

pervasive and early nature of their trauma and the

deficits in their early caretaking (Ford et al., 2013).

Consequently, treatment modalities designed for

delinquents should address damage resulting from early

9

childhood trauma to those core regulating capacities

(Anda et al., 2005; Heim and Nemeroff, 2001; Teicher,

2000). Moreover, given that the results of this study

indicate high rates of trauma related to household

situations, such as household substance abuse and

family violence, treatment for these juveniles should

engage their families to the greatest extent possible.

Over the last several years, CYFD has committed itself

to providing training in trauma-informed treatments

both internally as well as to community providers.

Because of its responsibility to care for populations that

are particularly traumatized, such as children involved

in the protective services and juvenile justice systems,

CYFD has raised the quality requirements for trauma-

informed care for children. The national epidemic of

excessive medication use in the welfare population is

directly related to the traumatic histories of these

children, and therefore the agenda to improve the

quality of trauma-informed care goes hand in hand with

CYFD’s simultaneous efforts to reduce unwarranted

medication use in the delinquent population

(Government Accountability Office, HHS Guidance in

Psychotropic Medications, 2011). Curtailing the culture

of medication overuse and advancing the skills of

community providers is both a long-term commitment

as well as an ongoing monitoring requirement for

CYFD. Further research should explore how to best

build on current efforts to develop a trauma-informed

system of care for delinquency-involved youth in the

state.

Because experience shows that only a minority of

delinquent adolescents require incarceration due to

being a public safety risk, trauma-informed services

should be available for this population while they are

still in the community for the specific purpose of

diverting youth away from incarceration-based

treatment (Shelden, OJJDP Bulletin, 1999; Kurlychek,

Torbet, and Bozynski, OJJDP Bulletin, 1999). As

indicated in Figure 5, the majority of the youth were

incarcerated because of a probation violation.

Community alternatives to incarceration should be

studied and designed to include various types and

intensities of trauma-informed care. These same trauma

-informed treatments should follow adolescents into

juvenile facilities when community-based intervention

fails to avert the need for incarceration. In all phases of

delinquent trauma treatment, the programs should

include an emphasis on basic life skills, independent

living, and vocational training in an effort to provide

adolescents with alternatives to previous criminal

activities.

POST-COMMITMENT TREATMENT NEEDS

Planning for aftercare of juveniles housed in New

Mexico’s juvenile justice facilities starts with the

recognition that the juveniles come from a background

of elevated family stresses, as indicated in Figure 2.

More than 85% come from families with parents

separated or divorced. This suggests that upon

returning home, the young person will navigate

complex relationship issues with one or more parental

figures with differing degrees of parental involvement.

More than 75% of the juveniles experienced families

affected by substance-use disorders, information that

should guide discussions of how the young person will

remain safe and not experience environmental triggers

to revisit their own use of legal and illicit substances.

Females, as shown in Figure 3, reported greater

prevalence of different types of ACEs than males, with

10% of females experiencing two ACEs compared to

3% of males and 23% of females having nine compared

to 3% of males. Females may need higher levels of

behavioral health support than males to address the

unresolved trauma experienced before commitment.

The youth who have experienced more than six ACEs

at time of commitment have greater risks for PTSD,

depression, self-injury, and suicide attempts, indicating

the need for consistent mental and behavioral health

care, as indicated in Table 1 of the appendix. A

significant measure reported in Table 1 of the appendix

is the fact that 96.4% of youth committed to New

Mexico’s juvenile justice facilities have identified

substance use disorders. While they may successfully

become substance-free during their commitment, most

of these young people will need ongoing treatment,

including counseling and possible medication-assisted

treatment, particularly for opioid substance use

disorder. Due to the lifelong chronic nature of

substance-use disorders, individuals receiving

treatment should plan for transition from children’s

behavioral health to service for adults with a period of

designed connection and without interruptions due to

insurance considerations. This is particularly important

given that a majority of youth were incarcerated for

issues of violation of their conditions of probation as

seen in Figure 5. The data generated from the cohort of

youth committed to New Mexico’s juvenile justice

facilities in 2011, obtained and organized through a

careful methodological review of corollary

information, provide strong support for implementation

of a comprehensive system of care after commitment

for youth with high levels of ACEs.

10

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Acknowledgements The project team would like to thank Erin Ochoa, BA,

for her thorough review and copy editing of the final

document.

11

Table 1. Incidence of Conditions or Traumatic Events

PSYCHOLOGICAL CONDITIONS

Self­Injury 19.1%

Suicide Attempt by Child 13.6%

Depression 47.7%

PTSD 28.6%

Axis I Diagnosis 99.5%

Youth Diagnosed with Substance Abuse Disorder 96.4%

Prior Determination of Special Education Eligibility 36.4%

FAMILY CONDITIONS

Unsubstantiated Report to Child Protective Services 43.2%

Substantiated Report to Child Protective Services 30.9%

Youth Experienced Prenatal Drug or Alcohol Exposure 16.4%

Out of Home Treatment 57.7%

Raised by Non-­Biological Parent-­No CYFD Involvement 13.6%

CYFD Removal from Home 17.3%

OTHER CONDITIONS OR TRAUMATIC EVENTS

Teen Pregnancy History of Female Youth 6.8%

Male Youth Who are Teen Fathers 16.8%

Death of Friend of Family Member 40.5%

Witness death/murder 16.8%

Obesity 2.7%

APPENDIX A.

12

APPENDIX A.

Table 2. Statistically Significant Categories

Statistically Sig. Categories Condition

Absent Condition Present

Avg. # of ACEs Where

Condition is Absent

Avg. # of ACEs Where

Condition is Present

Other Variables Collected

PSYCHOLOGICAL CONDITIONS

Self-Injury * 178 42 5.7 6.5

Suicide Attempt by Child ** 190 30 5.7 6.8

Depression *** 115 105 5.3 6.4

PTSD *** 157 63 5.5 6.7

FAMILY CONDITIONS

Unsubstantiated Report to Child

Protected Services *** 125 95 5.1 6.7

Substantiated Report to Child

Protective Services *** 152 68 5.2 7.2

Out of Home Residential

Treatment *** 93 127 4.9 6.5

OTHER CONDITIONS OR TRAUMATIC EVENTS

Witness death/murder * 183 37 5.7 6.4

* p < 0.05; ** p < 0.01; *** p < 0.001

The New Mexico Sentencing Commission The New Mexico Sentencing Commission (NMSC) serves as a criminal and juvenile justice policy resource to the three branches of state government and interested citizens. Its mission is to provide impartial information, analysis, recommendations, and assistance from a coordinated cross-agency perspective with an emphasis on maintaining public safety and making the best use of our criminal and juvenile justice resources. The Commission is made up of members of the criminal justice system, including members of the Executive and Judicial branches, representatives of lawmakers, law enforcement officials, criminal defense attorneys, and citizens. This and other NMSC reports can be found at: http://nmsc.unm.edu/reports/index.html