← Youth Justice Transformation in Action
Youth Justice Transformation in Action
Building a Gold Standard Trauma-Informed Youth Justice System: Awareness, Assessment, and Case Planning
00:54:17
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- [00:00]
John Toole
Foreign.
- [00:07]
Jody Martin
Welcome to Season three of Youth Justice Transformation in Action. We are the RFK National Resource center for Juvenile justice and we are on a mission to transform the youth justice system by partnering with people like you who are passionate about improving outcomes for you families and communities you serve. I'm Jody Martin, Deputy Executive Director and.
- [00:28]
John Toole
I'm John Toole, Executive Director. As we embark on Season three of Youth Justice Transformation in Action, we're diving deeper into crucial areas that shape our approach to juvenile justice. This season, we're thrilled to explore special topics that have a profound impact on the lives of young people within the justice system, including the complexities of emerging adults, the pivotal role of family engagement, the transformative power of growth, focused case management, and many more. Through insightful discussions, expert interviews and real life stories, we aim to shed light on innovative practices, challenges and opportunities in the realm of youth justice. Together, let's continue our journey toward creating a more fair, just and supportive system for our youth, families and communities.
- [01:15]
Jody Martin
Joining us today is Dr. Keith Cruz, professor and Director of Clinical Training in the Department of Psychology at Fordham University. Dr. Cruz is at the forefront of this work through his leadership at the center for Trauma Recovery and Juvenile justice, where groundbreaking projects are redefining how we support youth, families and the professionals who serve them. In today's conversation, we'll explore the vital role of screening for active trauma symptoms and why this early identification is a key step in addressing the unique needs of youth within the justice system. We'll also discuss the critical importance of trauma awareness and education, workforce development initiatives and trauma specific treatment models. We'll look at how trauma informed care aligns with the Risk Needs Responsivity model and how these approaches complement each other to create holistic, effective systems. And that's not all. We'll highlight transformational efforts happening in Nebraska and share actionable insights for embedding trauma informed practices into youth justice work. So whether you're a practitioner, policymaker or advocate, this episode has something for you. Let's dive into this important conversation with John and Dr. Cruz.
- [02:23]
John Toole
Welcome everybody to the RFK National Resource Center Transformation Youth justice in Action podcast. This is Season three. We are Episode four and we are pleased to welcome back a guest who appeared on our original season, Dr. Keith Cruz, speaking about the importance of riskneed responsivity assessment instruments in case planning, case management, and targeted identification of treatment and service interventions that help the youth avoid future reoffending and involvement in the youth justice system. It's a real pleasure to have Keith back with us. He's been A longtime partner at the RFK National Resource center, supportive of all of our work in the field. Keith, welcome.
- [03:04]
Dr. Keith Cruz
Thank you so much, John. I really appreciate the invitation to come back and share some important information and you know, engage in a good dialogue with you today about those screening and assessments and risk, these responsivity approaches to case planning and also how that incorporates in his respond to the trauma needs of youth as well.
- [03:25]
John Toole
Pete, you bring an enormous amount of expertise, a long history of focus in this arena. Again, we have been such the beneficiaries of your work and your contributions in the field, many of your colleagues likewise. Can you provide an introduction of your current role and your background in this work?
- [03:44]
Dr. Keith Cruz
Sure, happy to do that. So in my current role I am a professor in the Department of Psychology at Fordham University where I have been working for 18 years now and professionally I have been working in the field of adolescent mental health and juvenile justice for about 25 years now and licensed clinical psychologist. And I'm been recognized in the area of juvenile forensic psychology more broadly. And I would say in about the past 15 to 20 of those years have really been focusing on the effect of traumatic event exposures and trauma reactions as of very specific mental health need that impacts adolescents and how that helps us to really understand some of the delinquent behaviors that adolescents engage in, but then more importantly of how we should be responding as a system to that work as well. And so I do all of this work, you know, through my position at Fordham University, but I also serve as the director of Behavioral Health Screening Services through an organization called nysap, National Youth Screening and Assessment Partners, which has been a long standing partner and collaborator with RFK and the National Resource center as well. And I also currently am serving as the co director of a training and technical assistance organization called the center for Trauma Recovery and Juvenile justice as well.
- [05:11]
John Toole
Keith, all that work is critically important, particularly in light of the increasing complexity of the needs and the risks of the youth and the families that are being introduced into the youth justice system. Again, welcome. I would invite you now to describe your role within the center for Trauma Recovery and Juvenile justice and in the future during this episode I might just refer to it as the ctrjj but help the audience understand the mission and the goals of the CTRJJ and the work that you are now co directing and leading.
