“It Changed My Life”: Traumatic Loss,Behavioral Health,and Turning Points Among Gang-Involved and Justice-Involved Youth

Abstract

An especially vulnerable population to traumatic loss, violence exposure, and posttraumatic stress symptoms are those involved in the juvenile justice system. However, justice-involved youth are not a homogeneous group. Research looking at subpopulations within juvenile justice systems highlight the diverse backgrounds and treatment needs of justice-involved youth such as those who are also gang-involved. The current study seeks to address the interrelated issues of behavioral health, traumatic grief, loss, and self-reported turning points among a sample of formerly incarcerated youth who report extensive juvenile justice histories (N = 62). All youth participated in an extensive survey interview. Just over half (56.5%) of the youth reported being gang-involved. Chi-square analyses revealed that gang- and justice-involved youth were significantly more likely to have experienced traumatic loss compared with their justice-only peers (χ² = 4.265, p < .05). Gang involvement approximately doubled youth’s exposure to community violence, both direct and witnessed, and there were significant differences in the levels of posttraumatic stress symptoms and substance use, between the gang- and justice-involved youth compared with the justice-only youth. When asked to describe a turning point in their lives, 15% of the sample described significant loss and how it affected their lives, for better or worse. Findings lend support for a focus on supporting posttraumatic growth and increasing access to trauma-focused treatment, with an emphasis on grief and loss, for those who are both gang- and justice-involved.

Keywords

youth violence PTSD community violence

Introduction

Among a large sample of trauma-exposed children and adolescents, traumatic loss, separation, or bereavement were the most frequently endorsed trauma type with nearly half the sample having experienced it (Pynoos et al., 2014). This percentage increased among those in the sample who were juvenile-justice-involved, with 61% of them experiencing some form of traumatic loss, separation, or bereavement (Dierkhising et al., 2013). Traumatic grief or bereavement, a potential sequelae of traumatic loss, is the experience of both posttraumatic stress symptoms and grief. This includes grief symptoms such as mourning the person who passed and traumatic stress symptoms such as vividly re-experiencing moments of the loss or avoiding any thoughts or places that remind one of what happened (e.g., avoiding discussions of a friend who was lost traumatically). A person who has experienced a loss can develop traumatic grief symptoms if the death was sudden and unexpected or there were other factors surrounding the death, such as witnessing the death, if the loss involved violence, if the mourner is presented with multiple deaths, if the survivor believes that the loved one suffered, or if the survivor regards the death (or way of death) as unfair and unjust (Barlé, Wortman, & Latack, 2017). Because individuals often exert both posttraumatic stress and grief symptoms, the symptoms are thought to have an intertwining relationship where they can exacerbate one another (Layne, Kaplow, & Youngstrom, 2017).

An especially vulnerable population to traumatic loss, violence exposure, and posttraumatic stress symptoms are those involved in the juvenile justice system (Dierkhising et al., 2013; Wood, Foy, Layne, Pynoos, & James, 2002). Justice-involved youth are a highly traumatized and victimized population, elevating their risk for the experience of traumatic loss and grief. However, justice-involved youth are not a homogeneous group. Recent research focused on subpopulations within juvenile justice systems highlights the diverse backgrounds and treatment needs of justice-involved youth such as victims of sexual exploitation (Dierkhising, Walker Brown, Ackerman-Brimberg, & Newcombe, 2018), crossover youth (Dierkhising, Herz, Hirsch, & Abbott, 2018), polyvictimized youth (Ford, Grasso, Hawke, & Chapman, 2013), and gang-involved youth (Kerig, Chaplo, Bennett, & Modrowski, 2016). A commonality among these subpopulations are high rates of trauma exposure; yet, it is the type, severity, and impact of their particular trauma histories that may distinguish them. The current study seeks to examine potential differences in justice-involved youth’s experiences of traumatic loss, grief, community violence, and behavioral health problems based on whether or not they were also gang-involved. Further illuminating the potential differences in justice-involved youth’s trauma histories, and the associated behavioral health problems, can inform how to best tailor trauma treatment for justice-involved youth. This is particularly important in the case of grief and loss because of the complexity and, often, persistent symptom expression of traumatic grief and the potential for co-morbidity with posttraumatic stress among justice-involved youth.

Traumatic Loss as a Turning Point Among Gang-Involved Youth

Traumatic loss and death are common among justice-involved youth. For example, a study of incarcerated youth in Los Angeles revealed that 92% knew someone who was killed; 77% had seen a dead body; 72% were shot, or shot at; 57% saw someone being killed; and 17% saw someone commit suicide (Wood et al., 2002). Cuevas, Finkelhor, Shattuck, Turner, and Hamby (2015) found that incarcerated youth were at much higher risk than youth in the community to not only be victimized themselves but also suffer the loss of a loved one in violent fashion. In a study of justice-involved adolescents, Vaswani (2014) found that the rates of experiencing multiple deaths and traumatic deaths, such as murder, were higher among the justice-involved adolescents than in the general adolescent population. Furthermore, justice-involved adolescents experience higher rates of grief than the general adolescent population (Vaswani, 2014).

