Exposure to adverse childhood experiences (ACEs), such as poverty or abuse, is a known risk factor involvement in the justice system.
And, involvement in the justice system may be an indicator of toxic stress.
Thus, the justice system plays an important role in preventing the effects of ACEs and toxic stress.
That’s why, in December 2020, Dr. Nadine Burke Harris released her Roadmap for Resilience: The California Surgeon General’s Report on Adverse Childhood Experiences, Toxic Stress, and Health.
Salud America! is exploring the report as part of its 11-part series on toxic stress.
“Factors that underlie connections between victimization or trauma and later criminal justice involvement provide a window into areas for primary and secondary intervention strategies—reducing exposure to adversity and identifying those individuals with risk factors,” Burke Harris’ report states.
Why Those Working in the Justice System Need to Know About ACEs and Toxic Stress
The body reacts to stress through a complex process of involuntary biological, physiological, and behavioral responses.
Regardless of a person’s perception of or outward reaction to stress, their stress response system can be activated, and the amygdala, hypothalamus, pituitary gland, and adrenal glands can pump stress hormones without one’s awareness.
This becomes problematic in childhood if the stress response is activated too frequently or too intensely by adverse childhood experiences (ACEs) such as abuse, parental substance abuse, poverty, and racism.
Without the buffering protection of supportive relationships to help the biological stress response recover and regulate, it becomes dysregulated and disrupts development and functioning of the brain and other organ systems.
This is known as the toxic stress response, and it can cause lifelong physical, mental, and behavioral health problems.
Latino, Black, and other marginalized populations, have a higher prevalence of ACEs and more likely to be burdened by the harmful health and social impacts of toxic stress.
They are also more likely to face disciplinary action, arrest, and incarceration.
“The same populations that are disproportionately impacted by ACEs also are more likely to interact with the justice system,” Burke Harris’ report states. “Social and structural inequities disproportionately concentrate ACEs, toxic stress, their precursors, and their consequences in racially, socially, and economically marginalized communities.”
Similarly, groups who are high school nongraduates, uninsured or underinsured, in lower income brackets, and/or identify as lesbian, gay, bisexual, or transgender have a higher prevalence of ACEs and worse outcomes. They are more likely to be referred to the justice system, as well.
Additionally, “encounters with law enforcement and the justice system are intrinsically stressful and potentially traumatic,” Burke Harris’ roadmap states.
To truly prevent the effects of ACEs and toxic stress, the justice system has to play a big role.
Below are primary prevention, early detection, and early intervention strategies for justice systems to address ACEs and toxic stress among Latino and all people.
Primary Prevention Strategies in Justice Systems
Primary prevention includes efforts that target healthy individuals and aim to prevent harmful exposures and behaviors from ever occurring.
For justice systems, this means reducing cumulative adversity and preventing entry into the justice system.
Strategies to reduce cumulative adversity and prevent entry into the justice system should promote youth well-being, such as:
- Ensuring youth access to counselors and preventive healthcare
- Improving school connectedness and community sources of resilience
- Building youth leadership skills to advocate for services they believe are necessary
- Reducing the school-to-prison pipeline
- System-level policy changes to limit zero-tolerance policies and prevent children from entering adult criminal courts
- Increasing police accountability
In Virginia, for example, courts are required to consider a juvenile’s exposure to ACEs when sentencing a juvenile as an adult. This is known as trauma-informed sentencing.
Other trauma-informed justice practices include de-escalation techniques, restorative justice strategies, and allowing juveniles and adults to receive restorative care.
In addition to promoting youth well-being, strategies should also promote justice-sector employee well-being, such as providing staff with sufficient training before and after potentially traumatic experiences and increasing access to counselors and preventive healthcare.
Many justice-sector workers, like police officers, social workers, and probation officers have high levels of stress in their jobs and experience burnout at very high rates.
Additionally, many of these people have their own ACEs.
“One in nine report suicidal ideation (compared to one in 33 in the general population), and 27% of correctional officers have PTSD symptoms (compared to 6% of the general population),” Burke Harris’ report states.
Early Detection Strategies in Justice Systems
Early detection aims to identify risk factors and build protective factors for individuals with a history of ACEs who end up involved in the justice system.
This begins with trauma-informed training for all criminal justice professionals to identify and respond to those individuals in a way that mitigates stress and trauma and prevents re-traumatization.
“One aspect of toxic stress physiology that is of particular relevance to the justice system is the notion of stress sensitization,” Burk Harris’ roadmap states. “Individuals with a dysregulated stress response may be more sensitive to subsequent stressors in terms of risk of manifesting the neuro-endocrine-immune-metabolic consequences of cumulative adversity.”
This can lead to health problems, such as stroke, diabetes, and depression, as well as behavioral problems, such compromised impulse control and emotional dysregulation, which may lead to greater conflict.
In addition to trauma-informed training for employees, this also calls for trauma-informed practices.
“Trauma-informed practice in the justice sector relies on the integration of a deep understanding of the consequences of trauma and toxic stress into all interventions, services, and organizational structure and functioning,” Buke Harris roadmap states.
