Addressing the Mental Health and Substance Abuse Needs of Juvenile Justice Involved Youth

Through Systems of Care

Introductory Remarks Simon GonsoulinDirector, NDTAC

3

About NDTAC

Neglected-Delinquent TA Center (NDTAC)

Contract between U.S. Department of Education and the American Institutes for Research John McLaughlin,

Federal Coordinator, Title I, Part D Neglected, Delinquent, or At Risk Program

NDTAC’s Mission: Develop a uniform evaluation model

Provide technical assistance

Serve as a facilitator between different organizations, agencies, and interest groups

4

Agenda and Presenters

I. Sharon Hunt, Deputy Director of Operations, Technical Assistance Partnership for Child and Family Mental Health

II. Liz Doyle, Clinical Director, McHenry County Mental Health Board

III. Sharon Hunt

IV. Question and Answer Session

Addressing the Mental Health and Substance Abuse Needs of Juvenile

Justice Involved Youth Through Systems of Care

Sharon Hunt Deputy Director of

Operations, Technical Assistance Partnership for Child and Family Mental

Health

A system of care is a coordinated network of community-based services and supports that are organized to meet the challenges of children and youth with serious mental health needs and their families. Families and youth work in partnership with public and private organizations so services and supports are effective, build on the strengths of individuals, and address each person’s cultural and linguistic needs. A system of care helps children, youth and families function better at home, in school, in the community and throughout life.

Gary Blau, Child, Adolescent and Family Branch, CMHS, SAMHSA

• An estimated 4.5 to 6.3 million children and youth in the US face mental health challenges.

• National survey findings show that 11.5% of youth aged 12-17 received mental health services in an educational setting.

• National survey findings show that 5.4 percent of adolescents had past year dependence on or abuse of alcohol and 4.3 percent past year dependence on or abuse of illicit drugs.

SAMHSA (2009). Working together to help youth thrive in schools and communities. Briefing for National Children’s Mental Health Awareness Day, May 7, 2009.

SAMHSA (2007) National Survey on Drug Use and Health.

• Family driven and youth guided • Home and community based• Strength based and individualized • Culturally and linguistically competent• Integrated across systems• Connected to natural helping networks• Data driven, outcomes oriented

Adapted from Stroul, B., & Friedman, R. (1986). A system of care for children and youth with severe emotional disturbances (Rev. ed.) Washington, DC: Georgetown University Child Development Center, National Technical Assistance Center for Children's Mental Health. Reprinted by permission.

Families have a primary decision-making role in the care of their own children as well as the policies and procedures governing care for all children in their community, state, tribe, territory and nation.

• Choosing supports, services, and providers

• Setting goals

• Designing and implementing programs

• Monitoring outcomes

• Determining the effectiveness of all efforts to promote the mental health and well being of children and youth

Youth guided means that young people have the right to be empowered, educated, and given a decision-making role in the care of their own lives as well as the policies and procedures governing care for all youth in the community, state, and nation.  This includes giving young people a sustainable voice and the focus should be towards creating a safe environment enabling a young person to gain self sustainability in accordance to the cultures and beliefs they

abide by. Further, through the eyes of a youth-guided approach we are aware that there is a continuum of power and choice that young people should havebased on their understanding and maturity in this strength based change process. Youth guided alsomeans that this process should be fun and worthwhile.

• Reduce disparities and enhance cultural and linguistic competence among policy makers, administrators and service providers.

• Enhance organizational capacity for cultural and linguistic competence.

• Increase awareness and knowledge of factors that contribute to disparities.

• Develop specific approaches that contribute to the goal of eliminating disparities.

FROM TOFragmented service delivery Coordinated service delivery

Categorical programs/funding Blended resources

Limited services Comprehensive service array

Reactive, crisis-oriented Focus on prevention/early intervention

Focus on “deep end,” restrictive Least restrictive settings

Children/youth out-of-home Children/youth within families

Centralized authority Community-based ownership

Creation of “dependency Creation of “self-help”

Pires, S. (2002). Building systems of care: A primer. Washington, D.C.: Human Service Collaborative.

