The Childhood to Prison Pipeline: Early Childhood Trauma as Reported by a Prison Population

Abstract

This study explored the degree and type of childhood trauma experienced before the age of 18 years reported by prison inmates. The Adverse Childhood Experiences (ACE) instrument was administered to 328 incarcerated and/or recently released individuals. Participants included women, males convicted of sex offenses, and males convicted of low-risk crimes. The majority of respondents reported levels of childhood trauma substantially above that reported in the general population. Women and males convicted of sex offenses reported the highest degree of trauma. The discussion addresses how rehabilitation counselors can collaborate with others in the counseling profession for earlier identification of individuals who may be experiencing or have experienced childhood trauma and promote better trauma-informed transition services to postsecondary education and employment and reduce levels of incarceration.

Keywords

psychiatric disabilities adolescents collaboration forensic rehabilitation trauma

The Substance Abuse and Mental Health Services Administration (SAMHSA) defines trauma as

an event, series of events, or set of circumstances that is experienced by an individual as physically or emotionally harmful or life threatening and that has lasting adverse effects on the individual’s functioning and mental, physical, social, emotional, or spiritual well-being. (p. 7)

According to the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5; American Psychiatric Association, 2013), the trauma can be experienced directly by the person, witnessed directly by the person, or learned about by the person (DSM-5) and can involve actual or imagined events (Briere & Scott, 2014).

The Centers for Disease Control and Prevention (CDC) contracted with Kaiser Permanente to investigate the existence and prevalence of traumatic experiences by children, resulting in development of the Adverse Childhood Experiences (ACE) Survey (Felitti et al., 1998). The ACE became a resource for further research on the physical and psychiatric effects of childhood trauma on adults. From the original and subsequent research, the “ACE Pyramid” described the developmental impact of childhood trauma, including disrupted neurodevelopment; social, emotional, and cognitive impairment; adoption of health-risk behaviors such as substance abuse; disease; disability; socialization problems; early death; and epigenetic (changes in one’s genetic makeup due to environmental factors affecting gene mutation) changes that could be passed genetically to future generations (https://acestoohigh.com/got-your-ace-score/). The ACE is part of the CDC’s Behavioral Risk Factor Surveillance System, which is an annual survey used to track the health conditions and risk factors of adults since 2009. Thirty-two states and the District of Columbia use the ACE to correlate early childhood trauma with both high-risk behavior and health status. The CDC reports over 4,000 journal articles published regarding the instrument since its initial development.

At its heart, trauma expresses itself through the biological “trauma default network” (Bluhm et al., 2009; Wang et al., 2012). This network connects the nervous, endocrine, cardiovascular, gastrointestinal, and immune systems and shapes attachment, mental and physical illness, and executive functions. This network, therefore, has the potential to increase disability and result in a dramatic and lasting impairment of all aspects of people’s lives, which for some leads to incarceration. At the center of these impairments is the impact on neurodevelopment. According to Miller and Maner (2011) and Schaller and Park (2011) trauma affected the composition of a person’s gut microbiome (the composition of bacteria in the gut that facilitates digestion, but also senses and radiates one’s identity through the sense of smell), which is a key component of their behavioral immune system that senses threat in their surroundings. The behavioral immune system senses a “sick other,” a person who triggers a neuro-immune response to threat that is both affective (disgust) and behavioral (avoid/attack). Also part of the gut microbiome is the composition of neurotransmitters such as serotonin, which, in humans, contributes to the “shame/freeze response” found in the depersonalization, derealization, and dissociation aspects of the trauma response (Porges, 2011; van der Kolk, 2015).

Perceptually, the reticular activating system is a part of this trauma default network that processes external stimuli and activates the neurocognitive trauma default network (Bluhm et al., 2009). Two central elements of this trauma default network are the amygdala and the hypothalamus–pituitary–adrenal axis (HPA axis). The amygdala processes immediate affective responses to perceived stimuli regarding emotions, survival, and stored contextual (affective) memories related to events. The HPA directs the endocrine system to stimulate an overall sensory–motor response that includes folding (going limp), freezing (going rigid), fighting (establishing dominance), or fleeing (escaping to a safe place). Stored contextual memories trigger this automatic response to any new event or stimuli that are perceived as connected to the initial trauma (Levine, 2010, 2015); In essence, untreated traumas trigger intentional responses in search of a stimulus, resulting in repeated posttraumatic stress responses because the body expects to be traumatized (Marusak, Martin, Etkin, & Thomason, 2015).

Trauma also alters the genetic profile of individuals that affects their lives and the lives of their descendants through epigenetic gene expression on promoter genes that tell expresser genes when to activate or deactivate, and on telomeres that protect chromosomes from decomposition (Labonte et al., 2012). A grandparent’s trauma can be expressed in what could be posttraumatic stress responses to events not personally experienced by a grandchild. Understanding how childhood trauma is displayed in adults offers a better way to understand and treat adult behavioral disorders. It potentially can offer a way to better understand the psychotic spectrum (Szentagotai-Tatar, & Miu, 2016; Yen et al., 2002), intergenerational violence (Craig & Sprang, 2007; Langhinrichsen-Rohling, 2005), childhood bullying (Wolke, Copeland, Angold, & Costello, 2013), and criminal behavior (Salmond et al., 2011; Veer et al., 2015).