One understudied population with regard to the effects of suffering the loss of a loved one are gang-involved youth. Those who are gang-involved are disproportionately violently victimized, which may often lead to death or death of a loved one (Fleischman & Barondess, 2004; Wu & Pyrooz, 2016). For example, in Father Gregory Boyle’s (2010) memoir, he recounts numerous stories of young gang members who lose loved ones and how these experiences have a profound psychological, social, and existential impact on the young men and women he works with. For some youth, the loss may be one of the factors that pull them toward, and align them with, a gang for vengeance or attempts to address their anger and grief. For others, overwhelmed by their grief, the loss may be what pushes them away from their gang.

From the life course perspective, the experience of traumatic loss can be thought of as a turning point (Sampson & Laub, 1993). Turning points have long been theorized to affect delinquent trajectories with most research looking at how they lead to desistance (Sampson & Laub, 1993). When it comes to gang-involved youth and turning points, research is scarce, especially when it comes to youth exiting or desisting from gangs (Klein & Maxson, 2006). However, what research has been done has found that violence is often a key part of criminal desistance among gang-involved youth (Vigil, 1988). A study by Decker and Lauritsen (2002), in which 24 ex-gang members and 99 current gang members were interviewed, found that most former gang members reported violence as being the top reason they chose to leave their gang. Sixteen of the 24 ex-gang members reported they left the gang due to being victimized or through the violent victimization of a loved one. About half of the participants who were active gang members at the time of the study identified violence as the primary reason a person they knew had left the gang. They also stated that the person leaving the gang had been victimized or had loved ones violently victimized, mirroring the responses given by the ex-gang members (Decker & Lauritsen, 2002).

Although research has demonstrated that violence and victimization can serve as a turning point and result in gang leaving, it focuses on direct victimization. What effects, if any, losing a loved one has on a youth have not been a common area of focus. A single traumatic event can cause someone to change direction in their life course (Teruya & Hser, 2010). This means that being exposed to the death of an important person can have a deep impact on the direction a youth can take, for better or worse. It is for these reasons that it is important to explore the role that death and loss can have as a turning point for gang-involved youth, while also considering the behavioral health implications of traumatic loss.

Behavioral Health and Grief

Losing a loved one can exacerbate behavioral health problems and social problems that juveniles may be suffering from already, due to their high rates of exposure to other forms of violent victimization and traumatic stressors. Youth who are exposed to violence, whether being victimized directly or witnessing an act of violence, are at higher risk of suffering from behavioral health problems such as posttraumatic stress disorder (PTSD), depression, and thoughts of suicide (Kliewer, Lepore, Oskin, & Johnson, 1998; Slovak, 2002; Vermeiren, Ruchkin, Leckman, Deboutte, & Schwab-Stone, 2002). Behavioral health problems may manifest themselves in substance abuse, displays of aggression, and engagement in other forms of delinquency as well (Briggs-Gowan, Carter, & Ford, 2012; Caetano, Field, & Nelson, 2003; Nofzinger & Kurtz, 2005).

It has been shown that experiencing traumatic grief may make youth less resilient and has been linked to deviant behavior (Childhood Bereavement Network, 2008; Finlay & Jones, 2000). In a study by Draper and Hancock (2011), youth who had suffered a loss, particularly the death of a parent, were significantly more likely to be involved in delinquent behavior than youth who had not suffered a loss. The study showed that youth were more likely to be involved in delinquent behavior if the loss occurred while they were between the ages of 12 and 16 years old. These are critical ages for youth development, increasing their risk for the negative effects that traumatic death can bring (Layne, Kaplow, Oosterhoff, Hill, & Pynoos, 2018).

In a sample of gang-involved youth, Kerig et al. (2016) found that gang-involved youth were more likely to meet the criteria for a full or partial diagnosis of PTSD than their non-gang-involved counterparts, and girls were more likely than boys to meet the criteria for a full or partial diagnosis in both populations as well. Lansing, Plante, Beck, and Ellenberg (2018) found that in a sample of persistently delinquent youth, exposure to death was common and resulted in clinically significant bereavement-related distress and developmental disruptions. In addition, 72% of youth had reported experiencing a meaningful or important loss in the past 6 months, of which 33.8% stated that they joined or became more involved in a gang as a result of the death (Lansing et al., 2018).