• Sixty to eighty percent of youth entering substance abuse treatment have co-occurring disorders (substance abuse and mental health)

• Untreated mental health and/or substance abuse issues may create the following problems for youth:o Increase in criminal behavioro Decrease in school attendanceo Increase in mental health and substance abuse symptoms

50%

42%

35%

24%

14%

63%

45%

31%

22%

9%

66%

0%

10

%

20

%

30

%

40

%

50

%

60

%

70

%

80

%

90

%

10

0%

Any Co- occurring Psychiatric

Conduct Disorder

Attention Deficit/ Hyperactivity Disorder

Major Depressive Disorder

Traumatic Stress Disorder

General Anxiety Disorder

Ever Physical, Sexual or Emotional Victimization

High severity victimization (GVS>3)

Ever Homeless or Runaway

Any homicidal/ suicidal thoughts past year

Any Self Mutilation

17 Source: CSAT AT 2007 dataset subset to adolescent studies (N=15,254)

*Dealing, manufacturing, prostitution, gambling (does not include simple possession or use)

Source: CSAT AT 2007 dataset subset to adolescent studies (N=15,254)

Age 12-17

Source: NSDUH 2006

37% Sustained Problems

5% Sustained Recovery

19% Intermittent, currently in

recovery

39% Intermittent, currently not in

recovery

The Majority of Adolescents Cycle in and out of Recovery

Source: Dennis et al, forthcoming

29%

52%

61%

17%

67%

79%

0% 10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Reg

ular

alc

ohol

use In home

among work/school peers

among social peers

Reg

ular

dru

g us

e In home

among work/school peers

among social peers

Source: CSAT AT Common GAIN Data set

An Integrated Co-occurring Treatment Model in a System of Care

Liz DoyleMcHenry County Family CARENDTAC Webinar December 14, 2009

History of Family Child and Adolescent Recovery Experience (CARE) Integrated Co-occurring Treatment (ICT) Program

Substance Abuse and Mental Health Services Administration (SAMHSA) System of Care grant awarded in October 2005

Targeted population: Youth with co-occurring mental health & substance abuse disorders (one of four populations targeted by Family CARE)

Family and youth involvement - exposed to Integrated Co-Occurring Treatment (ICT) Model at SAMHSA Conferences

SAMHSA planning grant awarded in October 2007 Established a collaborative community group Partners: Court Services, Law Enforcement, Psychiatric Inpatient, Mental Health

Agencies, Crisis Program, Special Education Reviewed different models of treatment

ICT Model Selected – June, 2008 Training started - July 2008 Goals for ICT Program:

Specialized treatment for mental health & substance abuse Treatment option for youth being served by Screening, Assessment and

Support Services Program Prevent youth from entering the juvenile justice system; reduce arrests Reduce hospitalizations and at-risk behaviors

Definition of ICT Integrated Co-occurring Treatment (ICT)

Program is an Evidence-Informed home-based 24/7 treatment model developed to address the specific issues of youth with both mental health and substance abuse issues.

Major Goals: Prevent JJ contacts, decrease

substance abuse, and increase positive school, home and community interactions.

Components of Family CARE ICT Program

Development of ICT Screening Committee Subset of the Planning Committee Members –

Weekly meetings to review admissions and discharges and program challenges; responsible for evaluation.

Screening Committee meetings began in September, 2008

ICT Team 3 ICT Therapists; 2 (.25) ICT Supervisors (1 Mental

Health and 1 Substance Abuse)

Participants September 2008 to March 2009 18 youth were enrolled Gender:

56% Male 44% Female

Ages: 11% were 12 years old 44% were 15 years old 44% were 16 years old

Ethnicity: 72% White 28% Hispanic

Discharge Data

Average length of participation in program: 185 days

Number of discharges in first year: 18 15 (83%) successful discharges 3 (17%) unsuccessful discharges

Positive Outcomes

End of First Year: 67% decreased their substance use from

intake to discharge 67% had more positive interactions in their

home/family 28% had more positive interactions in the

community 17% made positive changes in peers 55% had more positive interactions in school

