Arts-Based Programs and Arts Therapies for At-Risk, Justice-Involved, and Traumatized Youths

Arts programs for at-risk, justice-involved, and traumatized or victimized youths can generally be separated into 1) arts-based programs (“art is therapy”), including arts education programming, and 2) arts therapies (“art in therapy”) that focus on healing processes (Djurichkovic, 2011).

Arts-Based Programs

A key assumption behind arts-based programs serving at-risk populations is that arts engagement can be therapeutic in itself (Hughes, 2005). As Ezell and Levy explained, “These programs focus on both the creative process and product while broadly defining ‘therapeutic’ as any artistic activity that promotes positive change” (2003, p. 108).

Arts-based programs for youths can be preventive or rehabilitative in nature. Programs usually target problem behaviors and behavioral health issues, including delinquency, anger, aggression, depression, anxiety, Attention Deficit Hyperactivity Disorder (ADHD), substance use disorder, and suicidal thoughts or ideations (Rapp–Paglicci, Stewart, and Rowe, 2008; Choi, Lee, and Lee, 2010; Ross, 2016; Morrison, Keene, and Leis, 2020). Such programs generally concentrate on improving outcomes such as stress management, resilience, problem-solving skills, interpersonal skills, confidence, self-regulation, academic achievement, school readiness, and family functioning (Rapp–Paglicci et al., 2011; Coholic, Eys, and Lougheed, 2012; Elliott and Dingwall, 2017; Brown et al.,  2018). Moreover, strengths also have been associated with the use of group art, especially for at-risk youth. In group settings, not only can the expressive nature of the art be less threatening, but group art also fosters a sense of community, which research has shown can reduce isolation and generate a sense of belonging and acceptance while also building an adolescent’s social support network. Further, working in a group setting can improve an individual’s self-regulation, self-awareness, and knowledge (Averett, Crowe, and Johnson, 2018).

Arts-based programs may be implemented at various points in the juvenile justice system. For example, programs may be designed as prevention interventions—targeting youths who have not yet come into contact with the juvenile justice system, but who have displayed problem behaviors that place them at risk for arrest or referral. Alternatively, some programs may be diversionary and directed toward juveniles who have committed low-level or first-time offenses. Programs also may be based in detention or residential facilities for adjudicated juveniles who have committed more-serious offenses (Clawson and Coolbaugh, 2001; Wolf and Holochwost, 2014; Ross, 2016; Miner–Romanoff, 2016).

Arts-based interventions can take many forms, including visual or theater arts, drama, dance, crafts, literature, and music. Program activities may involve performing, drawing, painting, sculpting, singing, and playing instruments (Hughes, 2005). Arts-based programs can also include expressive writing, in which one of the main goals is to encourage youths to write about stressful experiences (such as violence or victimization) and their feelings associated with those experiences, to help them process their emotions and gain more control over their responses (Kliewer et al., 2011; Travagin, Margola, and Revenson, 2015).

Different types of arts programs represent different approaches to working with youths. For instance, theater and performing arts place greater emphasis on communication skills, team building, and developing problem-solving skills or empathy, whereas the visual and literary arts, such as painting or creative writing, are more solitary activities that can allow for self-reflection and mood control (Ezell and Levy, 2003; Kliewer et al., 2011). However, these approaches are not mutually exclusive; instead, some programs may offer both visual arts and music. For example, Brown and colleagues (2018) examined a program for economically disadvantaged preschoolers that used both visual art and music to explore how these media make the children feel. The inclusion of art was used to promote artistic skills and other school readiness measures, such as mathematics, literacy, language, and social/cultural learning. Brown and colleagues (2018) found that preschoolers in the arts-based program had increased school readiness, self/social awareness, and understanding of direction and position more than preschoolers who were not involved in the arts-based program.

In general, arts-based programs are often led by master artists from the community, who can serve as prosocial role models or mentors (Hughes, 2005); however, they can also be led by teachers or other program staff who have received training in the arts-related activities. For example, the Choral Residency Program, a music education program offered in two secure youth detention facilities in a large northeastern city, was led by a professional choir director, who was assisted by six choir members who had backgrounds similar to the juveniles in the program. These choir members served as peer mentors for the detained juveniles by modeling positive behaviors and social interactions (Wolf and Holochwost, 2016). The program emphasized not only the personal aspects of responsibility and conduct but also interpersonal skills such as mutual support and respect. In evaluating the program, Wolf and Holochwost (2016) found that participation in the program was associated with decreased antisocial behavior and improved self-assessments of self-esteem, mood, and engagement in music.