Research also can offer ways to understand the intersectionality of trauma as it relates to issues such as self-appraisal, resilience and social marginalization (Brown, 2014), and involuntary subordination (Sturman, 2011). In cases of significant untreated trauma, the psychological and social toll childhood trauma exacts on a person may grow exponentially as they age through the “ACE Pyramid” facing possible dysfunctional relationships, physical and mental illness and disability, school failure, social exclusion, poverty, and early death. Too narrow diagnoses may ignore the need for early and comprehensive medical, psychological, educational, and social interventions. The concern is a possible “trauma to prison pipeline” that may contribute to the number of people imprisoned for crimes resulting from childhood experiences that were left untreated.

Trauma-related disorders also may affect the development of executive functions necessary for academic, social, and employment success (Sum, Khatiwada, McLaughlin, & Palma, 2009; Zou et al., 2013). This may affect transition from K–12 to postsecondary education and satisfying careers. School and rehabilitation counselors who are coordinating transitions need to know how to provide trauma-informed services that address both past traumas and the possible retraumatization that may occur through the transition process. Postsecondary programs need to provide appropriate and accommodating trauma-informed education so students receive the assistance needed to address all aspects of the trauma default network including academic, mental health, medical, and social supports.

The impact of brain development has also garnered a great deal of attention within the juvenile justice system. There is a growing body of medical research demonstrating and case law acknowledging that brain development is something that continues through young adulthood. This is causing judicial systems to rethink how they treat youth who commit crimes and who they define as youth (Massachusetts General Hospital Center for Law, Brain, & Behavior).

Specifically, the prefrontal cortex, which assists with regulating behavior does not reach maturity until an individual is in their early 20s (Cohen & Casey, 2014). As one of the areas of the brain along with the amygdala and hippocampus that are part of the stress response (Cohen & Casey) their delayed development as a result of childhood trauma could have even more significant implications for the criminal justice system.

This study examined three research questions.

Research Question 1: What is the level of childhood trauma in a prison population?

Research Question 2: Are there differences in the types of trauma between genders and inmates with different offenses?

Research Question 3: are there differences in the levels of trauma experienced between inmates with different offenses?

Method

Participants

Participants for this study were 328 individuals involved with the criminal justice system. Two prisons were asked to participate. One prison held only women and the other prison had two facilities, one that held male low-risk nonviolent offenders and one that held male sex offenders. Of these, 163 were females immediately after their release from prison, 77 were males currently incarcerated for sex offenses, and 88 were males currently incarcerated for low-risk nonviolent offenses. As a way to ensure confidentiality, no other identifying information was received from research respondents regarding individual identities or offenses.

Instrumentation

The instrument used to assess childhood trauma was the ACE Survey (Felitti et al., 1998). This survey was developed jointly by the CDC and the Kaiser Permanente Preventive Medicine Department to collect nationwide data on the incidence and prevalence of childhood trauma experienced up to the age of 18 years. The instrument includes 10 items asking questions regarding different types of trauma. Three types of childhood trauma were assessed: abuse (physical, sexual, and psychological), neglect (emotional and physical), and household dysfunction (substance abuse, divorce, mental illness, battered mother, and criminal behavior). Felitti et al. (1998) reported high validity and reliability for their study of 13,494 members of a large health maintenance organization. Strong reliability of retrospective reports of ACEs also was reported among specific populations (Dube, Williamson, & Thompson, 2004; Pinto, Correia, & Maia, 2014). The instrument has been validated in numerous settings and with different subjects since its introduction as recorded by the CDC (https://www.cdc.gov) and subsequent research sponsored by that agency.

Childhood trauma is defined by the ACE as indicating four or more “yes” responses. The CDC reported that 84.80% of females and 90.80% of males nationally reported three or fewer experiences indicative of childhood trauma. According to the CDC, this level of trauma (< four yes responses) does not predict later physical, psychological, or social deficits. Any person reporting four or more yes responses is considered to be at-risk of the disorders outlined on the ACE pyramid.

Procedure

We developed a plan for conducting the research and presented it to participating organizations and agencies. After their review, the proposal was submitted to institutional review board (IRB) for approval. The agency-serving women leaving prison administered the ACE as part of their half-way house entry and sent us only the scores with no other identifying information. Each potential participant was given a review of their rights and asked by agency staff whether they were willing to have their scores sent anonymously to and aggregated by the researchers. Only scores from consenting participants were sent to be part of this study.

The participating prisons for men established dates for us to go to the prisons and administer the ACE to participants who were currently incarcerated. In all cases, potential participants were read their rights as voluntary participants and allowed to join the study only after they gave approval. The ACE was administered in large classrooms and participants gave their informed consent before entering the room. If a participant began completing the survey and chose not to continue their assessment, they returned blank copies so nobody knew who did and did not choose to complete the survey. Staff in the prisons informed all inmates who came for the study, whether they completed the survey or not, that follow-up counseling would be offered to individuals wishing to discuss reactions to the study.

Results

The study allowed us to compare convicted females and males with the national studies. The study also allowed us to compare females, males incarcerated for sexual offenses, and males incarcerated with low-risk offenses such as substance abuse, burglary, robbery, and similar nonviolent crimes.

Research Question 1 (What Is the Level of Childhood Trauma in a Prison Population?)

To address this question, we examined the percent of participants who reported four or more different types of trauma as children. In this study 65.65% of female, 64.39% of sex offender, and 42.7% of low-risk prisoners reported four or more traumatic experiences. This is substantially higher than the 15.2% of female and 9.2% of male national normative respondents (Felitti et al., 1998). Beyond that, 13.5% of females, 4.11% of sex offender, and 3.37% of low-risk prisoners reported nine or 10 of the possible 10 traumatic experiences, something that has not been reported for the general population.

