Not Just Bad Kids: The Adversity and Disruptive Behavior Link

Not Just Bad Kids: The Adversity and Disruptive Behavior Link explores the theory that all behavior makes sense in context. If you understand a person’s frame of reference – their background, history and experience – you can imagine what might be driving their behavior. The book describes the social, cultural and environmental factors that shape the lives of many youths, including early childhood attachment which sets the foundation for how they interact with authority figures. The book also delves into an explanation of conduct disorder which is characterized by persistent, repetitive behaviors that violate the basic rights of other human beings and break rules.

Studies have shown that conduct disorder affects 1-4% of adolescents in the United States and oppositional defiant disorder is estimated to develop in approximately 10.2% of children. The presence of DBD is also known to be more prevalent in boys than it is in girls. As there is a growing need to understand why children and adolescent exhibit signs of hostility, defiance and isolation, this book is an ideal resource for this timely topic.

• Encompasses both ODD and conduct disorder
• Introduces readers to the social, cultural and environmental factors that play a crucial part in disruptive behavior
• Demonstrates the interrelationship of attachment problems, chronic trauma and disruptive behavior
• Discusses current best practices for intervention and treatment in youth with disruptive behaviors
• Provides casework examples of patients with disruptive behavior disorder

• Language: English
• Publisher: Academic Press
• Release date: Jan 25, 2022
• ISBN: 9780128189511

Book preview

Not Just Bad Kids

The Adversity and Disruptive Behavior Link

Editors

Akeem Nassor Marsh

Home of Integrated Behavioral Health, The New York Foundling, New York, NY, United States

Child and Adolescent Psychiatry, New York University, Grossman School of Medicine, New York, NY, United States

Lara Jo Cox

Correctional Health Services, New York City Health + Hospitals, New York, NY, United States

Table of Contents

Cover image

Title page

Copyright

Contributors

Biographies

Nick's words

Nick's world

Chapter 1. Setting the stage—putting kids in context

History of the juvenile justice system in the United States

A better future for justice-involved youth

Nick at family court

Chapter 2. Attachment: theory, application, & clinical tools

Starting at the beginning

Attachment theory and its origins

The nervous system

Attachment and the nervous system

Emotion regulation

Internal working models

Attachment styles and the strange situation

Attachment research

Attachment and trauma

Clinical tools from an attachment perspective

Conclusion

Chapter 3. Defining trauma, adversity, & toxic stress

Defining trauma, adversity, and toxic stress

Trauma versus traumatization

Adversity and toxic stress

Various forms of adversity and their impacts

The impact of trauma

Conclusion

Chapter vignette: the link between adversity and disruptive behavior

Chapter 4. Trauma, adversity, the brain, & the body

Chapter 5. The impact on interactions

Chapter 6. Trauma & externalizing behaviors

The wrong people

Gettin’ by

Doin’ what I gotta do

Reckless shit

Buggin’

My heart cold

Nick in the emergency room

Formulation

Chapter 7. The overlap between trauma & disruptive behavior disorders

Introduction

The why of conduct disorder, the reason for behavior: trauma is often the missing piece

Consequences of diagnosing conduct disorder: missing trauma and not treating it

Why isn't trauma considered

Conclusion

Chapter 8. The words we use

Introduction

What’s in a diagnosis?

Race, ethnicity, and culture: developing a common language

Connecting culture and behavior

Are all words created equal?

Social influences on understanding behavior

Deconstructing and reducing the impact of cognitive biases

Creating the labels

Strategies for managing cognitive biases

How is institutional racism operating here?

An overview of disruptive behavior disorders

Conduct disorder

Oppositional defiant disorder

Attention deficit hyperactivity disorder

Trauma-related disorders: DSM IV to DSM V

Discussion of the potential prejudicial effect of certain diagnoses

Prejudicial effects on the child and adolescent

Prejudicial effects on clinicians and the public

Prejudicial effects at the structural and institutional level

Clinical descriptions intersect with racism and classism

Conclusion

Chapter 9. Young kids: The impact of early adverse relational experiences

The role of the therapists in the context of systemic relational trauma

Rosa and how she changed the way she thought of herself

Conclusion

Nick at home

Physical aggression, curfew violation, suspected gang activity

Chapter 10. Kids at home

Introduction

Reactions to trauma

Household-based trauma

Community-based trauma

Conclusion

Nick at school

Police contact

Chapter 11. Kids in school

Why won't they just sit still and listen?!

Well, it worked for me and my parents and my parent's parents

Race, implicit bias, and zero tolerance

Suspensions, expulsions, and root behaviors

Restorative justice: a more compassionate response

Stopping the bad before it starts

Heart-centered communities

Comprehensive behavioral health model: a compassionate community response

The Childhood-Trauma Learning Collaborative: a regional multipartner project

Compassionate and holistic model of mental health treatment for all students

Conclusions: not bad kids, bad environments—that we can change

Nick and the boys

Chapter 12. Kids & their crews

Glossary of terms

Introduction

Friendship

Case vignette: Marcos

Gangs

Case vignette: Ray

Social media

Case vignette: Joel

Romantic relationships

Case vignette: Chauncey

Police

Case vignette: Reese

Conclusion

Nick in foster care

Chapter 13. Kids in foster care

Overview of foster care

Introduction

Foster care entry

Visitation

Permanency planning

What should teams do

Conclusion

Nick in detention

Chapter 14. Kids in detention

Understand the why

Build authentic and appropriate relationships

Highlight the positive

Use silence

Provide choices

Model the behavior you would like to see

Concluding remarks

Nick and Mama J

Chapter 15. Kids and drugs

Opening story discussion

Trauma

Trauma discussion

First hit

First hit discussion

Drugs and mental health in music: 11years old

Drugs and mental health in music discussion

ADHD and addiction

ADHD and addiction discussion

Street pharmacist—trapping/flipping packs/drug dealing

Dealing discussion

Pathway to polysubstance use

Pathway to polysubstance use discussion

Ongoing treatment issues

Ongoing treatment issues discussion

Kids, drugs, and the carceral system

Conclusion (and what could be)

Chapter 16. Kids grown up

Trauma and chronic illnesses of adulthood

Special considerations for subpopulations: substance misuse and adulthood

Attachment and development gone awry in adulthood

Long-term effects of adversity on parenting

Vagabondage and adulthood

Coming of age and incarceration

Special considerations for subpopulations: LGBTQIA+communities

Special considerations for subpopulations: adults and their crews

Conclusion

Chapter 17. Standard management—Part I: Embracing youth & families through Treatment Foster Care Oregon