Lessons Learned

Older youth with more chronic substance abuse

Youth involved with gangs Engagement of Schools

Did not understand the Reduction Theory of the ICT Model – wanted total abstinence

Buy-in of psychiatrists

Future Directions

Treating 45 - 60 adolescents in the ICT program per year

Sustaining 4 full-time therapists Recruiting a Spanish speaking ICT

therapist Soliciting more community referrals Collecting data and evaluating

outcomes

On the Horizon Further developing:

Family Resource Developers IFF (Illinois Federation of Families) Parent

Group Peer Leadership Support Group Peer to Peer Mentoring

Financing/Sustainability Plan

Blended Funding State Authorized Funding for SASS

Program participants Medicaid Clients/IL Rule 132 Private Insurance (if available) Non Medicaid Billable Services (IL

Department of Human Services) Local Tax Dollars

Contact Information

Liz Doyle, LCPCClinical DirectorMcHenry County Family CARECrystal Lake, IL (45 miles northwest of Chicago)Telephone: 815-788-4360Email: ldoyle@mc708.org

Systems of Care

Recovery

Transformation

Resilience

What is involved?• Rethinking traditional

approaches

• Strengths-based

• Family driven & youth guided

• Embracing culture

Who is involved?• Youth

• Adults

• Families

• Providers

• Communities

Fulfilling Potential

• Only 8% of youth in SOC for 12 months had repeated a grade, compared to 15% in the general public

• Youth receiving passing grades (C or better) increased from 55% upon entry into services to 66% after 12 months of services

• Within one year of entering SOC services, the percentage of youth attending school regularly increased from 75% to 81%

SAMHSA (2009). Working together to help youth thrive in schools and communities. Briefing for National Children’s Mental Health Awareness Day, May 7, 2009.

After receiving SOC services for 12 months:• There was a 22% reduction in the percentage of youth who changed

schools due to emotional and behavioral reasons• Expulsions from school decreased by 2/3 (from 15% at intake to

5%)• Sixteen percent of youth reported significant lower levels of

depression and 21% reported significant lower levels of anxiety than when they entered services

• Five percent of youth had reported suicide attempts (62% reduction after starting services)

US Department of Health and Human Services (www.samhsa.gov)

SAMHSA (2009). Working together to help youth thrive in schools and communities. Briefing for National Children’s Mental Health Awareness Day, May 7, 2009.

System of Care Communities of the Comprehensive Community Mental Health Services for Children and Their

Families ProgramCurrently Funded Communities

Funded Communities

2004 292005–2006 302008 182009 20

Date Number

Albany County,

NY

New London County, CT

Northern Kentucky

Montana &

Crow Nation

Los Angeles County, CA

Butte County, CAPlacer County,

CA

Blackfeet Tribe, MT

Wyoming

(statewide)

Minnesota(4

counties)

Kalamazoo County,

MI

InghamCounty,

MI

Beaver County, PA

Allegheny County 2, PA

Monroe County, NY

Mississippi

River Delta

area, AR

HarrisCounty,

TX

Honolulu, HI

MauryCounty,

TN

Mecklenburg County, NC

SarasotaCounty,

FL

Rhode Island 3 (statewide)

Worcester County, MA

Maine (3 counties)

Erie County, NY

Seven Generations System

of Care, CA

Pascua Yaqui

Tribe, AZ

St. Joseph, MO

Minnesota(6

counties)

Yankton Sioux

Tribe, SDMcHenry

County, IL

Iowa(10

counties)

Mississippi(3 counties)

Multnomah County, OR

Northwest Georgia

Delaware 2 (statewide)

Nassau County, NY

OrangeCounty,

NY

ShelbyCounty,

TN

Texas(11

counties) Texas(5

counties)

Northwest Portland Area Indian Health

Board

Yakima County, WA

Alamance County,

NC

Southeastern

Indiana

Oklahoma

(statewide)

Baltimore City, MD

Chautauqua

County, NY

Lummi Nation

Creek Nation

Kentucky(statewid

e)

Vermont 3 (statewide)

Hawaiʽi (3 communities)