- [05:39]
Dr. Keith Cruz
So the mission of the CTRJJ is to support a comprehensive framework for developing, adopting, implementing and sustaining evidence based trauma informed services for youth who are in the juvenile justice system or who are at risk for involvement in the juvenile justice system as well. And while this work places youth front and center in our mission, we also recognize that supporting youth also means supporting families and caregivers and also supporting the mental health professionals and the juvenile justice professionals who youth and families interact with once they do become involved in the system as well. The CTRJJ is practically it's a training and technical assistance center that's affiliated with the National Child Traumatic Stress Network or the nctsn. And it's funded through samhsa, the Substance Abuse Mental Health and Services Administration. And as a training and technical assistance center, we strive to provide training and education to both initiate and enhance trauma informed services for youth and families. And we do this through a some grounding principles. You know, the first is that one, our work needs to be grounded in implementation science and the evidence base. Second is we want to support youth and families as active collaborative partners in system reform. Third, we want to prioritize racial and ethnic and identity related diversity, equity and inclusion and belonging. And finally, we do this work working to enhance systemic engagement of cross system stakeholders as well. You know, I'm really proud of the work that our faculty do through the ctrjj. And our work is really anchored in the heavy need and demand for trauma informed services within the juvenile justice system. Just as an example of this, in 2024 trauma awareness and educational resources developed by the CTRJJ faculty reached over 7,000 individuals through direct emails, our CTRJJ website, consultations and faculty presentations. Our faculty delivered 138 unique consultations and or educational presentations that reached over 5,000 juvenile justice and mental health professionals in the past year. In addition to that, our faculty delivered 89 unique trainings that reached over 3,000 professionals, of which over 2,000 were mental health professionals. Now I'm really proud of all of those accomplishments, you know, through the ctrjj. But I it just speaks to the need and the recognition within the juvenile justice system that we need to be responding to the trauma needs of youth and families who are either at risk or are directly involved in the system as well.
- [08:33]
John Toole
And Keith, I would just accent at the end we need to respond and we need to respond more effectively given the identification of active trauma symptoms and trauma concerns among the youth and the family that are part of the youth justice system. There's so much more we can be doing and I think the CTRJJ is unearthing all those opportunities to more effectively identify, treat and mitigate the trauma that is part of the youth experience too often in our youth justice system. I appreciate the efforts. I certainly want to comment that the four principles that you spoke to that are part of CTR JJ are strongly grounded in the research and complement those as being the foundation of your work. And certainly the practicality of your work to implement practices that affect one youth and one family at a time is extraordinary. I have to say in full disclosure, I'm privileged to serve as an advisory board member to the ctrjj, so I've been fully exposed to its impact and the work that you are doing. I hope that this podcast episode gives us the chance to share with the audience the full scope of the work that you all are doing. They become more aware of how they might improve treatment of the trauma symptoms for the youth that we serve in the youth justice system. It's clear to me why trauma awareness is important, but could you share for the audience why that awareness and education for that youth justice system is so important in our work moving forward?
- [09:55]
Dr. Keith Cruz
The need is ever present and one of the things that drives the work of the CTRJJ and other organizations is really the full recognition of just the widespread prevalence of life adversities and traumatic event exposures that impact youth that come into contact with the juvenile justice system. Many of us working in this area, and this is by very strong, I would say probably well over two decades of research evidence documenting that exposure to an extreme stressor or a traumatic event like physical abuse, sexual abuse, community violence, exposure, trauma loss and separations from loved one families, caregivers and friends. These experiences are almost universal among youth that come into contact with the juvenile justice system. Research clearly supports, on average, a youth when they go through a screening or an assessment process, will acknowledge that it's not one event, it's not two events. It's about, on average, four different types of traumatic event exposures over the course of the lifetime. Then of course, that doesn't mean that rates of clinically identified post traumatic stress disorder are that high. But what we know is that a substantial proportion of boys and girls who have experienced lifetime traumatic events will go on to develop enough trauma reactions to meet a clinical diagnosis of post Traumatic stress disorder. And the research studies consistently show that on average, about 15% of youth in the juvenile justice system on a given day when they're assessed are walking around with enough symptoms of trauma reactions to meet the diagnostic definition for of post Traumatic stress disorder. What we also know is that 15% average is collapsing across both boys and girls. And what we know is that there is a gender difference in that prevalence as well, where rates for girls tend to be higher can be anywhere between 18 to 25% as well. So this really reinforced forces why national organizations, states and local systems have recognized a need in developing juvenile justice policies, practices and procedures, adopting and infusing a trauma informed approach.
