Mental Health and Juvenile Justice: Issues Trends and

Needed Directions

Joseph J. Cocozza, Ph.D.Director

National Center for Mental Health And Juvenile Justice

Policy Research Associates, Inc.

Statewide Interagency Advisory MeetingSt. Paul, MNApril 24, 2007

National Center for Mental Health and Juvenile Justice

Mission

To promote awareness of the mental health needs of youth in the juvenile justice system and to assist the field in developing improved policies and programs based on the best available research and practice

National Center for Mental Healthand Juvenile Justice

Key Functions:– Serve as National Resource Center– Conduct Research– Foster Policy and Systems Change

Funding:– John D. and Catherine T. MacArthur Foundation– Office of Juvenile Justice and Delinquency Prevention– Substance Abuse and Mental Health Services

AdministrationWebsite:

– www.ncmhjj.com

Overview

• Prevalence and Problems

• National Trends

• Comprehensive and Coordinated Programs and Models

• Conclusion

There is a growing sense of crisis surrounding the large numbers of youth in the justice system with mental health needs • Mental health is “the number one

emergent issue as far as juvenile justice is concerned” (Coalition for Juvenile Justice, 2000).

• In effect, our jails and prisons are now our largest psychiatric facilities…” (State Mental Health Commissions, 2002).

Large numbers of youth in the juvenile justice system are

experiencing mental health disorders

Prevalence of Mental Disorders- Findings From Recent Studies

Positive Diagnosis

NCMHJJ (2006) 70.4%

Teplin et al. (2002) 69.0%

Wasserman et al. (2002) 68.5%

Wasserman, Ko, McReynolds (2004) 67.2%

Types of Disorders by Gender (n=1437)

Overall

%

Males

%

Females

%

Any Disorder 70.4 66.8 81.0

Anxiety Disorder 34.4 26.4 56.0

Mood Disorder 18.3 14.3 29.2

Disruptive Disorder 46.5 44.9 51.3

Substance Abuse Disorder 46.2 43.2 55.1

Many of these youth experience multiple and severe disorders

• More than half (55.6%) of youth met criteria for at least two diagnoses

• 60.8% of youth with a mental disorder also had a substance use disorder

• About 27% of justice-involved youth have disorders that are serious enough to require immediate and significant treatment

Other factors are fueling the growing sense of crisis surrounding youth

with mental disorders• Numbers entering the juvenile justice system increasing

– Texas data show a 27% increase of youth with high mental health needs over a six year period (Texas Youth Commission, 2002)

• Youth being inappropriately placed– 2/3 of juvenile detention facilities’ youth held unnecessarily

because of unavailable services (Congressional Committee on Government Reform, 2004)

• Mental health services often unavailable or inadequate– Series of DOJ investigations document poor training, inadequate

clinical services, inappropriate use of medications etc. (U.S. Department of Justice, 2005)

There are a number of trends, services and strategies that are developing to support the better identification and treatment of these youth

• Standardized mental health screening and assessment procedures

• Evidence-based interventions and promising practices

• Comprehensive and coordinated mental health and juvenile justice programs and models

Rapid implementation of standardized, scientifically-based screening and assessment instruments

• MAYSI-2 most widely used screen in juvenile justice settings

• Diagnostic assessment instruments adapted for juvenile justice- Voice-DISC in place in 14 states

MAYSI now used system wide in 39 states

MAYSI™-2 Statewide by Gate

AK

AL

ARAZ

CA CO

CT

DC

DE

FL

GA

HI

IA

ID

IL IN

KSKY

LA

MA

MD

ME

MI

MN

MO

MS

MT

NC

ND

NE

NH

NJ

NM

NV

NY

OH

OK

OR

PA

RI

SC

SD

TN

TX

UT

VA

VT

WA

WI

WV

WY

Detention

Corrections

Probation

Detention & Corrections

Corrections & Probation

Probation & Detention

Corrections & Probation & Detention

Substance Use & Detention

Other – Non JJ

Grisso, 2006

Evidence-Based Practices

• Evidence-Based Practices (EBP) are:– Standardized, manualized approach

– Implemented with fidelity

– Examined using rigorous research design

– Demonstrated positive outcomes in repeated studies

Outcomes Associated withEvidence-based Practices

• Improved family functioning and school performance

• Decreased drug use and psychiatric symptoms

• Reduced rates of out-of-home placements

• Reduce rates of re-arrest

• Cost savings

-12%

-13%

-31%

-14%

-4%

-8%

10%

-5%

-2%

-1%

-31%

-25%

-18%

-37%

-27%

-5%

0%

-4%

-14%

13%

-17%

-15%

-12%

10%

-80% -60% -40% -20% 0% 20% 40%

Early Childhood Education for Disadvantaged Youth (N = 6)