Correlations across items were analyzed for each population to further address Research Question 1. This demonstrated that many items correlated significantly with other types of reported trauma. Table 1 reports correlations for female offenders. Of the 10 items on the ACE, one item correlated significantly with all but seven items (Item 6, mother or stepmother abused) and one item (Item 10, family member incarcerated) correlated significantly with all but one other item. Regarding male sex offenders, Table 2 demonstrates a similar pattern to that of females but fewer significant correlations across items. Seven items correlated significantly with six or seven items. The correlations of items for low-risk offenders shown in Table 3 demonstrates a pattern somewhat similar to that of the other two groups. Although this group reported fewer traumatic experiences, one can see similarities in item correlations. Seven items correlated significantly with six to eight items. These findings suggest that the level of childhood trauma includes both the relationship between affirmative responses to items on the ACE, and the cumulative number of affirmative responses.

Table 1.

Female Offender Correlations.

	Q1	Q2	Q3	Q4	Q5	Q6	Q7	Q8	Q9	Q10
Q1: Emotional abuse
Pearson correlation	1	.832^**	.487^**	.444^**	.308^**	.270^**	.396^**	.244^**	.330^**	.140
Significance (two-tailed)		0.000	0.000	0.000	0.000	0.000	0.000	0.002	0.000	0.075
N	163	163	163	163	163	163	163	163	163	163
Q2: Physical abuse
Pearson correlation	.832^**	1	.534^**	.522^**	.284^**	.256^**	.372^**	.229^**	.383^**	.154
Significance (two-tailed)	0.000		0.000	0.000	0.000	0.001	0.000	0.003	0.000	0.050
N	163	163	163	163	163	163	163	163	163	163
Q3: Sexual abuse
Pearson correlation	.487^**	.534^**	1	.448^**	.367^**	.176^*	.347^**	.308^**	.358^**	.048
Significance (two-tailed)	0.000	0.000		0.000	0.000	0.024	0.000	0.000	0.000	0.539
N	163	163	163	163	163	163	163	163	163	163
Q4: Emotional neglect
Pearson correlation	.444^**	.522^**	.448^**	1	.357^**	.271^**	.399^**	.377^**	.334^**	.059
Significance (two-tailed)	0.000	0.000	0.000		0.000	0.000	0.000	0.000	0.000	0.453
N	163	163	163	163	163	163	163	163	163	163
Q5: Physical neglect
Pearson correlation	.308^**	.284^**	.367^**	.357^**	1	.269^**	.487^**	.298^**	.226^**	.137
Significance (two-tailed)	0.000	0.000	0.000	0.000		0.001	0.000	0.000	0.004	0.082
N	163	163	163	163	163	163	163	163	163	163
Q6: Divorce/separation
Pearson correlation	.270^**	.256^**	.176^*	.271^**	.269^**	1	.353^**	.344^**	0.117	.121
Significance (two-tailed)	0.000	0.001	0.024	0.000	0.001		0.000	0.000	0.136	0.123
N	163	163	163	163	163	163	163	163	163	163
Q7: Mother abused
Pearson correlation	.396^**	.372^**	.347^**	.399^**	.487^**	.353^**	1	.407^**	.371^**	.258^**
Significance (two-tailed)	0.000	0.000	0.000	0.000	0.000	0.000		0.000	0.000	0.001
N	163	163	163	163	163	163	163	163	163	163
Q8: Substance abuse
Pearson correlation	.244^**	.229^**	.308^**	.377^**	.298^**	.344^**	.407^**	1	.225^**	.206^**
Significance (two-tailed)	0.002	0.003	0.000	0.000	0.000	0.000	0.000		0.004	0.008
N	163	163	163	163	163	163	163	163	163	163
Q9: Mental illness
Pearson correlation	.330^**	.383^**	.358^**	.334^**	.226^**	0.117	.371^**	.225^**	1	.168^*
Significance (two-tailed)	0.000	0.000	0.000	0.000	0.004	0.136	0.000	0.004		0.032
N	163	163	163	163	163	163	163	163	163	163
Q10: Incarceration
Pearson correlation	.140	.154	.048	.059	.137	.121	.258^**	.206^**	.168^*	1
Significance (two-tailed)	0.075	0.050	0.539	0.453	0.082	0.123	0.001	0.008	0.032
N	163	163	163	163	163	163	163	163	163	163

Correlation is significant at the .05 level (two-tailed).

Correlation is significant at the 0.01 level (two-tailed).

Table 2.

Male Sex Offender Correlations.