Introduction

Treatment Foster Care Oregon

A case study—Charles

TFCO research

TFCO in action

Charles's response to his team

Bringing the evidence to life

Charles—day two notes

Day 2 notes from foster parents

Day 2 notes from parents

Charles—after three months

Charles's response to emotion modulation

Charles—after nine months

Charles—entering aftercare

From the Petri dish to the street; a personal view of implementation of TFCO

Community building and engagement

The details of implementation

Feasibility and readiness: preparing a community for success

Cultural responsivity and adaptation

Summary

Chapter 18. Standard management–Part II: Multidimensional interventions for youth with trauma & disruptive behaviors

Systems- and Family-Level Interventions

Individual interventions specific to antisocial personality disorder

Youth-focused interventions specific to disruptive behavior disorders

Youth-Focused Interventions for trauma-related disorders and PTSD

Pharmacotherapy for traumatic stress and conduct/antisocial personality disorders

Considerations for the present and future

Chapter 19. Check your own baggage

Vignettes

Checking your baggage—terminology

How bias and racism affect the minoritized

What we can—and need to—do now

Nick in therapy

Chapter 20. Let's talk about race

Fundamentals

Understanding racism through attachment theory and trauma lens

Racial/ethnic socialization: why the conversation matters

Racial/ethnic socialization: Talking to kids about race/racism

The talk: special considerations for BIPOC youth

Considerations and challenges for multiracial/ethnic youth and ethnically ambiguous youth

Considerations and challenges for white identified/majority culture youth

How to help all kids cope with racial trauma

Antiracism—decolonization—liberation in action

Conclusion

Nick & Mich

Chapter 21. Be a person

Glossary

Index

Copyright

Academic Press is an imprint of Elsevier

125 London Wall, London EC2Y 5AS, United Kingdom

525 B Street, Suite 1650, San Diego, CA 92101, United States

50 Hampshire Street, 5th Floor, Cambridge, MA 02139, United States

The Boulevard, Langford Lane, Kidlington, Oxford OX5 1GB, United Kingdom

Copyright © 2022 Elsevier Inc. All rights reserved.

No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher. Details on how to seek permission, further information about the Publisher’s permissions policies and our arrangements with organizations such as the Copyright Clearance Center and the Copyright Licensing Agency, can be found at our website: www.elsevier.com/permissions.

This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be noted herein).

Notices

Knowledge and best practice in this field are constantly changing. As new research and experience broaden our understanding, changes in research methods, professional practices, or medical treatment may become necessary.

Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds, or experiments described herein. In using such information or methods they should be mindful of their own safety and the safety of others, including parties for whom they have a professional responsibility.

To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors, assume any liability for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material herein.

Library of Congress Cataloging-in-Publication Data

A catalog record for this book is available from the Library of Congress

British Library Cataloguing-in-Publication Data

A catalogue record for this book is available from the British Library

ISBN: 978-0-12-818954-2

For information on all Academic Press publications visit our website at https://www.elsevier.com/books-and-journals

Publisher: Nikki Levy

Acquisitions Editor: Joslyn Chaiprasert-Paguio

Editorial Project Manager: Tracy I. Tufaga

Production Project Manager: Maria Bernard

Cover Designer: Christian J. Bilbow

Typeset by TNQ Technologies

Contributors

John D. Aarons,     President TFC Consultants, Inc., Eugene, OR, United States

Nathan Aguilar,     Columbia School of Social Work, SAFElab, New York, NY, United States

Chase T.M. Anderson,     University of California, San Francisco, CA, United States

Dana Asby,     Innovation & Research Support, Center for Educational Improvement, New Haven, CT, United States

Jaclyn Breckwoldt,     Correctional Health Services, New York, NY, United States

Jennifer Cabrera

The New York Foundling, New York, NY, United States

New York University Grossman School of Medicine, New York, NY, United States

Jennifer Cearley,     Oregon Social Learning Center, Eugene, OR, United States

Lara Jo Cox,     Correctional Health Services, New York City Health + Hospitals, New York, NY, United States

Alexis Dallara-Marsh,     Neurology Group of Bergen County, Ridgewood, NJ, United States

Mark Dangerfield,     University Institute of Mental Health (Ramon Llull University), Barcelona, Spain

Amy Ellis,     Trauma Resolution & Integration Program, Nova Southeastern University, Davie, FL, United States

Steven N. Gold,     Trauma Resolution & Integration Program, Nova Southeastern University, Davie, FL, United States

Nawal Hassan,     University of Washington, Seattle, WA, United States

Brian Hodge,     City University of New York School of Medicine, New York, NY, United States

Jessica Isom

Codman Square Health Center, Dorchester, MA, United States

Yale Department of Psychiatry, New Haven, CT, United States

Qortni A. Lang

New York University Grossman School of Medicine, New York, NY, United States

Bellevue Hospital Children's Comprehensive Psychiatric Emergency Program (C-CPEP), New York, NY, United States

Jessica Linick

The Lionheart Foundation, Boston, MA, United States

New York University Grossman School of Medicine, New York, NY, United States

Norka Malberg,     Yale Child Study Center, New Haven, CT, United States

Akeem Nassor Marsh

Home of Integrated Behavioral Health, The New York Foundling, New York, NY, United States

New York University Grossman School of Medicine, New York, NY, United States

Gayla E. Marsh,     New York City Department of Homeless Services, New York, NY, United States

Christine Mason,     Center for Educational Improvement, Vienna, VA, United States

Myra Mathis

Strong Recovery, Rochester, NY, United States

Department of Psychiatry, University of Rochester, Rochester, NY, United States

Emily Menand,     New York-Presbyterian Hospital Weill Cornell Medical College, New York, NY, United States

Desmond Upton Patton,     Columbia School of Social Work and Department of Sociology, Curriculum Innovation and Academic Affairs, SAFElab, New York, NY, United States

Victoria Phillips,     NYU Grossman School of Medicine, New York, NY, United States

Noor Qasir,     University of Cincinnati College of Medicine, Cincinnati, OH, United States

Michael Quiñones,     Independent Practice in Clinical and Forensic Psychology, Fort Lauderdale, FL, United States

Jeanette M. Scheid,     Michigan State University, East Lansing, MI, United States

Altha J. Stewart,     Community Health Engagement, Public and Community Psychiatry, Center for Health in Justice Involved Youth, The University of Tennessee Health Science Center, Memphis, TN, United States

