Blueprint for Change: A Comprehensive Model for the Identification and Treatment of Youth with Mental Health Needs in Contact with the Juvenile Justice System

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Blueprint for ChangeA Comprehensive Model for
the Identification and Treatment of Youth with
Mental Health Needs in Contact with the Juvenile
Justice System

• Presenters
• Joseph J. Cocozza, National Center for Mental
  Health and Juvenile Justice
• Kathleen Skowyra, National Center for Mental
  Health and Juvenile Justice

The Federal Advisory Committee on Juvenile
Justice Washington, DC May 9, 2006
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Overview

1. Developing a Comprehensive Model Project
   Background and Purpose
2. Blueprint for Change Key Components of the Model
3. Dissemination and Implementation Plans for the
   Future

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I. Developing a Comprehensive Model Project
Background and Purpose

• Joseph J. Cocozza, Ph.D.
• Director
• National Center for Mental Health and Juvenile
  Justice

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National Center for Mental Healthand 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.

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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
  Administration
• Website
• www.ncmhjj.com

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Background

• There is growing concern over the extent,
  seriousness and adequacy of response to mental
  disorders among youth in the juvenile justice
  system.
• 1.Recent research, including a multi-state, multi
  system study completed as part of this project,
  consistently document high rate of mental disorder

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Comparison of Mental Health Prevalence Findings From Recent Juvenile Justice Studies Comparison of Mental Health Prevalence Findings From Recent Juvenile Justice Studies
Authors (Year) with a Positive Diagnosis
OJJDP Multi-State Prevalence Study (2005) 70.4
Teplin, Abram, McClelland (2002) 72.6
Wasserman, et al (2002) 68.5
Wasserman, Ko, McReynolds (2004) 67.2
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Types of Disorders by Gender (n1437) Types of Disorders by Gender (n1437) Types of Disorders by Gender (n1437) Types of Disorders by Gender (n1437)
Overall Males Females
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
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Number and Severity of DisordersMultiple
Disorders

• More than half (55.2) of youth met criteria for
  at least two diagnoses
• 37.5 of youth in the sample had both a mental
  health disorder and substance use disorder.
• About 25 of justice involved youth have
  disorders that are serious enough to require
  immediate and significant treatment

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Background (cont.)

• 2. The number of youth with mental health
  disorders entering the juvenile justice system
  appears to be increasing
• Texas data show a 27 increase of youth with
  high mental health needs under a six year period
  (2003)
• 3. Often, youth are being placed into the justice
  system because of the lack of community-based
  mental health services
• 2/3 of juvenile detention facilities youth held
  unnecessarily because of unavailable services
  (Congressional Committee on Government Reform,
  2004)
• 4. There is little evidence to suggest that youth
  in the juvenile justice system are routinely
  provided with adequate or effective mental health
  services.
• Series of DOJ investigations documenting poor
  training, inadequate clinical services,
  inappropriate use of medication etc.

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• At the same time there are a number of trends,
  services and strategies that are developing to
  support the better identification and treatment
  of these youth
• Greater recognition by both the mental health and
  juvenile justice systems
• Wide spread use of standardized mental health
  screening and assessment procedures
• Increasing reliance on evidence-based and
  promising practices
• Development of collaborative programs across the
  country

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• Despite this progress, the field lacks 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.

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OJJDPs Response

• In response, OJJDP released RFP aimed at
  summarizing and substantially improving the
  knowledge base in order to develop a
  comprehensive model for addressing the mental
  health needs of youth in the juvenile justice
  system.
• Represents OJJDPs largest investment in mental
  health research to date
• Contract awarded to National Center for Mental
  Health and Juvenile Justice in partnership with
  the Council of Juvenile Correctional
  Administrators

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Steps Associated with the Development of the Model

• Review the research and literature.
• Identify and site visit existing, promising
  programs and practices across the country.
• Conduct a study of mental health needs and
  services for youth in three different states and
  in three different juvenile justice settings.
• Use data and information collected to inform the
  development of a Model for providing a broad
  range of mental health services.

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Steps Associated with the Development of the
Model (cont.)

• Model development guided by Advisory Group of
  national experts.
• Final draft reviewed by leaders representing key
  associations and systems, as well as youth and
  family members.
• Completed document submitted to OJJDP.

