“Being in the system is really difficult and…I wouldn’t wish it on anybody.” Trauma and the public sector system of care for youth

Youth involved in public sector services for substance use and other forms of mental health, juvenile justice, foster care, or homelessness report higher rates of trauma compared to the general youth population. We interviewed 26 youth, ages 14–21, with lived experience in public systems of care for the purpose of a state-contracted needs assessment evaluation. Qualitative analysis of these data indicated trauma occurs sequentially vis-à-vis the system of care. Participants experienced family adversity and a lack of social support, which has been defined as pre-system trauma. Because of this pre-system trauma, youth were referred to the public sector system of care. Rather than resolving trauma, system involvement exacerbated existing trauma and introduced new forms of trauma, defined as system-based trauma. Existing policies and practice address pre-system trauma, though there is room for improvement for both pre-system and system-based trauma. The field has yet to reckon fully with system-based trauma and this may be the next transformation for public sector youth services.