1. Mental Health and Juvenile Justice: Issues Trends and Needed Directions Joseph J. Cocozza, Ph.D. Director National Center for Mental Health And Juvenile Justice Policy Research Associates, Inc. Statewide Interagency Advisory Meeting St. Paul, MN April 24, 2007

2. 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

3. 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.comwww.ncmhjj.com

4. Overview Prevalence and Problems National Trends Comprehensive and Coordinated Programs and Models Conclusion

5. There is a growing sense of crisis surrounding the large numbers of youth in the justice system with mental health needs Mental health is the number one emergent issue as far as juvenile justice is concerned (Coalition for Juvenile Justice, 2000). In effect, our jails and prisons are now our largest psychiatric facilities… (State Mental Health Commissions, 2002).

6. Large numbers of youth in the juvenile justice system are experiencing mental health disorders Prevalence of Mental Disorders- Findings From Recent Studies Positive Diagnosis NCMHJJ (2006)70.4% Teplin et al. (2002) 69.0% Wasserman et al. (2002)68.5% Wasserman, Ko, McReynolds (2004)67.2%

7. Types of Disorders by Gender (n=1437) Overall % Males % Females % Any Disorder70.466.881.0 Anxiety Disorder34.426.456.0 Mood Disorder18.314.329.2 Disruptive Disorder46.544.951.3 Substance Abuse Disorder46.243.255.1

8. Many of these youth experience multiple and severe disorders More than half (55.6%) of youth met criteria for at least two diagnoses 60.8% of youth with a mental disorder also had a substance use disorder About 27% of justice-involved youth have disorders that are serious enough to require immediate and significant treatment

9. Other factors are fueling the growing sense of crisis surrounding youth with mental disorders Numbers entering the juvenile justice system increasing –Texas data show a 27% increase of youth with high mental health needs over a six year period (Texas Youth Commission, 2002) Youth being inappropriately placed –2/3 of juvenile detention facilities youth held unnecessarily because of unavailable services (Congressional Committee on Government Reform, 2004) Mental health services often unavailable or inadequate –Series of DOJ investigations document poor training, inadequate clinical services, inappropriate use of medications etc. (U.S. Department of Justice, 2005)

10. There are a number of trends, services and strategies that are developing to support the better identification and treatment of these youth Standardized mental health screening and assessment procedures Evidence-based interventions and promising practices Comprehensive and coordinated mental health and juvenile justice programs and models

11. Rapid implementation of standardized, scientifically-based screening and assessment instruments MAYSI-2 most widely used screen in juvenile justice settings Diagnostic assessment instruments adapted for juvenile justice- Voice-DISC in place in 14 states

12. MAYSI now used system wide in 39 states Grisso, 2006

13. Evidence-Based Practices Evidence-Based Practices (EBP) are: –Standardized, manualized approach –Implemented with fidelity –Examined using rigorous research design –Demonstrated positive outcomes in repeated studies

14. Outcomes Associated with Evidence-based Practices Improved family functioning and school performance Decreased drug use and psychiatric symptoms Reduced rates of out-of-home placements Reduce rates of re-arrest Cost savings

16. Development and Spread of Evidence-based Practices Expansion of EBPs (MST, FFT, MDTFC, CBT, etc.) across and within states –e.g., MST currently operating in 35 states and 10 countries Executive/Administrative action to foster growth –e.g., State of Connecticut redirection of funds from secure facilities State legislative mandates and actions for change –e.g., State of Oregons law requiring use of EBPs

17. Comprehensive and Coordinated Programs and Models SAMHSAs Policy Academies DOJs Justice and Mental Health Collaboration Program Models for Change Initiative-MacArthur Foundation OJJDP/NCMHJJs Blueprint for Change

19. Models for Change Initiative The goal is to create a new wave of juvenile justice reform by producing system-wide change in multiple states that others will learn from and emulate.