	Q1	Q2	Q3	Q4	Q5	Q6	Q7	Q8	Q9	Q10
Q1: Emotional abuse
Pearson correlation	1	.710^**	.347^**	.519^**	.161	.388^**	.542^**	.388^**	.294^**	.074
Significance (two-tailed)		0.000	0.002	0.000	0.162	0.000	0.000	0.000	0.009	0.522
N	77	77	77	77	77	77	77	77	77	77
Q2: Physical abuse
Pearson correlation	.710^**	1	.273^*	.338^**	0.154	.299^**	.469^**	.410^**	.273^*	.164
Significance (two-tailed)	0.000		0.016	0.003	0.182	0.008	0.000	0.000	0.016	0.155
N	77	77	77	77	77	77	77	77	77	77
Q3: Sexual abuse
Pearson correlation	.347^**	.273^*	1	.293^**	.042	.306^**	.380^**	0.186	.364^**	.164
Significance (two-tailed)	0.002	0.016		0.010	0.717	0.007	0.001	0.106	0.001	0.155
N	77	77	77	77	77	77	77	77	77	77
Q4: Emotional neglect
Pearson correlation	.519^**	.338^**	.293^**	1	.213	.361^**	.325^**	.245^*	.398^**	−.059
Significance (two-tailed)	0.000	0.003	0.010		0.063	0.001	0.004	0.032	0.000	0.610
N	77	77	77	77	77	77	77	77	77	77
Q5: Physical neglect
Pearson correlation	.161	.154	.042	.213	1	.112	.223	.226^*	.140	−.018
Significance (two-tailed)	0.162	0.182	0.717	0.063		0.332	0.051	0.048	0.225	0.874
N	77	77	77	77	77	77	77	77	77	77
Q6: Divorce/separation
Pearson correlation	.388^**	.299^**	.306^**	.361^**	.112	1	.201	.215	.141	.046
Significance (two-tailed)	0.000	0.008	0.007	0.001	0.332		0.080	0.060	0.220	0.689
N	77	77	77	77	77	77	77	77	77	77
Q7: Mother abused
Pearson correlation	.542^**	.469^**	.380^**	.325^**	.223	.201	1	.349^**	.380^**	.366^**
Significance (two-tailed)	0.000	0.000	0.001	0.004	0.051	0.080		0.002	0.001	0.001
N	77	77	77	77	77	77	77	77	77	77
Q8: Substance abuse
Pearson correlation	.388^**	.410^**	.186	.245^*	.226^*	.215	.349^**	1	.348^**	.198
Significance (two-tailed)	0.000	0.000	0.106	0.032	0.048	0.060	0.002		0.002	0.085
N	77	77	77	77	77	77	77	77	77	77
Q9: Mental illness
Pearson correlation	.294^**	.273^*	.364^**	.398^**	.140	.141	.380^**	.348^**	1	.327^**
Significance (two-tailed)	0.009	0.016	0.001	0.000	0.225	0.220	0.001	0.002		0.004
N	77	77	77	77	77	77	77	77	77	77
Q10: Incarceration
Pearson correlation	.074	.164	.164	−.059	−.018	.046	.366^**	.198	.327^**	1
Significance (two-tailed)	0.522	0.155	0.155	0.610	0.874	0.689	0.001	0.085	0.004
N	77	77	77	77	77	77	77	77	77	77

Correlation is significant at the .05 level (two-tailed).

Correlation is significant at the .01 level (two-tailed).

Table 3.

Male Low-Risk Offender Correlations.

	Q1	Q2	Q3	Q4	Q5	Q6	Q7	Q8	Q9	Q10
Q1: Emotional abuse
Pearson correlation	1	.741^**	.251^*	.566^**	.434^**	.339^**	.476^**	.405^**	.389^**	.114
Significance (two-tailed)		0.000	0.019	0.000	0.000	0.001	0.000	0.000	0.000	0.291
N	88	88	88	88	88	88	88	88	88	88
Q2: Physical abuse
Pearson correlation	.741^**	1	.334^**	.403^**	.339^**	0.190	.412^**	.262^*	.169	.180
Significance (two-tailed)	0.000		0.001	0.000	0.001	0.076	0.000	0.014	0.115	0.093
N	88	88	88	88	88	88	88	88	88	88
Q3: Sexual abuse
Pearson correlation	.251^*	.334^**	1	.321^**	0.152	.277^**	.482^**	.141	.129	.279^**
Significance (two-tailed)	0.019	0.001		0.002	0.158	0.009	0.000	0.189	0.229	0.009
N	88	88	88	88	88	88	88	88	88	88
Q4: Emotional neglect
Pearson correlation	.566^**	.403^**	.321^**	1	.389^**	.309^**	.337^**	.089	.321^**	.110
Significance (two-tailed)	0.000	0.000	0.002		0.000	0.003	0.001	0.409	0.002	0.307
N	88	88	88	88	88	88	88	88	88	88
Q5: Physical neglect
Pearson correlation	.434^**	.339^**	.152	.389^**	1	.236^*	.129	0.131	.227^*	.223^*
Significance (two-tailed)	0.000	0.001	0.158	0.000		0.027	0.230	0.225	0.034	0.037
N	88	88	88	88	88	88	88	88	88	88
Q6: Divorce/separation
Pearson correlation	.339^**	.190	.277^**	.309^**	.236^*	1	.229^*	.351^**	.270^*	.389^**
Significance (two-tailed)	0.001	0.076	0.009	0.003	0.027		0.032	0.001	0.011	0.000
N	88	88	88	88	88	88	88	88	88	88
Q7: Mother abused
Pearson correlation	.476^**	.412^**	.482^**	.337^**	.129	.229^*	1	.391^**	.207	.250^*
Significance (two-tailed)	0.000	0.000	0.000	0.001	0.230	0.032		0.000	0.053	0.019
N	88	88	88	88	88	88	88	88	88	88
Q8: Substance abuse
Pearson correlation	.405^**	.262^*	.141	.089	.131	.351^**	.391^**	1	.079	.438^**
Significance (two-tailed)	0.000	0.014	0.189	0.409	0.225	0.001	0.000		0.465	0.000
N	88	88	88	88	88	88	88	88	88	88
Q9: Mental illness
Pearson correlation	.389^**	.169	.129	.321^**	.227^*	.270^*	.207	.079	1	−.100
Significance (two-tailed)	0.000	0.115	0.229	0.002	0.034	0.011	0.053	0.465		0.356
N	88	88	88	88	88	88	88	88	88	88
Q10: Incarceration
Pearson correlation	.114	.180	.279^**	.110	.223^*	.389^**	.250^*	.438^**	−.100	1
Significance (two-tailed)	0.291	0.093	0.009	0.307	0.037	0.000	0.019	0.000	0.356
N	88	88	88	88	88	88	88	88	88	88

Correlation is significant at the .05 level (two-tailed).

