Balancing Justice and Treatment: Some Lessons from the RWJF Reclaiming Futures Initiative

1
Balancing Justice and Treatment Some Lessons
from the RWJF Reclaiming Futures
Initiative Jeffrey A. Butts, Ph.D.Chapin Hall
at the University of ChicagoSeptember 4,
2008 Presented to
2
RWJFs Reclaiming Futures Initiative

• Improving justice interventions for drug-using
  youth
• Areas of focus
• Quality improvement
• Screening and assessment
• - Leadership
• - Systems integration and agency coordination
• - Data systems
• - Family involvement
• Community engagement
• Similar to many other efforts to improve systems

3
RWJFs Reclaiming Futures Initiative

• Yet, different from other system change efforts
• Difficult to manage the inherent tensions
  between treatment and justice

• Example
• Panel study of 1,000 8th graders followed to age
  22
• Researchers tested the effect of juvenile justice
  intervention on school success, employment, and
  adult crime controlling for criminal record,
  poverty etc.
• Intervention reduces the chances of high school
  graduation and adult employment
• Intervention increases the number of predicted
  crimes during adult years by a factor of 5
• Source Bernburg and Krohn (2003).
  Criminology.

• Both place youth at greater risk of future
  offending and court involvement

4
To Treat or Not To Treat

• Adolescent drug use is nearly normal behavior
• Most drug-using youthful offenders will age out
  of drug use, just as most adolescents desist
  with age
• The challenge is to identify which youth wont
  desist
• Both juvenile court adjudication and drug abuse
  are potentially harmful to youth
• Normal drug use by itself should not be used
  as legal leverage to entangle youth in the
  formal justice system
• Inherent tensions between justice and treatment
  goals are eliminated only when the seriousness
  of a youths law violation justifies the use of
  coercive intervention

5
How Common is Teen Drug Use?
Alcohol Any use 33
Been drunk 18
Use in Past Month by 10th Graders
Source Monitoring the Future 2007, University of
Michigan.
6
How Common is Teen Drug Use?
Any Illicit Drug 17
Use in Past Month by 10th Graders
Source Monitoring the Future 2007, University of
Michigan.
7
How Common is Teen Drug Use?
Any Illicit Drug 17
Use in Past Month by 10th Graders
Abuse/Dependence in Past Year (12-17)
Drug 5
Source SAMHSA, Office of Applied Studies,
National Survey on Drug Use and Health, 2006.
8
How Common is Teen Drug Use?
Any Illicit Drug 17
Use in Past Month by 10th Graders
Abuse/Dependence in Past Year (12-17)
Incl. Alc. 8
Source SAMHSA, Office of Applied Studies,
National Survey on Drug Use and Health, 2006.
9
How Common is Teen Drug Use?
Any Illicit Drug 17
Use in Past Month by 10th Graders
Abuse/Dependence in Past Year (12-17)
Any SUD 8
SUD Substance Use Disorder
General PopulationJustice-Involved
Any SUD 11
Youth referred to an intake and assessment
center soon after a first contact with police.
Source McReynolds et al. (2008). Crime
Delinquency.
10
How Common is Teen Drug Use?
Any Illicit Drug 17
Use in Past Month by 10th Graders
Abuse/Dependence in Past Year (12-17)
Any SUD 8
General PopulationJustice-Involved
Drug 5
Any SUD 11
Any SUD 25
Youth referred to probation intake after initial
screening by law enforcement or other agency.
Source Wasserman et al. (2005). Amer. Journal of
Public Health.
11
How Common is Teen Drug Use?
Any Illicit Drug 17
Use in Past Month by 10th Graders
Abuse/Dependence in Past Year (12-17)
Any SUD 8
General PopulationJustice-Involved
Drug 5
Any SUD 11
Any SUD 25
Any SUD 37
Youth formally involved with a juvenile justice
agency some but not all with previous
out-of-home placements.
Source Aarons et al. (2001). Journal of the
Amer. Acad. of Child and Adolesc. Psych.
12
How Common is Teen Drug Use?
Any Illicit Drug 17
Use in Past Month by 10th Graders
Abuse/Dependence in Past Year (12-17)
Any SUD 8
General PopulationJustice-Involved
Drug 5
Any SUD 11
Any SUD 25
Any SUD 37
Any SUD 49
Serious juvenile offenders held in the secure
detention center of Cook County (Chicago)
Illinois.
Source Teplin et al. (2002). Archives of General
Psychiatry
13
Clearly, Drug Problems are More Common the Deeper
One Looks into the Juvenile Justice Process
In a sense, drug-using youth accumulate in the
deep end of the juvenile justice system

