C4 Innovations

Healing for Youth with Disruptive Behaviors

An episode of “Changing the Conversation” podcast

Akeem Marsh and Lara Cox discuss adversity and healing for youth with disruptive behaviors with host Katie Volk. This episode is sponsored by the New England Mental Health Technology Transfer Center Network (MHTTC).

May 3, 2021


Katie Volk, Host: [00:05] Hello, and welcome to Changing the Conversation. I’m your host Katie Volk. Today’s podcast is sponsored by the New England Mental Health Technology Transfer Center. We’re talking with Dr. Akeem Marsh and Dr. Lara Cox about how to promote healing when working with youth with disruptive behaviors and who may be justice involved. Dr. Marsh is the Assistant Medical Director of the Home for Integrated Behavioral Health of the New York Foundling. Akeem, it’s great to have you here today.

Akeem Marsh, Guest: [00:33] Thank you so much. It’s great to be here as well.

Katie: [00:36] Dr. Lara Cox is an attending psychiatrist with the Bellevue Juvenile Justice Mental Health Service. Lara, welcome. It’s great to have you.

Lara Cox, Guest: [00:45] Thanks Katie. Super excited to be with you guys today.

Katie: [00:48] Now I know both of you are calling in from New York and are here to talk a little bit about what the relationship is between trauma and the juvenile justice system, and some of the young people that you’re working with. I wonder if, Akeem, we could toss it to you first, just to describe a little bit about the kind of work that you’re doing.

Akeem: [1:12] Yes absolutely. Originally I started my career at a fellowship working in the same service that Dr. Cox is working on currently. After being there within the system for so long, I just made a transition out into the community. Where I’m at now it is a mental health clinic, the Home for Integrated Behavioral Health. Basically the primary population served is the community, but specifically within the community, it’s mostly patients who are involved either in foster care or who are justice involved as in some situation may have come up and that they would have had their cases on some kind of diversion in which mental health services are part of that. I’m actually the primary psychiatrist in the clinic. I supervise two nurse practitioners, and all of us see patients who are in a variety of programs that exist within the clinic.

Katie: [2:18] Excellent. Lara, my understanding you do the same kind of work. Do you want to say a little bit about that?

Lara: [2:27] Yeah. I work within the juvenile justice system itself. I provide care for kids who are in secure and non-secure detention, who are in the process of having their cases processed and resolved here in New York.

Katie: [2:40] I found that the phrase “justice involved youth” covers a wide range of things and is sometimes kind of a catch all, and I wonder what you find are the pathways. How does someone become justice involved and get that label? What are the common pathways you see?

Akeem: [2:59] Basically it all starts with trauma I’d say, at the beginning of it all. Almost every youth that is involved has some sort of trauma experience, but it’s not a simple thing like a car accident or some sort of terrible fall or something like that. It’s usually intense things like ongoing physical abuse, perhaps sexual abuse, extensive community violence, and it’s often a mix of those things as well. The way we view the youth, the way we understand them to become justice involved would be they have their traumatic experiences as the pretext, and then they have their own reactions to that trauma, and whatever their reactions happen to be tends to lead them to the attention of authorities, and that is basically the pathway in which they become justice involved.

Katie: [4:08] Yeah. Authority can be, I think, a big trigger for anyone who’s had a trauma history, particularly when it’s complex trauma or chronic trauma. Lara, what’s on your mind?

Lara: [4:21] I was just going to add about systemic trauma and our kids’ experiences with the system tend to be pretty traumatic as well. I’m talking the child welfare system, the educational system, the justice system. Their experiences don’t tend to be particularly positive and so that also contributes to both of the disruptive behaviors and to people’s interpretations of those behavior and where our kids end up.

Katie: [4:50] I know you all have talked about this and written about it extensively. You’ve got a book coming out called, Not Just Bad Kids: The Adversity and Disruptive Behavior Link. Tell me a little bit about what that link is, and then I have a bunch of follow-up questions.

Lara: [5:06] I would say that link is that all behavior makes sense in context. So the behaviors that we’re seeing from our kids, they make sense in the context of their lives and their histories.

Katie: [5:18] Certainly. We don’t do what we do for no reason. You’ve got to get to the root of the issue. Although I’ve found that sometimes folks don’t quite understand that and they see a kid who may be being rude or perceived as disruptive or something when actually there’s so much else going on underneath the surface. Akeem, I wonder if you want to respond to that.