The Current Study

The current study seeks to address the interrelated issues of behavioral health, grief, violence, loss, and turning points among a sample of justice-involved youth. Specifically, we examine loss experiences, community violence exposure, and symptoms of grief among gang- and justice-involved youth and justice-only youth. In doing so, we also explore whether youth identify their loss experiences as a turning point in their life from a qualitative perspective. Because of the exploratory nature of this study, the mixed-methods approach is most appropriate to identify whether youth report traumatic loss as a turning point in their life from an inductive approach. In addition, we also examine the potential differences between justice-only and gang- and justice-involved youth with regard to behavioral health issues (i.e., posttraumatic stress, depression, and substance use) that are common among justice-involved youth (e.g., Dierkhising et al., 2013). Overall, we hypothesize that gang-involved youth will exhibit higher behavioral health problems, community violence exposure, and loss experiences compared with their justice-only counterparts and that experiences of loss will stand out as a turning point more frequently for gang-involved youth.

Method

Participants

Participants were recruited from a community-based organization that serves formerly incarcerated youth and adults in Southern California. Youth were eligible to participate if they were at least 18 years old and had been incarcerated in a juvenile justice facility within the last year. Once participants consented, they completed a survey in the presence of the first author. Length of the assessments ranged from 45 min to 2 hr; however, the majority took 1 hr 15 min.

Participants (N = 62) were mostly male (75%), 18 years old (SD = 0.57), and Latinx (82.9%) with 10.9% of the sample identifying as African American and 6.2% as Mixed/Other. Most of the youth resided with their mother (40.6%), 21.9% lived with both parents, 14.1% lived with another relative, and about a quarter of youth (23.4%) reported some other type of living situation (e.g., on their own, with a boyfriend or girlfriend, with friends, with father, with guardian, homeless, or other). Most youth did not have a high school diploma (70.3%) but 66.1% were currently enrolled in some type of school (e.g., still in high school, GED [General Education Development] classes, community college, or trade school). Approximately one quarter of youth (24.2%) reported residing in foster care at some point in their life. In addition, 23.4% of youth had at least one child of their own.

The majority of the sample self-reported extensive experience with the juvenile justice system. Participants were first arrested (regardless of adjudication) early in life with a mean age of 13.77 years old (SD = 1.75) and a range from 9 to 17 years old. More than half of the youth (55%) reported being arrested more than 5 times, although two youth could not remember how many times they had been arrested. Participants reported institutional stays in a variety of types of juvenile facilities (e.g., detention facilities, residential placements, and state corrections), and were incarcerated 4 times on average (SD = 2.41). Across all times incarcerated, the average time they spent incarcerated in adolescence was 17.19 months (SD = 15.57), ranging from 2 weeks to 6.25 years.

Measures

Gang involvement

Gang involvement was assessed using one question from the Gang Affiliation Index (Wood, Foy, Layne, Pynoos, & James, 2002). This Index covers current involvement in gang-related activities, such as whether they have family members involved in gangs and whether they are on a police list as a known gang member. These questions are followed by a brief history of the participant’s familial gang involvement, and whether they have officially been in a gang or were never in a gang. For the current study, we used the latter question to identify a youth as gang-involved (= 1) versus not (= 0). The other questions were included for descriptive purposes.

Traumatic grief symptoms

Grief symptoms were assessed using items from the Inventory of Traumatic Grief (Prigerson & Jacobs, 2001), a 30-item assessment tool used for measuring the severity of traumatic grief symptoms. For the current study, we utilized an adapted version of this tool with only 10 questions. If participants reported that they had experienced the loss of a close friend or family member to an act of violence, they were then asked to report how often they experienced each symptom using a Likert-type scale: 0 (never), 1 (rarely), 2 (sometimes), 3 (often), and 4 (always). If participants had experienced multiple losses, they were asked to think about the most recent or most difficult one.

Posttraumatic stress symptoms

Posttraumatic stress symptoms were assessed using the UCLA (University of California at Los Angeles) Posttraumatic Stress Disorder Reaction Index (PTSD-RI; Steinberg, Brymer, Decker, & Pynoos, 2004; Steinberg et al., 2013), which provides a continuous measure of posttraumatic stress symptoms with a suggested clinical cutoff score of 38 and above. Participants reported how often they experienced the symptom during the past month using a Likert-type scale: 0 (never), 1 (a little, about 2 times a month), 2 (sometimes, 1-2 times a week), 3 (a lot, 3-4 times a week), and 4 (most of the time, almost every day). In addition to reporting on symptom expression, youth also indicated which traumatic experience bothered them the most at the time of assessment. For the current study, the PTSD-RI yielded a Cronbach’s alpha of .943.

