Providing mental health support to children who need it most.
There is an urgent need for mental health support for gang-affiliated children.
Gang-affiliated children tend to be victims of polytrauma.
Mental health providers have the potential to offer value to this population.
“Why do you work with those people?” asked an inquisitive colleague when I mentioned that I treat gang-affiliated children. Her expression revealed a combination of shock and slight disgust.
She had already broken a cardinal rule of asking why questions. I felt attacked, judged, and alone. It reminded me of the negative reactions I received in the past from other associates. Throughout my career, I have received a range of responses. Clinicians often inquire about whether I feel concerned about my safety. I also get questions along the line of, “All that training and this is who you decide to work with?” I understand. The media portrays gangs as an intractable and insurmountable problem. Unfortunately, this makes it difficult for these children to get adequate help. There are not many clinicians who work with gang-affiliated children. In fact, some facilities refuse to treat children who self-identify as being gang members. Conventional wisdom promotes encouraging children to leave gangs in lieu of helping them address emotional concerns (i.e., depression, anxiety, trauma, etc.). It is an onerous task to find helping professionals who are interested in the mental health needs of these children. According to Boxer, Kubik, Ostermann, and Veysey (2015), there are no empirical interventions to support children who are in gangs. To address this concern, we developed a clinical think tank that conducts research on evidence-based practices for helping this population. We regularly invite mental health professionals to have discussions on “what works” with these clients. Through my individual practice—and four years of collecting data from our think tank—there are a few lessons worth sharing:
Gang-affiliated children are like most other children. Most of their time is spent engaged in harmless, non-criminal, activity (Carson & Esbensen, 2019). These children tend to engage primarily in age-appropriate pursuits (i.e., sports, games, cartoons, etc.).
They care about how you view them. Clients avoid disclosing their level of involvement in gangs due to fear of how they may be perceived. Society has a myopic view of these children, which results in apprehension about revealing their status to you.
It is hard for them to find adequate help. As Harris et al. (2013) assert, “gang-affiliated youth are often outside the bounds of the traditional mental health services and have particular needs." One of the main places where these children are treated is in juvenile detention centers. One issue to note is that children often do not remain in one housing facility for the duration of their sentence; they may be moved frequently. This makes it challenging for them to develop a strong therapeutic alliance with their providers. Further, children may fear negative consequences of speaking to people within the system.
They experience multiple types of traumas. One study of 441 gang-identified participants found that 80% had experienced six or more traumatic events (Nydegger et al., 2019). This is important to note because trauma has deleterious effects on mental health outcomes.
They look to us for hope. Our presence matters to them. Clinicians are nonjudgmental (hopefully) and provide a safe space for them to share their worldview. As a result, we are often a source of hope for these children. In a recent session, one client mentioned, "You are one of the people that gives me hope” and "Talking to you eases my pain.”
Mental health practitioners have a lot to offer with regard to helping these children. Here are some themes from our think tank discussions on strategies that work:
Spend time developing rapport (Estrada, Hernandez, & Kim, 2017). It is normal for clients to be guarded at the beginning of the therapeutic relationship. As I have mentioned before, there is a lot of mistrust of mental health professionals. Taking the time to form a genuine connection could mean the difference between clients opening up versus shutting down.
Emphasize strengths. I invite clients to tell me what is good about them early in treatment. I encourage them to tell me what they are proud of or perceive themselves to be adept at. If they struggle, I offer my own positive observations (i.e., they show up on time, are energetic, fashionable, etc.). Though seemingly simplistic, it is drastically different from how people usually engage them.
Approach them holistically (Hughes, Hardcastle, & Perkins, 2015). We are all complex. Most people appreciate being recognized for their unique qualities. Meet them where they are and show a genuine curiosity for all aspects of their lives.
Help them get their needs met. In addition to basic needs—such as food, clothing, and shelter—we can help them identify and achieve more nuanced needs such as feeling valuable, significant, and powerful.
Allow alternate means of expression. Children do not always have the language that enables them to label their feelings. In addition to helping them build their emotional vocabulary, we can encourage other forms of expression (i.e., poetry, dance, music, etc.).
Help them build self-esteem. Low self-esteem is one predictor of children joining gangs in the future (Dmitrieva, Gibson, Steinberg, Piquero, & Fagan, 2014). One way to improve self-esteem is by providing them with opportunities for success (Capuzzi & Gross, 2019).
Engage parents and other family members. It has been found that parental warmth is associated with less antisocial behavior (Backman, Laajasalo, Jokela, & Aronen, 2021). In addition to providing warmth to clients yourself, consider engaging families and encouraging them to do the same.
This is not meant to be a comprehensive guide. For instance, there are other promising interventions—that include mental health components—such as the Arches Transformative Mentoring Program (Cespedes, 2020). However, the strategies mentioned above are simple ways that we can start connecting with some of our most vulnerable children. We all deserve access to quality mental health services. These clients are no different. They are not “those people,” but our children.