Ohio’s Behavioral Health Juvenile Justice Initiative: Effectively diverting juvenile justice-involved youth with behavioral health issues into community-based treatment. Amita L. Pujara, M.S., LPCC-S, MFT, LICDC- LIFE Program Manager, South Community, Inc., Wright State University Jeff M. Kretschmar, Ph.D. - Begun Center for Violence Prevention Research and Education, Jack, Joseph, and Morton Mandel School of Applied Social Sciences, Case Western Reserve University September 14, 2018

Ohio’s Behavioral Health Juvenile Justice (BHJJ) Initiative 1998 - Response to judges who were concerned about limited options for kids with serious mental health issues 1998 - Departments of Youth Services and Mental Health created a joint committee to explore alternatives 1999/2000 - Initial BHJJ program funded 2004 – S.H. vs Stickrath 2005 – Ohio’s Behavioral Health Juvenile Justice Initiative was re- funded

BHJJ Goal -To divert youth from local and state detention centers into more comprehensive, community-based behavioral health treatment. Began in 2005 with 6 projects (7 counties) Requirements Use of evidence based or supported models Youth must be JJ involved and experience BH issues Funding through: ODYS & OhioMHAS

BHJJ in Montgomery County

The LIFE Program 2005-present Community-Based Counseling Program Youth 10-18 involved with Montgomery County Juvenile Court Counseling for the entire family (relational focus) Targets mental health concerns of youth and parents Targets substance use concerns of youth and parents Increases healthy functioning of the entire family

Functional Family Therapy Short-term phasic model (3-5 months) Engagement and Motivation- Relational Assessment Behavior Change Generalization Culturally sensitive and informed Respect-based and strength-based Trauma informed Supervision Training

Functional Family Therapy Consistent with state/local initiatives Proven track record with juvenile offenders Reduction in recidivism/violent behavior Low drop out rates Positive impact on family conflict Siblings and family benefit

Accountability Support from judges and court administrators Clear expectations from treatment/courts Frequent oversight and monitoring Collaboration culture

Partners Family Probation/Parole Officer Intervention Center Natural Helper Child Welfare Other Systems Case Western Reserve University Functional Family Therapy, LLC.

LIFE Program Structure Community-based family therapy Psychiatric services Intensive probation Case management

Expanding Our Services Montgomery County LIFE Juvenile Mental Health Treatment Court FFT, FFT-Contingency Management (CM) Montgomery County Juvenile Treatment Court FFT-CM Montgomery County Family Treatment Court FFT-Child Welfare (CW) (not part of BHJJ)

Montgomery County Outcomes

Demographics 1,754 youth enrolled since 2006 54% male 50% Non-white Average age at intake: 15.5 years 83% of youth lived with at least one biological parent at intake (60% mother) Over 80% of caregivers had a high school diploma or GED Average household income was between $20-25,000

Youth and Family History Question Females Males Has the child ever been physically abused? 17.4% 14.4% Has the child ever been sexually abused? 23.1% ** 8.9% Has the child ever run away? 58.6% ** 48.8% Has the child ever had a problem with substance abuse, including alcohol and/or drugs? 41.1% 51.3% ** Has the child ever talked about committing suicide? 47.6%** 32.3% Has the child ever attempted suicide? 23.5% ** 10.0% Has the child ever been exposed to domestic violence or spousal abuse, of which the child was not the direct target? 39.1% 38.8% Has anyone in the child’s biological family ever been diagnosed with depression or shown signs of depression? 68.3% 64.8% Has anyone in the child’s biological family had a mental illness, other than depression? 51.3%* 46.0% Has the child ever lived in a household in which someone was convicted of a crime? 39.0% 39.3% Has anyone in the child’s biological family had a drinking or drug problem? 63.1% 60.1%

DSM Diagnoses DSM-IV Axis I Diagnosis Females Males Alcohol-related Disorders 13.1% ** 8.1% Attention Deficit Hyperactivity Disorder 27.4% 52.8% *** Bipolar Disorder 9.5% 7.4% Cannabis-related Disorders 26.7% 33.7% *** Conduct Disorder 11.8% 22.3% ** Depressive Disorders 32.4% *** 14.3% Mood Disorder 13.3% 10.9% Oppositional Defiant Disorder 49.0% 52.1% Post-traumatic Stress Disorder 7.7% *** 3.3% 32% of females and 40% of males had a co-occurring substance use and mental health diagnosis.

