1. The Federal Advisory Committee on Juvenile Justice
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
Developing a Comprehensive Model: Project Background and Purpose
Blueprint for Change: Key Components of the Model
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:

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. 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 (n=1437)
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. OJJDP’s 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 OJJDP’s 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 Division’s MST Initiative; Akron, Ohio’s Integrated Co-Occurring Treatment Model; Washington State’s 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 Island’s Project Hope; New York City’s 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
Children’s 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