- [12:21]
John Toole
Those numbers and percentages you cited, Keith, translate to an enormous impact within our youth justice system. And unchecked, undiagnosed, untreated, can lead us as professionals in the youth justice system to interpret their recalcitrants or their opposition or their failure to act as directed by the court, engaging in treatment and services as just that, recalcitrants and subject to the sanctions of the court, when in fact if we can diagnose and treat and serve, we may be able to mitigate that. Again, just capture percentages and the numbers you've spoken to with those diagnoses. We can make a significant difference in the outcomes for youth if we apply the approaches that the CTRJJ are developing jurisdictions across the country. Thanks for that explanation and really that background, Keith. The CTRJ also supports work that impacts the workforce in the youth justice system. If you don't mind, can you speak a little bit to highlighting some of the approaches that you all are supporting that make a more trauma informed workforce to address these issues as well?
- [13:29]
Dr. Keith Cruz
Yeah, John, I'm happy because I'd like to talk about a few of the CTRJJ initiatives around workforce and I think I would be remiss if I didn't take one step back. And first, because you and I have both mentioned this term trauma informed care or trauma informed approach multiple times and many of the listeners on this podcast are probably very familiar with that term. We hear it a lot. But I think it's also really important to recognize is that there is not one univers accepted definition of what a trauma informed approach is. In fact, there's been a lot of inconsistencies in the field in relation to this. So I'd like to just take a moment and outline the guidance and some of the guiding principles that the CTRJJ utilizes when we think about a trauma informed approach. So we can think about this at the systems level. Right. As being consistent with what SAMHSA identified back in 2014 as the four Rs of a trauma informed approach. And what SAMHSA articulated back in 2014 is that a program or organization or system that is trauma informed and this would include a juvenile justice system as well, first realizes the widespread impact of trauma and understands the potential paths for recovery. Two, it recognizes the signs and symptoms of trauma and the clients, the youth, the families, and also staff and others involved within that system as well. And third, it responds by fully integrating knowledge about trauma into policies, practices and procedures within that system and does all of this with that final R. And the fourth R is an organization that actively seeks to resist retriggering those trauma experiences as well. Now, through this, you know, trauma informed care could be viewed through the social ecology of youth and families, right? And through a cultural lens that really recognizes the context plays a really important role in how individuals perceive and process information about their past traumatic events and whether that they are acute, you know, an event that has happened really recently or represents that kind of chronic load as well. And of course, this trauma informed approach really involved at the organizational level some vigilance and strong attention to anticipating and avoiding institutional processes and individual practices that are going to reactivate those experiences as well. We do all of this through also really thinking that trauma informed approaches uphold the importance of stakeholder involvement, really anchoring this on the lived experiences of youth and families who really are the experts about their own lives. Often when they are asked through thoughtful and appropriate and evidence based mechanisms like screening and assessment will fill us in about their lives in a way that can help to inform us about what they may need. But I also want to recognize too, is that a trauma informed care or a trauma informed approach is. No system is going to accomplish this through any single, just any single technique or. This is not a checklist, right. It's a philosophy that requires some constant attention and caring awareness and sensitivity to the need of some culture change within our organizations. So this can involve some ongoing internal organizational assessment and quality improvement. It's going to involve staff training. It's going to involve sort of an awareness of the need to engage with your community stakeholders. And embedding this approach takes some ongoing thoughtful attention and work. I just want to say that it's never a one and done so from that there are a number of sort of trauma informed principles that we can think about viewing our current policies and practices through that are really consistent with this idea of those four Rs, and the first is thinking about safety, are our practices supporting both the physical and psychological safety of youth and families? We want to think about our practices as reflecting trust and transparency. We want to think about our practices as treating youth and families as co collaborators, right? Not only the development of the individual case plans that we might be focusing on to address Delinquency risk reduction, but also, you know, co collaborators and the types of broader services that were, that are available within the system as well, and doing good trauma informed approaches and care centers, this work in an empowerment model. And so all of these, all of these characteristics and principles really are important as a way for us to really think about what it means to be trauma informed. Now, how does the CTRJJ support staff? We support staff and then we support a more trauma informed juvenile justice workforce, you know, in a number of ways, you know, during and coming out of the pandemic. John I think we have all experienced the challenges in maintaining staffing in the juvenile justice system and that's both in the community and also in residential settings as well. But of course, the latest data that's emerging about the overall mental health of adolescents in general and