This diversity of arts-based programs can be seen in the YouthARTS Development Project. In 1995 the Office of Juvenile Justice and Delinquency Prevention (OJJDP) partnered with the NEA to conduct a national evaluation of the program. The YouthARTS Development Project was designed to identify, implement, and refine effective arts-based, delinquency-prevention programs in three selected communities: Atlanta, GA; Portland, OR; and San Antonio, TX. Each site implemented different arts-based programs targeting a specific population of at-risk youths. For example, in Atlanta, a program targeting juveniles who committed their first status offense (truants, primarily) was designed to provide art instruction, job training, and literacy education. In Portland, the arts program was designed to allow youths (who were on probation for any status or delinquency offense) to work with artists and be involved in the production and administration of a public arts project. The media included printmaking, photography, poetry, drama, and videography. Finally, in San Antonio, an afterschool program for high-risk students involved three artists at each school who designed and implemented arts activities for students, including dance, visual arts, drama, creative writing, and storytelling (Clawson and Coolbaugh, 2001). Evaluations of the programs were conducted separately for each site. Overall, the evaluations suggested the programs made positive impacts on youths’ attitudes and behaviors (including delinquent behaviors). However, the evaluations had notable limitations, including small sample sizes, high attrition rates, and data collection mismanagement such as misplaced surveys (Clawson and Coolbaugh, 2001).

Arts Therapies

Although the arts can be therapeutic in nature, arts therapies are distinctive in that their underlying goal is to use the medium of art to create a therapeutic relationship between the therapist and the client (Hughes, 2005). Additionally, arts therapies strive to encourage the client to approach his or her own emotional and psychological issues from a therapeutic perspective. Arts therapies have the ability to increase an individual’s awareness of the self and of others, cope with stress and traumatic experiences, and enhance cognitive abilities (Jackson, 2015). They create a forum in which therapists can engage at-risk and traumatized youths in alternative ways of processing negative feelings, insecurities, and vulnerabilities, rather than acting out in destructive ways (Vice, 2012).

Because of the therapeutic nature of these interventions, art therapy must be delivered by trained and certified professionals (Hughes, 2005; Jackson, 2015). Art media can vary across programs and include visual art therapy, drama therapy, dance therapy, and music therapy. For example, visual art therapy may involve the creation and investigation of images, leading to the expression of feelings that a youth is unable or unwilling to express verbally (Jackson, 2015). By using various art materials, youths are able to create metaphors for what they are feeling; this method gives therapists a greater understanding of their clients and serves as a noninvasive conversation-starter (Sutherland, Waldman, and Collins, 2010; Jackson, 2015). Forms of arts therapies that involve personally creating or performing artwork are often called “creative arts therapy” (van Westrhenen and Fritz, 2014).

Similar to arts-based programming, art therapy can be offered in detention facilities, in the community (during the adolescent’s transition from a detention facility), or as a preventive therapeutic approach for at-risk youth. For example, Artistic Noise, a New York–based nonprofit, offers programming for system-involved and at-risk youth in detention facilities and in the community (Artistic Noise, 2021). The program includes licensed art therapists, artists, and educators, all of whom focus on providing the youth with access to resources (e.g., case managers, social workers, and mentors) and increased professional and emotional support (DelliCarpini, 2020). By using art as a tool for self-expression, the therapeutic approach provides youths with the opportunity to explore their emotions, experiences, and identities, while also developing better methods to regulate their emotions. However, to date, no rigorous research has evaluated the program’s effects.  