Unsuccessful Completers Successful Completers Education   Unsuccessful Completers Successful Completers Typical Grades Frequency at Intake Frequency at Termination Mostly A’s and B’s 17.5% 9.0% 23.1% 26.1% Mostly B’s and C’s 21.8% 22.8% 23.0% 35.3% Mostly C’s and D’s 25.4% 37.4% 26.3% 26.8% Mostly D’s and F’s 30.8% 11.8% At termination, workers reported that 40.5% of youth were attending school more than before starting treatment (48.7% were attending school ‘about the same’ amount)

Ohio Scales: Problem Severity All comparisons from intake to termination are significant at the p < .001 level

Ohio Scales: Functioning *all comparisons from intake to termination are significant at the p < .001 level

Trauma Symptoms Statistically significant means observed from intake to termination for all subscales

Violence and Trauma % Yes BHJJ Sample (n = 397) % Yes National Sample In the last year, did someone threaten to hurt you when you thought they might really do it? 39.5% 14.4%a In the last year, did a boyfriend or girlfriend or anyone you went on a date with slap or hit you? 9.1% 2.8% b In the last year, did anyone steal anything from you and never give it back? Things like a backpack, money, watch, clothing, bike, stereo, or anything else? 48.9% 16.6% a In the last year, did a grown-up touch your private parts when they shouldn't have or make you touch their private parts? Or did a grown-up force you to have sex? 4.0% 0.3% b Now think about other kids, like from school, a boyfriend or girlfriend, or even a brother or sister. In the last year, did another child or teen make you do sexual things? 5.3% 1.2% b

Violence and Trauma (cont’d) % Yes BHJJ Sample (n = 397) % Yes National Sample In the last year, was anyone close to you murdered, like a friend, neighbor, or someone in your family? 21.9% 5.4% a In the last year, did you get scared or feel really bad because grown-ups in your life called you names, said mean things to you, or said they didn't want you? 32.9% 9.7% a In the last year, did you SEE a parent get pushed, slapped, hit, punched, or beat up by another parent, or their boyfriend or girlfriend? 12.4% 3.3% b Not including spanking on your bottom, did a grown-up in your life hit, beat, kick or physically hurt you in any way? 23.2% 5.6% a

Substance Use Males Females % Ever Used Age of First Use Alcohol 52.3%   Males Females % Ever Used Age of First Use Alcohol 52.3% 13.29 57.1% 13.41 Cigarettes 12.71 50.1% 12.63 Chewing Tobacco 16.6% *** 13.60 4.4% 13.93 Marijuana 63.6%** 13.02 57.2% 13.26 Cocaine 5.2% 14.52 6.7% 14.68 Pain Killers (use inconsistent with prescription) 14.0% 14.13 15.3% 13.89 Heroin 1.5% 14.15 2.0% 14.86 Ritalin (use inconsistent with prescription) 7.4% 13.63 14.11 Non-prescription Drugs 5.8% 14.02 5.3% Hallucinogens 6.5% 14.53 4.7% 14.76 Tranquilizers 13.7% 14.48 13.9% 14.39

Termination Termination Reason All Youth Successfully Completed Services 60.8% Client Did Not Return/Rejected Services 6.8% Out of Home Placement 7.8% Client/Family Moved 2.9% Client Withdrawn 11.8% Client AWOL 2.6% Client Incarcerated 2.1% Other 5.2%

Termination (cont’d) The average length of stay in the BHJJ program was 153 days. Workers reported that police contacts has been reduced for 62% of the youth and had stayed the same for 28% of the youth. At intake, 51% of the youth were at risk for out of home placement. At termination, 25% of youth were at risk for out of home placement. Of those youth who successfully completed BHJJ treatment, 5% were at risk for out of home placement at termination while 55% of youth who terminated unsuccessfully from the program were at risk for out of home placement.

Recidivism We examined data for those youth who committed felony offenses in the 12 months prior to their BHJJ enrollment to determine if they had new felony charges after their BHJJ termination. Of the 200 youth who entered BHJJ with a felony, 27.9% were charged with a new felony in the 12 months after their termination from BHJJ. 21 of the 1,700 BHJJ youth (1.2%) were committed to an ODYS facility at any time following their enrollment.

Cost The average cost of a placement in our state-run juvenile prison for the ALOS (12.6 months) is ~$190,000. Rough estimate of BHJJ costs per participation is ~$10,000

Using Outcomes for Program Improvement Regularly reviewing outcomes Reviewing FFT fidelity measures Training and ongoing support Sharing outcome progress with families BY

Success Stories Jesus 17 years old Black/ Hispanic Lives with Mom/ Step Dad, siblings Referred for robbery Risk factors Parents undocumented Drug use marijuana, cocaine Parents do not speak English Needs to help support family

Success Stories (cont’d) Lee 17 year old Caucasian Lives with Mom Referred for theft/truancy Risk factors Smokes marijuana daily 1 credit in high school Negative acting our peers

Feedback From Clients “LIFE helped my family get along better.” “I finally have my daughter back.” “I am able to understand my child and not react as quickly.” “I am learning lots of coping skills.” “I really liked my therapist and they were very respectful to my family.”

LIFE Program Dayton, Ohio Over 3000 families served and counting Sustained funding for over 13 years Expanded FFT-CM, Seven Challenges and FFT-CW Strong partnership with courts Consistent positive outcomes

The Future 13 Years and Counting with Positive Results Court and Treatment Partnership Treatment Fidelity, Ongoing Evaluation, and Sustainable Funding 13 Years and Counting with Positive Results