Sasha Stok,     NYU Grossman School of Medicine, New York, NY, United States

J. Corey Williams,     Georgetown University Medical Center, Washington, DC, United States

Biographies

Akeem N. Marsh, MD

Assistant Medical Director of the Home of Integrated Behavioral Health—The New York Foundling

Clinical Assistant Professor of Child and Adolescent Psychiatry, New York University Grossman School of Medicine

Dr. Akeem Marsh has dedicated his career to working with children and families of medically neglected communities. He currently serves as the Assistant Medical Director of the Home of Integrated Behavioral Health—The New York Foundling and as a member of the Verywell Mind Review Board. He also holds a faculty appointment as a clinical assistant professor of child and adolescent psychiatry at the New York University Grossman School of Medicine. He previously served for many years as an attending psychiatrist with the Bellevue Juvenile Justice Mental Health Service, providing clinical care to youth in New York City's juvenile detention system. He is board-certified in both general and child and adolescent psychiatry. He received his bachelor of science degree from the prestigious Sophie Davis School of Biomedical Education/CUNY School of Medicine at the City College of New York and earned his medical doctorate from the SUNY Health Science Center at Brooklyn/Downstate College of Medicine. He completed both his residency in general psychiatry and his fellowship in child and adolescent psychiatry at the Zucker School of Medicine at Hofstra/Northwell. He is a fellow of the American Psychiatric Association and a distinguished fellow of the American Academy of Child and Adolescent Psychiatry (AACAP). He also serves as a member of the Board of Directors of the New York Council on Child and Adolescent Psychiatry and on the editorial board of the organization's newsletter.

Lara J. Cox, MD, MS

Attending Psychiatrist, Correctional Health Services, New York City Health + Hospitals, New York, NY, United States

Dr. Lara Cox is an attending psychiatrist with Correctional Health Services, the division of New York City Health + Hospitals that provides medical and mental health care to individuals incarcerated on Rikers Island. She was previously an attending psychiatrist with the Bellevue Juvenile Justice Mental Health Service, providing clinical care to youth in secure and nonsecure juvenile detention in New York City, and had a dual appointment as a clinical assistant professor in the Department of Child and Adolescent Psychiatry and the Division of Forensic Psychiatry at New York University's Grossman School of Medicine. Dr. Cox completed her adult psychiatry residency, in addition to her child and adolescent psychiatry and forensic psychiatry fellowships, at NYU. She is board-certified in general, child and adolescent, and forensic psychiatry. She earned her medical degree and a master's degree in clinical research from the University of Pittsburgh, after graduating from Kenyon College with a bachelor's degree with high honors in neuroscience and psychology. She maintains membership in the American Psychiatric Association, the American Academy of Child and Adolescent Psychiatry, and the American Academy of Psychiatry and the Law.

Drs. Marsh and Cox have shared primary interests in terms of clinical care, advocacy, and research, including the nexus of trauma-related symptoms and disruptive behaviors, trauma-informed juvenile justice reform, and antiracism in education and practice. They also have a vision for the future of creating a safe space for and with youth in the community, dedicated to meeting their needs, so kids who too often must fend for themselves will always have a place to go and caring people who will be there for them. Since 2016, they have given many presentations on trauma and disruptive behaviors as well as racism in medicine and psychiatry. They have presented both together and individually, to a wide range of local, national, and international audiences.

Nick's words

I'm smoking and I'm drinking

tryna stop what I been thinking

Flashbacks running my mind

every time I get to blinking

Hiding my feelings got me drowning

I'm sinking

Can't tell the diff'rence ‘tween

gun cock & bottles clinking

just tryna reach third period

but them cop tires be screeching

The boys got me hemmed up

and always gun reaching

Got lucky this time

They always be preaching

plastic blade on me for haters

who scheming

a lil bit of act right

is what they been needing

Metal detectors can't stop them

from bleeding

cheeks gon be leaking

if I catch them creeping

Textbooks & notebooks laid out on the desk

But my homie AK just showed up to get rest

Won't make no difference he failed alla them tests

But you looking for a get-away, the school is the best

Classroom is a mess

Teachers getting stressed

Riding me to give up an educated guess

Talking bout bullets & I'm dreaming ‘bout vests

Remembering the blood rushing out DJ's chest

My hoodie drench in red. soaked in whatever's left

I'm first person POV to my best friend's death

This ain't call of duty, no chance to restart

You wanna know how fast bullets are?

Try having one in your heart

I'm hiding all of my scars

I'm kinda falling apart

just want attendance for POs

& fuckin' report cards

think everyone got it hard

Don't see the shambles and shards

My momma in & outta rehab

And my pop's running some yard

witness violence since birth

& you'll always be on guard

I was taking backhands since a toddler, on God

no one spoiled this child & no one spared the rod

ain't no ounce of discipline to keep haters off my bod

So kick me out of yo' classroom

throw me out of yo' school

learning lessons from the street

So I can't follow none of yo' rules

Of course I got me a tool

life done been so cruel

I'm blacking out when I'm acting out

So keep your hands off me fool

Ain't none of this shit new

they call themselves professional

But ain't got a fucking clue

Never sure of what to do

I was seeing red & now I'm finally coming to

I'm cuffed up in the backseat

And I'm steady staring at you

Feel like I was born with PTSD

But y'all refuse to see the truth

Nick's world

Nick startles awake. His heart's pounding in his chest. Then he realizes the loud noise he's hearing's just his damn alarm. Nick rolls over and fishes the phone out from under his pillow. Fucking thing's still blasting and it's making his head hurt. Nick cracks open an eye, trying to focus. He realizes first period started three minutes ago. He starts cussing and sits up. Nick digs through the laundry on the floor to find a clean-enough hoodie and jeans. He tosses them on his bed, then grabs the other shit he needs from the basket in the closet. Even though his eyes still ain't hardly even open, he pulls on clothes and somehow finds his belt. Nick sprays himself with mad cologne but just about forgets deodorant until he knocks it over setting the bottle down.

Nick debates which sneakers to wear today for a second before he slides his feet in the Jordans he racked last week. He shoves all his shit for the day in his bookbag and his pockets, then takes the chop from where it's tucked between the mattress and the wall. He checks the clip and makes sure the safety's on, puts it in his fanny pack, and shrugs his head and left arm through. Nick's got the fanny's strap buckled across his chest and the grip tucked up tight under his left arm. He zips up his hoodie to hide the fanny just in case he runs into his moms on his way out the door.