among adolescents, you know, who are system involved is that the frequency and severity of mental health problems is higher than ever. And even in the context of juvenile arrest and system involvement leveling off or decreasing nationally coming out of the pandemic, we have to recognize that our youth are really hurting and becoming system involved then adds another stress and strain on an adolescent and their family as well. Then by extension, the CTRJJ really recognizes that Then we're asking juvenile justice staff who are on the front lines to respond to these increasing needs, you know, through policies and practices that are evidence based and trauma informed and gender and culturally responsive and to ultimately to be accountable to also then balancing all of that with trying to do the job of protecting the public and reducing delinquent behaviors as well, that's a challenge. That's a challenge that our system and our staff are under as well. So with the ctrjj we really recognize is that supporting youth and families means supporting the training and the competencies and capabilities of the workforce as well. And I would ground all of this is that we just really need to lean in and recognize is that there's a cost for caring, right? And the CTRJJ really recognizes that. So then by doing this, we have a number of models that we support regarding staff training. So first we support a direct care staff training model that we call tcare. And TCARE teaches four practical steps that help staff and that staff can use really in the moment, on their day to day jobs to help themselves self regulate, which then also helps them to help teach youth and families they're working with on how to more effectively manage their own stress reactions as well. And it's really anchored in this idea that That a professional who can recognize and deal knowledgeably with other stress reactions and their own stress reactions are going to be more effective in their role. And so the practical skills that are taught through tcare, they include things like a focus on really understanding the impact of stressful events, learning about what it means to be experiencing what we call an alarm reaction, how to recognize a trigger of that alarm reaction, and then some real practical skills, skills on how in the moment to focus on what we call the SOS and that's a real practical skill of how we slow down, how we orient and how we self check. And then in the moment how we can find a goal that recognizes both the stress level that a person might be experiencing right there in that moment and also their personal control. And that is a model that we call TCARE and it is a staff training model in some of these practical self regulation skills. Now, CTRJJ also supports a supervisor training and consultation model that we call TCARE plus. And John, I think you and I both know that too often, right, Our systems do what we call well, you know, we train and pray and then we just kind of hope something from that training sticks, right, and results in some level of change. And it's not the most effective approach, you know, to staff training, particularly when we start thinking about supporting the competencies and capabilities and capacities of staff. So TCARE plus is a model of supervisor training that further supports supervisors and how to coach and reinforce use of TCARE skills with their supervisees. Through additional training and six months consultation, supervisor supervisors can explore how they can work one on one with their staff to coach and reinforce these TCARE skills, how to incorporate use of these TCARE skills really through day to day practices within their organization. For example, how do I coach or remind staff about these skills during a staff meeting or a shift change, or during a roll call, or more importantly, in debriefing and supporting a staff member that's gone through a critical incident with the youth as well. And it also really provides an opportunity to think through how supervisors can engage their agency leadership in developing policies and practices that are really aligned with the TCARE approach. And I say all of this because too often our systems really hoist the responsibility of staff self care directly onto the staff themselves. And that cost of caring shows up in a variety of ways. It can include everything from staff burnout to compassion fatigue and also show up in secondary traumatic stress. Secondary traumatic stress is a term we use in the field to recognize when a staff member is experiencing active trauma reactions themselves. Based on that day to day exposure to and listening to the story stories of youth and families who have experienced that trauma. So CTRJJ supports a staff training curriculum developed by a colleague of mine, Dr. Patricia Kerig, at the University of Utah that's called RTIP. And RTIP stands for Resilience for Trauma Informed Professionals. RTIP is a training curriculum that provides practical skills to promote resilience in the face of exposure to trauma response related materials. And it's really anchored in the knowledge of secondary traumatic stress. And it provides both individuals and organizations with a three stage approach to be thinking about staff wellness within that organization that's aligned with our knowledge of secondary traumatic stress, focusing on thinking about pre exposure preparation and some practical skills at the organizational level level and the individual level during that phase. And then also how do we actively cope in the presence of trauma with these types of symptoms of secondary traumatic stress and also how we recover in the aftermath of these exposures as well. So all three of these, we think about these as three different layers of training models of staff support and wellness that have been implemented effectively within juvenile justice order organizations with some strong pre and post training support around uptake of the concepts in these curriculum, but then also satisfaction with how they feel that they are better equipped to do this really, really important job of taking care of youth and families.