Akeem: [5:42] Yeah, absolutely. We got to this point of putting this book together because we really wanted to get a sense of the nuance of what was going on with these kids. We see things going on, we see the system happening, we see how we’re dealing with everything, and we’re just coming from an angle of what is really going on here. What are we really doing? And are we really handling this kind of situation the right way? And are there other ways that we could handle it? We try to answer those kinds of questions in our book, and then also giving understanding and perspective to the youth and the families themselves, as well as all of the people who may be working with them.

Katie: [6:40] Right, students don’t exist or young people don’t exist in a vacuum; we exist in a context, in a community with relationships, with siblings and caregivers and teachers and other people in our lives. I wonder, you’ve talked about right ways and not so right or wrong ways to approach young people. What are some of the dos? How should we be approaching someone who’s experienced the kinds of trauma that you’re talking about in the systems that you’re talking about?

Lara: [7:09] I think that a lot of the time kids’ behaviors are so intense and our interactions with them can be so intense that we get stuck in the moment. We forget about that context, and we forget about how their behavior might make sense and stop trying to make sense of it. We just try to make them stop doing what they’re doing. Unless we understand where that comes from and why they’re doing it and why that works for them, it’s very hard to get people to change their behavior. That sort of stepping back, taking a breath, remembering what we know about this particular kid, or even if we don’t know that much about this particular kid, what we know is on average about kids who tend to be system involved, which is that history of trauma, that history of interactions with the system that aren’t positive and think about what we know in that context so that we can react more calmly and helpfully.

Katie: [8:13] Certainly. I hear you talking about different systems and different policies, and I wonder, Akeem, what have you seen that works well, but also I know sometimes systems try to put in zero tolerance policies for XYZ behaviors and that tends to backfire, and I wonder if you could speak to that.

Akeem: [8:34] I think of the things that works really well really comes down to coming to meet the kids where they’re at, coming down to their level, humbling yourself and not trying to be such an authoritative figure. Simple things like we kind of culminate it in one of our chapters, as be a person. Really it comes down to being a true, authentic human being. Essentially you be consistent with the things that you say. Don’t promise things that you aren’t absolutely sure you can deliver on. Basically talk to the kids on their level where they’re at and don’t try to talk above them or at them. Try to be just a normal person. That seems like a simple thing, but it really is a challenge in different settings and training and cultures, and different things add layers to that.

Akeem: [9:47] As far as things that don’t work, what we see a lot of is people are having all kinds of triggers and all kinds of reactions going on all the time and often the authorities or the people who are there to take care of the youth, are reacting to the youth’s reactions without the context or without being mindful of the context. As a result of that, they’ll be in some sort of disciplinary action, some sort of trouble. Whatever the setting is like, for example, if we’re in school, the youth are turned off from school. “I don’t want to go to school.” Or if they’re supposed to be engaged in some kind of program, sports, or some other activity, then when something like that happens, then they’re disengaged. As a result, it just has a snowball effect. They go from there and spiral in all different directions that should not have happened if the proper context was understood and people were giving them the appropriate kind of treatment and support that they really need.

Katie: [11:08] So much of what we’re talking about around authority and power, I think is scary for someone who has never worked in this kind of way. It’s so simple, and yet it’s so complex to say, actually, it’s okay to just be human and to give young people a little bit of power and trust that in an authentic relationship they’ll use it and use it wisely, and if they don’t, then you can talk with them about what that looks like. It’s a really different way of engaging with people and can be so healing, but I also think is so intimidating to systems that have not typically been able to engage in this way for a whole host of reasons. It would I think be helpful for our listeners if one or both of you could speak to why authority and power is such a trigger for young people.

Lara: [12:04] Many of our kids have been having to make adult decisions and having adult level responsibilities, like taking care of their own food, taking care of their little siblings, finding a place to stay for months or years. It’s very hard to go back from being an adult and having those kinds of responsibilities and the need to make those decisions for yourself and to take care of yourself, to being a kid in a kid role who is supposed to just listen to adults and do what they say. That level of autonomy, independence has to get respected. When we forget about that, it’s very easy to end up in a conflict.

Lara: [12:51] The other thing is that, like we were saying, many of our kids, most of our kids have had pretty negative experiences with authority and with people in authority, and so if you try to come down in this hierarchical way, they get very reactive because it’s a trauma reminder in and of itself to be hierarchical, to talk down to them because they don’t feel heard, they don’t feel seen. So they’re basically like, “Well, F you then.” Whereas if you come to them as a person on their level, and you’re clearly listening to them and reflecting back what you hear, then they’re more likely to be willing to listen to you too.