Depressive symptoms

Depressive symptoms were assessed using the Center for Epidemiological Studies Depression Scale (CES-D; Radloff, 1977). The CES-D includes 20-items that assess symptoms within the last week with five response options of 0 (rarely or none of the time), 1 (less than 1 day), 2 (some or a little of the time, 1-2 days), 3 (occasionally or a moderate amount of time, 3-4 days), and 4 (most or all of the time, 5-7 days). The CES-D has shown high reliability with a Cronbach’s alpha of .85 on average in community samples (Radloff, 1977) and .772 in the current sample. The CES-D is considered a screening tool for depression symptoms, not to be used for diagnostic purposes, and provides a continuous symptom severity score with a cutoff score of 16 and above indicating mild to significant depression symptoms (Radloff, 1991). We transformed the score using a square root transformation to adjust the positive skew of the variable.

Substance use

Three questions were used to assess recent (i.e., post-release) drug and alcohol use. These questions asked if they have drank alcohol, smoked marijuana, or used anything else to get high since they were released from their last incarceration period. Response options were yes/no. One general question was asked to assess the youth’s perception of their drug use. They were asked how they would describe their drug use (regardless of type of drug), with six response options ranging from 0 (non-user) to 5 (very heavy user).

Community violence exposure

Lifetime exposure to community violence was assessed using a subscale of the Survey of Community Exposure to Violence (SCEV) developed by Richters and Martinez (1993), in which seven questions ask about direct victimization with a parallel measure assessing witnessing community violence. The direct experiences included being beaten up or mugged, threatened with serious physical harm, shot or shot at, attacked or stabbed with a knife, chased by gangs or individuals, and seriously wounded in an incident of violence. For the witnessing experiences, the participants were asked if they had seen the aforementioned six incidents in their community. Response options are ordinal, with higher levels indicating more exposure, and include never, once, a couple of times, and often.

Turning point narrative

Turning point narratives were prompted in an open-ended format using the following question from Nelson et al. (2012):

In looking back on your life, you may be able to identify certain key “turning points”—episodes through which you experienced an important change in your life. A turning point can be an event, an experience, or even a realization. Please choose one key turning point in your life and describe it in detail. Please tell me about what comes to mind. What led up to it, what happened, where and when it happened, who may have been involved, and what you were thinking and feeling.

Analytic Approach

Chi-square and ANOVA tests were used to evaluate the potential between group differences for those who were gang-involved compared with those who were not due to the categorical nature of the gang-involvement variable. When the dependent variable is continuous, we use the one-way ANOVA, and when the dependent variable is categorical, we use the chi-square test for independence. Finally, a correlation matrix is also presented for the variables of interest for descriptive purposes. Thematic analysis, the process of identifying themes across a dataset (Braun & Clarke, 2006), was used to analyze the qualitative data and was coded by the first author. The open coding method was used to identify the key event (i.e., turning point) in each response. For the current study, only the themes that related to death and loss were extracted.

Results

Gang Involvement

Just over half (56.5%) of the youth reported being gang-involved. In addition, 29% of the youth in the total sample reported inviting or initiating other people into a gang. When asked whether they went on dates or parties with gang members, 62.9% of the youth reported doing so. With regard to family, 59.7% reported that someone in their family used to be or is an active gang member. Finally, 51.6% of the youth believed that they were on a police list of gang members.

Traumatic Loss, Traumatic Grief, and Gang Involvement

Many of the youth (72.6%) reported having experienced traumatic loss at the time of assessment. Chi-square analyses revealed that gang-involved youth were significantly more likely to have experienced traumatic loss compared with their justice-only peers (χ² = 4.265, p < .05). More specifically, 82.8% of the gang-involved youth and 59.3% of the justice-only youth experienced a traumatic loss. Only youth who reported having experienced a traumatic loss responded to the grief inventory (n = 45). These youth had an average grief score of 15.69 (SD = 8.09) with a range of 2 through 33. As only those who reported a traumatic loss responded to the grief scale, more gang-involved youth responded to the grief scale than justice-only youth. Nevertheless, we ran an ANOVA on the grief symptoms by gang involvement and, as expected, there were no significant differences on the grief scores.

Community Violence and Gang Involvement

All youth in the sample experienced some level of both direct and witnessed community violence (see Table 1). On average, youth were exposed to multiple incidents of community violence, direct and witnessed. Witnessing community violence was slightly more common (M = 10.82, SD = 6.26) among all youth than direct community violence exposure (M = 8.29, SD = 4.94). In comparing gang- and justice-involved youth with justice-only youth, gang-involved youth had significantly higher levels of community violence exposure, for both types (see Table 1). Gang involvement approximately doubled youth’s exposure to community violence (see Figure 1).

Table 1.

ANOVA Between Gang-Involved and Not Gang-Involved Youth on Their Level of Exposure to Community Violence.

	Total		Not Gang-Involved		Gang-Involved		F	p
	n	M (SD)	n	M (SD)	n	M (SD)	F	p
Direct Community Violence	62	8.29 (4.94)	27	5.96 (4.72)	35	10.09 (4.37)	12.64	<.001
Witnessed Community Violence	62	10.82 (6.26)	27	7.40 (5.71)	35	13.46 (5.37)	18.3	<.001

Figure 1.