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II. Blueprint for Change Key Components of
the Model

• Kathleen Skowyra
• Senior Consultant
• National Center for Mental Health
• and Juvenile Justice

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Goals of the Model

• Capture existing activity
• 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
• Offer practical recommendations, guidelines and
  examples to foster change in jurisdictions across
  the country

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Key Components of the Model

• Underlying Principles that serve as the
  underpinning of the Model and provide the basis
  for the recommendations put forward
• Cornerstones that provide the necessary
  infrastructure for the model and reflect areas
  where key improvements can be made to better
  serve youth with mental health needs
• Critical Intervention Points that identify places
  within the juvenile justice system where
  opportunities exist to implement or address the
  Cornerstones
• Program Examples that illustrate existing efforts
  to provide services to youth in contact with the
  JJ system

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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

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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

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Critical Intervention Points

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

Detention
Secure Placement
Initial Contact and Referral
Judicial Processing
Intake
Re-Entry
Probation Supervision
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Program Examples

• Over 50 programs are referenced
• Descriptions and contact information are provided
  in a separate appendix
• Plan to update this periodically

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Recommended Actions

• 33 action-oriented recommendations organized by
  Cornerstone
• Provide guidance and specific direction for
  addressing the issues of improved collaboration,
  identification, diversion and treatment
• Include program and other examples of how this
  can be done
• Apply to the Critical Intervention Points as well

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Recommended Actions

• Collaboration
• Recognize joint responsibility at all stages
• Family Members should be included
• Identification
• All youth should be screened
• Access to emergency mental health services must
  be available
• 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
• Attempts should be made to treat youth in their
  home and community environments

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Conceptual Framework of the Comprehensive Model
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Practical Application at Critical Intervention
Points

• Initial Contact
• Specialized training for law enforcement
  officials
• Co-responding teams
• Program Example Rochester, NY Community Mobile
  Crisis Center
• Probation Intake
• Standardized mental health screening for all
  youth
• Creation of diversion mechanisms
• Program Examples Indiana Family Project Texas
  Special Needs Diversion Program

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Practical Application at Critical Intervention
Points (cont.)

• Detention
• Standardized mental health screening
• Establishment of linkages with community-based
  mental health providers
• Program Example Bernalillo County, AZ, Juvenile
  Detention Center
• 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

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Practical Application at Critical Intervention
Points (cont.)

• 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 Divisions MST Initiative Akron, Ohios
  Integrated Co-Occurring Treatment Model
  Washington States Integrated Treatment Model
  (ITM)
• 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 Examples Rhode Islands Project Hope
  New York Citys CASES School Re-Entry Program for
  Court-Involved Youth

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Key Features of the Model

• Targeted to juvenile justice and mental health
  administrators and program directors.
• Offers a blueprint for how mental health issues
  can be addressed within the system in its
  entirety as well as compartmentalizes the system
  into discrete points of contact, allowing
  communities to consider implementing individual
  components of the model as a first step.
• Includes an extensive directory of related
  resources, materials and weblinks on the issue.

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III. Dissemination and Implementation Plans
for the Future
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A. Dissemination activities aimed at informing
key stakeholders about the model

• Publications
• OJJDP Bulletin and Report
• Research and Program Brief
• Web-Based Version
• Presentations
• OJJDP Administration
• Childrens Mental Health Research Conference
• OJJDP Conference
• SAMHSA
• Key National Organizations

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B. Building support to allow the Center to help
implement the Model

• Federal Level
• OJJDP
• Congressional Meetings
• Mental Health Advocates
• State Level
• FACJJ
• Possible funding streams
• Incentives for states to prioritize mental health

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C. Planned implementation activities

• Develop practical tools
• Training curriculum
• Checklist for change
• Identify possible sources of support
• Given the availability of federal funds, develop
  implementation plan and timeline for implementing
  the Model in select jurisdictions

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C. Planned implementation activities (cont.)

• Prepare and disseminate information to state
  leaders about the availability of the Model and
  technical assistance
• Work with interested states to develop plans and
  timeframes based on state objectives and
  available funds
• Provide assistance to states to map needs,
  develop strategic plans and deliver training
• Assess the impact of implementing the model in
  affecting comprehensive changes to polices and
  practices