• Why?
• Do drug issues increase the seriousness of
  criminal behavior by juvenile offenders?
• Do drug issues increase the coerciveness of the
  legal response to juvenile offenders?

14
Consider this
15
100
What proportion have a substance use disorder? -
McReynolds et al. (2008)
11
Youth at a Juvenile Assessment Center
16
100
About half of all arrested youth are referred to
juvenile court authorities. - Juvenile Court
Statistics, OJJDP
Of these, what proportion have a substance use
disorder? - Wasserman et al. (2005)
25
11
Youth at a Juvenile Assessment Center
Youth Referred to Juvenile Probation
17
100
About 20 percent of all court referred youth are
held in secure detention at some point. -
Juvenile Court Statistics, OJJDP
Of these, what proportion have a substance use
disorder? - Teplin et al. (2002)
25
11
49
Youth at a Juvenile Assessment Center
Youth Referred to Juvenile Probation
Youth Held in Secure Detention
18
100
When they first enter the juvenile system, the
prevalence of substance abuse among young
offenders is similar to other teens. Substance-abu
sing offenders, however, are more likely to be
retained through to the more restrictive stages
of justice processing.
The preponderance of drug-abusing youth in the
deep end of the justice system is a function of
how case decisions are made. Drug-abusing youth
are treated more coercively.
Thus, they are a larger subgroup by the end of
the juvenile justice process.
25
11
49
Youth at a Juvenile Assessment Center
Youth Referred to Juvenile Probation
Youth Held in Secure Detention
19
Youth with Identified Drug Issues are Handled
More Coercively in the Juvenile Justice System

• This may be an accurate and legitimate use of
  resources if drug-using youth are higher-risk and
  in need of stronger sanctions.
• Just what type of drug users are referred to the
  juvenile justice system?

20
Substance Use Disorders
Among Youth Referred to a Juvenile Assessment
Center
Among Youth Referred to Juvenile Probation Intake
Abuse Disorders (past month) Alcohol
2 Marijuana 4 Other drug 1 Dependence
Disorders Alcohol 1 Marijuana 5 Other
drug 1 No Disorder Detected 89
Abuse Disorders (past month) Alcohol
7 Marijuana 10 Other drug 3 Dependence
Disorders Alcohol 3 Marijuana 13 Other
drug 4 No Disorder Detected 75
Source McReynolds et al. (2008)
Source Wasserman et al. (2005)
21
Substance Use Disorders

• 10-25 of youthful offenders have substance
  use issues that could be called problematic
  either abuse or dependence
• Most of these substance use issues (80-90
  involve alcohol and marijuana only

22
The Key Policy Question How Serious Does a
Teens Use of Alcohol and Marijuana Have to be to
Pose a Greater Threat to his or her Future than
the Threat Posed by Juvenile Court Adjudication
and the Criminal Record that may Follow?
23
Two Dimensions in Decision Making