Summary of differences in behavioral health and community violence exposure based on gang involvement.

Mental Health, Substance Use, and Gang Involvement

For all youth, the average posttraumatic stress score was 19.73 (SD = 14.18) with 14.5% of youth in the clinical range for PTSD (≥38). When youth were asked what traumatic event bothered them the most at the time of the assessment, the most common response was traumatic loss (24.6%), followed by having been shot or shot at (18%), and seeing a dead body in the community (11.5%). As shown in Table 2, youth averaged 14.12 (SD = 8.2) in depression symptoms with 34.4% of youth in the clinical range for depression (≥16). The majority of youth (75.8%) reported using drugs to some degree: 24.2% of youth reported either heavy or very heavy drug use, 24.2% reported moderate use, and 24.2% reported not using drugs. However, the majority of youth (83.6%) had recently used some type of drug or alcohol. Youth averaged 1.69 (SD = 1.01) on the drug and alcohol use scale indicating a count of different types (e.g., a variety score) of drugs or alcohol that were used recently.

Table 2.

ANOVA Between Gang-Involved and Not Gang-Involved Youth on Their Levels of Drug and Alcohol Use, Depression Symptoms, and Posttraumatic Stress Symptoms.

	Total		Not Gang-Involved		Gang-Involved		F	p
	n	M (SD)	n	M (SD)	n	M (SD)	F	p
Substance use	62	1.69 (1.01)	27	1.22 (1.01)	34	2.06 (0.85)	12.29	<.001
Depression symptoms	61	14.12 (8.20)	27	12.15 (6.01)	34	15.68 (9.38)	2.88	=.095
Posttraumatic stress symptoms	61	19.73 (14.18)	27	15.11 (13.41)	35	23.29 (13.90)	5.43	<.05

In assessing the differences in mental health symptoms (i.e., depression and posttraumatic stress symptoms) and substance use between gang- and justice-involved youth compared with justice-only youth, we found significant differences for posttraumatic stress symptoms and substance use, with gang- and justice-involved youth exhibiting higher levels than their justice-only peers (see Table 2). There was not a significant difference in depression symptoms between the groups. These differences are also visually displayed in Figure 1.

Turning Points

When asked about a turning point in their lives, nine youth reported something death-related (15% of the sample). Eight of those nine youth were gang-involved. Four of the eight narratives that related to death among the gang-involved youth discussed death or loss experienced during incarceration. For example,

When I was at camp I had gotten a phone call by my RO. When I called my friend he didn’t answer, his phone was off and I called his mom and she told me he had passed away two weeks ago and that he had been shot three times in the head around the corner of his house. When I first heard everything I couldn’t believe it, but as the days went by I realized that no one is safe in this game anyone could be killed. (18 years old, Latino)

Other youth discussed the loss or illness of family members while they were incarcerated. For example,

When I was in and out of juvenile halls and my father was sick—it changed my life!!! I was too busy gangbanging in the streets, I really never payed attention that my dad was sick. He ended up passing away while I was in placement! It made me realize a lot of things . . . And I have become a different person towards my family. I have more time and bond with my mom and family as much as I can. (Latina, age missing)

When I was just recently in camp I was supposed to get released [. . .] 3 days before my birthday but because of all the fighting I did, my judge gave me 6 more months to do which in total would make one whole year. I got a phone call a couple of days later saying that my great-grandmother, the one who raised me, was on her death-bed. It made me change because I saw that my actions made me miss out on my last days with someone important. (18 years old, African American female)

The fourth youth who discussed death during incarceration witnessed it happen to a friend. This 18-year-old Latino youth stated,

This last time I was locked up, one of my friends’ mom passed away while he was also locked up. It made me realize that I need to stop going back to jail and there’s better things out there that need to be cherished and gangbanging is not of those things.

Two youth identified witnessing a death as a turning point. For example,

It was at the age of 12 when I witness the death of my cousin that changed my life. The change wasn’t a good change. Things after that became worse I joined a gang and started my drug life. This change got me to where I’m at right now I’m struggling in school, and because of my drug use I’m unemployed. (18 year old, Latino)

Another youth recalls witnessing his mother’s death in detail:

When my mom got ran over by a drunk driver and died in front of my eyes when I was young. It was me, my sister, & my mom walking to the market and my mom was about to cross the street when a truck came really fast and hit her and the bumper of the car kept dragging her around the street on to the sidewalk and she died instantly this happen in August of [redacted], when I was 10 years old in [redacted] around 7:00 PM. (18 year old, Latino)

