Building a Juvenile Justice System of Care

A Juvenile Justice System of Care—A Comprehensive Approach

Definition and recognition of the problem Screening and assessment to identify the problem Integrated systems approach Matching both risks & needs to appropriate

interventions through a continuum of care that integrates both accountability (e.g., graduated sanctions), social interventions, and treatment interventions

Utilizing a strengths-based approach to assessment and service provision

Family involvement/engagement Culturally competent/gender appropriate programming Commitment and investment from key stakeholders,

interested parties, supervisors, and line-staff

Defining Screening & Assessment

Screening: A brief process used to identify offenders who have a particular characteristic

Assessment: A more thorough investigation into this characteristic to assess the extent and level to which it exists and the appropriate system response it requires

Used for multiple purposes—in particular, they are used for two purposes in the juvenile justice system

To measure offender risk for reoffending Detention screening tools Risk/need assessment tools

To measure whether an offender has any mental health problems and/or substance abuse problems

What is Screening for Mental Health & Substance Abuse

The problem: Juvenile justice personnel are not trained as mental health professionals or substance abuse counselors—how can they identify the presence of a problem?

Solution: Screening Screening=brief process used to identify youth who are

at-risk of having disorders that warrant immediate attention, intervention, or more comprehensive review (e.g., Massachusetts Youth Screening Instrument, Version 2: MAYSI-2)

Facilitates a “triage” process No special training (or minimal training) is required to

administer screening tools Scoring thresholds provide valuable information to

“next step”

What is Assessment for Mental Health and Substance Abuse?

An assessment is completed by certified mental health professionals

Substantively, it is a comprehensive examination of: Psychosocial needs and problems Type and extent of mental health and substance use disorders Other issues associated with the disorders Recommendations for treatment

Requires much more time than screening Can be administered at regular intervals to measure the impact of

recommended supervision levels and treatment programming Many screening and assessment tools exist—therefore, it is critical

to choose the tools that are most appropriate for the population on whom it will be used

NEW RESOURCES Thomas Grisso, T. Vincent, G., & Seagrave, D. (2005). Mental Health Screening and Assessment in Juvenile Justice.

New York: Guilford Press. http://www.umassmed.edu/nysap/about.cfm Screening and Assessing Mental Health and Substance Use Disorders Among Youth in the Juvenile Justice System: A

Resource Guide for Practitioners http://www.ncjrs.org/pdffiles1/ojjdp/204956.pdf

Juvenile Justice Risk Assessment

Simultaneously, juvenile justice agencies should also assess a youth’s level of risk by consistently utilizing a standardized risk/need tool

Use of the tool provides several advantages: Provides a scoring threshold for level of risk Provides the basis for a case plan for supervision and

intervention Serves as the baseline for measuring change in behavior

over time Creates a level playing ground for offenders

Examples of risk/need tools: Youth Level of Service/Case Management Inventory (Hoge & Andrews, 1995), Washington State Juvenile Court Assessment

How Should Screening & Assessment be Used?

Screening Assessment Intervention

--Pre-Adjudication: Further assessment & intervention is voluntary--Post-Adjudication: Assessment & Intervention can be mandatory

If problem is indicated, offender is referred to more thorough assessment by MH/SA professional

DSM-IV Diagnosis

Based on the professional’s assessment, appropriate level of treatment is provided—this information is combined with the risk assessment outcome to ensure integrated levels of accountability & treatment

When Can Screening & Assessment be Used?

Achieving a Comprehensive Response through a Juvenile Justice System of Care

Barriers to Providing Effective Services

Herz, D. & Poland, A. (2002). Assessing the Need for and Availability of Mental Health Services for Juvenile Offenders

http://www.ncc.state.ne.us/documents/other/mental_health.htm Focus groups held with detention facility staff, probation

officers, Office of Juvenile Services personnel, and treatment providers

Surveys sent to judges, county attorneys, and public defenders Barriers identified by these groups:

Few resources/funds Caseload size and time available No standardized process screening and assessment Lack of availability of appropriate services Inappropriate placements Funding drives placements rather than need Delays in Medicaid processing

Barriers to Effective Services, Continued

Inconsistent quality of treatment services Removal of family from process System’s reactive approach Interagency conflict & turf boundaries Lack of cross-training across juvenile justice and

behavioral health Lack of cross-training across juvenile justice agencies Lack of training for providers on antisocial behavior Politics Availability in rural areas Bilingual services/culturally and gender specific

services

The Solution: Integrating SA, MH, and Justice Responses

Requires a shift in organizational cultural thinking in juvenile justice and behavioral health

Shared responsibilities rather than a shift from one system to another

Utilizing evidence-based programming within a continuum of care to address both risk and need

Build programming around youth and family strengths

Using a matrix of risk/need as an example

Integrating Responses: The Matrix Example

Level of Risk

Level o

f Need

Low Moderate High

Low Diversion+ prev./educational interventions

Traditional probation + prev./educational interventions (ART)

Intensive supervision to correctional placement + prev./educational interventions (ART)

Moderate

Diversion + outpatient/intensive outpatient care

Probation + Outpatient/Intensive outpatient care to Drug/MH Courts

Drug/MH Courts to Multisystemic Therapy (MST)

High Residential treatment care + restorative justice programming

Intensive probation+ outpatient/intensive outpatient care to residential treatment/correctional placement

MST to residential care that combines correctional structure & intensive mental health treatment

Key Components to Service Delivery

Utilizing a strengths-based approach to assessment and service provision

Measure youth and family strengths and incorporate them into programming

Family involvement/engagement Make family a central component to intervention Have alternatives in mind when incorporating families is

not possible Culturally competent/gender appropriate

programming Recognize differences and the value of traditional cultural

values and beliefs Incorporate individual/group experiences into evidence-

based programming

Moving Toward a Comprehensive Response

What Does it Take? Identification and inclusion of

stakeholders Support from policy-makers and agency

heads Working agreements across agencies Inclusion and overcoming philosophical

differences—finding room for compromise Building trust in the other systems and

fulfilling obligations

Who are the Stakeholders?(People impacted by a decision or with the ability to impact a decision)

Community: Schools, victims, media, local policy makers, state legislators, advocacy organizations, businesses, parents and youth

JJ: Police, Detention Personnel, Prosecutors, Defense Attorneys, Judges, Probation Officers, State Juvenile Correctional Agency, and Parole Officers

MH & AOD: Healthcare organizations, Substance Abuse Provider Organizations, Mental Health Organizations, State SA and MH Authority

Consequences of No Intervention and/or Ineffective Intervention

Consequences for System Processing Inappropriate use of detention Swinging pendulum between juvenile justice and behavioral health System conflicts & Funding manipulation

Consequences for System Responses Availability of resources and treatment providers Using appropriate levels and types of treatment and accountability Effective outcomes

Consequences for Youth Missed opportunities for prevention and to improve youth’s quality of

life Missed opportunities Race & gender disparities Serious offenders

In Summary, A Comprehensive Response is Critical Because…

It increases public safety and enhances public health simultaneously

It promotes positive outcomes for offenders, families, and communities

It is a more efficient use of resources and is accountable for the impact it is having

It stresses resource and experience sharing across systems

It increases the likelihood that juvenile justice will reach its intended mission