Correlation is significant at the .01 level (two-tailed).

Research Question 2 (Are There Differences in the Types of Trauma Between Genders and Inmates With Different Offenses?)

To address this question, we examined how the type of trauma varied across participant groups. The results are reported in Table 4. The ACE includes three subscales: abuse, neglect, and family dysfunction. The first three items on the ACE refer to abuse (emotional, physical, and sexual). Emotional abuse was reported by 55.21% of females, 55.84% of male sex offenders, and 39.33% of low-risk male inmates. Physical abuse was reported by 50.31% of females, 57.14% of sex offenders, and 31.46% of low-risk males. Sexual abuse was reported by 50.31% of females, 42.86% of sex offenders, and 14.61% of low-risk males.

Table 4.

Adverse Childhood Experiences Survey t Tests.

All Items 1–10
	Gender	n	M	SD	SE mean	Significance (two-tailed)
Total yes	Female	163	4.85	2.992	0.234	0.002
Total yes	Male	165	3.88	2.785	0.217
	Institution	n	M	SD	SE mean	Significance (two-tailed)
Total yes	Female	163	4.85	2.992	0.234	0.360
Total yes	Sex offender	77	4.48	2.808	0.32
	Institution	N	M	SD	SE mean
Total yes	Female	163	4.85	2.992	0.234	0.000
Total yes	Low risk	88	3.35	2.67	0.285
	Institution	n	M	SD	SE mean	Significance (two-tailed)
Total yes	Sex offender	77	4.48	2.808	0.32	0.009
Total yes	Low risk	88	3.35	2.67	0.285	0.009
Items 1, 2, 3
	Gender	n	M	SD	SE mean	Significance (two-tailed)
Abuse	Female	163	1.56	1.296	0.102	0.007
Abuse	Male	165	1.19	1.172	0.091
	Institution	n	M	SD	SE mean	Significance (two-tailed)
Abuse	Female	163	1.56	1.296	0.102	0.999
Abuse	Sex offender	77	1.56	1.186	0.135
	Institution	n	M	SD	SE mean	Significance (two-tailed)
Abuse	Female	163	1.56	1.296	0.102	0.000
Abuse	Low risk	88	0.86	1.063	0.113
	Institution	N	M	SD	SE mean	Significance (two-tailed)
Abuse	Sex offender	77	1.56	1.186	0.135	0.000
Abuse	Low risk	88	0.86	1.063	0.113
Items 4, 5
	Gender	n	M	SD	SE mean	Significance (two-tailed)
Neglect	Female	163	0.81	0.782	0.061	0.000
Neglect	Male	165	0.52	0.668	0.052
	Institution	n	M	SD	SE mean	Significance (two-tailed)
Neglect	Female	163	0.81	0.782	0.061	0.010
Neglect	Sex offender	77	0.55	0.619	0.071
	Institution	n	M	SD	SE mean	Significance (two-tailed)
Neglect	Female	163	0.81	0.782	0.061	0.002
Neglect	Low risk	88	0.50	0.711	0.076
	Institution	n	M	SD	SE mean	Significance (two-tailed)
Neglect	Sex offender	77	0.55	0.619	0.071	0.664
Neglect	Low risk	88	0.50	0.711	0.076
Items 7, 8, 9, 10
	Gender	n	M	SD	SE mean	Significance (two-tailed)
Family problems	Female	163	1.800	1.292	0.101	0.035
Family problems	Male	165	1.500	1.277	0.099
	Institution	n	M	SD	SE mean	Significance (two-tailed)
Family problems	Female	163	1.800	1.292	0.101	0.700
Family problems	Sex offender	77	1.730	1.363	0.155
	Institution	n	M	SD	SE mean	Significance (two-tailed)
Family problems	Female	163	1.800	1.292	0.101	0.003
Family problems	Low risk	88	1.300	1.166	0.124
	Institution	n	M	SD	SE mean	Significance (two-tailed)
Family problems	Sex offender	77	1.730	1.363	0.155	0.030
Family problems	Low risk	88	1.300	1.166	0.124

The next two items assessed trauma through neglect. Neglect (emotional and physical) was reported by all inmates with females again showing the highest rates. Emotional neglect was reported by 53.37% of females, 46.75% of sex offenders, and 32.58% of low-risk males. Physical neglect was reported by 50.31% of females, 57.14% of sex offenders, and 31.46% of low-risk offenders.

Household dysfunction is addressed through the last five items of the ACE (loss of a parent, mother or stepmother abused, addiction, mental illness, or imprisonment among family members) and showed similar variations. Loss of a parent through separation or divorce was reported by 68.71% of females, 64.94% of sex offenders, and 68.54% of low-risk offenders. Having their mother or stepmother abused was reported by 39.26% of females, 31.17% of sex offenders, and 21.35% of low-risk offenders. Addiction in the family was reported by 68.71% of females, 62.34% of sex offenders, and 51.69% of low-risk offenders. Mental illness in the family was reported by 39.88% of females, 42.86% of sex offenders, and 24.72% of low-risk offenders. Having a family member imprisoned was reported by 31.90% of females, 36.36% of sex offenders, and 30.34% of low-risk offenders.