Two youth discussed their friends’ passing and how it affected their outlook on life. For example an 18-year-old Latino youth stated, “The passing of my close homie which did wake me up. It gave me that push to take a step back and see the importance of life.” And another reported,

My turning point was when one of my close friends was murdered over gang related issues. It actually woke me up into realizing its honestly not worth gangbanging. And I also realized there is much more to see in the world other than gangbanging. My friend was about the same age as me, which is why it hit me pretty hard. It has impacted me immensely even to this day regarding in how I live my life and in how I see the world. (19 year old, Latino)

Associations Among Key Variables

Experiencing a traumatic loss was significantly associated with gang involvement, witnessing community violence, directly experiencing community violence, posttraumatic stress symptoms, and depression symptoms. Traumatic grief was significantly associated with posttraumatic stress symptoms and depression symptoms. Of note, the association between traumatic grief and traumatic loss could not be tested because only those who experienced loss completed the grief inventory which meant there was no variability to explain. Among the full sample, witnessing community violence was significantly associated with gang involvement, directly experiencing community violence, posttraumatic stress symptoms, traumatic death, and substance use (see Table 3). Directly experiencing community violence was associated with gang involvement, witnessing community violence, posttraumatic stress symptoms, depression symptoms, traumatic death, and substance use.

Table 3.

Correlations Between Gang Involvement, Community Violence, Behavioral Health, Grief, and Loss.

	Measure	M	SD	1	2	3	4	5	6	7	8
1	Gang involvement^a	0.57	0.50	—
2	Witnessed community violence	10.82	6.26	.483**	—
3	Direct community violence	8.29	4.94	.417**	.706**	—
4	Posttraumatic stress symptoms	19.73	14.18	.288*	.424**	.504**	—
5	Depression symptoms	14.12	8.20	.22	.24	.279*	.622**	—
6	Substance use	1.69	1.01	.415**	.516**	.449**	.398**	.405**	—
7	Traumatic grief	15.69	8.09	.04	.17	.14	.575**	.322*	.16	—
8	Traumatic loss^a,b	0.73	0.45	.262*	.495**	.464**	.345**	.256*	.14	—	—

Dichotomous variable.

No coefficient for traumatic loss and traumatic grief can be generated because only those who experienced a traumatic loss responded to the traumatic grief inventory.

p < .05. **p < .01 level (two-tailed).

Gender

Gender differences were not included in the research questions due to the small sample size (females; n = 15); however, we did run difference tests on all key variables based on gender for exploratory purposes. No significant gender differences were found on any of the key variables. Although, direct community violence exposure did reach a p value of .051 with male youth reporting higher levels of direct community violence exposure (M = 8.98, SD = 4.97) compared with female youth (M = 6.13, SD = 4.32).

Discussion

The current study looks at behavioral health, grief, traumatic loss, violence, and turning points among justice-involved youth and the potential differences among those youth who were also gang-involved. All youth in the sample were justice-involved and over half (56.5%) were also gang-involved. Almost three quarters of the sample (72.6%) reported experiencing a traumatic loss. When it came to mental health, 14.5% of the sample scored within the clinical range for PTSD and 34.4% were in the clinical range for depression. One key finding from these results was that the most common response to the referent traumatic event among the youth was traumatic loss (25%). In addition, just over half of the referent traumatic events (54%) were death or near-death-related events (i.e., loss, being shot at, or seeing a dead body). The vast majority of the youth (75.8%) also reported some form of recent substance use. These findings are consistent with and support previous literature regarding justice-involved youth and increased risk of violence exposure, traumatic loss, and their impact on mental and behavioral health (Cuevas et al., 2015; Dierkhising et al., 2013; Vaswani, 2014; Wood et al., 2002).

Importantly, gang-involved youth are indeed a vulnerable sub-group among the broader justice-involved sample. In evaluating the sub-group of gang-involved youth, we found significantly higher levels of traumatic loss, substance use, community violence exposure, and posttraumatic stress symptoms. All the youth experienced direct or witnessed community violence, with many experiencing multiple forms of community violence. Yet, the youth who were also gang-involved were exposed to approximately double the amount of community violence, both direct and witnessed, compared with their justice-only peers. An overwhelming majority (83%) of the gang-involved youth reported traumatic loss which was also significantly greater compared with their justice-only counterparts (59%). Given that gang involvement results in higher levels of traumatic loss and exposure to community violence, it was expected and confirmed that gang-involved youth scored higher in behavioral health problems. The gang-involved youth had significantly higher levels of substance use and posttraumatic stress symptoms but not depression symptoms. These findings are mostly consistent with prior work, besides the depression results (Kliewer et al., 1998; Slovak, 2002; Vermeiren et al., 2002). Depression was, however, significantly correlated with direct community violence but not witnessed community violence. Conversely, posttraumatic stress symptoms and substance use were significantly associated with both forms of community violence exposure. Future research should consider moderated mediation models among larger samples to tease out the potential cascading and interactive effects of different or cumulative forms of violence exposure and traumatic loss on mental health outcomes and potential differences in model fit between gang-involved youth and their counterparts.