- [25:27]
John Toole
Keith, you just walked us through some very important applicable models and approaches to implement practices that have this impact, that have the positive impact. But what you did in that time frame was also undergird the reason, the cause for paying that kind of attention to this issue with the research, with the evidence, with the prevalence. I don't think we're talking about theory at this point. We're talking about real cases, real youth, real families experiencing these kinds of traumatic experiences. But what you then followed with that. And I would to say that as I was listening, I'm thinking of all the jurisdictions we're working with, we get right down on the ground with the supervisors, with the staff, with the leadership, with judges, attorneys, they'll say yeah, that's great in theory and yes, we're trauma informed, we attended a training. But what you just described was a practical approach that indeed is trained, is coached, is supported to develop the skills and the competencies to have that direct impact impact not just for youth and families, but for their staff who are required to respond to those. I think what you just laid out is an imperative for youth justice system leaders to focus on this issue and recognize that there are approaches out there that can be trained, coached and successfully implemented to have a significant impact. And I can't say enough about how much I appreciate your commitment to that issue. Your CTRJJ website provides more details on your Roadmap to Change podcast on the tcare, the TCARE plus the rtip. I really appreciate you laying that out. It is a critical issue for youth justice systems. But let me transition just a little bit with all that information now for our listeners. You and I both know we've spoken about this at the outset of the podcast. We're both deeply committed to screening and assessment or risk need responsivity approaches to inform case planning, case management, and connections to targeted treatment and service interventions we hear often in this environment. I can't do anything more at this point. I have a workforce challenge. I have initiatives going all around me. But aren't you about to explain that these trauma specific treatment approaches exist to support youth and families and be integrated with or complementary to risk and needs responsivity approaches? Could you share a little bit about that to highlight that aspect of your work?
- [27:48]
Dr. Keith Cruz
Absolutely. And John, thank you. Because I hear this as well in some system consultations, et cetera. It's a desire to be trauma informed, but it's also with a recognition of what's it going to take to get there. Historically, there's also been a tendency to think about trauma informed approaches as either converting our system from a juvenile justice system into a mental health system or a probation officer saying, you know, that's not the job that I signed up for or I'm not a mental health professional. And yes, that's all true. Right. And yes, you know, becoming a trauma informed system does require all of that dynamic ongoing dialogue and reviewing of your policies and procedures as well. And it can seem overwhelming. But what I hope to outline here is taking a trauma informed approach to screening, assessment and case planning both complements and can be coordinated with the most common approach to screening, assessment and case planning that's utilized in the juvenile justice system. And that's of course, the risk needs of responsivity approach as well. Now, these two frameworks for thinking about screening, assessing and serving youth and families, they complement one another in ways that I think that don't necessarily just jump at one as being, as being connected with one another. And if you allow me, let me talk to you about how I talk to agency leaders about how we can really think about a model of integrated case planning that stays true to the RNR model, but also stays true to understanding the impact of traumatic event Exposures and trauma reactions. And so from the RNR lens, we know that the cumulative load of dynamic delinquency risk factors are what drives a risk about future delinquent behaviors or future offending. The substance use needs, the educational needs, the attitudes, you know, and beliefs that a youth might have that may reinforce their aggression or may reinforce their delinquent behavior. We know that these are the needs that drive delinquency risk and we know to attend to those needs as well. But you know, from what we talked about is we also need to really recognize is that if our case plan that are attending appropriately to those dynamic delinquency risk factors are not also acknowledging the histories of traumatic event exposures and you know, these active trauma reactions, my perspective is that it can fail to support delinquency risk reduction because of the complex interactions, you know, and that that can happen between those dynamics, delinquency risk factors, and this trauma information. Right. But of course, what we know is that through that RNR lens, mental health problems in general, and trauma in particular are identified as a responsivity factor that could impact a youth's day to day functioning. And that it's a reminder as a responsivity factor. If we don't take that into account in our case planning, in our, our case management approaches, we may not be developing a case plan that is going to have the maximal impact on reducing delinquency risk and enhancing youth strengths and more appropriate overall functioning. But what we also know from the literature is that the cumulative load of traumatic event exposures can lead to these active trauma reactions. And what we know is from the trauma literature that there is a link, There is a supporting path that links traumatic events to trauma reactions and that can lead to future reoffending. But oftentimes that research has failed to account for the associations between traumatic events and those active trauma reactions and how it interacts with these dynamic risks and needs as well. So through this approach is I think the first thing that we want to do is we want to think about understanding while we're doing our risk needs assessment is that needs to be informed by an understanding of what has this youth experienced in the past in terms of lifetime traumatic event exposures. And what we need to fully lean in and recognize is that traumatic event exposures can both increase the likelihood of dynamic delay frequency risk factors. And the reverse is also true as well. Let me give you a concrete example of that. A youth who experiences community violence exposure may be more likely to migrate towards a peer group that they See as a way of protecting themselves from further community violence exposure, then that may emerge and increase the likelihood that that youth may be involved with a group of peers that is more likely to engage in aggression, more likely to use a weapon, you know, in the context of that aggression as well. And so that may, that may pop up on our delinquency risk needs assessment as negative peer group involvement. But having an awareness of what a youth has experienced in the community may help us to understand why that negative peer group is there as well. Now, it can also work in the flip direction as well. We know that substance use is a known dynamic delinquency risk factor. What we might also recognize is that a youth who's experienced a destabilizing traumatic event where they have been harmed physically, psychologically, and that may be experiencing some trauma reactions is they may start engaging in that substance use as a way to cope, cope with those active trauma reactions that have emanated from that traumatic event exposure. Now, unfortunately, what can also occur is when that youth, in the context of that negative peer group involvement and substance use, is going to maybe be placing themselves at an increased risk for further exposure to traumatic events through community violence, you know, in their communities as well. So we can do a good job of thinking about those dynamic delinquency risk factors, but an understanding of the traumatic event exposure experienced and some of those active trauma reactions that could emanate from that could help us to understand why these dynamic risk factors may be present. And if we can understand why they might be present, then we're in a much better position to determine how it is that our services need to be matched to changing those dynamic delinquency risk factors as well.