The t tests reported on Table 4 indicate that females and male sex offenders were similar in the types of trauma they reported and significantly different from male low-risk offenders. On the abuse subscale items of emotional and physical abuse, over half of both women and sex offenders reported they had these experiences as children as compared with low-risk offenders. The neglect items showed less dramatic, but still significant results with women and sex offenders reporting more emotional and physical neglect than low-risk offenders. The highest similarity across groups occurred on the household dysfunction scores, but the pattern of low-risk offenders being different from the other two groups persisted.

Research Question 3 (Are There Differences in the Level of Trauma Between Genders and Inmates With Different Offenses?)

To address this question, we assessed the mean number of people indicating they had experienced each type of trauma reported on the ACE. ANOVA was conducted and the results are presented in Table 5. As indicated in Table 5, there were significant differences between the groups on total number of people reporting different traumatic events. There were significant differences between females and males on the total number of people reporting ACEs (F = 7.916, p < .000), reporting abuse (F = 10.574, p < .000), reporting neglect (F = 6.525, p < .002), and reporting family dysfunction (F = 3.162, p < .044). Females and sex offenders consistently demonstrated similar levels of trauma. This was found for both total traumatic experiences reported, abuse reported, and neglect reported, while less remarkable among the three groups regarding family dysfunction.

Table 5.

ANOVA Differences in Level of Trauma Between Groups.

ANOVA-dependent variable: Total yes
	Sum of squares	df	Mean square	F	Significance
Between groups	130.06	2	65.030	7.916	0.000
Within groups	2,669.767	325	8.215
Total	2,799.826	327
	(I) Institution	(J) Institution	Mean difference (I–J)	SE	Significance
	Lower bound	Upper bound	Mean difference (I–J)	SE	Significance
Tukey HSD	1	2	0.372	0.396	0.616
		3	1.500^*	0.379	0.000
	2	1	−0.372	0.396	0.616
		3	1.128^*	0.447	0.032
	3	1	−1.500^*	0.379	0.000
		2	−1.128^*	0.447	0.032
ANOVA-dependent variable: Abuse
	Sum of squares	df	Mean square	F	Significance
Between groups	31.075	2	15.537	10.574	0.000
Within groups	477.547	325	1.469
Total	508.622	327
	(I) Institution	(J) Institution	Mean difference (I–J)	SE	Significance
	Lower bound	Upper bound	Mean difference (I–J)	SE	Significance
Tukey HSD	1	2	0.000	0.168	1.000
		3	.695^*	0.160	0.000
	2	1	0.000	0.168	1.000
		3	.695^*	0.189	0.001
	3	1	−.695^*	0.160	0.000
		2	−.695^*	0.189	0.001
ANOVA-dependent variable: Neglect
	Sum of squares	df	Mean square	F	Significance
Between groups	6.915	2.000	3.457	6.525	0.002
Within groups	172.195	325.000	0.530
Total	179.110	327.000
	(I) Institution	(J) Institution	Mean difference (I–J)	SE	Significance
	Lower bound	Upper bound	Mean difference (I–J)	SE	Significance
Tukey HSD	1	2	.264^*	0.101	0.024
		3	.310^*	0.096	0.004
	2	1	−.264^*	0.101	0.024
		3	0.045	0.114	0.916
	3	1	−.310^*	0.096	0.004
		2	−0.045	0.114	0.916
ANOVA-dependent variable: Family dysfunction
	Sum of squares	df	Mean square	F	Significance
Between groups	15.066	2	7.533	4.62	0.011
Within groups	529.91	325	1.63
Total	544.976	327
	(I) Institution	(J) Institution	Mean difference (I–J)	SE	Significance
	Lower bound	Upper bound	Mean difference (I–J)	SE	Significance
Tukey HSD	1	2	0.07	0.177	0.916
		3	.502*	0.169	0.009
	2	1	−0.07	0.177	0.916
		3	0.432	0.199	0.078
	3	1	−.502*	0.169	0.009
		2	−0.432	0.199	0.078

Note. HSD = honestly significant difference.

The mean difference is significant at the 0.05 level.

Tukey’s honest significant difference (HSD) posthoc analyses were used to identify significant between-group differences. Regarding total “yes” responses, significant differences were found between females and low-risk offenders (mean difference = 1.500, p < .000), and between sex offenders and low-risk offenders (mean difference = 1.128, p < .000). On the abuse subscale, significant differences were found between females and low-risk offender (mean difference = 0.695, p < .000) and between sex offenders and low-risk offenders (mean difference = 0.695, p < .000). On the neglect subscale, female responses were significantly different from both sex offenders (mean difference = 0.264, p < .05) and low-risk offenders (mean difference = 0.310, p < .01). No significant difference was found between male sex offenders and male low-risk offenders. Regarding family dysfunction, females and low-risk offenders showed significant differences (mean difference = 0.502, p < .01), and there was no significant difference between the two groups.

Discussion

As of 2014, there were 2.2 million people in U.S. jails and prisons, which is a 500% increase since the 1970s. This has not corresponded with a general increase in crime, but a change in incarceration policy, including mandatory sentencing, harsher incarceration for drug offenses, and longer termed sentences (Carson, 2015). The results of this study indicate that the incarcerated participants had consistently high levels of childhood trauma across multiple dimensions. These results are consistent with theorizing by Martin, Eljdupovic, McKenzie, and Colman (2015) in which they suggested that up to 55% of males and up to 80% of females may have experienced childhood traumas. These results also offer a caution to re-entry programs that place people in housing situations with minimal consideration given to trauma-informed planning. Some research suggests victims of early childhood abuse tend to bond with their abuser and carry that bonding pattern into adult relationships (Bluhm et al., 2009; Craig & Sprang, 2007; Ratcliffe, Ruddell, & Smith, 2014; Rincon-Cortes et al., 2015; Sartory et al., 2013), often in the form of involuntary subordination (Sturman, 2011)—an unfortunate metaphor for imprisonment.

