Trauma Treatment in Forensic Settings: Clinicians' Perspectives, Barriers to Effective Treatment, and Suggestions for Clinical Practice

Between 30% and 90% of the prison population is estimated to have survived traumatic experiences such as sexual, emotional, and physical abuse prior to incarceration (Anonymous, 1999; Fondacaro, Holt, & Powell, 1999; Messina & Grella, 2006; Pollard & Baker, 2000; Veysey, De Cou, & Prescott, 1998). Similarly, information from the Bureau of Justice Statistics (as reported in Warren, 2001) estimated that more than half of the women in state prisons have experienced past physical and sexual abuse. Thus, given the astonishing number of inmates who appear to be victims of some kind of trauma, it seems likely that those who work with these inmates (e.g., prison staff, guards, and treatment providers) will in some way encounter challenges related to the inmates' trauma history. These difficulties may appear in any number of forms including inmates' behavioral outbursts, increased emotionality, sensitivity to triggering situations, and chronic physical or mental health needs (Veysey, et al., 1998). It is also likely that these individuals with trauma histories would benefit greatly from treatment while incarcerated. This treatment could be utilized to minimize symptoms of posttraumatic stress, decrease behavioral problems, and help the inmate function more effectively in society when released from incarceration (Kokorowski & Freng, 2001; Tucker, Cosio, Meshreki, 2003). Few studies have explored the types of trauma treatment that are effective with inmate populations or made specific suggestions for clinicians working in forensic settings (Kokorowski & Freng, 2001). Essentially, there appears to be a large gap in terms of the need for trauma treatment for inmates and the lack of literature addressing what to do about it. However, clinicians across the country seem to be quietly attempting to fulfill this need for trauma treatment with incarcerated populations. They are providing this greatly needed treatment every day. in the face of enormous challenges and often without recognition or the opportunity to share their valuable work with the larger community.

Evidence-Based Practice in the Juvenile Justice System: Balancing Clinical Expertise with Best Available Research and Client Variables

Each year, thousands of adolescents are processed through the juvenile justice system -- a system that is complicated, expensive, and inadequately addressing the needs of the youth in its care. While there is extensive literature available in support of interventions for youthful offenders that are clinically superior to current care and more cost-effective than the existing structure, there is a gap between research and practice that is preventing their implementation. The use of Evidence-Based Practice in Psychology (EBPP) as defined by the American Psychological Association is presented as one method to bridge this gap. This paper identifies and discusses each of five barriers to effective use of EBPP: cost, fragmentation of the mental health system, historical and systemic variables, research methodology, and clinician variables. These barriers are first defined and then illustrated using examples from the author's experience working in the juvenile justice field. Finally, recommendations for the field are presented.