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


1
Blueprint for Change A 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
2
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

3
I. Developing a Comprehensive Model Project
Background and Purpose
  • Joseph J. Cocozza, Ph.D.
  • Director
  • National Center for Mental Health and Juvenile
    Justice

4
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.

5
National Center for Mental Health and 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

6
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

7
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
8
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
9
Number and Severity of Disorders Multiple
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

10
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.

11
  • 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

12
  • 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.

13
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

14
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.

15
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.

16
II. Blueprint for Change Key Components of
the Model
  • Kathleen Skowyra
  • Senior Consultant
  • National Center for Mental Health
  • and Juvenile Justice

17
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

18
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

19
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

20
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

21
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
22
Program Examples
  • Over 50 programs are referenced
  • Descriptions and contact information are provided
    in a separate appendix
  • Plan to update this periodically

23
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

24
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

25
Conceptual Framework of the Comprehensive Model
26
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

27
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

28
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

29
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.

30
III. Dissemination and Implementation Plans
for the Future
31
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

32
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

33
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

34
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
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