Toxic Stress in the Legal and Judicial System and How to Prevent It

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Exposure to adverse childhood experiences (ACEs), such as poverty or abuse, is a known risk factor involvement in the legal and judicial system.

And, involvement in the legal and judicial system may be an indicator of toxic stress.

Thus, the legal and judicial system plays an important role in preventing the effects of ACEs and toxic stress.

That’s why, in December 2020, Dr. Nadine Burke Harris released her Roadmap for Resilience: The California Surgeon General’s Report on Adverse Childhood Experiences, Toxic Stress, and Health.

Salud America! is exploring the report as part of its 11-part series on toxic stress.

“Factors that underlie connections between victimization or trauma and later [legal and judicial] involvement provide a window into areas for primary and secondary intervention strategies—reducing exposure to adversity and identifying those individuals with risk factors,” Burke Harris’ report states.

Why Those Working in the Legal and Judicial System Need to Know About ACEs and Toxic Stress

The body reacts to stress through a complex process of involuntary biological, physiological, and behavioral responses.

Regardless of a person’s perception of or outward reaction to stress, their stress response system can be activated, and the amygdala, hypothalamus, pituitary gland, and adrenal glands can pump stress hormones without one’s awareness.

This becomes problematic in childhood if the stress response is activated too frequently or too intensely by adverse childhood experiences (ACEs) such as abuse, parental substance abuse, and poverty.

Without the buffering protection of supportive relationships to help the biological stress response recover and regulate, it becomes dysregulated and disrupts development and functioning of the brain and other organ systems.

This is known as the toxic stress response, and it can cause lifelong physical, mental, and behavioral health problems.

Some groups in the US, including Latinos (19.5% of the US), have a high prevalence of ACEs.

These groups are also more likely to face disciplinary action, arrest, and incarceration.

“The same populations that are … impacted by ACEs also are more likely to interact with the [legal and judicial system] system,” Burke Harris’ report states.

Similarly, groups who are high school nongraduates, uninsured or underinsured, and/or are in lower income brackets have a higher prevalence of ACEs and worse outcomes. They are more likely to be referred to the legal and judicial system system, as well.

Additionally, “encounters with law enforcement and the [legal and judicial] system are intrinsically stressful,” Burke Harris’ roadmap states.

To truly prevent the effects of ACEs and toxic stress, the legal and judicial system has to play a big role.

Below are primary prevention, early detection, and early intervention strategies for legal and judicial systems to address ACEs and toxic stress among Latino and all people.

Primary Prevention Strategies in Legal and Judicial Systems

Primary prevention includes efforts that target healthy individuals and aim to prevent harmful exposures and behaviors from ever occurring.

For legal and judicial systems, this means reducing cumulative adversity and preventing entry into the legal and judicial system.

Strategies to reduce cumulative adversity and prevent entry into the legal and judicial system should promote youth well-being, such as:

• Ensuring youth access to counselors and preventive healthcare
• Improving school connectedness and community sources of resilience
• Building youth leadership skills
• Reducing the school-to-prison pipeline
• System-level changes to limit zero-tolerance policies and prevent children from entering adult criminal courts
• Increasing police accountability

In Virginia, for example, courts are required to consider a juvenile’s exposure to ACEs when sentencing a juvenile as an adult.

Other ACEs-informed practices include de-escalation techniques, restorative strategies, and allowing juveniles and adults to receive restorative care.

In addition to promoting youth well-being, strategies should also promote judicial-sector employee well-being, such as providing staff with sufficient training before and after potentially harmful experiences and increasing access to counselors and preventive healthcare.

Many legal and judicial-sector workers, like police officers, patient support workers, and probation officers have high levels of stress in their jobs and experience burnout at very high rates.

Additionally, many of these people have their own ACEs.

“One in nine report suicidal ideation (compared to one in 33 in the general population), and 27% of correctional officers have PTSD symptoms (compared to 6% of the general population),” Burke Harris’ report states.

Early Detection Strategies in Legal and Judicial Systems

Early detection aims to identify risk factors and build protective factors for individuals with a history of ACEs who end up involved in the legal and judicial system.

This begins with ACEs-informed training for all legal and judicial professionals to identify and respond to those individuals in a way that mitigates stress.

“One aspect of toxic stress physiology that is of particular relevance to the [legal and judicial] system is the notion of stress sensitization,” Burk Harris’ roadmap states. “Individuals with a dysregulated stress response may be more sensitive to subsequent stressors in terms of risk of manifesting the neuro-endocrine-immune-metabolic consequences of cumulative adversity.”

This can lead to health problems, such as stroke, diabetes, and depression, as well as behavioral problems, such compromised impulse control and emotional dysregulation, which may lead to greater conflict.

In addition to ACEs-informed training for employees, this also calls for ACEs-informed practices.