• Severity of substance abuse
• Severity of criminal behavior

24
Total Population of Youth Offenders
25
Total Population of Youth Offenders
26
Total Population of Youth Offenders
27
Total Population of Youth Offenders
28
If we combine the two dimensions
Severity of Drug-Using Behavior
Severity of Criminal Behavior
29
Coercion for Treatment?
Coercion for Public Safety
Maximum Intervention
Treatment
IatrogenicRisk
When is it appropriate to use the justice
system to coerce youth into compliance, knowing
that coercion itself present risks to their
future?
How far down into less serious offenses can
coercion be used before we introduce iatrogenic
risks making things worse?
Severity of Drug-Using Behavior
Minimum Intervention
Justice
Severity of Criminal Behavior
30
Coercion for Treatment?
Coercion for Public Safety

• Iatrogenic Risk Could be Eliminated With Perfect
  and Objective Knowledge of 4 Factors
• Actual harm caused by a youths current drug use
• Trajectory and impact of future drug use
• Methods for selecting and delivering treatment
• The effectiveness and behavioral impact of
  treatment
• Our Knowledge Will Never Be Perfect

Maximum Intervention
Treatment
IatrogenicRisk
Severity of Drug-Using Behavior
Minimum Intervention
Justice
Severity of Criminal Behavior
31
Coercion for Treatment?
Coercion for Public Safety
Maximum Intervention
Treatment
IatrogenicRisk
To the extent we have only imperfect knowledge,
our willingness to use coercion for treatment
goals alone should be limited to serious drug
problems.
Severity of Drug-Using Behavior
Minimum Intervention
Justice
Severity of Criminal Behavior
32
Coercion for Public Safety
Coercion for Treatment?
Maximum Intervention
Treatment
IatrogenicRisk
Injustice
Imperfect Knowledge
Severity of Drug-Using Behavior
Minimum Intervention
Justice
Severity of Criminal Behavior
33
In Juvenile Justice, Treatment Must Be

• Largely community-based, non-coercive
• Designed for the vast majority of youth who are
  drug using, sometimes abusing, but not drug
  dependent
• Ready to address a wide range of drug use but
  still appropriate for the 90 of youthful
  offenders who use only alcohol and marijuana
• Designed to avoid unwarranted legal coercion by
  providing services, activities and supports that
  are actually appealing to non-mandated,
  voluntary clients
• Free of any financial incentives that lead to
  excess use of formal adjudication and
  court-ordered treatment

34
Jeffrey A. Butts, Ph.D.Research FellowChapin
Hall at the University of Chicagojabutts_at_uchicag
o.eduwww.chapinhall.orgwww.jeffreybutts.net
35
Aarons, Gregory A., Sandra A. Brown, Richard L.
Hough, Ann F. Garland, and Patricia A. Wood
(2001). Prevalence of Adolescent Substance Use
Disorders across Five Sectors of Care. Journal of
the American Academy of Child and Adolescent
Psychiatry, 40(4) 41926.Bernburg, Jón Gunnar
and Marvin D. Krohn (2003). Labeling, Life
Chances, and Adult Crime The Direct and Indirect
Effects of Official Intervention in Adolescence
on Crime in Early Adulthood. Criminology 41(4)
1287-1318.McReynolds, Larkin S., Gail A.
Wasserman, Robert E. DeComo, Reni John, Joseph M.
Keating, and Scott Nolen (2008). Psychiatric
disorder in a juvenile assessment center. Crime
Delinquency, 54(2) 313-334.Substance Abuse and
Mental Health Services Administration (2007).
National Survey on Drug Use and Health.
Rockville, MD Substance Abuse and Mental Health
Services Administration.Teplin, Linda A., Karen
M. Abram, Gary M. McClelland, Mina K. Dulcan, and
Amy A. Mericle (2002). Psychiatric Disorders in
Youth in Juvenile Detention. Archives of General
Psychiatry, 59(Dec) 1133-1143.Wasserman, Gail
A., Larkin S. McReynolds, Susan J. Ko, Laura M.
Katz, and Jennifer R. Carpenter (2005). Gender
Differences in Psychiatric Disorders at Juvenile
Probation Intake. American Journal of Public
Health, 95(1) 131-137.
References