The assortment of arts therapies represent different techniques for working with youths. For instance, music therapy, whether through active music-making or passive listening, can facilitate cognitive development by helping youths make links across areas of experience that are not otherwise accessible. Rickson and Watkins (2003) evaluated a music therapy program that was delivered to adolescent boys in New Zealand with social, emotional, and learning difficulties. The group therapy included positive discussion of group members’ self-selected music; personalization of a song, which was used for greeting peers; rhythm games in which the boys would engage in creative improvisation through a range of percussion instruments; and group songwriting activities. The program’s goal was to encourage the boys to offer an appropriate response to a question, wait their turn, offer creative ideas, accept others’ ideas, and use self-control. However, in a preliminary evaluation, Rickson and Watkins (2003) did not find any discernible treatment effects for the music therapy program. Instead, for some individuals, the program increased the number of impulsive behaviors.

Several different psychological theories analyze how arts-based programs can bring about changes in youths’ behaviors. Two of the main theories are cognitive–behavioral therapy and positive youth development (Hughes, 2005).

Cognitive–behavioral therapy (CBT) is a problem-focused approach to help people identify and change the dysfunctional beliefs, thoughts, and patterns of behavior that contribute to their problems. The main premise of CBT is that, to change behavior, it is first necessary to change the way a person thinks (Development Services Group, Inc., 2010). Some arts-based programs incorporate principles of CBT by involving exercises or activities that focus on self-awareness, expression, problem solving, self-identification, and other areas that relate to how a person thinks (Hughes, 2005). For example, activities such as role-playing allow youths to practice certain prosocial skills and behaviors that they may learn in a program. (For more information, see the Model Programs Guide literature review on Cognitive–Behavioral Treatment.)

Another theoretical model underlying some arts-based programs is the positive youth development (PYD) framework. Rather than relying on a deficits model, which views youths as “broken” individuals who need to be fixed, PYD focuses on their assets and healthy development (Development Services Group, Inc., 2014; Wolf and Holochwost, 2014). Programs based on PYD take a strengths-based approach by providing youths with opportunities for prosocial involvement, enhancing skills, and facilitating the development of positive relationships (Rapp–Paglicci, Stewart, and Rowe, 2008). (For more information, see the Model Programs Guide literature review on Positive Youth Development.) Arts-based programs can incorporate principles of PYD by encouraging the development of supportive relationships with prosocial adults (such as the master artists who run the program), educating youths about the arts and nurturing their creativity and skills, and providing a safe environment to participate in arts activities (Maschi et al., 2013).

Although not as prominent as cognitive–behavioral therapy or positive youth development, some programs—in recognizing that arts-based programs can enhance the cultural relevance of education for students from marginalized group—also draw from a culturally relevant pedagogy (Forrest–Bank et al., 2016; Brown et al., 2018; Ladson–Billings, 1995). Culturally relevant pedagogy, which emphasizes the importance of culture in teaching practices, suggests that incorporating a student’s culture into the curriculum may increase student engagement, by building a bridge between the home and school. This is especially important for arts-based programs, as the cultures of many marginalized groups include expression through arts. For example, movement expressiveness, which is a “preference for the interwoven mosaic of music, movement, and percussive dance” (Boykin and Cunningham, 2001, p.73), is significant in the experiences of many different cultures. As a result, incorporating arts-based programming into education may bridge the gap between the home and school environments, making students from marginalized communities feel a sense of belonging, acceptance, and validation (Brown et al., 2018), all of which can reduce later delinquency (Stinson, 2009).

In addition, several theoretical frameworks support the use of arts therapies with traumatized children, including neuropsychological and developmental models. According to the neuropsychological model, traumatic memories may be stored in the part of the brain that is nonverbal, meaning that youths may have difficulties when attempting to verbalize their issues during therapy. This orientation suggests that nonverbal, expressive therapies (such as certain arts therapies) can be more effective than verbal therapies in maltreated children with traumatic histories (Klorer, 2011).

Various developmental models are also used as foundations for creative therapy approaches for youths with traumatic histories. The arts can help children through each stage of development by helping them acquire multiple skills that can foster the development of their cognitive, social, and personal competencies (Hughes, 2005). For example, art provides youths with the opportunity to learn through play, creating a medium for them to build bridges across stages of their personal development. Artistic practice can allow children to express their thoughts in a way that may not have been possible without using a creative medium (Hughes, 2005; van Westrhenen and Fritz, 2014).