These correlations suggest that, regarding childhood trauma among imprisoned adults, there may be an element of intersectionality—it may be more than the experience of a single type of trauma that matters; it may be that the impact of multiple types of childhood abuse, neglect, and family dysfunction also warrant further investigation. If women, sex offenders, or low-risk offenders experienced one type of abuse—emotional, physical, or sexual—they were significantly more likely to experience the other types of abuse and emotional neglect. If people’s parents were separated or divorced, they were significantly more likely to experience emotional abuse, sexual abuse, and emotional neglect. If people’s mother or stepmother was abused, all groups were more likely to have experienced all three types of abuse; emotional neglect; lived with someone who abused substances, was mentally ill, and had a record of being incarcerated. If any of the participants lived with someone who abused substances, they were significantly more likely to be emotionally and physically abused, and have experienced their mother or stepmother being abused. If any of the participants reported living with someone who was mentally ill, they were significantly more likely to report that they were emotionally abused and emotionally and physically neglected. If participants reported living with a family member who had ever gone to prison, they were significantly more likely to also report they had their mother or stepmother abused. These cumulative ACEs can begin a journey that results in incarceration if no effective, consistent, and trauma-informed interventions are introduced.

One of the more compelling findings from this study is the similarity between women and male sex offenders. Roughly two thirds of women and male sex offenders scored high enough on the ACE to be considered severely traumatized. Although the low-risk offenders’ ACE scores also were higher than the general population, they were not as high as the other two groups. This becomes especially apparent when scores on the three abuse subscale items (emotional, physical, and sexual abuse) are considered. Over half of the women reported emotional (55.21%), physical (50.31%), and sexual (50.31%) abuse. Sex offenders indicated similar results with emotional abuse (55.84%), physical abuse (57.14%), and sexual abuse (42.86%).

The trauma default network can be expected to play a substantial role in the adult lives of these participants, their relationships, and their descendants. Research on the ACE shows correlations with ongoing detrimental consequences, and this study suggests those consequences include criminal behavior that results in imprisonment. This, along with other consequences such as physical and medication restraint; mandatory inpatient treatment; exclusion from educational, social, and occupational activities; denial of some public services and employment opportunities; and subsistence in poverty traps suggest lifelong consequences of events that occurred during a person’s childhood that they experienced as a victim. The intersectionality of childhood trauma with other factors such as minority status, poverty, disability, and gender warrants consideration regardless of the initial reason a person seeks counseling, is referred for counseling, or is incarcerated.

Involuntary subordination presents a paradoxical situation for diagnosing and treating trauma. A child who is traumatized is likely to experience the “fold or freeze effect” of depersonalization/derealization (Ellason & Ross, 1999; Levine, 2015). This experience is mediated through the amygdala as a general helplessness and shame response. If, at a later time, the person feels as though they are in a dominant situation, the amygdala can shift into a blame response. This shame/blame processing can reflect a person who freezes in response to abuse in one situation (shame) and becomes the abuser (blame) in a similar situation that triggers the response (Cozolino, 2006; Gold, Sullivan, & Lewis, 2011; Stuewig, Tangney, Heigel, Harty, & McKloskey, 2009; Szentagotai-Tatar, & Miu, 2016; Thomason et al., 2015). To what extent can one say the person committing the crime that gets them incarcerated is not displaying posttraumatic stress behavior?

Exposure to trauma has been found to be related to a variety of diagnosed mental illnesses (Lucenko, Sharkova, Huber, Jemelka, & Mancuso, 2015). It may be that the presentation of dysfunctional behavior is best diagnosed as trauma and stressor-related rather than as such diagnoses as reactiveattachment disorder; attention deficit hyperactivity disorder; anxiety, depression, oppositional defiant disorder; conduct disorder; or a personality disorder (Allen, 2014). With more accurate diagnoses based on ACE scores, better interventions may be appropriate and trauma-informed services may become more prevalent. Transition services also can benefit from being trauma-informed when considering how to appropriately address pre-employment opportunities, postsecondary placement, job placement, and career planning.

Rehabilitation and other counselors should view these data as encouragement for developing trauma-informed competencies and advocating for trauma-informed integrated care systems. One would not necessarily expect parents to offer information on the trauma their children experienced, and their willingness to cooperate in providing trauma-informed interventions may impair the ability of counselors to be effective. One would expect to see trauma as a correlate of adult divorce or separation, maternal abuse, mental illness, poverty, and substance abuse. Without specifically addressing childhood trauma as a possible co-occurring condition of any presenting physical or psychiatric diagnosis, intervention efficacy is likely to be limited. Fortunately, many of the counseling strategies used to promote resilience and health promotion among youth also are effective as trauma-informed interventions (Cozolino, 2006; Siegel, 2012, 2015).

Rehabilitation counselors who work with transition-aged youth with disabilities, adults with disabilities being served through various settings, and people with disabilities involved in the criminal justice system are part of this larger trauma-informed system. Because a criminal record is one of the most problematic barriers to becoming employed, the role of rehabilitation is central to facilitating successful escape from the cycle of incarceration and recidivism. Not only understanding trauma-informed care, but also understanding the possible retraumatization of uncoordinated services across employment and human service agencies is critical for rehabilitation success.

