Teenagers in jumpsuits lie on yoga mats, their eyes closed, their bodies still. This is the image Megan Hoxhalli describes as remarkable for juvenile detention—a place where youth arrive shaken, dysregulated, and scared about their future. As team lead of trauma-informed services for Lutheran Services in Iowa, she provides support for youth in Polk County Juvenile Detention and for the staff who work with the youth.
“We’re seeing a change in the way they feel and the way they think,” Hoxhalli says. “Hopefully, down the road, that will show in their behaviors.”
Her trauma-informed services role was created in October 2017 after several stakeholders in central Iowa recognized the impact of adverse childhood experiences (ACEs) on health and behaviors and were looking for a way to respond and reduce recidivism of court-involved youth.
Suzanne Mineck, president of Mid-Iowa Health Foundation, which provided funding for technical assistance on the project, says the initiative launched as partners dug deeper to understand why and how certain kids keep ending up in the judicial system.
“We are failing them if that’s where they land," says Mineck. "Our kids are tremendous human beings. If supported in the right way, if those people surrounding them have the right tools and resources, their lives can look different. They don’t have to keep going down the path they are headed.”
The Trauma-Informed Juvenile Detention initiative has focused on helping youth better understand how their past experiences can connect to their current feelings and behaviors. The program prepares them to regulate their actions in court and seek services after release.
Youth who have experienced the program describes its impact:
“I learned to go to my safe place.”
“I learned that being mad ain't the way.”
The transition to a trauma-informed detention system began several years ago when court judges, officers, government leaders, and staff heard about The ACE Study and the lifelong impact of trauma on future well-being.
“One phrase that stuck in the heads of all probation officers is: ‘Don’t ask what’s wrong with the kid. Ask what happened to them. It made sense with the behaviors kids are engaging in in spite of consequences and punishments.” -- Eric Kool, director of Polk County Community, Family, and Youth Services, the department that oversees detention
The Trauma-Informed Care Stakeholders Group in Des Moines wrote a white paper on how to address trauma in court and some judges began ordering trauma-informed care services for kids. But there was no clear definition of trauma-informed services and no model to follow nationally.
“Nobody was doing it, or they weren’t writing about it,” says Teresa Burke, director of Polk County Decategorization, which provided the funds from juvenile court services to implement the project.
A group formed to talk about what could be implemented with consistency, fidelity, and measurement. As part of that group, Burke approached Mid-Iowa Health Foundation to develop a request for proposals (RFP) for an organization to provide trauma-informed services in detention. Mineck, one of the founders of the Iowa ACEs 360 Coalition, was so intrigued that she visited detention to better understand the environment.
“The tour was gut-wrenching,” she says, “because you see that the kids in detention are my kids’ ages. How do you get there? How does that happen and who is loving them? Who is seeing them as this terrified 15-year-old?”
The foundation supported the RFP, as well as provided a grant for technical assistance to help the team in defining the new model. Lutheran Services in Iowa successfully bid to provide services and Chris Foreman, liaison with the National Center for Child Traumatic Stress, joined as a consultant.
The goal was to provide “trauma services” but the proposal was not prescriptive. The LSI team, led by Foreman and Hoxhalli, collaborated with stakeholders to identify steps and tools they could use in defining their approach.
“When kids come in, they are extremely traumatized,” says Burke. “They manifest that in different ways.”
A key challenge is how to work with youth who have experienced significant trauma when the average stay in detention is two weeks.
“I think at first we thought we were going to do therapy here. We realized this isn’t a place to do therapy. You don’t really want a kid getting into what’s happened to them, because then they go back and are locked in their room and thinking about it.” -- Megan Hoxhalli
“You have to manage psychological safety and well-being in the short-term,” says Foreman.
Instead, they landed on these approaches:
Intake assessments: Within 48 hours of entering detention, a therapist meets with the youth to help them calm down. In the session, the youth complete an assessment to understand what has happened to them and another assessment to determine how those experiences have affected them. Then staff introduce methods for coping and self-regulating.
Hoxhalli says the youth often enter crying and confused about how long they'll be in detention. "They have all these ideas," she says, "and probably the juvenile court officers have explained it to them, but what happens when you’re in crisis mode is that you don’t absorb what’s really going on.”
Helping to regulate emotions is especially important as youth prepare for court. Behaviors in the courtroom can influence where a judge sends them.
