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STEERING PAST TROUBLE

Danica Knight employs trust-based interventions to help troubled youth.

Talk about tempers and trouble.

Soon after two youths at a residential juvenile justice facility started arguing, their heated exchange turned physical. One of them injured a staff member who intervened, which triggered an automatic security alert.

Though the teen had been making significant progress in controlling his violent outbursts, he faced daunting consequences for the assault: isolation, a transfer to a more secure facility or going to an adult prison, depending on a judge’s decision.

But jumping to the punishment phase might not benefit anyone in the long run, said Danica Knight, professor of psychology. Many children and teens feel frustrated or angry and don’t know how to handle those feelings, so they act out.

Danica Kalling Knight, IBR Senior Research Scientist and associate professor of psychology in TCU’s College of Science and Engineering. Dr. Knight also serves as Associate Director of Research at the Karyn Purvis Institute of Child Development.
PHOTO BY Leo Wesson

“The first thing caregivers tend to do is jump in and correct,” Knight said. “Instead, they could pause to think about what the need behind the behavior is. What is the child dealing with? What is the bigger issue?”

Often, those issues can be traced back to challenges the child faced early in life, such as abuse, violence or poverty.

For three decades, Knight has been studying how young people go awry. Often, youth delinquency and substance abuse stem from a combination of childhood trauma and not learning to self-regulate.

She spent 27 years with TCU’s Institute of Behavioral Research, where she led multimillion-dollar grant projects to develop substance abuse intervention programs for young people. In 2019, she moved to the university’s Karyn Purvis Institute of Child Development, where she serves as associate director of research.

One of the principles Knight teaches caregivers is that they need to see the need to meet the need.

After the altercation, another staff member pulled the youth aside to understand why he had turned physical. The adolescent said he had been provoked by the staffer who intervened and couldn’t handle his frustration. As a result of their conversation, leadership at the facility determined the situation was not the teen’s fault, which helped his mother advocate for her son when he faced the judge over the incident.

The judge gave the kid a second chance to complete his rehabilitation program and stay at the facility. There, he continued to work with the staff and his mother as he addressed his problems. With support systems in place, he could learn how to manage his impulses rather than turning to risky, potentially fatal decisions as he entered adulthood.

Effective interventions are the goal of Knight and her research team, including project director Yang Yang and project coordinator Lainey Tinius. As part of a new National Institute on Drug Abuse-funded research project, they are testing whether their intervention programs in justice facilities can curb drug abuse once a juvenile returns home.

This project is a joint venture between the Purvis Institute and the Institute of Behavioral Research and is part of the National Institutes of Health’s Helping to End Addiction Long-Term, or HEAL, initiative. The federal program is a multidisciplinary effort to find science-based solutions to the opioid crisis in the United States.

The overarching goal of Knight’s project is to right the ship for struggling young people so they can steer past dangerous behaviors like opioid abuse.

The answer, more often than not, means dealing with childhood trauma through interventions that involve the whole family.

ATTACHMENT THEORY

HÉLÈNE DESPLECHIN | MOMENT | GETTY IMAGES

The basis of Knight’s new project, Trust-Based Relational Intervention®, was developed in the early 2000s by TCU’s Karyn Purvis and David Cross, who worked with families of fostered and adopted children.

Cross, the Rees-Jones director of the Karyn Purvis Institute and a professor of psychology, served as Purvis’ adviser when she came to TCU for degrees in child development and psychology. Their research, based on attachment, sensory processing and neuroscience, addresses the physical, relational and emotional needs of children who have experienced trauma.

Attachment is the theory that a child’s emotional needs stem from the bond formed between the caregiver and the child during the first two to three years of life. “When a child is raised in an environment where their needs are met consistently, an emotional connection between parent and child is made,” Knight said. “The child can learn to self-regulate in partnership with the parent.”

A rift in that relationship happens when the child’s physical and emotional needs are not met. Consequently, the child never forms the bond of trust that allows the caregiver to teach self-regulation skills amid healthy and appropriate boundaries.

Using Purvis and Cross’ materials, Knight’s research team, which includes TCU students and faculty, developed a two-track intervention curriculum for families with sons and daughters in the juvenile justice system. The program’s intent is to mend the family relationship so the child has a supportive environment that fosters healthy communication. This is the first step toward addressing the roots of the behaviors that can eventually lead to substance abuse disorder.

