Adjudicated clients

Today, I look at several articles dealing with people involved in the legal system. First, van der Ploeg, Rameckers & van Emmerik (2024) published “The Efficacy of Psychological Interventions for Posttraumatic Stress Disorder Symptoms in Incarcerated Forensic Populations: A meta-analysis of randomized controlled trials” in Psychological Trauma: Theory, Research, Practice, and Policy. Here are the edited abstract and impact statement:

Given the high prevalence of posttraumatic stress disorder (PTSD) symptoms in incarcerated forensic populations, this meta-analysis estimated the efficacy of interventions in this field and explored predictors of intervention outcomes. Twelve randomized controlled trials of psychological interventions for PTSD symptoms in incarcerated forensic populations were included. A combined Hedges’s g effect size was synthesized, quality assessments and risk of bias analyses were performed, and publication bias was assessed. Gender and type of control group were explored as predictors. Thirteen comparisons from 12 studies were included in the main analysis. A small to medium combined effect size (g = 0.43, p = .005) was found at posttreatment. The type of control group (p = .156) and gender (p = .953) did not predict outcomes. When we analyzed the available follow-up data (k = 5), the effect was nonsignificant (g = 0.36, p = .123). Study quality was poor and risk of bias high, and studies of first-line PTSD treatments were not found in the literature. A few studies suggest that PTSD treatment may improve symptoms in incarcerated forensic populations, at least temporarily. Follow-up data are still too scarce to draw conclusions about long-term outcomes. Findings of this study indicate that methodologically rigorous outcome research in these populations is needed, with a specific focus on first-line PTSD treatments, long-term efficacy, measurement of recidivism, as well as addressing comorbid conditions given the common complex clinical and social needs in this population. 

While incarcerated forensic populations appear to have high rates of untreated posttraumatic stress disorder, problematic substance use, and other comorbid complaints, the outcomes of treating these issues in forensic populations have been greatly understudied. If these issues are treated, it may have a significant positive impact on incarceration and postincarceration functioning, as well as criminal recidivism. Further research is needed to determine these relationships. 

While the conclusion is not surprising, what I find most notable is that untreated PTSD, substance abuse and comorbid mental health conditions are predictors of recidivism. We clearly need more research. The next study looks at judges. McKinsey et al. (2024) published “Judges’ Attitudes and Experiences Related to a Trauma-Informed Approach: An exploratory study” in Psychological Trauma: Theory, Research, Practice, and Policy. The edited abstract and impact statement follow:

Understanding judges’ views is crucial to the successful adoption of a trauma-informed (TI) approach in the U.S. court system, yet little is known on this topic. We explored judges’ attitudes of and experiences with TI practice to help fill this gap. We surveyed 91 North Carolina district court judges, assessing their attitudes related to TI practice, use of trauma-informed practices (TIPs), previous trauma education, and support for different justice goals. We conducted independent-samples t tests and Poisson regression analyses to compare attitudes, use of TIPs, and education experiences between judges working in juvenile justice and those not in juvenile justice; descriptive statistics to examine rates of engagement with different TIPs; and bivariate correlation analyses to assess associations between TI practice outcomes and justice goals. Analyses revealed more favorable attitudes toward a TI approach and greater engagement with trauma education among judges working in juvenile versus adult courts; TIPs with the lowest levels of engagement related to policies and procedures; and strong positive correlations between favorable TI practice attitudes and support for rehabilitation and restoration. Findings highlight areas for growth in the movement to create more TI courts, such as strengthening support for TI practice in the adult criminal system and implementing TIPs related to policies, procedures, and outcomes, not just communication. Findings also support the connection between a TI approach and less punitive justice practices, signaling the potential role that TI judicial practice can play in shifting our legal system toward more transformative forms of justice. 

Judges’ support of a trauma-informed (TI) approach is crucial to realizing a judicial system that takes court-involved people’s trauma into account, does not retraumatize them, and connects them to services that can promote healing and growth. We found a greater commitment to TI practice among judges working in juvenile justice compared to those in adult criminal court and low engagement with various practices related to policies and procedures. Policymakers, educators, and judicial leadership can use findings to enhance trauma education programming and address systemic barriers that hinder the comprehensive implementation of TI practice.

I liked this one because it acknowledges the trauma many people bring into the justice system and illustrates the value of trauma-informed practices. While it’s reassuring that more juvenile court judges believe in such practices, the fact that few adult court judges use them is disturbing, especially when many teens are being adjudicated as adults despite their immaturity. It’s no surprise that judges who use trauma-informed practices more likely believe in restoration and rehabilitation. The next study looks at ethnically diverse youth. Lampe, Mulder & Vermeiren (2023) published “Ethnic Differences in Assessment: How self-report and observation converge and diverge among ethnically diverse incarcerated youths” Journal of Threat Assessment and Management.  Again, the edited abstract and impact statement follow:

While structured observation and self-report (SR) are of great value for risk assessment in forensic youth psychiatry, a number of conclusory variances should be taken into consideration as it pertains to cultural sensitivities. This study therefore researches data collected by self-report using standardized questionnaires, and by an observation checklist (OC) in an ethnically diverse population of incarcerated youths. Our sample consisted of 228 male incarcerated juveniles, with the identifiable majority (30.2%) of Moroccan origin, 11.2% of Dutch origin, 11.2% of Surinamese origin, 9.1% with a Netherlands Antilles origin, and 8.2% of Turkish origin. Adolescents from other origins or whose ethnicity data was missing, constituted 30.1% of the final sample. First, scores on each self-report subscale and OC concept were analyzed for differences between ethnic origins. Second, OC concepts were matched to relevant self-report scales, for example, proactive aggression of the OC to proactive aggression of the Reactive Proactive Aggression Questionnaire. Finally, convergence and divergence between the two matched concepts was analyzed. Large differences were found for the separate methods, and the divergence and convergence between the two methods. Most prominently was the very different scoring profile between youths of Dutch and Moroccan origin, with the latter self-reporting fewer problems than youths of Dutch origin, while more problems were observed. Possible explanations, such as (racial or ethnic) bias in observing, lack of cross-cultural validation for self-report, or biases such as shame, fear of judicial consequences are discussed. 

Ethnic differences impact self-report and cultural biases impact observation. This strongly urges practitioners and researchers to use a multimethod approach in risk assessment, which is more culturally sensitive, while being highly sensitive during observation to avoid biases impacting results and outcomes.

While the ethnic diversity examined here is different from that found in a typical US court system, what’s important here is the unreliability of self-report. A multimethod approach is always wise but may make a huge difference when, as with the Moroccan youth cited here, they report fewer problems despite more observed problems. Each of these studies illustrates the challenges of doing forensic work and the importance of doing it better.