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

Overview Developing a Comprehensive Model: Project Background and Purpose Blueprint for Change: Key Components of the Model Dissemination and Implementation: Plans for the Future

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

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.

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

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

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%

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

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

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.

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

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.

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

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.

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.

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

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

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

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

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

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

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

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

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

Conceptual Framework of the Comprehensive Model

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

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

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

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.

III. Dissemination and Implementation: Plans for the Future

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

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

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

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