In the kitchen, the sink is dripping hard enough again it's splashing water on the sticky note on the counter. Have a great day! I left for work already. Get home by 8, pork chops for dinner. Charles is coming over. Don't be late. XOXO <3, Mom Nick rolls his eyes. He crumples the post-it and tosses it towards the trash bin. If Charles is gonna be there, Nick sure as fuck ain't coming home for dinner. His moms can keep forgiving that scumbag and making excuses for him, if that's what she's gonna do, but Nick's not jacking it. And he ain't about to have his moms call the cops on him again when Charles does some dickhead shit and he's gotta intervene. Plus, since when is she the world's best mom? He ain't even been back with her a whole year this time around.

Nick snags some granola bars from the pantry. He unwraps one and shoves the others in his bookbag. Nick holds the granola bar between his teeth and almost drops it digging in every pocket for the keys. He finally finds them in his jeans. He unlocks the door and goes out in the hall, then relocks all three locks from outside. Nick takes a bite of the granola bar and walks down the hall towards the elevator. He hears a door slam and turns quick to check before he realizes it was inside another apartment.

The light above one of the elevators is out. Shit's down again. Nick sees the other one's all the way down on the ground floor. He watches it creep up to 2, then 3, but then he gets too restless and goes to the stairwell instead. Nick opens the door and listens for any signs of movement. Ain't shit moving. Nick looks back at the elevator. Shit's still on the third floor.

Nick decides he's taking the stairs. When he hits the sixth floor, he hears one of the stairwell doors opening a few flights down. Nick pauses. He's getting ready to sprint back up to his apartment until he hears footsteps running away from him, down towards the first floor. Nick lets out the breath he was holding and continues on his way downstairs. Like always, the fucking stairwell smells like stale cigarettes and piss. Nick don't want to fuck up the new kicks. He tries to keep an eye out for puddles, but assholes can't stop breaking the fucking lights and it's mad dark between some of the floors.

Nick makes it downstairs without running into problems. He goes out the back door, passing the trash piled high. It smells so bad out there he thinks his granola bar might repeat on him. Nick swallows hard. He fights the urge to put his hand over his nose while he scans the sidewalk up and down the block. Seeing no opps and no cops, he hits the street and heads towards school.

Three blocks down, Nick turns right. His shoulders tighten. He automatically checks the playground on the corner and looks down the alley across the street. The alley's empty. The three bums passing a paper bag back and forth on one of the playground benches ain't doing shit but drinking. There's a few elementary school kids on the merry-go-round ignoring the bums and Nick. One kid's freestyling to the beat from another's phone. The only nigga Nick's age in sight is nearly to the end of the block. He's headed the same way Nick's going, and he don't even look back before he turns the corner. Nick sees a chick he sort of knows with a stroller on the other side of the street. Nick can't remember ever seeing her pregnant, and it makes him start to wonder. That paranoid feeling crawls up between his shoulder blades. His hand creeps up towards the chop. Then the chick leans over with a pacifier and Nick sees a baby's hand wave in the air. Definitely a kid, not a set-up. He takes a breath.

Nick peeps the alley one more time. His heart jumps for a second when he sees movement. Then, a rat darts across from underneath the dumpster. It disappears between the trashcans lined up crooked against the building on the other side. Other than the fucking rat, shit's quiet on the block. An image of the night X and him got hopped over by the swings flashes into Nick's mind, like always, but ain't nothing going on today to make it stick.

Another block down, Nick turns left. His shoulders relax a little. Outside the corner store, his big homie and a couple older heads are posted up smoking a bogie. They got their beads in plain sight. Everyone's just chillin', no more on point than they always are. Nick peaces them all as he walks by. He stops real quick to get the word from his big homie. Yo, you hear ‘bout Tay? Nick shakes his head. "Niggas put him in the wrong crib on the island, even though they been knowin' what he jacks. That nigga from Truman was in the crib with him. Caught Tay lackin' on the phone and put a pussy on his face, tried to give him a buck fitty. He got sliced up real bad."

One of the other guys jumps in. Rico says Tay's gonna be straight. And they had to move him after that shit, now he's with the set.

Still, bro. He got mad stitches. Nick's big homie takes another drag off his bogie. He blows out the smoke and looks at Nick. "Shit's mad fucked up, lil bro. Iono why they put him in there in the first place. They had to know some shit was goin' down."

Nick realizes he's rubbing the scar up by his left shoulder where he got cut so bad last year. Must've started doing it as soon as Remy said the word sliced. It's a big-ass fucking scar. Nick probably should've got that shit stitched up when it happened, but he ain't want his moms to know. She would've lost her shit. Nick just kept putting more bandages on until he finally stopped bleeding. Then he snuck the trash out when he left the next day to make sure his moms ain't see all that blood. Nick tries not to imagine what would've happened if they slashed his face instead. Damn, bro. You sure Tay good?

Remy shrugs. Gonna talk to my mans who's in the house with him. We'll make sure he got everything he need. Don't stress. He pauses for another drag off his cigarette. Ain't you and Tay been tight since way back?

Nick gets a big cheesy grin on his face. Yeeooo, that's my right hand. His moms is my moms. I been callin' her ma since we was kids, and she jacks I'm her son. Deadass, Mama J been steady holdin' me down all those times shit got bad with my moms. I was always at Tay and DJ's crib comin' up. I mean, really it was me and DJ who was mad tight, I ain't been over there like that since… Nick pauses, his grin gone. He still hates saying that shit out loud. You know, since then. But yeah, I fucks with Tay. That's my big bro, too, you feel me?

I feel you, Remy says. He looks at his watch, then looks at Nick. "Bro. Probation been on ya body already ‘bout school, and you just goin' in now? You want your PO to violate you?"

Nah, brody. I'm out. Nick peaces everyone again. He heads down the block, kicking an old soda cup into the street. When he hits the corner, his skin starts crawling like somebody's got their eyes on him. Nick pauses his music. He needs to hear everything. Sometimes you can hear engines revving or tires squealing a block or two away. He hears them coming, it might give him just enough time to get low.

Nick sees an old lady with a walker on the sidewalk across the way. Somebody's sitting at the bus stop past the next corner, too. That don't mean shit around here, though. Fucking opps don't care who they hit. Last time Nick saw somebody get shot on this block, ain't even matter the bus was letting off a bunch of kids on their way home from school. Took the cops twenty minutes just to get there that time. Ambulance was even slower. Nigga ain't even have a chance. And ain't no one in this neighborhood talking to 12, neither. Nick shakes his head a little. His hand moves to where his grip's tucked underneath his arm.