- [34:52]
John Toole
Once again, Keith, if we train these skills to our workforce for identification, for intervention, for support, it's my argument that given the research, the evidence, the prevalence of these characteristics among our youth justice population, we can more appropriately assign accountability to these youth that they can understand and hold themselves accountable for future behavior. We can in fact, mitigate that risk and reduce that risk for future reoffending, which contributes to an increased community safety by reducing that risk of those youth to reoffend. We can provide for long term positive behavior change opportunities by diagnosing that this is the background. These are the causation factors for these triggers. It makes sense, it's logically laid out, and CTRJJ is at the forefront of providing those practical means skills, competencies to address behavior in this way. Part of this argument is against what we hear all too frequently that that's too soft. Our approach is not soft. It's research based, evidence driven to protect community safety, to hold youth accountable, but promote a long term behavior change opportunity. And again, given what you've laid out with the complexity of the youth that are now populating our youth justice system, these measures, these trainings, these capacity and skill buildings for staff in addressing these youth and families is in my regard an imperative. So I really appreciate you laying it out so clearly that it is a fundamental maybe to those who might say, hey, I'm not a, I'm not a mental health therapist. No, there is no expectation. But if we provide the skills and abilities to identify the existing factors that may be associated with trauma, then we can make appropriate referrals for assessment for proper intervention for these youth.
- [36:42]
Dr. Keith Cruz
Yeah, John, you're absolutely right. And trainings and my work and speaking to judges, attorneys and you know, probation officers or detention staff or example is, and really unpacking this, we could, we could summarize this, and I use this phrase a lot is trauma does not excuse delinquent behavior. It can help to explain delinquent behavior. And then by extension, we need to be thoughtfully thinking about the way that we are screening for mental health difficulties. You know, how we are equipping staff to engage in appropriate trauma screening and then how staff can be utilizing that information then to be really unpacking and thinking about is this a youth who I need to be getting a further trauma assessment for? Because our screening has been, is throwing out some red flags that the either the traumatic event exposure history or the possibility of some possible act of trauma reactions is driving or sustaining this use problem with substances, this use problems with going to school, this use challenges and how they're interacting with their peers or their family. And this is why I think that these two approaches can complement one another and our failure to think thoughtfully about how we are responding to these trauma needs and incorporating this into the day to day work that we do in the juvenile justice system is going to result in case plans that don't comprehensively meet the youth where they're at and fully acknowledge the struggles that they're having based upon their prior adversities, their traumatic event exposures and their active trauma reactions. Because when they are present, they cause trauma day to day challenges and how the youth is experiencing their thoughts, their feelings and ultimately how that's impacting their behaviors.
- [38:49]
John Toole
So let's tie this to, once again, a specific example of how this is being used and implemented. We've been partners to our benefit in multiple State and local jurisdictions for a number of years now, Keith, we are working together, along with Dr. Robin Jenkins, along with Hunter Hurst at NCJJ to support Nebraska's efforts to bring about juvenile justice system enhancement. And I, I'd love for you to talk a little bit about how this has been implemented, how it is being implemented as a system improvement methodology to address youth in a state that already embraces the YLS significantly as a risk need responsivity approach and are now integrating the approaches that you've talked about about into their practice statewide. Can you talk a little bit about Nebraska and the ongoing efforts there that really bring all this together and ensure that our audience knows. No, no, no. This wasn't just theory and suggestion that we might. This is practical and is having an impact across an entire state.
