A Trauma-Informed Approach to Youth Mental Health Issues

Behavioral health professionals are working on the front lines of a youth mental health crisis as we cope with the stress, trauma, and losses of the pandemic. 

Working with youth who have experienced trauma can be both challenging and rewarding. But it’s not the same as working with adults. 

It’s important to understand how to recognize and treat child traumatic stress, understand the impact of adverse childhood experiences (ACEs), and learn how to talk about suicide and self-harm.

How Common Are Youth Mental Health Issues?

Some studies show that as many as one in every four or five youth meet diagnostic criteria for a lifelong mental disorder. This can make home and school life challenging for them, especially if their problems go untreated.

Trauma-informed treatment and trauma-specific services can help promote positive mental health for young people and help them navigate the stresses and challenges of life, along with the added trauma of the pandemic. 

Child Traumatic Stress

Too many children experience traumatic events in their lives, making it difficult to connect and thrive in their homes, schools, and communities. The Substance Abuse and Mental Health Services Administration (SAMHSA) shared the results of one study:

• 8% of youth between the ages of 12 and 17 reported a “lifetime prevalence of sexual assault.” 
• 17% reported physical assault
• 39% witnessed violence

Any one of these events is enough to harm a child, but many young folks are re-traumatized repeatedly.

Examples of Child Traumatic Stress

SAMHSA offers the following examples of child traumatic stress:

• Neglect and psychological, physical, or sexual abuse
• Natural disasters, terrorism, or violence in their schools and communities
• Witnessing or experiencing intimate partner violence 
• Sex trafficking or exploitation
• Serious accidents, illness, or loss of a loved one
• Refugee and war experiences
• Family stresses related to military deployment, loss, or injury

Signs of Traumatic Stress for Middle and High School Youth

Experiencing traumatic stress can most certainly get in the way of healthy functioning for young people. Middle and high school are already tough times for many young people, but those who have experienced trauma are more likely to react by:

• Feeling depressed or alone
• Developing eating disorders and self-harming behaviors 
• Beginning to abuse alcohol or drugs
• Becoming sexually active

What Happens When a Young Person Survives Trauma?

A young person who has experienced trauma may experience negative effects in many aspects of their life. They may struggle socially in school, get lower grades, and be suspended or expelled from school. They may become involved in the child welfare and juvenile justice system. And they often experience more physical health problems as they grow, like diabetes and heart disease. 

That’s why the work of behavioral health professionals in providing trauma-informed treatment is so critical in these formative years.

Adverse Childhood Experiences (ACEs)

One of the most common diagnostic tools to determine if someone has experienced trauma is called the ACE Score Questionnaire. It has been used by thousands of professional clinicians and researchers, and it includes questions that help determine if someone was mistreated by an adult, whether abuse of others was occurring in the home, whether they grew up feeling like they didn’t have enough to eat, or if their parents were too impaired by drugs and alcohol to take care of them. 

Trauma‑informed and Trauma‑specific Treatment

Once we understand what the young person has experienced in their home and community, we can treat trauma in one of two ways: 

1. Trauma‑informed treatment, which incorporates knowledge of trauma even though the treatment focuses on substance use, mental health disorders, or other issues

2. Trauma‑specific treatment, which is specifically designed to address trauma

Heed the Surgeon General’s Warning

In 2021, the US Surgeon General issued an advisory report warning of a public health crisis facing children and youth since the pandemic. Rates of mental health issues are increasing at an alarming rate. Depressive and anxiety symptoms have doubled during the pandemic. And by early 2021, the rate of emergency room visits for suspected suicide attempts was 51% higher for adolescent girls and 4% higher for adolescent boys than in 2019.

Adolescent brains aren’t fully developed until the age of 23 or 24, so the mental and social challenges of the pandemic may have lasting effects on our young people’s mental health. 

Talking about Suicide and Self-Harm

One important thing to remember is that self-harm is not the same as suicidal ideation. Both are serious mental health issues, but it’s important for behavioral health professionals to know the distinction and not unknowingly contribute to self-harming behaviors.

To stop the epidemic of youth suicide, we need to normalize talking about it. 

When the topic of suicide is taboo, the emotional pain festers and grows. So, we need to help get suicide out in the open. 

Behavioral health professionals who encounter young people in this type of emotional pain need to ask, “Are you thinking about killing yourself?”

5 Steps for Helping a Young Person in Emotional Pain

The National Institute of Mental Health (NIMH) provides 5 Action Steps for Helping Someone in Emotional Pain:

1. Ask “Are you thinking about killing yourself?”

2. Keep them safe by reducing access to lethal items or places.

3. Be there by listening carefully and acknowledging their feelings.

4. Help them connect with resources, including the National Suicide Prevention Lifeline: 1-800-273-8255

5. Stay connected. Follow up and stay in touch after a crisis.

Trauma-Focused Cognitive Behavioral Therapy

One intervention used by clinicians to treat young people who have experienced a traumatic event or events is called Trauma-Focused Cognitive Behavioral Therapy (TF-CBT). 

It uses principles of Cognitive Behavioral Therapy (CBT) to address trauma by gradually exposing and discussing the events. And it helps the person move past the trauma and into a present where they feel safer and more able to cope with life’s challenges.

Young People Speaking Out and Reaching Out

Diana Chao, one of the keynote speakers at the 2022 Trauma & Recovery Conference, has firsthand experience with youth mental health issues. The first-generation Chinese American immigrant nearly ended her life when she was a high school sophomore. As a response, she founded Letters to Strangers (L2S), a global youth-for-youth nonprofit that has published a Mental Health Guidebook and YouTube series. 

“I grew up with bipolar disorder and c-PTSD and didn't believe I deserved the air I breathed,” Chao writes on the LTS website. “After surviving a series of suicide attempts, I found healing from an unexpected source: writing. In writing letters to strangers, I realized that I wasn't alone - I never was alone.”

A Healthier Future

When youth-led projects like L2S, schools, clinicians, and families all have a shared understanding of the impact of childhood trauma and the effective ways to treat it, our children and youth have a better chance of thriving. 

It’s up to us to notice the signs of child traumatic stress and offer trauma-informed treatment for building a healthier society.