Seattle Social Development Project (N = 1)

Quantum Opportunities Program (N = 1)

Children At Risk Program (N = 1)

Mentoring (N = 2)

National Job Corps (N = 1)

Job Training Partnership Act (N = 1)

Diversion with Services (vs. Regular Court) (N = 13)

Diversion-Release, no Services (vs. Regular Court) (N = 7)

Diversion with Services (vs. Release without Services) (N = 9)

Multi-Systemic Therapy (N = 3)

Functional Family Therapy (N = 7)

Aggression Replacement Training (N = 4)

Multidimensional Treatment Foster Care (N = 2)

Adolescent Diversion Project (N = 5)

Juvenile Intensive Probation (N = 7)

Intensive Probation (as alternative to incarceration) (N = 6)

Juvenile Intensive Parole Supervision (N = 7)

Coordinated Services (N = 4)

Scared Straight Type Programs (N = 8)

Other Family-Based Therapy Approaches (N = 6)

Structured Restitution for Juvenile Offenders (N = 6)

Juvenile Sex Offender Treatment (N = 5)

Juvenile Boot Camps (N = 10)

Lower Recidivism Higher Recidivism

The number in each bar is the "effect size" for each program, which approximates a percentage change in recidivism rates.

The length of each bar are 95% confidence intervals.

Type of Program, and the Number (N) of studies in the Summary

Source: Meta-analysis conducted by the Washington State Institute for Public Policy

The Estimated Effect on Criminal Recidivism for Different Types of Programs for Youth and Juvenile Offenders

Development and Spread ofEvidence-based Practices

• Expansion of EBPs (MST, FFT, MDTFC, CBT, etc.) across and within states– e.g., MST currently operating in 35 states and 10

countries

• Executive/Administrative action to foster growth – e.g., State of Connecticut redirection of funds from

secure facilities

• State legislative mandates and actions for change– e.g., State of Oregon’s law requiring use of EBPs

Comprehensive and Coordinated Programs and Models

• SAMHSA’s Policy Academies

• DOJ’s Justice and Mental Health Collaboration Program

• Models for Change Initiative-MacArthur Foundation

• OJJDP/NCMHJJ’s Blueprint for Change

Models for Change Initiative

The goal is to create a new wave of juvenile justice reform by producing system-wide change in multiple states that others will learn from and emulate.

Models for Change: Systems Reform in Juvenile Justice

• Framework grounded in set of principles promoting rational, fair and effective juvenile justice reform

• Provides long-term support to lead grantee, state and local groups and leaders to develop and implement plan for reform

• Technical assistance, training and consultation to sites provided by National Resource Bank of key grantee organizations

• Activity focused on identified targeted areas of improvement

Models for Change States

PennsylvaniaLead Entity-Juvenile Law Center•Targeted Areas of Improvement (TAI)

– Mental health-juvenile justice coordination– Aftercare– Disproportionate minority contact

IllinoisLead Entity-Loyola University Chicago and Coordinating Council• Targeted Areas of Improvement (TAI)

– Community-based alternative sanctions and services– Juvenile court jurisdiction– Disproportionate minority contact

Models for Change State (cont.)LouisianaLead Entity- Louisiana Board of Regent• Targeted Areas of Improvement (TAI)

– Alternatives to formal processing and secure confinement– Evidence-based practices– Disproportionate minority contact

WashingtonLead Entity-Center for Children and Youth Justice• Targeted Areas of Improvement (TAI)

– Mental Health– Disproportionate minority contact – Alternatives to formal processing and secure confinement

Advancing the Models• Building an evidence base

– Select bellwether states– Develop and test tools to support reform– Document and assess the process of change– Create new knowledge

• Creating interest and demand– Understand how innovation travels through

information and technical assistance– Establish Action Networks on mental health

and DMC

Despite progress, the field has lacked a comprehensive framework that pulls together and integrates the best information available for responding to youth with mental health disorders who come in contact with the juvenile justice system.

