Juvenile Justice Reform: Creating Developmentally Informed Systems of Care

1. Juvenile Justice Reform: Creating Developmentally Informed Systems of Care Kayla Pope, MD, JD Boys Town National Research Hospital December 6, 2012

2. Juvenile Justice Reform • National Academy of Sciences Report • Major Themes • Punishment v Rehabilitation • Focus on developmentally appropriate systems and practices • What does that mean?

3. Major Themes in System Reform • Three emerging lines of evidence • Developmental neuroscience • Epidemiological data on prevalence of mental illness • Trauma

4. Developmental Neuroscience • Supreme Court decisions on the treatment of juvenile offenders • Roper • Graham • Miller

5. Developmental Neuroscience • Decisions influenced by research • Key considerations: • More impulsive in decision making especially when emotionally charged situations • Less capable of taking into consideration future consequences when making decisions • More likely to be influenced by external factors including peers

6. Prevalence of Mental Health Problems in Juvenile Justice Population • Several studies in different jurisdictions • Findings consistent • 60 to 70% of juvenile offenders have an Axis I diagnosis (anxiety, depression, PTSD, ADHD) • Most are never identified and do not receive care • Failure to treat leads to greater morbidity and mortality

7. Prevalence of Mental Health Problems Mood Disorder 20% Anxiety Disorder 22% Substance Use 51% (Rates slightly higher among juveniles in adult system)

8. Trauma High prevalence of abuse and neglect among juvenile offenders- but not well documented Few facilities screen for trauma Long thought to be associated with mental health problems but little data to support

9. Prevalence Data (King et al, 2011) • Juvenile Justice Population by gender • Females • Severe Physical Abuse- 35% • Moderate Physical Abuse- 76% • Sexual Abuse- 41% • Severe Physical and Sexual Abuse- 21% (Rates highest among white, non-Hispanic females)

10. Prevalence Data • Males: • Severe Physical Abuse- 15% • Moderate Physical Abuse- 68% • Sexual Abuse- 11% • Both Severe Physical and Sexual Abuse- 4% (Rates for psychical abuse highest among white males and sexual abuse Hispanic males)

11. Association Between Trauma and Mental Health Problems • Females: • Moderate Physical Abuse- 74% mental illness (Anxiety, Depression, etc), 37% had a disruptive behavior (ADHD, ODD, CD) • Severe Physical Abuse- 80% with a diagnosis, 56% with DBD • Sexual Abuse- 88% with a diagnosis, 52% DBD • Severe Physical and Sexual Abuse- 92% with a diagnosis and 68% with a DBD

12. Association Between Trauma and Mental Health Problems • Males: • Moderate Physical Abuse- 77% with a diagnosis, 45% with DBD • Severe Physical Abuse- 80% with a diagnosis; 56% with a DBD • Sexual Abuse- 88% with a diagnosis; 52% with a DBD • Severe Physical Abuse and Sexual Abuse; 92% with a diagnosis and 68% with a DBD

13. Reform in Nebraska Parole for Juvenile Offenders The Use of Seclusion Evaluating Competency and Restoration

14. We Can Do Better