Clinical Forensic Issues in Child Trauma Stemming from Juvenile Fire Setting and Bomb Making: Culturally Responsive Risk Assessment and Treatment Paradigm for Rural Settings

Introduction

Children in rural settings are not immune to the negative healthcare impact resulting from explosions, electrical accidents, and fires. Such injuries are frequently experienced as traumatic psychological events by child burn survivors and their families (Askay, Wiechman & Magyar-Russell, 2009; Mashreky, 2009). Burn Survivors and Juvenile Fire Setting and Bomb Making (BS-JFSB) refers to any person that builds, creates or ignites an explosive or incendiary device that caused self-injury requiring significant medical attention. The assessment, diagnosis and treatment of BS-JFSB are an ongoing challenge in rural settings because of a blend of clinical forensic issues found in these cases. For example, youth involved in BS-JFSB could be in an unwanted legal situation as a result of significant property damage, death or injuries to others (Johnson & Jones, 2014). The rates of BS-JFSB are rapidly climbing in urban areas. However, for rural settings, providing services for BS-JFSB can be complicated because of lower budgets for emergency healthcare (Lee, Jiang, Phillips, & Ohsfeldt, 2014). The blend of JFSB and BS-JFSB also presents as an important determinant for intervention services. In this case, comprehensive BS-JFSB services can be defined along a continuum and differently for several overlapping disciplines (e.g., fire service, healthcare providers, schools, counseling, psychology and the criminal justice system). From a BS-JFSB trauma perspective in rural settings, this also means that it is essential to adopt a culturally responsive healthcare model that includes establishing treatment protocols, developing diagnostic impressions, collecting psychosocial histories, using psychoeducation, and incorporating research-based methods. For rural settings, BS-JFSB requires the orchestration and management of interdisciplinary interventions for the clinical forensic trauma issues that often accompany these cases. For example, some of these clinical forensic issues include low budgets for emergency mental health care; lack of mental health providers experienced in the unique treatment aspects of both BS and JFSB. These same clinical forensic issues fuel the need for engaging multiple disciplines/agencies in the collaborative culturally responsive treatment intervention as well as the importance of assisting with school/community reintegration and survivor support.