A Blueprint for Change: Improving the System Response to Youth with Mental Health Needs Involved with

the Juvenile Justice System

Blueprint for Change

• Developed by NCMHJJ through grant from OJJDP.

• Multi-year effort involving literature review, site visits, data collection and informed by key stakeholders and a National Advisory Board

• Targeted to juvenile justice and mental health administrators and program directors

Goals of the Model

• Provide a comprehensive and integrated blueprint that offers practical guidelines, examples and recommendations to foster change in jurisdictions across the country

• Summarize what we know about the best way to identify and treat mental health disorders

• Present this in a comprehensive way that examines the juvenile justice system as a continuum from arrest to aftercare

Key Components of a Comprehensive Approach for Improving the Identification and

Treatment of Youth with Mental Health Needs in Contact with the Juvenile Justice System

1. There should be a clear, agreed upon policy and set of principles that guide decisions

2. Actions should be taken to address the four key cornerstones of a comprehensive approach

3. Opportunities at all critical intervention points in the juvenile justice continuum should be examined

4. Promising and research-based program examples implemented across the country should be used to identify possible effective strategies

Underlying Principles

• Represent the foundation on which a system can be built that is committed and responsive to addressing the mental health needs of youth in its care

• Youth should not have to enter the JJ system solely to access mental health services

• Whenever possible and matters of public safety allow, youth should be diverted into evidence-based treatment in community settings

Cornerstones

• Collaboration: The JJ and MH systems must work jointly to address the issue

• Identification: Systematically identify needs at all critical stages

• Diversion: Whenever possible divert youth to community-based services

• Treatment: Provide youth with effective treatment to meet their needs

Recommended ActionsCollaboration• Recognize joint responsibility at all stages• Family Members should be included

Identification• All youth should be screened• Instruments should be standardized and scientifically sound

Diversion• Procedures should be in place to identify youth appropriate for

diversion• Effective services must be available to serve diverted youth

Treatment• Mental health services provided to youth should be evidence-based• Discharge planning/re-entry services should be provided to ensure

continuing access to services

Critical Intervention Points

Places within the juvenile justice system where opportunities exist to improve collaboration, identification, diversion and treatment for these youth.

SecurePlacement

ProbationSupervision

Re-Entry

InitialContact

andReferral

Intake

Detention

JudicialProcessing

Program Examples

• Over 50 programs are referenced

• Descriptions and contact information are provided in a separate appendix

Program Examples at Critical Intervention Points

1. Initial Contact–Specialized training for law enforcement officials–Co-responding teams

Program Example: Rochester, NY Community Mobile Crisis Center

2. Probation Intake–Standardized mental health screening for all youth–Creation of diversion mechanisms

Program Example: Texas Special Needs Diversion Program

Practical Application at Critical Intervention Points (cont.)

3. Detention– Standardized mental health screening– Establishment of linkages with community-based mental health

providers

Program Example: Bernalillo County, AZ, Juvenile Detention Center

4. Judicial Processing– Ensure that Judges have access to the information they need to

make informed dispositional decisions

Program Examples: Cook County, IL, Juvenile Court Clinic; Summit County Ohio Crossroads Court

Practical Application at Critical Intervention Points (cont.)

5. Dispositional Alternatives– Consider the use of community-based alternatives with a strong

probation supervision component whenever possible– Improve access to evidence-based mental health treatments for youth

committed to juvenile corrections

Program Examples: Connecticut Court Support Services Division’s MST Initiative; Akron, Ohio’s Integrated Co-Occurring Treatment Model; Washington State’s Integrated Treatment Model (ITM)

6. Re-Entry– Discharge planning should begin shortly after placement – Linkages must be in place with community providers to ensure access

to mental health services– Planning should include efforts to ensure that a youth is enrolled in

Medicaid or some other type of insurance

Program Example: Rhode Island’s Project Hope

Conclusions• Growing sense of crises across the country• Significant advances in identification and treatment have

occurred• Number of specific areas still to be effectively addressed,

e.g. girls, co-occurring disorders, diversion programs, re-entry

• Series of extremely difficult issues remain- interagency collaboration, funding, prioritizing these youth, political will

• Resources, models and practical examples are available to support efforts to better address the needs of youth with mental health disorders who come in contact with the juvenile justice system