Trauma, Family, and Developmental Assessment and Interventions for Youth with Violent Behaviors

By Dr. Kathryn Seifert for the International Conference on Children and the Law 17-10 September, 2009

http://drkathyseifert.com http://thecare2.com drkathy2@cs.com

RISK FACTORS BY GENDER AND AGE US SAMPLE

Male 6 12 Years of Age (correlations >= .3 with more than 3 assaults) Assault Causes Injury/Death Three or less assaults History of severe behavior problems History of moderate behavior problems Assault authority figure Belief in aggression as legitimate means to end Assault using a weapon Delinquency Severe attachment disorder Lacks remorse for actions or empathy for others Bullying Behavior Chronic School Behavior problems

Female 6 12 Years of Age (correlations >= .3 with more than 3 assaults)

Three assaults or less Severe or chronic behavior problems Moderate behavior problems Assault causes injury/death Severe attachment disorder Lacks remorse or empathy for others Assault of authority figure Escape from custody Harms animals Delinquency Attachment problems Early neglect Very poor or extremely good, but superficial social skills Bullying behavior Emotions poorly regulated

Male Adolescent (correlations >= .3 with more than 3 assaults)

Assault Causes injury/death 3 or less assaults Assault using a weapon Assault of authority figure Delinquency Anger management problems Lacks remorse or empathy Belief in the legitimacy of aggression as a means to an end Favorable attitudes toward anti-social behavior

Female Adolescent (correlations >= .3 with more than 3 assaults)

Assault causes Injury/death Chronic or severe behavior problems Moderate behavior problems Delinquency 2 3 assaults Runaway behavior Chronic School behavior problems

Risk
Not all risk and resilience factors are created equal. Some are more strongly correlated with actual violent behaviors than others. The risk of future violent behavior increases as the number of risk factors increases and the number of resiliency factors decreases. Risk and resilience factors are different by gender and age.

International Understanding of Youth Risk for Violence

Several international projects have been discussed by the RISC team IAFMHS (International Association of Forensic Mental Health Services) I am in discussion with a professor in Iran for a large scale factor analysis of the CARE2

Interventions
Family problems Family Therapy, Wraparound models, family coaches, parent education Skill building Cognitive Behavioral approaches, Behavioral Objective Sequence, Behavioral Contracting, Skill Coaching, reinforcers at a ratio of 4:1 Complex PTSD Trauma therapy, emotional regulation, relaxation techniques, mindfulness. Coordination among all service providers for the family.

Resiliency
Increase pro-social activities Increase contact with pro-social peers Improve family functioning Press family members to seek treatment for problems involving mental health, substance abuse, delayed development of skills, or criminal activity Help families find housing in safe neighborhoods

Developmental Sequencing of Skills

BEHAVIOR OBJECTIVE SEQUENCE BY DR. SHELDON BRAATEN

BOS Domains
Adaptive Self-management Task Interpersonal Personal Communication

BOS
Children and adolescents who are at risk for violent behaviors are in the preschool levels of skill development. Programs must work with the youth at the appropriate developmental level and move them forward in sequence Expecting them to have high school skills when they have preschool skills is like asking them to speak Russian when they have never heard or studied that language.

BOS

Adaptive: Responds appropriately to routine and new expectations respond independently to materials for amusement appear alert and able to focus attention bring no weapons to school use amusement materials appropriately wait for turn without physical intervention use and return equipment without abuse accept positive physical contact touch others in appropriate ways refrain from stealing respond when angry without hitting recognize and show regard for possessions accept verbal cue for removal from a situation respond when angry without abuse of property respond appropriately to substitute respond when angry without threats walk to timeout without being moved by an adult work or play without disrupting others refrain from inappropriate behavior when others lose control respond to provocation with self-control respond when angry with self-removal

The Care 2 (Seifert, 2008): http://thecare2.com

Does not have international norms, although we are in early negotiations for 2 international studies. Does break out risk and resiliency by age and gender Does have suggestions for interventions that are evidence based practice. Is available for research

Conclusion
Identify Youth at risk as early as possible, so services can begin Treat the whole family, not just the child Identify risk and resiliency factors by age and gender Intervene based on risk and resiliency factors Understand risk and resiliency from an individual, family, gender, age, and developmental perspective. Coordinate efforts with all service providers involved with the family Evaluate and treat all areas that may contribute to risk and resiliency Strengthen skills using developmentally appropriate sequences.