Nick looks a little further down the street. There's four niggas in hoodies on the stoop outside the trap passing a blunt. They all four got their hoods up, and Nick don't know the two guys facing him. Right away, he's calculating all the ways shit could go down if they try and make a move on him. Nick realizes he's already got hold of the fanny's zipper.

One nigga's acting like he knows Nick from somewhere. He gives Nick the nod. Seems like he's half doing it to let the others know Nick's there. Nick starts unzipping the fanny when the two guys who were faced away from him start turning around. Then he recognizes his friend AK sitting on the bottom step.

Nick's hand falls back to his side. He blows out the breath he was holding. He fakes like he's just chillin' as he turns up the sidewalk to the trap. Yo, you good, fam? AK passes the blunt. He gets up off the stoop and gives Nick a pound. Nick says wassup to the rest of the guys, and AK takes one last pull before they leave.

Once they get a couple blocks away, Nick slings his bookbag off his shoulder. He takes out a couple granola bars, some socks, and a t-shirt and hands them to AK. AK tears hungrily into a granola bar. Nick keeps digging, trying to find his wire and the portable charger. He gives that to AK, too. You gotta give that back before I go home, he says. I only got the one wire.

AK nods, still chewing. He plugs in his phone and slides it in his hoodie pocket. You good, bro? Nick asks.

I'm good, AK replies around a mouth full of granola bar. "Was mad cold in the trap last night, but you know ya boy found a way to stay warm."

Nick laughs. Yeeeeahhh, boyyyy! He pauses as AK finishes his second granola bar. Sorry I ain't bring you a whole fit today, I gotta clean my clothes. But I got you tomorrow.

It's cool, says AK. Appreciate you.

They start past the block of projects across from school. AK's looking over his shoulder every twoseconds. You know that opp I got over here, the one who tried to line me behind some dumb shit last year? Tasha said he got locked this weekend for blastin' on some kid on her block. You heard? he says. He's staring hard at the building in the middle of the complex.

Nah, Iono, Nick says. You valid if we go up in here? I gotta stop somewhere a minute.

Yeah, we valid as long as we ain't goin' over there, AK replies, nodding towards the middle building.

Nah, we goin' ‘round the corner, Nick tells him. They walk the rest of the way down the block. AK checks the charge on his phone. He smiles and puts his headphones in and starts humming under his breath. They round the corner and hit the building entrance. Nick looks at AK. You comin' up? He pauses. You prolly better. Imma be quick, but Ion wanna leave you doley.

AK nods. They walk slow towards the door, waiting for someone to come out. Housing fixed the door a couple days back and did some slick shit to the hinges, so it ain't broken again yet. Might need some tools for that shit. A lady comes outside pushing a stroller. She's got another little kid hanging on the side of her coat. AK catches the door and holds it open for her, then he and Nick slide into the lobby. The lady hurries away with the kid tagging along after.

Nick pushes the elevator button. The doors open right away. Once they're inside, he hits 5. Then they hear the building door slam open and closed. Footsteps run towards the elevator. They look at each other and AK hits the door close button, hard. Then a little girl sprints into view, braids flying. She's maybe nine or ten. Nick sticks his foot in the door right before it closes and holds it for her.

The girl gets on, a little out of breath. She pushes the button for 11. Then she turns around to look behind her and sees it's just her and Nick and AK in the elevator. When she realizes she don't know them, her eyes get a little wide. Nick smiles at her, trying to let her know she ain't gotta be scared. The girl smiles nervously, then hitches her bookbag up on her shoulder and turns back to face the doors.

Nick sends a text from the elevator to let X know they're coming up. The elevator stops at 5. Nick checks the hall to make sure it's clear before AK gets off behind him. They go to the fourth apartment on the right. Nick knocks twice, then one more time. X opens the door with no shirt on. He scans the hallway quick. Yo, Nick says, sliding past him. This my son AK. He valid.

Nick sees the tension in AK's shoulders when he steps inside. X closes the door behind them. AK sees the three guys sitting on the broke-down sofa and gives them a tight nod. His eyes scan the whole room. AK moves up closer to Nick, hands in his pockets.

AK, huh? Nah, bro, Ion know him, X says. He turns to AK. That's a serious name, bro. You a shooter? He puts out a hand.

Shiiiiittttt, you know what happens in the streets stays in the streets! AK takes his hand out of his pocket and daps X up, his big grin looking kinda forced. AK scans the room again. Nick sees him relax when none of the other guys even move. Now AK's smile looks real. No cap, everybody been callin' me AK since I was a little-ass kid. My moms always got so tight at niggas, but now she be callin’ me that, too. Her fault, anyway, for givin' me those initials!

X laughs out loud, slapping his knee, then gives AK a pound. He turns to Nick and nods towards the bedrooms. You know where to put it. Ain't nobody touchin' shit in there, not while I'm here. And I ain't goin' nowhere till tonight.

Heard you, Nick says. He goes down the hall to the room where X sleeps. Nick opens up the closet and moves the pile of sneaker boxes to get at the last one on the bottom. He unstraps the fanny from across his chest and puts it in the box, then piles all the other boxes back on top of it. As always, Nick feels sort of naked without the blixk, even with the plastic blade he always keeps in his pocket.

Aiight, we good, Nick says as he walks back in the living room. He nods to the guys on the couch. See y'all after school. He pauses. Nah, prolly before then. You know school's dirt. Shit's mad boring, I'll prolly pop out with y'all at lunchtime. The guys laugh. Nick peaces X, then he and AK walk out the door.

They're waiting for the elevator when AK shoots a look towards the stairwell. Yo, bro. You wanna spark up here before we get to school?

Word, Nick says. I got a lil spot up the stairs. You got, though? I'm dry right now.

AK takes an L out of his pocket and waves it at Nick. We good. You got fuego?

Nick fishes through his pockets and comes up with a lighter. Fuego.

He and AK go a couple floors down, stopping on the landing between two levels so they can see the doors above and below them. They smoke in near silence, except AK keeps humming under his breath. After a while, he takes out one of his headphones. He holds it out to Nick. You gotta hear this new shit Polo G just dropped, bro. My son dumped on this track!

Nick puts it in his ear. They finish the blunt and the song. Yo, that shit's fire! he says. AK nods and takes back his headphone. He puts the clip in his pocket and they head downstairs. Nick goes to leave out the back door, but AK stops him. C'mon, bro. You know we can't be goin' that way.