20. Models for Change: Systems Reform in Juvenile Justice Framework grounded in set of principles promoting rational, fair and effective juvenile justice reform Provides long-term support to lead grantee, state and local groups and leaders to develop and implement plan for reform Technical assistance, training and consultation to sites provided by National Resource Bank of key grantee organizations Activity focused on identified targeted areas of improvement

21. Models for Change States Pennsylvania Lead Entity-Juvenile Law Center Targeted Areas of Improvement (TAI) –Mental health-juvenile justice coordination –Aftercare –Disproportionate minority contact Illinois Lead Entity-Loyola University Chicago and Coordinating Council Targeted Areas of Improvement (TAI) –Community-based alternative sanctions and services –Juvenile court jurisdiction –Disproportionate minority contact

22. Models for Change State (cont.) Louisiana Lead Entity- Louisiana Board of Regent Targeted Areas of Improvement (TAI) –Alternatives to formal processing and secure confinement –Evidence-based practices –Disproportionate minority contact Washington Lead Entity-Center for Children and Youth Justice Targeted Areas of Improvement (TAI) –Mental Health –Disproportionate minority contact –Alternatives to formal processing and secure confinement

23. Advancing the Models Building an evidence base –Select bellwether states –Develop and test tools to support reform –Document and assess the process of change –Create new knowledge Creating interest and demand –Understand how innovation travels through information and technical assistance –Establish Action Networks on mental health and DMC

24. Despite progress, the field has lacked 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.

25. A Blueprint for Change: Improving the System Response to Youth with Mental Health Needs Involved with the Juvenile Justice System

26. Blueprint for Change Developed by NCMHJJ through grant from OJJDP. Multi-year effort involving literature review, site visits, data collection and informed by key stakeholders and a National Advisory Board Targeted to juvenile justice and mental health administrators and program directors

27. Goals of the Model Provide a comprehensive and integrated blueprint that offers practical guidelines, examples and recommendations to foster change in jurisdictions across the country 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

28. Key Components of a Comprehensive Approach for Improving the Identification and Treatment of Youth with Mental Health Needs in Contact with the Juvenile Justice System 1.There should be a clear, agreed upon policy and set of principles that guide decisions 2.Actions should be taken to address the four key cornerstones of a comprehensive approach 3.Opportunities at all critical intervention points in the juvenile justice continuum should be examined 4.Promising and research-based program examples implemented across the country should be used to identify possible effective strategies

30. 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

31. 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

32. Recommended Actions Collaboration Recognize joint responsibility at all stages Family Members should be included Identification All youth should be screened Instruments should be standardized and scientifically sound 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 Discharge planning/re-entry services should be provided to ensure continuing access to services

33. Critical Intervention Points Places within the juvenile justice system where opportunities exist to improve collaboration, identification, diversion and treatment for these youth. Secure Placement Probation Supervision Re-Entry Initial Contact and Referral Intake Detention Judicial Processing

34. Program Examples Over 50 programs are referenced Descriptions and contact information are provided in a separate appendix

35. Program Examples at Critical Intervention Points 1.Initial Contact –Specialized training for law enforcement officials –Co-responding teams Program Example: Rochester, NY Community Mobile Crisis Center 2.Probation Intake –Standardized mental health screening for all youth –Creation of diversion mechanisms Program Example: Texas Special Needs Diversion Program

36. Practical Application at Critical Intervention Points (cont.) 3.Detention –Standardized mental health screening –Establishment of linkages with community-based mental health providers Program Example: Bernalillo County, AZ, Juvenile Detention Center 4.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

37. Practical Application at Critical Intervention Points (cont.) 5.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) 6.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 Example: Rhode Islands Project Hope

38. Conclusions Growing sense of crises across the country Significant advances in identification and treatment have occurred Number of specific areas still to be effectively addressed, e.g. girls, co-occurring disorders, diversion programs, re- entry Series of extremely difficult issues remain- interagency collaboration, funding, prioritizing these youth, political will Resources, models and practical examples are available to support efforts to better address the needs of youth with mental health disorders who come in contact with the juvenile justice system