Akeem: [13:38] Yeah, I just want to echo that. If you come to them on their level, hopefully they’ll come around. I think if you do that enough the kids will really see, “Hmm, maybe this person is not like everyone else who thinks they’re the big stuff, that thinks they’re the big shot, thinks they’re so much better than me. Maybe this person really has some of my interests.” You see that sometimes where some of them will come around.

Katie: [14:14] It requires a great deal of mindfulness, I would guess on the part of practitioners, because like you both were saying earlier, there’s an instinct to just react I think when something big happens or when you’re in the moment, and it requires practicing that pause on the part of the clinician or the teacher or the caseworker or whoever. That sometimes is a really good starting point for someone. I wonder if you could comment on that.

Akeem: [14:42] Yes, I would say definitely mindfulness in a sense that we have to be grounded ourselves. We have to be in tune with ourselves and really know ourselves well. That’s where everything kind of starts. We start with ourselves and then from there, we have to be able to mentalize as best we can what’s going on with this person in front of me and really try to take a approach that’s caring and understanding and not punitive or disciplinary. I feel like that’s not just true for what we’re talking about, but it’s also true for so much of what’s happening in the world. If we all just kind of shifted our orientations a little bit, then maybe things would flow so much better for all of us.

Katie: [15:47] Certainly, certainly. Lara, what are your thoughts?

Lara: [15:54] I think that being present and being aware are hugely important. We have to be aware of ourselves and what’s going on with us and our own reactions, our own feelings, our own history, our own triggers, as well as the kids. Sonya Renee Taylor talks about radical self-love, and I think that’s huge; this idea of loving and accepting who you are and then being able to expand that to other people.

Katie: [16:26] I love that concept, and it also developmentally fits well for young people in the age range that we’re talking about, to accept yourself as you are now, and to work with people who also respect that, but know that also, you’re going to be many selves. That’s what that adolescent period is, is figuring out who you are and where you fit and how you’re going to be in the world and the messages that you’re receiving from the people around you really play a huge role in all of that.

Katie: [16:56] I like to end this podcast, which we really try to keep focused on resilience and recovery, by asking where you find resilience and recovery in your own lives and in your own practice. Akeem, I’ll toss it to you first.

Akeem: [17:12] I find resilience in being able to hold space for somebody who has had issues in the past with trust and trauma obviously. Just really being able to be that person for an individual is a huge honor I feel and a privilege. It also is magical. It’s like something special. I feel like that gives me life. Of course, outside of work, there’s other things that I continue to do that I feel like helps keep a balance. Doing things to take care of myself, like getting some fresh air, spending time with the kids, the kids at home, going out to different places, not so many places now because of coronavirus, but whatever way I can make that work. Just feeling like I’m having some kind of impact or are fighting the good fight, I feel like that keeps me going forward.

Katie: [18:26] Ordinary magic. Lara, what about you?

Akeem: [18:30] I find resilience in connections with people. Those moments of connection are absolutely magic. And in being able to see other people’s resilience. The resilience that our kids have is remarkable, and just being willing to spend a little time with us and open up even a tiny bit is such a marker of that resilience. Those moments of joy and connection and a sense of profound awe at how resilient people are and how much depth and strength that they have. Keeping that sense of awe and keeping that sense of joy, I think is where I find a lot of mine. That’s connections with people, like Akeem, both inside and outside of work. You kind of create your family and that’s amazing.

Katie: [19:27] It has been such a pleasure to talk with both of you about all of these topics. For our listeners, if you’re interested in learning more, you can check the show notes where there’ll be a link for, Not Just Bad Kids. The book is coming out at …

Akeem: [19:43] I would say later this year.

Katie: [19:44] Yeah, so check that out. Akeem and Lara, I just want to say thank you so much for joining us today.

Akeem: [19:51] Thank you so much for having us.

Lara: [19:53] Yeah, thank you for having us. It’s really been a pleasure.

Katie: [19:56] And to our listeners, join us next time on Changing the Conversation.

Erika Simon, Producer: [20:00] Visit c4innovates.com and follow us on Twitter, Facebook, LinkedIn, and YouTube for more resources to grow your impact. Thank you for joining us. This episode is sponsored by New England Mental Health Technology Transfer Center, and was produced by Erika Simon and Christina Murphy. Our theme song was written and performed by Peter Hanlon. Our host for this series is Katie Volk. Join us next time on Changing the Conversation.


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