Exposure to the justice system can contribute to cumulative adversity itself as well as through incarceration, removal of youth and adults from communities, and disconnection from support systems.
“Cumulative adversity is also associated with poorer educational and social outcomes, including learning, developmental, and behavior problems, high school noncompletion, unemployment, low life satisfaction, and poverty—many of which increase risk of incarceration and also serve to transmit adversity to the next generation,” Burke Harris’ report states.
Thus, strategies should focus on preventing further exposure to the justice system.
For individuals who commit non-violent offenses, strategies include various alternatives to traditional justice proceedings, such as:
- Restorative justice is an alternative that emphasizes repairing the harms caused by a crime and often involves victim-offender mediation.
- Neighborhood Courts are an alternative to traditional criminal court proceedings for misdemeanor cases where volunteers hear from both the offender and the victim to discuss the case and its impact on the community.
- Drug courts and mental health courts are alternatives that connect individuals to needed services.
- Pretrial diversion programs are alternatives where charging attorneys refer individuals to job training, mental health services, parenting support, intensive case management, and education opportunities.
- Alternative sentencing options, such as home monitoring, drug courts, and mental health courts that connect individuals to needed services.
The Back on Track program, which is a 12-to-18 month pretrial diversion program, “had less than 10% reoffending rate over two years, compared to a rate of 53% among those who did not take part in the program,” Burke Harris’ roadmap states.
Early Intervention Strategies in Justice Systems
Early intervention includes efforts that target people already under the care of the justice system who have ACEs or toxic stress to encourage rehabilitation and recovery and to reduce the magnitude of negative downstream outcomes when they re-enter society.
Screening for ACEs and other adversity help identify physical and mental health needs as well as other needs, such as housing and family reunification, and help link justice-involved individuals to programs.
It is important that programs are comprehensive to address various medical, educational, occupational, and psychosocial needs.
Programs should also support restorative justice principles, healing from trauma, educational opportunities, vocational opportunities, and transition programming.
“Interventions such as multisystemic therapy, cognitive-behavioral therapy, and family-based therapies, such as functional family therapy, have succeeded in improving mental and behavioral health in justice-involved individuals and also in reducing rates of recidivism,” Burke Harris’s report states.
Additional strategies include:
- Providing preventative and treatment-oriented physical and mental healthcare for justice-involved or incarcerated individuals
- Providing trauma-informed assessment and care in justice services
- Re-entry programs that support restorative justice principles, healing from trauma, educational opportunities, vocational opportunities, and transition programming
- Establishing data systems that function across sectors are necessary to track referrals and services, facilitate follow-up to ensure that each individual receives the necessary care, and assess outcomes
- Collaborating between the justice system, the health system, the child welfare and other social service systems, the educational system, and community resources
“Providing proper preventive and treatment-oriented physical and mental health care while an individual is justice-involved or incarcerated results in lower rates of delinquency and recidivism, higher employment, better social functioning, and other positive outcomes,” Burke Harris’ roadmap states.
What Can We Do About Toxic Stress?
Share our Salud America! team’s 11-part exploration into the important recommendations in Dr. Nadine Burke Harris’ roadmap to address ACEs and toxic stress:
Toxic Stress and its Lifelong Health Consequences. Toxic stress is a public health crisis that has lifelong impacts on physical, mental, and behavioral health.
We Need to Recognize Toxic Stress as a Health Condition with Clinical Implications. Health experts are pushing to elevate toxic stress and developmental trauma on national research and policy agendas.
Cut Toxic Stress with 3 Types of Public Health Prevention Interventions. Preventing toxic stress requires a three-level public health intervention approach.
How to Use Healthcare Strategies to Address Toxic Stress. In clinics, hospitals, and other healthcare settings, workers can provide universal trauma-informed care and more.
Using Public Health Strategies to Address Toxic Stress. When it comes to ACEs and resulting toxic stress, the public health sector can play a critical role by strengthening economic support, positive family relationships, and social services.
How to Use Social Service Strategies to Address Toxic Stress. We need trauma-informed training for social workers, as well as family-friendly workplaces and home visits.
Toxic Stress in Early Childhood and How to Prevent It. Early childhood is a key time for preventing ACEs and toxic stress.
Toxic Stress in the Justice System and How to Prevent It. Encounters with police are “intrinsically stressful and potentially traumatic,” especially for youth of color. (current article)
Toxic Stress in Education and How to Address It. ACEs and toxic stress can hinder a person’s learning and school success. (coming Feb. 25, 2021)
California’s Epic Response to Toxic Stress and ACEs. California, already leading the nation in addressing ACEs, is making inroads to address toxic stress. (coming March 1, 2021)
Let’s Make 2011 the Year of Health Toxic Stress. Here are ways you can take action to address toxic stress. (coming March 4, 2021)
“Minimizing encounters with the justice system and ensuring the least restrictive environment promotes the most positive outcomes for both youth and adult offenders,” Burke Harris’ roadmap states.
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