Most children and teens in the justice system have experienced multiple traumatic events or ongoing, prolonged trauma, known as complex trauma. Knight said that children who have experienced this type of trauma possess heightened emotions and do not self-regulate well, making them more likely to engage in substance abuse and other risky behaviors.

Those uncontrollable emotions stem, in part, from neurochemistry. Children who have experienced complex trauma tend to produce more cortisol, one of the stress hormones that is part of the body’s fight-or-flight system. These children struggle socially because they are unable to express themselves in constructive ways and tend to respond to difficult situations with anger, fear or withdrawal.

In the youth-focused training sessions, adolescents learn how to communicate what they are feeling and react to difficult situations in healthy ways.

In adult-focused training sessions, caregivers learn how to recognize their child’s needs and respond in ways that equip children to regulate their impulses.

Then adults and youth attend combined sessions, called nurture groups, to practice what they learned and begin to build trusting, supportive relationships that will continue once the children go home.

Knight said that trust-based intervention can change the trajectory of an entire family.

AVOIDING OPIOIDS

Opioid abuse has been an escalating problem in the United States, and federal agencies are desperate for research-backed creative interventions.

In 2018, the NIH HEAL initiative reported that 10.3 million Americans 12 and older misused opioids, including heroin. The Centers for Disease Control and Prevention estimated that between May 2019 and May 2020 more than 81,000 people died from drug overdoses — the majority involving synthetic opioids.

Studies indicate that people between ages 16 and 30 are the most at-risk group for initiating opioid use, misusing opioids and dying from an opioid-involved overdose. Children and teens in the justice system are especially at risk for future opioid addiction.

Knight said she gravitated toward the NIH initiative because it targeted vulnerable adolescents, including those in the justice system. That population was at the center of the work she had long done at the Institute of Behavioral Research.

“Ninety percent of kids in the juvenile justice system end up using substances at some point and often do so at the point of having a substance abuse disorder,” Knight said.

In 2019, the Purvis Institute and the Institute of Behavioral Research were jointly awarded funding for the one-year development phase of Knight’s study. The development phase was completed in August 2020, and in October 2020 the two institutes were awarded $4,460,305 in additional funding for the four-year main study phase of the project.

In March 2021, Knight’s research team began recruiting youth in 10 secure residential facilities in Texas and Illinois, as well as their caregivers, with a goal of 360 youth/caregiver pairs over a three-year period. In the first phase, families will take part in assessments to document the youths’ progress after release. In 2022, the project will recruit families to participate in assessments plus Trust-Based Relational Intervention training to examine the value added by the intervention. All the families will go through the dual-track intervention sessions.

Currently, TCU staff conduct the intervention groups and assessments. In the last year of the five-year project, facility staff will be trained on how to implement the intervention groups. But in the meantime, facilities that want to use TBRI strategies with youth in day-to-day interactions will get the training and support.

The research team will check in with the families to determine whether parents and youth continued using the skills and techniques they learned in the training sessions once the kids returned home.

The team will also conduct long-term studies to identify whether early intervention helped deter later misbehavior and opioid use.

Knight said the preliminary results are promising. She cited one example of a youth who had a history of aggressive outbursts. While spending time at a secure facility that used her curriculum, he spiraled into anger. He told one of the staff members that he was “in the red,” a phrase he learned in the training sessions that indicates feeling out-of-control frustration.

“This simple statement represents a milestone for this youth,” Knight said. “Because of using that one phrase, he was able to identify his emotions, recognize that he was not in an ideal place — in the green — and signal to an adult his need for help.”

Aliya Moore, a senior psychology and Spanish major, worked with Knight translating documents and surveys for Spanish-speaking families in the research program. One of her major takeaways was that intervention is a team effort. “Each person on the project plays a crucial role to the success of the participants in the project, including the participants themselves.”

Knight said she agrees that a team-based approach is necessary: “Children live and function in multiple contexts — families, schools, etc.”

She said she hopes that her work will eventually be used by all adults who interact with children, including teachers, counselors and probation officers. “Imagine how a child would thrive if in all these contexts adults paid attention to what they truly needed and found a way to meet that need.”

BY HEATHER ZEIGER