You right, you right, Nick says. They walk through the lobby. Nick steps outside first. He does a quick scan and gives AK a nod to let him know shit's all clear. They round the building corner and AK pulls up hard in front of Nick, so fast Nick runs into his shoulder. Nick glares at AK. The fuck, nigga?

Shut up! AK says. The Ds is pullin' up on us.

Nick sees an unmarked cop car double-parked a few car lengths away. Two guys in plain clothes get out and slam their doors. They come towards Nick and AK. The tall one's pulling his badge out of his shirt as he walks. Morning, boys, the other says. Shouldn't y'all be in school?

That's where we headed, says Nick. He feels AK next to him starting to amp up and prays AK stays chillin'. AK's a real buggout sometimes. Him turning up on the boys right now won't be a good look.

Didn't class start already? says the first detective, moving way too close. He uses his height to loom over them.

Yeah, you makin' us late, AK says. He tries to sidestep the D and cross the street towards school.

Stop right there! the cop says. He throws up an arm to block AK's movement. AK's hands go up to keep the guy's arm out of his face. All of a sudden the Ds are shouting and grabbing them up, being mad aggressive. They shove Nick and AK hard against the wall. Don't make a fucking move! one yells. Keep your hands where I can see them! yells the other. He's backed his gun out on them for no reason.

Nick and AK have their hands on the wall of the building and their faces just about on the bricks as the cops pat-frisk them roughly. One D takes the t-shirt and socks out of AK's pocket and shakes them out like he thinks AK's stashed rocks in there or some shit. Then he crumples the clean clothes up and tosses them on the ground.

The other D takes Nick's bookbag. He says he needs to look through it. Nick knows he got nothing in there to worry about, so he don't even argue. He feels like his blade's about to burn a hole in his pocket. He knows it just looks like a broken piece of plastic, but he's worried the Ds are gonna find it. If they see the size of that shit and peep how sharp it is, and figure out he was gonna take it in the school, he could catch a whole new case behind that. Or something even worse could go down. You never know what the boys are gonna do. Nick's seen them pull some real shit for way less than that.

Nick's practically shaking thinking about the type shit the cops do sometimes. And fucking get away with, too—ain't nobody arresting they asses for that shit. Not over a couple gangbangers. Probably just say good riddance. And ain't nobody gonna believe Nick or AK even if they snitched about it, anyways. But at least AK ain't started tweaking. And the hothead cop's putting his gun away.

Nick tries to breathe. Seems like maybe they'll get through this okay. He can't fucking believe the Ds caught them up right after he dropped off the strap. Shit could've been so much worse.

After what feels like forever, the cop holding Nick's bookbag grunts. He drops it on the ground. Got nothing for us today, huh? he says. Maybe we'll have better luck next time. Now get your asses in that school before I call your fucking PO.

Nick scoops up his bookbag and AK bends to pick up the clothes. The Ds get back in their car and pull away. Fuck 12! AK screams after them. He tries to brush the dirt off the t-shirt and looks at Nick. They some scumbags, for real. But fuck, brody. It's a good thing they got us goin' and not comin'!

Nick nods. He still feels like he might throw up, but he just shrugs. Mothafuckas always gonna be too slow to catch me up. We good. AK daps him up. Assholes fucked up my high, though. Why they always gotta be on that type of time?

AK shrugs. Because they assholes? Nick shrugs back. They cross the street and walk towards the school building. Nick looks at his phone. He sees third period just started a few minutes ago. He decides he should probably go in and go to class before they mark him absent for the whole day and call his moms again. Or worse yet, snitch on him to his PO.

He and AK walk through the school doors. The principal, Mr. Anderson, is standing behind the metal detectors. He gives Nick and AK a look he clearly thinks is hard. Mr. Donella. Mr. King, he says. Nice of you to grace us with your presence this morning.

Mornin', Mr. A, Nick says. He turns to take off his bookbag and his hoodie, then empties his pockets of anything that might beep and puts it all through the metal detector. He rolls his eyes at AK, who just smirks. AK dumps all his shit in the bin and goes through the metal detector, but he forgets the lighter in his pocket and has to go back through. Then he has to go back through again because he forgot a quarter in a different pocket. AK's cussing loudly the whole time. Fuck alla this bullshit, man. I ain't got time for this shit!

Mr. A tells AK to watch his language unless he wants a detention. AK gets quieter, but he keeps cussing under his breath. He and Nick gather up their shit, shove everything back in their pockets, and put their belts back on. Mr. A sniffs dramatically as they walk by. Lovely fragrance you're wearing today, boys.

Thanks! Nick says, all perky and shit. He's trying not to giggle—he knows they smell mad loud, even he can smell the weed on them. He and AK go down the hall. When they hit their lockers, Nick busts out laughing. AK just kicks his locker and starts cussing again. That motherfucker always grillin' me first thing in the mornin'. I'm just tryna have a chill day. What's his fuckin' problem? I oughtta fuck him up, for real!

Nick shushes him, looking over his shoulder to make sure Mr. A ain't hear. AK quiets down as they get to their classroom. Nick opens the door and they head to their desks. Their teacher throws a look at the clock. She rolls her eyes and turns back to the chalkboard as they drop their asses in their seats. "Good morning, gentlemen, she says. So glad you could join us. Today, we're studying the Pythagorean theorem."

The fuck is that? AK says under his breath. Nick snorts. He pulls out his textbook and his notebook, then starts digging through his bookbag for a pencil. AK cusses under his breath again. He rolls his eyes at Nick, slouches further down in his chair, and bounces his foot a couple times. Then AK stops. He makes a whole movie pulling his hood down to shade his eyes, letting everybody know he's about to just sleep through class.

Then again, ain't like AK got a textbook. Or a notebook. He ain't even got a pencil. He ain't got no place to keep his shit except the bum-ass locker here. Everything he got is in there or on his body. Plus, Nick knows AK gotta be tired as fuck. Sleeping in the trap ain't real sleep. Even when you're smacked, you still gotta sleep with one eye open and all your shit under your arm, or you might wake up with your shit gone and your opps in your face. Nick's always tired when he stays in the trap, especially if he's gotta crash there more than a couple nights. And AK failed the last two marking periods in this class anyways, he ain't about to get the credits. He might as well sleep here. At least he's warm and Nick can watch his back.

The teacher continues talking to the chalkboard. You've missed the basic explanation, but you can catch up in the textbook and just read along as we go. Amir, if you have once again forgotten your book, perhaps Nicholas can share.