Funding by Medicaid or other managed care organizations may become problematic to counselors working with children with high ACE scores because the experience of beginning to receive trauma-informed services, only to have those services discontinued due to lack of funding may contribute to retraumatization. A child may be placed in a residential treatment facility, only to be discharged due to discontinued funding rather than having reached maximum service benefits. A person may receive counseling through a third-party payer, only to have the payer determine the nature and duration of services regardless of the client’s needs. A person may need immediate inpatient care but not have such care available, leaving jail or prison as the only remaining placement option.

Strengths and Limitations of This Study

Strengths

The ACE instrument is widely researched and used. Data gathered through this study can be combined with other research that uses the ACE to gain a better perspective on how childhood trauma affects the lives of the individuals and families involved. Showing the differences between female and male inmates, and the similarities between females and males convicted of sex offenses offers some insight into how different crimes correlate with different traumatic experiences.

Limitations

Lack of demographic data regarding the people who responded to this study is a significant limitation, as is information regarding their educational and criminal records along with other data on disability and chronic health conditions. We deliberately did not seek to obtain that information to better protect the identities of participants and minimize the potential distress of asking further questions. Future studies that provide longitudinal information would be useful for identifying how to interrupt this pipeline and add to existing research on effective interventions. Larger data sets and more rigorous experimental designs may allow counselors to advocate for improved alternatives to incarceration, changes in legislation, and advocacy that challenges the stigma of criminal records.

Implications for Counseling Practice

Rehabilitation counselors play a central role in providing and coordinating the services that keep people off the childhood to prison pipeline. Especially since passage of the Workforce Innovation and Opportunity Act (WIOA), rehabilitation counselors can focus on pre-employment transition services that identify transition-aged youth who may have experienced traumas and coordinate school and community services to interrupt this pipeline. Rehabilitation counselors also play a key role in postsecondary training and education programs that serve both transitioning youth and adults with disabilities, so they can bring trauma-informed services into educational and employment settings.

Attention to trauma and its consequences has gained greater attention through introduction of the DSM-5 and new Council on Accreditation of Counseling and Related Programs (CACREP) standards. With the merger of the Council on Rehabilitation Education (CORE) and CACREP, and with the emphasis on service integration under WIOA, rehabilitation counselors now have greater support for building pipelines from school to satisfactory employment rather than to poverty and imprisonment. Although the outline of a demand-side school to employment pipeline has been provided (Gilbride, Bruinekool, & Stensrud, in press), this research suggests a complementary set of interventions may be needed to address childhood experiences that could interfere with those successful transitions. Satisfactory employment, in settings that are supportive and offer the promise of stability, is what rehabilitation counselors offer to individuals with disabilities. The promise of such a future and the support of resilient, purposeful actions on the part of participants, is a central element is the diverse counseling interventions needed by people who experienced traumatic childhoods and the adult consequences (Draine, Salzer, Culhane, & Hadley, 2002; Stanford Center on Poverty and Inequality, 2015).

Trauma-informed rehabilitation counseling is, by itself, insufficient to address this childhood to prison pipeline. Earlier intervention; justice system reform, improved reimbursement for residential, inpatient, and outpatient care; earlier introduction of promising self-sufficient futures; and the ability to ensure seamless services across public, nonprofit, and for-profit organizations are needed. Rehabilitation counselors are unique in that they touch all these elements, so effectively integrating them to create promising futures becomes our next challenge (Stensrud, 2015).

Conclusion

A growing body of research offers insight into how to identify children who experienced or are experiencing trauma (Bendall, Jackson, & Hulbert, 2010; Ko et al., 2008; Wiest-Stevenson & Lee, 2016). Rehabilitation and other professional counselors can collaborate with schools, community providers, and family services to facilitate care for traumatized children and their families to interrupt any school to prison pipeline. The transition of youth with disabilities into pre-employment and employment experiences, postsecondary education, and satisfactory careers, involves understanding how to identify and address the possibility of childhood trauma as a psychiatric disability, and as a risk factor for other disabilities and health conditions. This implies that individuals are not necessarily diagnosed and treated appropriately using minimalist managed care diagnostic and acuity protocols. Because trauma can be disguised as different psychiatric disorders from attention deficit hyperactivity disorder, to oppositional defiant disorder, depression or anxiety disorders, psychotic disorders, or personality disorders, misdiagnosis can easily lead to inappropriate treatments, incomplete interventions, and failed outcomes with minimal capacity for counselors to challenge this reductionistic method.

Bauman (2007) referred to the contemporary social environment as one in which those individuals who are deemed to be of insufficient value to the culture (possessing insufficient social capital) become identified as “surplus people” (p. 29). Once identified as such, these individuals become assigned to the “surplus human waste disposal industry” (p. 29) where they are segregated from the rest of humanity through refugee camps, encapsulated poverty traps, or public institutions such as prisons. The rehabilitation counseling profession is one of the critical resources that can keep individuals out of this trajectory, but we must do so within the constraints of our existing institutions. Schools, community mental health agencies, and rehabilitation agencies play a central role in identifying and correcting the consequences of childhood trauma so the trajectory becomes one of childhood to school to self-sufficiency. Without effort to address this now, our clients may become the parents and grandparents of future childhood to prison pipeline victims. With successful treatment of trauma, we see the resilience that comes from overcoming ACEs and the stories of those who used their wounds to find a deeper purpose to their lives offer impressive testimony (Lesser, 2005).

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

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