Although the research literature has identified generally positive relationships between arts participation and social–emotional skills among children and youths (Menzer, 2015), more studies are needed to clarify the potential impacts of arts interventions on at-risk, justice-involved, and traumatized youths. The available research suffers from methodological limitations such as small samples, lack of comparison groups, self-selection, short follow-up periods, and reliance on self-report measures (Hughes, 2005; Bittman, Dickson, and Coddington, 2009; Gara and Winsler, 2019).

In addition, for programs or therapies that integrate the arts with other components, research on the impact of the arts-specific components is lacking. Therefore, it is not known what effect the arts component of a program may have on outcomes, when compared with the effect of other components. Even within the context of standalone arts programs or arts therapies, more research is necessary to understand the relative effects of interventions using different art forms.

Finally, research has also suggested that art therapy and arts-based programs may be better suited for certain populations (Coholic, Schwabe, and Lander, 2020; Rickson and Watkins, 2003). For example, some research has emphasized that girls typically prefer visual and interactive arts-based programs (Atkinson and Wade, 2015), whereas most boys prefer outdoor arts-based activities over programs in which participants sculpt something while they are listening to music. Similarly, as briefly noted above, in their evaluation of a music therapy program, Rickson and Watkins (2003) noted that the program increased the number of impulsive behaviors for juvenile boys (ages approximately 11 to 15) with ADHD. Taken together, although these studies underscore that arts-based programs may affect certain populations differently, more research is needed to unpack these subgroup differences.

Although the quantity and quality of the research is limited, below are examples of arts-based programs and arts therapies featured on the Model Programs Guide and their varying impacts on youth-related outcomes.

Reading for Life. One example of a literature-based arts program is Reading for Life (RFL). RFL is a diversion program in Indiana for juveniles (ages 11–18) who have committed nonviolent offenses. In this program, juveniles study works of literature in small reading groups, led by trained volunteer mentors. The goal is to foster moral development in juveniles who have committed offenses and reduce their rates of recidivism. The program is based on the idea that literature can facilitate moral development by helping youths vicariously experience situations and stories presented in books, and relate the lessons they learn to experiences in their own lives (Bruner, 2003; Seroczynski et al., 2015).

Seroczynski and colleagues (2015) found that RFL participants had significantly lower recidivism rates than the comparison group had. Specifically, at the 2-year follow-up, RFL participants had a lower chance of being prosecuted for any offense (including misdemeanors and felonies) and had fewer arrests than the comparison group had.

Project Venture. Project Venture is an outdoor/experiential program that targets at-risk American Indian youths. The program focuses on American Indian cultural values—such as learning from the natural world, spiritual awareness, family, and respect—to promote healthy, prosocial development. The goals of Project Venture are to help youths develop a positive self-concept, effective social and communication skills, a community service ethic, decisionmaking and problem-solving skills, and self-efficacy. The program is designed for American Indian communities seeking strategies to prevent alcohol misuse. Project Venture does not provide a standard drug-and-alcohol education curriculum. Instead, the program uses American Indian cultural values to build a positive environment through thinking activities, and arts-based activities such as speaking and singing, and storytelling of traditional folk stories/metaphors, to achieve prosocial outcomes.

An evaluation of Project Venture found youths in the treatment group demonstrated less restraint in substance use as measured by four outcome measures (cigarettes, marijuana, alcohol, and other illicit substances) taken together. The program also had a significant effect on the treatment group’s use of alcohol (Carter, Straits, and Hall, 2007).

School-Based Expressive Writing Intervention for At-Risk Urban Adolescents. This is a preventive intervention targeting at-risk, seventh-grade students at an urban public school. The goal was to reduce students’ aggressive behaviors and improve emotion regulation. The intervention included a standard expressive-writing condition and an enhanced expressive-writing condition. In the standard expressive-writing condition, students wrote about their thoughts and feelings related to violence they had seen or experienced. Students who had not seen or experienced violence were to write about something bothering them. In the enhanced expressive-writing condition, students were instructed to write stories, skits, songs, or poetry about violence, instead of—or in addition to—giving a narrative account of their feelings about violence. Students were also given an opportunity to share their writing with the rest of the group (Kliewer et al., 2011).

In evaluating the intervention, Kliewer and colleagues (2011) found no statistically significant differences among the standard writing condition, the enhanced writing condition, or the control condition on any of the outcomes analyzed at the 6-month follow-up (e.g., self-reported aggression, teacher-reported measures of aggression, and teacher-reported emotion regulation).