Nick sighs. Fucking Nicholas again? And why this bitch gotta put AK's shit on blast like that? She got no clue what he's dealing with. Nick opens up his textbook and finds the right page, then scoots his desk closer to AK so it looks like AK can read along. AK just shakes his head at Nick. He drops his chin on his chest, sneaking a headphone in one ear as he adjusts his hood. AK closes his eyes and his breathing deepens. Nick tries to find a spot on the page that looks anything like what the teacher scribbled on the board.

Chapter 1: Setting the stage—putting kids in context

Altha J. Stewart     Community Health Engagement, Public and Community Psychiatry, Center for Health in Justice Involved Youth, The University of Tennessee Health Science Center, Memphis, TN, United States

Abstract

As the US juvenile justice system was established over a century ago, its mission has not changed—ensure public safety while holding youth accountable to victims and communities for delinquent acts. We now understand more clearly that these are not just bad kids. Most enter the system for reasons other than the delinquent act with which they are charged. Decades of study of the impact of disruption in child and adolescent brain development has demonstrated there are many factors involved in why youth enter the system. Differential treatment occurs during community encounters based on race, gender, age, mental health status, and trauma exposure influence point and duration of involvement. Building trauma-informed, family and community-engaged systems supports positive outcomes and reduced recidivism. And while we wait for the legal system to catch up, we must continue to work to change programs and policies to reform the system.

Keywords

Bad kids; Delinquent; Justice-involved youth; Juvenile; Juvenile justice; Mental health; Racial/ethnic disparities; Trauma-informed care; Treatment services

Across the United States, every day there are thousands of children who wind up in out-of-home community placements or confinement due to behaviors that are defined as delinquent acts by law. Often, we just say it's because they are bad kids and leave it to the juvenile justice system to determine the consequences of committing those acts. The juvenile justice system was established to ensure public safety and protection of the community while holding youth offenders accountable to victims and communities for their delinquent acts. The laws governing the juvenile justice system require a balance to ensure care. This balance includes the protection and wholesome mental and physical development of children, and a program of treatment, training, and rehabilitation consistent with the child's best interests and the protection of the public interest.

History of the juvenile justice system in the United States

The developers of the early juvenile courts in the United States believed that they were supporting the development of a youth's competency and character to assist them in becoming responsible and productive members of society. In the United States, changes in the 19th century resulting largely from industrialization created the belief of the social construction of childhood … as a period of dependency and exclusion from the adult world (Coupet, 2000a). This led to the opening of the first programs targeting juvenile delinquency, with the New York House of Refuge in 1825 as the first (Kole). Before this ideological shift, the application of parens patriae was restricted to protecting the interests of children, deciding guardianship and commitment of the mentally ill. In the 1839 Pennsylvania landmark case, Ex parte Crouse, the court allowed use of parens patriae to detain young people for noncriminal acts in the name of rehabilitation (Finley, 2007). As these decisions were carried out in the best interest of the child, the due process protections afforded adult criminals were not extended to youth. The nation's first juvenile court was formed in Illinois in 1899 and provided a legal distinction between juvenile abandonment and crime (Coupet, 2000b). Establishing a juvenile court helped reframe cultural and legal interpretations of the best interests of the child. The underlying assumption of the original juvenile justice system, and one that continues to prevail, was that juveniles are generally more amenable to rehabilitation than adult criminals (Zimring & Tanenhaus, 2014). This new application of parens patriae and the development of a separate juvenile court formed the foundation for the modern juvenile justice system.

Juvenile justice in the 21st century

Today's juvenile justice system still maintains rehabilitation as its primary goal and distinguishes itself from the criminal justice system in important ways. With few exceptions, in most states, delinquency is defined as the commission of a criminal act by a child who was under the age of 18at the time. Most states also allow youth to remain under the supervision of the juvenile court until age 21. In lieu of prison, juvenile court judges draw from a range of legal options to meet both the safety needs of the public and the treatment needs of the youth. Unfortunately, youth may be confined in juvenile correctional facilities that too often resemble adult prisons and jails and routinely impose correctional practices such as solitary confinement, strip searches, and the use of chemical or mechanical restraints. Fortunately, most of these practices are no longer allowed by law.

Justice-involved youth are entitled to receive educational programming while incarcerated. Educational and therapeutic programming may be provided in the child's community or the child may be placed out of the home in a residential treatment program and ordered to attend school on-grounds. Unlike adult criminal proceedings, juvenile court hearings are often closed to members of the public and records in some states remain confidential, protecting children from stigma and collateral consequences if their records are made publicly available. Juvenile records have increasingly become more accessible and in most jurisdictions are not automatically sealed or expunged when the young person becomes an adult. This creates barriers to obtaining employment, serving in the military, or enrolling in higher education programs later in life.

The primary goals of the juvenile justice system remain the same as when the system was created. In addition to maintaining public safety in an environment of rehabilitation, the system must provide skill development, address any treatment needs, and prepare the youth for successful reintegration back into the community. However, the implementation of the tough on crime policies of the 1980s created a juvenile super predator myth and laid the framework that underlies the increased numbers of young people still being arrested and detained today (Roper, 2005). Weapon and drug possession on school property has resulted in laws that are interpreted as grounds for immediate suspension, expulsion, and involvement with juvenile courts. Schools have become the primary staging ground for juvenile arrest, with the charges brought against them and punishments they face as increasingly severe. That process is known as the school-to-prison pipeline (Curtis, 2014).

All of this even though research now shows that youth offenders have a greater capacity for change than adults. And thanks to recent policy reform that incorporates the science of the adolescent brain and interventions and mitigation strategies that are trauma informed and designed to engage the youth, their families, caregivers, and the communities in which they live, more young people are getting that chance to change. Courts have even begun to recognize that the character of a juvenile is not as well formed as that of an adult, and [t]he personality traits of juveniles are more transitory, less fixed (Feye, Keator, Phillippi, & Irons, 2019a). As a result, more juvenile justice systems are seeking to become more trauma informed.

Impact of mental disorders and trauma on justice-involved youth

In recent years, research by the MacArthur Foundation Research Network on Adolescent Development and Juvenile Justice led many states and courts to view juvenile crime and juvenile justice through a scientific lens. Developmental psychology, which describes a youth's developmental immaturity, particular susceptibility to negative peer influences, and a capacity for change and rehabilitation, is supported by neuroscience. We now understand that key areas of the adolescent brain continue to develop well into the mid-1920s. This research has forced constitutional changes in how youth are sentenced when prosecuted in the criminal justice system and required the adoption of new rules including standards for law enforcement interrogation of youth, determination of a youth's competency to stand trial, and the reliability of youth confessions, among other things (MacArthur Foundation Research).