Traumatic grief is characterized by the presence of both grief and posttraumatic stress symptoms. In line with this, we see a significant and large association between posttraumatic stress symptoms and grief symptoms in the current study (r = .575, p < .001). Traumatic grief was also associated with depression symptoms (r = .322, p < .05). These findings indicate the need for behavioral health supports and interventions specific to posttraumatic stress symptoms, traumatic grief, and traumatic loss for those who are justice-involved; particularly for those who are both gang- and justice-involved. While gang-involvement is often a risk indicator for criminogenic need, results from the current study indicate it would also be an important indicator for trauma-focused, mental health referrals and interventions. Trauma-focused interventions that focus specifically on loss and grief for gang-involved youth should be prioritized. For example, Trauma and Grief Component Therapy for Adolescents (TGCTA; Saltzman et al., 2017) is a manualized treatment program that is specifically designed to address the complex needs of youth who must contend with the interplay of trauma and grief. This intervention employs a modular design that allows it to be flexible in addressing the specific needs of the youth and can vary in the length of treatment. The modules promote (a) building foundational knowledge and skills to enhance posttraumatic emotional, cognitive, and behavioral regulation; (b) group sharing and processing of trauma experiences; (c) group sharing and processing of grief/loss experiences; and (d) resumption of adaptive developmental progression and future orientation. TGCTA can be delivered in classroom settings, small group treatment settings, or individual treatment settings (Saltzman et al., 2017).

In a study by Olafson et al. (2018), TGCTA proved to be effective in significantly reducing posttraumatic stress symptoms in a sample of 69 youth housed in four juvenile justice facilities. These youth had been exposed to multiple traumatic or potentially traumatic events (10-11 on average) with witnessing community violence (i.e., seeing someone get beaten up, shot, or killed) as the most commonly reported event. When concluding treatment, youth had attributed gained knowledge such as “learning to think more before I do things,” “how to be calm,” “ways to make myself feel better,” and “more hope for my future” as results of their involvement in TGCTA (Olafson et al., 2018). Providing such services that address both trauma and grief for justice- and gang-involved youth are of key importance because youth who suffer traumatic grief are at risk for persistent distress related to the circumstances surrounding the death (Kaplow et al., 2018). In other words, and as the turning point narratives confirm, the events surrounding the loss of a person can affect a youth’s mental health and, ultimately, their recovery.

A distinct contribution of the current study to the broader literature are the descriptive narratives that provide insight into how youth conceptualize and contextualize their experiences with traumatic loss. For all youth, these were traumatic experiences; however, for some (who reported on death as a turning point), it led to posttraumatic growth (i.e., positive adaptation following a traumatic event; Tedeschi & Calhoun, 2004) and for at least one person, it led to maladaptive or survival coping (Kerig & Becker, 2010) such as drug use. Both the turning points and trauma literature reveal potential for change following a significant event and that the impact brought by the event can be either positive (improvement) or negative (aggravation). These differences in response align with the theoretical conceptualization of the processes of desistance and persistence in criminal trajectories from the life course perspective (e.g., Melde & Esbensen, 2011). Thus, turning points, posttraumatic growth, and traumatic events, in this case traumatic loss, seem to share some characteristics in that they can foster changes in identity, routine activities, and relationships.

Posttraumatic growth can be thought of as benefit finding or thriving following, and because of, a traumatic event (Tedeschi & Calhoun, 2004). It is often also considered a coping strategy where an individual can find meaning in their experience to grow from it (Park, Aldwin, Fenster, & Snyder, 2008). Meaning or posttraumatic growth derived from traumatic loss may be done in an existential manner given the shattered worldview that traumatic losses generate. The narratives highlight this in describing the meaning some youth derived from their loss, such as realizing the need to spend time with family or the need to move away from the gang lifestyle. What will be important to understand from future research is why some events lead to growth or desistance while others lead to the processes associated with persistence in gang-involvement. One potential theory is that it may depend on the timing of the event. For youth who are older, such as those in the current study, they may already be aging out of crime compared with younger youth who may experience traumatic events in ways that push them toward risky behavior.

