Finally, we must call for investment in community safety models that extend beyond police involvement, shifting our approach from punitive to therapeutic. At the systems level, we can advocate for policies that incentivize trauma-informed crisis management training for all staff involved in education, child welfare, and other systems that interface with youth. ![]() ![]() 7 In addition, we can collaborate with school nurses, social workers, and other colleagues 3 to shift from suspensions, expulsions, and policing in schools to more restorative and individualized approaches focused on health and wellness. At the community level, we should advocate for a trauma-informed approach, including standardized, holistic trauma screening to identify children who would benefit from referrals to mental and behavioral health services or evidence-based trauma treatment. We can also cultivate more supportive environments by equipping families with the education and skills necessary to respond to traumatic stress crises with patience and empathy rather than judgment. We should empower youth with the knowledge that their reactions to trauma are normal responses to abnormal experiences while encouraging them to take an active role in symptom management. At the individual level, we should identify our own biases that may perpetuate pathologizing and discriminatory practices toward youth who have experienced trauma. Thus, a multifaceted approach is needed to educate and support youth, their caregivers, and the systems that support them.Īs health care providers, we must use an ecological approach to understand and dismantle the trauma-to-prison pipeline ( Fig 1). 7 Particularly for those who identify as Black, Indigenous, or people of color youth who are lesbian, gay, bisexual, transgender, and queer and youth with disabilities who are disproportionately institutionalized, 4 continually disciplining or medicating behaviors without therapeutically addressing underlying traumatic stress can perpetuate cycles of abuse, trauma, and incarceration. In addition, a limited understanding of trauma symptomology, paired with difficulties with record keeping, may lead to misdiagnosis or greater attempts to control behavior through psychotropic medications, which may be less effective in facilitating long-term resolution of trauma compared with other evidence-based therapies. Because caregivers in foster families and congregate settings (eg, group homes) may be less familiar with children’s unique trauma manifestations, they may be more likely to use harsher disciplinary tactics, including calls for police involvement. In addition to the maltreatment precipitating their entry into foster care, the system itself can be traumatic (eg, removal from their homes, placement instability, minimal social supports, and risk of further abuse), leading to complex behavioral needs that are difficult to address without caregiver education and support. 6 Children within this system face complex and cumulative trauma, much of which precedes initial removal from the home. This pushes children with trauma histories, who might benefit from additional educational and counseling services, away from educational environments and into carceral systems that do not adequately address their underlying needs.Ī second pathway is the foster care–to-prison pipeline, 4, 5 in which more than half of youth in foster care experience an arrest, conviction, or overnight stay in a correctional facility by age 17. The school setting itself, in which youth lack control over many aspects of their day, can exacerbate previous traumas, particularly when signs of traumatic stress crises are not recognized by adults. 3 As described above, children with unaddressed trauma are more likely to be perceived as disruptive, particularly in situations in which stress is triggered. This places children, particularly Black, Indigenous, and people of color, through discriminatory application of these policies, at a greater risk for poor educational and health outcomes. ![]() 3 Zero tolerance policies can result in suspension, expulsion, police investigation, or arrest. ![]() Disciplinary “zero tolerance” policies were initially introduced to the school system in the 1990s to address violence but were subsequently expanded to address other behavioral problems. The first pathway is the school-to-prison pipeline: policies and practices that increase the likelihood of a child becoming disengaged from school and involved in carceral systems.
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