Group Sessions: Next, youth receive group-based education about trauma. They cover how trauma can lead to a fight or flight response when the brain senses danger, and how that response can lead to reactions. They practice strategies for coping with stress and regulating.
Hoxhalli says that teaching coping skills in a setting where youth cannot listen to music or go take a walk is especially difficult. She provides specific strategies to manage stress in their heads or in their room alone, and tools like stress balls.
Prior to taking a trauma-informed approach, stress balls weren't permitted in detention. Now, they're seen as a necessary support.
“I think in juvenile justice world, you have to be mindful that this is a criminal matter and a community safety issue. And it is a switch from that mindset to see these kids have been traumatized and a lot of them from a very specific kind of trauma.” -- Teresa Burke
Hoxhalli's team, with Foreman’s guidance, has educated detention staff and stakeholders on how to work with youth in a trauma-informed way. The goal is that everyone surrounding the kid has a shared understanding of the skills youth are learning and interacts with youth to support those skills and not retraumatize.
“We’ve seen staff notice kids’ behaviors that are trauma-related and respond to them differently,” Hoxhalli says.
Kool sees the value in this cross-sector collaboration and interaction between therapists and detention staff: “Staff’s number one priority is to have an environment where people are safe, but these are real child welfare professionals, and they are really interested in helping kids as well, so inherently compassion and mentoring go on.”
Building understanding among everyone in the system “creates this nest around these kids,” says Foreman. She has encouraged cross-sector collaboration to put new systems in place for trauma-informed care to last long-term. She wants to solidify a trauma-informed culture, especially as stakeholders or staff turn over. Hoxhalli hopes that over time, staff gain confidence to lead their own group trainings.
In addition to their direct supports, LSI provides the juvenile court more information about the youth. Judges now receive a two-page document outlining what the youth has been through, the coping skills they use, and what their triggers might be.
Establishing the model and beginning implementation took two years. The team also deeply considered how to evaluate the work.
The ultimate goal is to reduce recidivism, but with only about two weeks to work with youth, the team recognized that proving long-term impact would be difficult. Instead, they have focused on short-term indicators by measuring youth’s knowledge and use of calming strategies and their interest in seeking therapy and other services outside of detention.
“When you adopt a trauma lens, you want to teach everybody everything, but you can’t do everything and do it well. What are a few things you can do really well to have the kind of impact this project can have? Then, figure out how to make the cultural shift, so you are doing it sustainably.” -- Chris Foreman
Results have shown that many of the youth are using trauma-informed strategies, such as deep breathing meditation and a stress ball. Most youth also express that they are thinking of seeing a therapist or accessing services after detention, which is a huge shift in mindset for many who don’t want therapy when they enter detention.
“We’ve seen a lot more kids want to participate in therapy and think of therapy as something useful for them,” Hoxhalli says. Driving this shift is how therapists work with youth in detention. “I think with kids it’s that safety and that acceptance, and trust is so huge,” she says.
But getting therapy services right after detention can be a challenge. Hoxhalli has started to take on a limited caseload and some youth can get connected to services in school. But barriers with insurance, getting parental consent, and having enough services to meet the demand persist.
Kool especially recognizes that the progress youth have made in detention can fade when they re-enter activities and relationships with friends that compete for their attention.
“Trying to make rapid and quality transition is sometimes a challenge,” he says.
Overall, those in the system have worked hard to share what they are learning and to work together on implementing this model, even if the pace has taken several years, adding in the work with other responsibilities. The LSI contract can continue to be renewed annually, up to six years, with funding through DCAT.
“I really hope and think everyone is wanting to believe this is a different way to interact with kids in detention to increase health and well-being and increase community safety,” says Foreman. “And hopefully this is a cultural shift that lasts long after funding for this particular project.”
When the program first launched, Hoxhalli was nervous that the kids would resist the approach, but has seen youth embrace it. "It’s something they didn’t know they wanted or needed, but they have really taking it in and making changes," she says.
“I think kids appreciate the chance to talk about themselves, not as bad behaviors, but who they are and what has happened to them,” says Kool. “I think a lot of kids have made a breakthrough in understanding current behaviors are affected by things that have happened in the past and being cognizant of past and want to change it.”
Teenagers in jumpsuits lying on yoga mats, their eyes closed, their bodies still. This is the image Megan Hoxhalli describes as remarkable for juvenile detention, a place where youth arrive shaken, dysregulated, and scared about their future.