- [39:51]
Dr. Keith Cruz
Yeah, absolutely, John, and thank you. And it's. It's been. Been really outstanding to work with RFK on this statewide initiative as well. And this has worked with the Administrative Office of Courts and Probation in Nebraska, which is responsible for juvenile probation services. And my work specifically, you know, with this was following up on some really outstanding work that RFK did in one jurisdiction in Nebraska looking at a probation system review. And through this, there was a recognition at the leadership level is that the system needed and wants to embrace and train juvenile probation staff on an appropriate trauma screening procedure to inform case plans. And more specifically, even before case plans was to inform the predisposition investigations that a youth will experience after an adjudication. Through this work, what we did is when we started to have the dialogue about trauma screening, what it became, you know, very important and clear is that trauma screening needed to be built onto an appropriate behavioral health screening process that would also involve ensuring that probation staff had a very good understanding of the why, why we are engaging in behavioral health screening in general and then trauma screening in particular, Then how is that going to help with better triage and decision making to support providing the court with the most comprehensive understanding of that risk needs responsivity picture? And so through this work, you know, I've worked with an implementation task group in Nebraska to really look at their current behavioral health screening practices and to see where there are some gaps and tweaks that needed to be made in terms of the overall process. We selected a trauma screening tool to infuse and build into that process as well. And what's very important, John, through this work, and Nebraska is going to end up being a leader here is the recognition of, is that we're not going to silo Trauma screening away from general mental health screening. This needs to be viewed consistently and informed, good triage and decision making. And ultimately too we've designed a process by which a youth receives an evidence based general mental health screen, an evidence based trauma screen that probation staff are being trained in a very comprehensive way of how to introduce the screening process to youth and families. And that is really anchored in trauma informed principal's idea of voice and choice and transparency. And this also leans into the idea of more positive youth and family engagement on the front end of this process as well. So probation officers now have a way of fully informing youth and families about the investigation process, fully informing youth and families about both the purpose, the how, the why and the what that's involved in the behavioral health screening process that includes the trauma screen. Staff are also now equipped and being trained in how to engage in thoughtful post screening, triage and decision making that can involve, you know, circling up if a youth is currently involved in services to be supporting cross system collaborative discussions with current treatment providers or you know, some triaging and some guided decisions on when and under what circumstances it would be most appropriate to get a follow up mental health assessment. With all of that is guiding then their ability, the probation officer's ability to then to approach that interview with youth and family, to gather the information information to rate the youth level of service case management inventory and then ultimately to be incorporating all of that information that is gathered during the investigation process and to thoughtfully place it in a set of recommendations for services for youth as well. And so it started John, and you well know this, it started with the system saying we want to train and implement a trauma screen. But through the work of engaging with the leadership in the state and also through the collaborations with RFK and our other partners was a full recognition is that we need to look at this from a broader implementation perspective about how the overall investigation process is working, how it's consistent with RNR and it's also attending to the mental health and trauma needs and how that is guiding recommendations for services. And the system has relabeled this with the acronym TRACTS and that stands for targeted and responsive assessment is key to youth success. Very proud that we've been working with the state to develop this model. It's currently being trained in cohorts and will be rolled out through employees implementation over the next year such that every probation officer by this time next year will have been trained in the TRACKS model to support more comprehensive and trauma responsive screening assessment and case planning for all youth who go through the post adjudication predisposition investigation process in the state of Nebraska.
- [45:34]
John Toole
Yeah, Keith, to me it's so impressive what they have done. Your support has been invaluable. They have indeed committed to the use of the Maysi 2. They've committed to a selected child trauma screen which is recognized by the National Child Traumatic Stress Network. They have developed a screening and triage decision tool that supports what you said is a part of this process. They incorporate that or integrate, as you've been talking about, integrate this into the application of the wireless CMI 2.0 assessment methodology that develops a truly informed, fully informed dispositional recommendation for the court about mitigating against risk and certainly providing targeted treatment, intervention and service interventions for these youth. And the training approach that they've taken, guided by your all's support, by your support, is truly impressive. The bottom line is targeted responsive assessment for the court is key to youth success. Their tricky little acronym is indeed being branded across the state and trained in every judicial district for application. It's truly impressive and demonstrates that everything that we've talked about in this podcast can be applied, can be trained, can be coached, can be implemented and can be measured for its success and impact on youth and families in the youth justice system. And I think you've given a great layout of how we can get there. Once again, I may argue editorially the imperative of getting there given the youth that we're experiencing and their families in our youth justice systems currently. Keith, you've done a wonderful job at laying out all these tools and instruments. Final word before I ask one more question to get your wisdom to share with the audience. But final word on TRACKS or any of the information that you've provided us in our episode this morning.
