1. 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

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

3. 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

4. BHJJ in Montgomery County

5. The LIFE Program 2005-present
Community-Based Counseling Program
Youth 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

6. 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

7. 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

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

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

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

11. 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)

12. Montgomery County Outcomes

13. 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

14. 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%

15. 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.

16. 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)

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

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

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

20. 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

21. 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

22. 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

25. 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%

26. 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.

27. 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.

28. 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

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

30. 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

31. 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

32. 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.”

33. 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

34. 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