Posttraumatic growth should be fostered among gang-involved youth and interventions, such as trauma-focused therapies, and help build the foundation for recovery and growth following trauma while also teaching self-regulation and adaptive coping skills. The problem for many gang-involved youth, however, is that their trauma exposure is ongoing and possibly inescapable depending on their social, socio-economic, and familial circumstances. Therefore, while it is important to provide and increase access to trauma-focused interventions, it is also important to identify and support the basic needs of gang-involved youth such as physical health, emotional support, and safety. One way to address these needs and reduce youth’s trauma exposure is encouraging desistance from gang involvement, and many gang interventions have been successful in doing so (Boxer, Docherty, Ostermann, Kubik, & Veysey, 2017; Sexton & Turner, 2011; Weinrath, Donatelli, & Murchison, 2016). However, the current work further supports the need for gang intervention programming to include trauma-informed practices and trauma-focused interventions (Dierkhising & Kerig, 2018) to address these basic needs and behavioral health in an integrated fashion.

Limitations

Although the current study expands on the literature regarding gang involvement, traumatic loss and grief, and behavioral health problems, it must be interpreted in light of its limitations. The most important limitation being the small sample size which limited our ability to apply more advanced statistical models. The small sample size also affects our ability to detect an effect when one exists; thus, it is possible that we did not reject the null when we should have. For instance, the finding that depression was not significantly higher among gang-involved youth may be due to a Type II error. Future research will need to replicate these findings amid larger samples sizes. It would also be important to look at gender differences, as we noted, and racial/ethnic differences among larger and more diverse samples. Regardless, youth who are heavily entrenched in gangs and also formerly incarcerated are a very difficult population to reach and conduct in-depth research with, making these findings still important in light of the sample size.

The study was also limited in geography and focused on youth in Southern California, where gangs are more prevalent. While this made it possible to conduct such a study, it also limits the generalizability of these findings to other geographical areas. Relatedly, the sample was predominantly Latinx which limits the generalizability to gang-involved youth of other races/ethnicities. However, our findings were consistent with prior research on gangs, particularly as it relates to victimization and trauma exposure, lending some confidence to the sample being representative to other areas and/or gang members.

Another limitation, which is common in the gang literature, was our measurement of gang-involvement. The use of self-report and self-identification, as was done in this study, does allow for the possibility of false reporting about one’s gang involvement. Either a youth may overstate their involvement to accentuate their “toughness” or they may understate their involvement to protect themselves (Boxer, Veysey, Ostermann, & Kubik, 2014). There is also the risk that this method casts too wide a net and may capture past members, “wannabes,” and people with weak affiliations (Battin, Hill, Abbott, Catalano, & Hawkins, 1998; Winfree, Fuller, Vigil, & Mays, 1992). Finally, participants’ definition of gang membership and involvement may differ and youth who are gang-involved may not see themselves as such (Bjerregaard, 2002). Despite these limitations, however, self-identification and self-report of gang membership and affiliation is commonly used and is believed to be a mostly face valid way of measuring gang membership and involvement (Esbensen, Winfree, He, & Taylor, 2001).

Conclusion

The goal of this study was to address the interrelated issues of behavioral health, grief, loss, and turning points among a sample of justice-involved youth, while making comparisons between those who were gang- and justice-involved and those who were only justice-involved. Our findings reveal higher rates of traumatic loss, posttraumatic stress symptoms, substance use, and community violence exposure among gang- and justice-involved youth compared with their justice-only peers. In addition, this study provided a unique look at the turning point narratives from gang- and justice-involved youth who describe, in their own words, how traumatic loss has affected their lives. These findings support the need to provide trauma-focused interventions to address the multitude of service needs that gang-involved and justice-involved youth are experiencing. Specifically, there is a need to increase access to therapies that focus specifically on traumatic loss (e.g., TGCTA; Saltzman et al., 2017) to address the profound loss and grief that gang- and justice-involved youth experience.

Footnotes

Acknowledgements

We are extremely grateful to the young adults who participated in this study and the agency that made this study possible. We are also thankful to the dedicated research assistants, Sunnaa Mohammad and Kevin Giron, for their work on this project and for the guidance from Misaki Natsuaki.

Authors’ Note

Jose A. Sanchez is now at University of Colorado, Boulder, in the department of sociology. Luis Gutierrez is now at the Veteran’s Administration in Los Angeles County.

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) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study was supported, in part, by the Doris Duke Fellowship for the Promotion of Child Well-Being: Seeking Innovations to Prevent Child Abuse and Neglect awarded to the first author in 2011-2013.

ORCID iD

Carly B. Dierkhising

Author Biographies

Carly B. Dierkhising, PhD, is an assistant professor in the School of Criminal Justice and Criminalistics at California State University, Los Angeles. Her primary area of research is in trauma and juvenile justice with a focus on how to improve services for trauma-exposed youth in the juvenile justice system from both a practice and policy perspective.

Jose A. Sanchez, MS, is a doctoral student at the University of Colorado, Boulder. His primary areas of research are gang dynamics, juvenile delinquency and victimization, and program development and evaluation.

Luis Gutierrez, MS, received his master’s in criminal justice from California State University, Los Angeles, in 2018. His primary areas of research are mental health within the criminal justice system, substance use, and public policy.

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