Alabama(3

counties)

Knox County, TN

Illinois(3

counties)

Champaign County,

IL

KentCounty,

MI

Alameda County, CA

Madison County, ID

Orange County, FL

Miami-Dade

County, FL

Maryland (9 counties)

New Mexico (3 areas)

Onondaga County, NY

Pennsylvania (15

counties)

San Francisco, CA

Guam

Mississippi

(statewide)

Boston, MA

Clermont County, OH

Hamilton County, OH

System of Care Communities of the Comprehensive Community Mental Health Services for Children and Their

Families ProgramGraduated Communities

Funded Communities

1993–1994 221997–1998 231999–2000 222002–2003 25

Date Number

East Baltimore, MD

Passamaquoddy Tribe, ME

Delaware 1 (statewide)

Worcester, MA

Westchester County, NY

Bismarck, Fargo, &

Minot, ND

Northern Arapaho

Tribe, WY

Wisconsin(6

counties)

Sacred Child Project, ND

Willmar, MN

Nebraska(22

counties)

Birmingham,AL

Hillsborough

County, FL West Palm

Beach, FL

ClarkCounty,

NVNavajo Nation

Las Cruces, NM

King County, WA

Clark County, WA

Clackamas County, OR

Lane County, OR

Wai'anae &

Leeward, HI

Napa & Sonoma Counties, CA

California 5 (Riverside, San Mateo,

Santa Cruz, Solano, & Ventura Counties)

Santa Barbara County, CA

Sedgwick

County, KS

Southeastern Kansas

San Diego County, CA

Eastern Kentucky

St. CharlesCounty,

MO

RuralFrontier,

UT

TravisCounty,

TX

Sault Ste. Marie Tribe,

MI

Detroit,MI

Allegheny County 1, PA

Southern Consortium

& Stark County, OH

Pima County, AZ

Yukon Kuskokwim

Delta Region, AK

Contra Costa County, CA

United Indian Health Service, CA

Denver area, CO

Gwinnett &

Rockdale Counties,

GA

Lake County, IN

Nashville, TN

Guam

Puerto Rico

Fairbanks Native

Association, AK

ChoctawNation,

OK

Southwest

Missouri

Southeastern

Louisiana

Colorado (4 counties)

El Paso County, TX

Oklahoma(5

counties)

Ft. Worth, TX

San Francisco, CA

Sacramento County, CA

Glenn County, CA

Idaho

Urban Trails,

Oakland, CAMonterey,

CA

Mid-ColumbiaRegion

(4 counties), OR

Broward County, FL

Lyons, Riverside,

& Proviso, IL

Chicago, IL

Cuyahoga

County, OH

Charleston, WV

Greenwood, SC

North Carolina (11 counties)

Burlington County, NJ

New Hampshire (3 regions)

Montgomery County, MD

Vermont 2 (statewide)

Rhode Island 2 (statewide)

North Carolina (11 counties)

Maine (4 counties)Vermont 1

(statewide)

Edgecombe, Nash, & Pitt Counties, NC

Alexandria,VA

Rhode Island 1 (statewide)

Charleston, SC

South Philadelphia, PA

Mott Haven, NY

South Carolina (3 counties & Catawba Nation)

Washington, DC

Bridgeport, CT

New York, NY

Lancaster

County, NE St.

Louis,MO

MarionCounty,

IN

OglallaSiouxTribe,

SD Milwaukee, WI

HindsCounty,

MS

• Go to TA Partnership website (www.tapartnership.org) or SAMHSA’s website to see list of SOC grantees (http://mentalhealth.samhsa.gov/cmhs/childrenscampaign/grantcomm.asp)

• Contact your state children’s mental health director to get contact for the SOC.

• Contact the project director at the SOC to discuss ways to collaborate.

• Bring your resources to the table.

Pires, S. (2002). Building systems of care: A primer. Washington, D.C.: Human Service Collaborative.

Youth Involvement in Systems of Care http://www.tapartnership.org/docs/Youth_Involvement.pdf

Technical Assistance Partnership for Child and Family Mental Health website: www.tapartnership.org