The Effectiveness of Trauma Interventions Among Juvenile Offenders in the US: A Critical Review

Background and Purpose: Juvenile delinquency is a prevalent social problem in the US. Studies overwhelmingly report high trauma exposure among this population, which increases the risk of delinquency. Posttraumatic Stress Disorder (PTSD) symptoms are also common among juvenile offenders. To address the impact of trauma, juvenile serving agencies started implementing trauma specific interventions.  This review discusses the efficacy of these trauma interventions.

Methods:The researchers searched databases up to April 2015: PsycInfo, ASSIA, CINAHL Guide, Social Services Abstract, Sociological Abstracts, Social Work Abstracts, PILOTS, Criminal Justice Abstracts and Google Scholar. Selected articles reference lists were reviewed for additional studies. The syntax variations for database search included: offen*, delinquen*, crim*, convic*, incarcerat*, detention*,  prison*, court*, reformato*, youth offending team, probation, borstal, jail; and treatment*, program*, therap*, rehabilitation*, intervention*, counsel*, macro*, organization*, communit*, practice*; and juv*, adoles*, youth*, young adult*, young people*, child*, young person*, teen*; and trauma*, post-traumatic stress disorder*, traumatic stress*, PTSD, post trauma*, disorder*. 

Studies were included if: conducted in the US, peer-reviewed, included juvenile with delinquent behaviors and/or criminal arrest, sample mean age of 21 or below, reported sample trauma exposure and/or PTSD symptoms, implemented therapeutic treatment to address psychological trauma and/or related symptoms. The Campbell Collaboration calculator computed the effect sizes for comparison among quantitative studies. The study used Cohen’s deffect size scale.

Results: The literature search yielded 3,132 articles but only 15 met inclusion criteria. Eleven used quantitative and four used qualitative research designs. Trauma Affect Regulation Guide for Education and Therapy (TARGET) was the most studied intervention evaluated in three articles. Seventy-three percent of the interventions were implemented in residential settings.

Ten quantitative studies focused on reducing the overall severity of PTSD and/or a symptom of PTSD as their key outcome. The effect size results are: six had large effect, one had medium effect, one had small effect, one had small effect on PTSD severity and medium effect on specific PTSD symptoms, and another one had no effect. In the other quantitative, TARGET sessions had a small effect on disciplinary incidents (d=0.24) and seclusion time (d=0.22) occurring in residential facilities.  

Only three studies included re-arrest or delinquency incidents as an outcome:  TARGET had no effect, Multidimensional Treatment (MTFC+T) had medium effect (d=0.6), and Structural Group had small effect (d=0.3) at three months but no effect at six months follow-up.

In the four qualitative studies: two reported over 50-100% reduction in psychological trauma from clinical to non-clinical levels in participants, and two reported no trauma results.

Only three studies measured their outcomes at both post-test and follow-ups, while the others measured at only one time point, either post-test or follow-up.

Conclusions and Implications: Overall, the interventions were effective in reducing participants’ psychological trauma symptoms but little is known about their effects on re-offense rates. For the few studies which addressed re-offense or delinquency, trauma interventions had no effect to medium effects. Additionally, the long term effect of most interventions remains unknown due to the lack of follow-up assessments.