Exposure to the legal and judicial system can contribute to cumulative adversity itself as well as through incarceration, removal of youth and adults from communities, and disconnection from support systems.

“Cumulative adversity is also associated with poorer educational and … outcomes, including learning, developmental, and behavior problems, high school noncompletion, unemployment, low life satisfaction, and poverty—many of which increase risk of incarceration and also serve to transmit adversity to the next generation,” Burke Harris’ report states.

Thus, strategies should focus on preventing further exposure to the legal and judicial system.

For individuals who commit non-violent offenses, strategies include various alternatives to traditional legal and judicial proceedings, such as:

• Restorative measures are an alternative that emphasizes repairing the harms caused by a crime and often involves victim-offender mediation.
• Neighborhood Courts are an alternative to traditional criminal court proceedings for misdemeanor cases where volunteers hear from both the offender and the victim to discuss the case and its impact on the community.
• Pretrial diversion programs are alternatives where charging attorneys refer individuals to job training, parenting support, intensive case management, and education opportunities.
• Alternative sentencing options, such as home monitoring, drug courts, and other courts that connect individuals to needed services.

The Back on Track program, which is a 12-to-18 month pretrial diversion program, “had less than 10% reoffending rate over two years, compared to a rate of 53% among those who did not take part in the program,” Burke Harris’ roadmap states.

Early Intervention Strategies in Legal and Judicial Systems

Early intervention includes efforts that target people already under the care of the legal and judicial system who have ACEs or toxic stress to encourage rehabilitation and recovery and to reduce the magnitude of negative downstream outcomes when they re-enter society.

Screening for ACEs and other adversity help identify physical and other health needs as well as other needs, such as housing and family reunification, and help link judicial-involved individuals to programs.

It is important that programs are comprehensive to address various medical, educational, occupational, and other needs.

Programs should also support restorative principles, healing from ACEs, educational opportunities, vocational opportunities, and other programming.

“Interventions such as multisystemic therapy, cognitive-behavioral therapy, and family-based therapies, such as functional family therapy, have succeeded in improving … health in [legal and judicial-involved individuals] and also in reducing rates of recidivism,” Burke Harris’s report states.

Additional strategies include:

• Providing preventative and treatment-oriented healthcare for legal and judicial-involved or incarcerated individuals
• Providing ACEs-informed assessment and care in legal and judicial services
• Re-entry programs that support restorative principles, healing from ACEs, educational opportunities, vocational opportunities, etc.
• Establishing data systems that function across sectors are necessary to track referrals and services, facilitate follow-up to ensure that each individual receives the necessary care, and assess outcomes
• Collaborating between the legal and judicial system, the health system, the child welfare and other service systems, the educational system, and community resources

“Providing proper preventive and treatment-oriented … health care while an individual is [legal and judicial-involved] or incarcerated results in lower rates of delinquency and recidivism, higher employment,” Burke Harris’ roadmap states.

What Can We Do About Toxic Stress?

Share our Salud America! team’s 11-part exploration into the important recommendations in Dr. Nadine Burke Harris’ roadmap to address ACEs and toxic stress:

1. Toxic Stress and its Lifelong Health Consequences. Toxic stress is a public health crisis that has lifelong impacts on health.
2. We Need to Recognize Toxic Stress as a Health Condition with Clinical Implications. Health experts are pushing to elevate toxic stress and developmental issues on national research and change agendas.
3. Cut Toxic Stress with 3 Types of Public Health Prevention Interventions. Preventing toxic stress requires a three-level public health intervention approach.
4. How to Use Healthcare Strategies to Address Toxic Stress. In clinics, hospitals, and other healthcare settings, workers can provide universal ACEs-informed care and more.
5. Using Public Health Strategies to Address Toxic Stress. When it comes to ACEs and resulting toxic stress, the public health sector can play a critical role by strengthening economic support, positive family relationships, and services.
6. How to Use Service Strategies to Address Toxic Stress. We need ACEs-informed training for patient support workers, as well as family-friendly workplaces and home visits.
7. Toxic Stress in Early Childhood and How to Prevent It. Early childhood is a key time for preventing ACEs and toxic stress.
8. Toxic Stress in the Legal and Judicial System and How to Prevent It. Encounters with police are “intrinsically stressful and potentially traumatic.” (current article)
9. Toxic Stress in Education and How to Address It. ACEs and toxic stress can hinder a person’s learning and school success.
10. California’s Epic Response to Toxic Stress and ACEs. California, already leading the nation in addressing ACEs, is making inroads to address toxic stress.
11. 5 Upstream Ways You Can Take Action to Address Toxic Stress. Here are ways you can take action to address toxic stress.

“Minimizing encounters with the [legal and judicial] system and ensuring the least restrictive environment promotes the most positive outcomes for both youth and adult offenders,” Burke Harris’ roadmap states.