Expressive Writing Interventions for Adolescents. Expressive writing interventions for adolescents are brief psychosocial interventions focused on improving emotional expression and processing during stressful situations. These interventions typically target youths ages 10 to 18, with the overall goal of improving psychological and physical health. Although the program components vary across interventions, expressive writing interventions typically include three or four sessions, each lasting 15 to 20 minutes. The topic of the expressive writing assignment also varies across programs, with some programs asking adolescents to write about a general topic (for example, an upsetting event) and others asking them to write about a specific topic (for example, a trauma or death).

Travagin, Margola, and Revenson (2015) conducted a meta-analysis of studies on expressive writing interventions for adolescent populations. The authors found that adolescents who participated in the expressive writing interventions experienced statistically significant improvements in problem/at-risk behaviors, internalizing behavior, school participation, and somatic complaints. However, there was no statistically significant impact on school performance.

Arts-based programs and arts therapies provide a unique way to help youths in times of transition and development. It is sometimes difficult for at-risk, traumatized, and justice-involved youths to trust authority and verbalize their feelings and experiences—a challenge that positions the arts as a beneficial approach (Coholic and Eys, 2016; DelliCarpini, 2020). The arts provide a nonthreatening, engaging way for children and adolescents to express their feelings, manage emotional and behavioral problems, cope with trauma and victimization, develop artistic talents and skills, and improve strengths and assets they already possess (Riley, 2001; Clawson and Coolbaugh, 2001; Coholic, Schwabe, and Lander, 2020). Moreover, research has found that arts can influence the social and emotional functioning of at-risk juveniles, while also having positive effects on all parties involved in the implementation of the programs, such as community members, staff from arts organizations, and staff from other organizations and justice agencies (Sitzer and Stockwell, 2015; Metis Associates and Westat, 2018).

Arts-based programs (including arts education programming) and arts therapies represent two approaches to incorporating the arts into treatments for at-risk, traumatized, and justice-involved youths. Although the two approaches are similar in terms of the various programmatic elements that are implemented, each uses a different method for working with youths and resolving problem behaviors. Arts therapies focus on the therapeutic relationship between the therapist and the youth, whereas arts-based programming focuses on the process of creating art as a way to address youths’ issues (Djurichkovic, 2011).

For a population whose members feel that their lives are out of control, arts-based programming and arts therapies can provide youths with a greater sense of stability (DelliCarpini, 2020). Given that art is an interactive process, youths engaged in these programs or therapies have the opportunity to form trusting relationships with prosocial adults (therapists, master artists, or teachers) who can encourage them to participate in solitary or group activities while reflecting on their problems (Coholic and Eys, 2016; DelliCarpini, 2020). Youths also have the opportunity to create a final product (through either arts therapy or arts programs), thereby earning a sense of accomplishment and, in the process, completing a piece of art that reflects the hard work done during the healing and rehabilitation process (Vice, 2012; Paukste and Harris, 2015).

Despite the indications of such benefits, more evidence is needed to disaggregate and connect the arts components of specific interventions to positive outcomes. Future studies should explore how and in what optimal conditions the arts can directly affect the behavior of at-risk, justice-involved, and traumatized youths. Finally, to address this methodological gap, future studies should aim to overcome selection effects that plague much arts-based research, and—when possible—conduct longitudinal analyses. Overall, arts-based programs and art therapies represent a unique, engaging, and nonthreatening approach to connecting with at-risk, justice-involved, and traumatized youth who otherwise might have viewed the programming and therapy as invasive and not relatable (Paukste and Harris, 2015; Sitzer and Stockwell, 2015).

The original version of this literature review from May 2016 was completed in partnership with the National Endowment for the Arts.

Suggested Reference: Development Services Group, Inc. 2021. Arts-Based Programs and Arts Therapies for At-Risk, Justice-Involved, and Traumatized Youths. Literature review. Washington, DC: Office of Juvenile Justice and Delinquency Prevention. https://ojjdp.ojp.gov/sites/g/files/xyckuh176/files/media/document/arts-based-programs-for-youth.pdf

Prepared by Development Services Group, Inc., under Contract Number: 47QRAA20D002V.

Last Update: May 2021