- [47:20]
Dr. Keith Cruz
Yeah, I think the final word that I would just say very specifically to TRACKS is two things sort of anchoring back on that where we started with system reform from this trauma informed approach is there was a commitment through the development of all of these components of TRACKS to be anchoring that on better engagement and thoughtful engagement, reflecting trust, transparency, voice and choice with youth and families and doing this work work with the probation staff in Nebraska. I'm thinking about how is a youth going to be experiencing their post adjudication predisposition process differently now based upon the development of the TRACKS model. And ultimately that's where this work sits is we are all committed to better service engagement and service delivery for youth. Balancing that with protecting the public, but doing with that by being responsive to youth needs. And the TRACTS process is really anchored on that. And then finally, what I would say is that there's a commitment to implementing the components of TRACS and evaluating the utility of the process as well. And this is really important. Important. And I think, you know, through all this, we can talk aspirationally about, you know, the models and our services and what we're trying to develop and deliver. But ultimately we need to do that and evaluate that to. So where we can understand. Is what we built actively working? Is it working in the ways that it was intended? Does the tracks process create any unintended consequences that we need to be thoughtful and that we need to recognize is data will speak to the success of that model, and data will always speak to the success of any trauma informed approach as well.
- [49:17]
John Toole
Yeah. This is where you and I additionally align the necessity of not just talking about practically implementing, but measuring so that we can sustain or adjust, where necessary, to achieve the desired impact on youth and families and on our youth justice system. Keith, what a great way to flows from your perspective. But I have one more question just to allow you to muse with our audience. If you could change one thing about youth justice currently, what would that be?
- [49:45]
Dr. Keith Cruz
Oh, there's so many things I think that I would like to change. You know, John, so it's. It may be hard to. Maybe hard to pinpoint that down. Down to just one. But if there's one thing that I could change, it is. Is an awareness of everyone that comes into contact with the system is that trauma needs aren't static. They don't define who a youth is. They don't define how a youth is going to always respond. And I think we all need to understand that embedded with the impact of trauma is also the possibility of change. And I do all of this work with that recognition. You know, whether it's, you know, speaking to judges, speaking with attorneys, you know, training and supporting the competencies and capabilities of probation officers, or even in doing my own assessments as well, is a recognition of that. Yes, life has been hard and things have been difficult, and adolescents can recover, adapt, and get on a trajectory that is more. More consistent with their overall approach to positive youth development. So I realized that that's sort of not necessarily just a tangible or a practical change in the system, but I think if we remember that and we utilize that to guide the ways that we're thinking about a screening and assessment practice or how our youth are navigating through the court system, that that should serve us well. You know, you've heard me use this term before, that I think that adolescents in general need buffers, not barriers. And I think these approaches we've been talking about today are just entirely consistent with that. We can hold youth accountable for their behaviors, but in a way that supports meeting them where they're at based upon their history and their current experiences and, you know, delivering services that places them in a better position in the future. And I've started to share this quote, John, at the end of presentations, and I'll share it with the listeners here today as well. And it's this idea that hope is not optimism which expects things to just turn out well, but something that's rooted in the conviction that there is good worth working for. This is why we do this work, work in youth transformation and why I am personally and professionally committed to supporting trauma informed approaches and working with youth and families.
- [52:19]
John Toole
Keith, thank you so much. I need to add, when we stop seeking to aspire for more positive change and impact, then we cease to be effective. You've used the aspirational term here today, but you've provided the practical roadmap for us to achieve that aspirational change. I think that's invaluable for our listeners and I really appreciate that in the longer term. I want to thank you for all the great contributions you've made to behavioral health for youth and the youth justice system. But I also be remiss if I didn't thank your colleague Dr. Gina Vincent at NYSAP and Dr. Julian Ford at the CTRJJ, among many other colleagues who have made significant contributions to our work in the field. We really appreciate you taking the time to sit down and talk with us this morning about the CTRJJ and approaches to impacting trauma in our youth justice population. Keith, thank you.
- [53:12]
Jody Martin
Thank you for joining us for Season three of Youth Justice Transformation in Action. We'll be back with season four in 2025. We're excited to share that. On June 18th through 20th, 2025, the RFK National Resource center is hosting the Transformation of Youth Justice Symposium in San Diego, California. The two and a half day event will provide unique opportunities to learn, connect and contribute to the nationwide momentum improving outcomes for children, families and communities. To learn more about the RFK National Resource center for Juvenile justice, including the symposium and podcast, please visit our website@rfknrcjj.org and connect with us on LinkedIn SA.