But many still say, "they are just bad kids." Of course, it's not that simple and each child's experience is different. The outcome for each child depends on many factors including the needs of the child, the nature of the offense and whether injury or damage was done, whether it is the first arrest, and whether there is a risk to other people or property.

Factors that must be examined as we evaluate the behavior of many justice-involved youth include the following:

Presence of mental disorders or trauma exposure

Untreated mental illness and traumatic stress can have significant negative effects on lifetime health and well-being. A 2017 study reported that on any given day 45,000 were being held in residential placement facilities (Feye, Keator, Phillippi, & Irons, 2019b). The prevalence of behavioral health conditions and exposure to trauma is consistently found to be disproportionate among youth in the juvenile justice system when compared with the general adolescent population (Aarons, Brown, Hough, Garland, & Wood, 2001). Upwards of 70% of justice-involved youth have at least one diagnosable mental illness, nearly half have a substance use disorder, and at least 75% have experienced traumatic victimization (Garland et al., 2001; Teplin et al., 2007, pp. 7–47; McClelland et al., 2013; Shufelt & Cocozza, 2006; Sprague, 2008).

Influence of social media

Social media is a significant part of our lives and brings many challenges for today's youth. They have easier access to the internet and social media on cell phones, tablets, and computers. A 2011 study by Nielson found that nearly 80% of active Internet users visit social media sites with youth aged 9–17 spending an average of 9h a week on social networking sites. Parental control on limiting access to social media sites is a major challenge, and monitoring children online has been proven to be extremely difficult (Nielson Social Media, 2011).

However, a study by Boyd found that 31% of 10-year-olds, 44% of 11-year-olds, and 55% of 12-year-olds reported using a social network site (Boyd, Hargittai, Schultz, & Palfrey, 2011). And while some sites do have age requirements, others such as Twitter do not. This increased use has led to an increase in cases of cyberbullying, defined as bullying through social media sites by the electronic posting of mean-spirited messages about a person, often anonymously (Cyberbullying). The anonymity offered by most social media sites makes these attacks easier. In fact, one survey conducted by The Pew Internet and American Life Project found that 39% of social media users had experienced some form of cyberbullying, as compared to 23% of nonsocial media users (Lenhart, 2007). Other concerns include the posting of inappropriate pictures and sharing personal information with strangers. Helping youth to understand that such actions are dangerous and that information posted online is never permanently erased is essential. Parents must initiate conversations with their children about the impact of cyberbullying and the importance of not engaging in this behavior. It is also important that youth understand to let a parent or other trusted adult know if it is happening to them. When these attacks are allowed to continue without relief, there is a greater likelihood for a young person to react in a harmful or even lethal manner. We know some of the immediate effects of social media in the lives of youth, but more study is needed on the longer-term effects.

Influence of peers and relationships with peer groups

Adolescents spend most of their time with their peers, not the adults in their lives. The influence of peer groups can be either positive or negative and is a significant factor in molding beliefs and behaviors. Such peer pressure is strongest during adolescence, making it easier to encourage involvement in delinquent acts. The fear of being left out and isolated is a strong motivation to be part of the group, no matter the potential consequences (Steinberg & Monahan, 2007; Vaquera & Kao, 2008). Committing delinquent acts may start with skipping school, smoking, or abusive language and evolve into more serious crimes.

Influence of home, school, and community violence (including gangs)

Exposure to violent events can be traumatic and can negatively impact multiple areas such as normal child development, academic functioning, coping skills, and relationships. Children today are being exposed to violence in their communities at higher rates than previously and may become more aggressive because of their environment. Greater access to weapons increases the likelihood that they may carry weapons. For some, this is mainly about survival but may also set them on the path into the juvenile justice system.

Children and adolescents do not have to be the victim of a violent crime to experience trauma. This can come from multiple sources, for example, exposure to gang activity, witnessing a shooting or other violent crime or the death of a friend or family member. Warning signs that youth may be involved in illegal activities include unexplained new clothes, devices, cash, or friends, skipping school, going/staying out without explanation, or drug use/possession (Exposure, 2018).

Influence of social determinants of health (socioeconomic status, home environment and built environment, family/home stability)

Adolescence is an important developmental period and has a significant influence on the future psychological, biological, and behavioral development and can modify childhood trajectories toward positive psychological health and behaviors in adulthood (Viner et al., 2012; World Health Organization, 2012). For youth in or at risk for entering the justice system, persistent poverty and compromised social determinants of health can reinforce antisocial attitudes and behaviors that contribute to ongoing participation in the justice system and mitigate future successful outcomes. Research illustrates that adolescents who experience persistent poverty are at a greater risk of engaging in risky behaviors and experience poor health outcomes. This was demonstrated in a longitudinal study where poverty predicted aggressive or delinquent behavior and risky behavior (such as the earlier onset of alcohol consumption and smoking) among adolescents (Najman et al., 2010). Numerous other studies indicate that there is a relationship between the extent of poverty and compromised social determinants of health. Youth offenders who grow up under high poverty conditions are reported to experience higher frequencies in family structure instability, less parent involvement or concern, greater grade failure and lack of educational attainment, lack of organized leisure activities, and greater gang affiliation within the community (Tyrrell, 2017).

We know that stressful or traumatic childhood experiences such as abuse, neglect, or forms of household dysfunction are a common pathway to social, emotional, and cognitive impairments that lead to increased risk of unhealthy behaviors, violence or revictimization, disease, disability, and premature mortality. These experiences, described as adverse childhood experiences or ACEs, may also serve as the starting point along the path into juvenile justice and child welfare confinement systems (Felitti et al., 1998). In addition, one might consider two categories of behaviors that might accompany any cooccurring mental health disorders—internalizing and externalizing. When focused internally, these negative behaviors include depression, anxiety, and dissociative disorders. When directed outward and toward individuals or the environment, they include antisocial behaviors or conduct disorders (i.e., oppositional defiant disorder and intermittent explosive disorder).

We now more fully understand that an adolescent's susceptibility to peer influence and weaknesses in self-regulation reflect their incomplete identity or sense of self. More than two-thirds of justice-involved children will experience one or more traumatic events by the time they reach age 16. Traumatic event exposures include intentional acts such as sexual and physical abuse, sexual assault, exposure to domestic violence and gangs, victimization by bullying and violence in schools and community settings, and witnessing violent crimes and death. They also include unintentional or circumstantial traumas such as sudden death of a parent or family member, automobile