Mental Health Juvenile Justice Program

1. Mental Health Juvenile Justice Program

2. MHJJ Program Rationale • Research has found that 66% of juvenile detainees in Illinois have a diagnosable psychiatric condition. • The most common conditions were substance abuse and conduct disorders. • Approximately 15% of the all youth also had a major mental illness, such as major depressive disorder or psychosis. Teplin LT, Abrams KM, McClelland GM, et al: Psychiatric disorders in youth in juvenile detention. Arch Gen Psychiatry 59: 1133-1143, 2002

3. Psychiatric Disorder Prevalence in a Juvenile Justice Sample (Teplin et al., 2002)

4. MHJJ Program Rationale continued The same research group conducted additional studies with over 1000 youth in detention in Cook County and found: • 92.5% of youth in JJ experienced one or more traumatic events in their past. • The average number of traumas experienced was 14.6 per youth. • 11.2% of youth met full criteria for PTSD in the past year. • Almost all youth with PTSD (96%) also had another psychiatric disorder. • Over ½ of the youth with PTSD (54%) had 2+ comorbid psychiatric disorders. Abram, Teplin, Charles, Longworth, McClelland & Dulcan, 2004. Posttraumatic Stress Disorder and Trauma in Youth in Juvenile Detention. Arch Gen Psychiatry, V61, 403 – 410. Abram, Washburn, Teplin, Emanuel, Romero & McClelland, 2007. Posttraumatic Stress Disorder and Psychiatric Comorbidity Among Detained Youths. Psychiatric Services, V 58, 10, 1311 – 1316.

5. Purpose of the MHJJ Program #1: To facilitate the identification, screening, referral, and case monitoring of juveniles in detention who are identified as having mental illness, including post-traumatic stress reactions. #2: The initiative is also aimed at strengthening the linkages among courts, probation, detention, schools, health care, mental health, and other community-based services.

6. Enhancing the linkages Importantly, the MHJJ program relies on the liaison’s ability to educate and advocate with court and correctional bodies about the MHJJ Program and the type of youth that may qualify for services. The liaison educates the youth and his/her family about the MHJJ program and completes the informed consent protocol. Rather than providing direct services, the liaison works to link the youth to community based services that meet his/her individual mental health needs.

7. MHJJ Program History • In January of 2000, the Illinois Department of Human Services awarded contracts to providers in 7 counties to pilot (test out) the MHJJ program. • Based on the early success of the program, it was expanded to all counties with juvenile detention centers. Currently, over 20 agencies participate in the program and hundreds of youth are served every year.

8. Youth Referral to MHJJ A youth can be referred to the MHJJ program by: • Court personnel (e.g., judge, SA, public defender) • Probation officers • Correctional officers • Other professionals who think the youth may by eligible for MHJJ. A youth must be between the ages of 10 and 17 to be eligible for entry into the MHJJ program.

9. MHJJ Youth Eligibility: A youth who is referred must meet the following criteria and sign consent before being enrolled in the MHJJ program… • Have been involved with the juvenile justice system at some time during the past six months. • Be between the ages of 10 and 17 • Exhibit symptoms of Anxiety, Depression, Psychosis or Post-traumatic Stress. Youth do not have to have a current or previous diagnosis to be eligible for referral, but their symptoms must earn a score of a 2 or a 3 on the CSPI.

10. MHJJ ELIGIBILITYCONT’D • Since MHJJ is an opportunity for youth to prevent further involvement with JJ, the program is open to interceding at the earliest possible point of a youth's contact with the JJ system. It is not necessary for a youth to be in detention to qualify for MHJJ. • In many instances, youth have had numerous "contacts" with the law, not resulting in convictions or status offenses. The MHJJ program considers these youth at serious risk and as such they are able to be screened for eligibility.

11. MHJJ ELIGIBILITYCONT’D • Juveniles who have disruptive behavior disorders (e.g. conduct disorder) are excluded from the MHJJ program. • Above is true UNLESS the youth also has other psychiatric problems including anxiety, depression, psychotic symptoms and/or trauma related reactions. • Youth who are wards of the Department of Children and Family Services are not eligible for the program.

12. ACCEPTANCE INTO MHJJ • Referral: when the liaison receives a referral s/he contacts the youth and his/her guardian to seek consent for further screening. • Screening: If the youth and guardian consent, the youth is screened for eligibility using the MHJJ abbreviated version of the Child Severity of Psychiatric Illness Scale (CSPI). • Eligibility: If the youth scores a 2 or 3 on one or more of the four eligibility items on the CSPI the liaison conducts further assessment with the Child and Adolescent Needs and Strengths tool (CANS) and then develops an action plan matched to the youth’s individualized needs and strengths.

13. THE LIAISON: LINKAGE AND ADVOCACY The most crucial staff role in the program is the MHJJ liaison. • The liaison does not usually provide direct therapy to the youth. • The liaison devises an individualized action plan for the youth, based on the needs and strengths identified in the CANS and then links the client to outside services. • Other key liaison responsibilities are: • Involvement in the youth’s court process; • Interacting with / relating to the client’s family; • Re-integrating the client back into the community.

14. The Role of the MHJJ Supervisor • The supervisor's role is to provide clinical support to the liaison as they would in any other capacity. • The supervisor should have equal or greater knowledge of the clinical tools used for the assessment of MHJJ youth. • The supervisor can review the assessment measures with the liaison, monitor open cases and support the liaison in making appropriate referrals for services in the action plan.

15. Service Period is Time Limited • The MHJJ program model is designed to provide service linkage for six months. • Although extensions may be granted on a case-by-case basis, it is imperative that the program attempt to establish service linkage and efforts toward community re-integration in a timely manner.

16. MHJJ Assessment • REFERRAL FORM:Received from Corrections, Court, or Probation; qualified referrals require follow-up by an MHJJ liaison. • BACKGROUND INFORMATION SHEET (BIS):Basic demographics, as well as criminal and treatment history. • CHILDHOOD SEVERITY OF PSYCHIATRIC ILLNESS (CSPI). Determines eligibility assessment for entry into MHJJ • CHILD & ADOLESCENT NEED AND STRENGTH TOOL (CANS): Given at opening, midpoint (3 months) and closing of case (6 months). • ACTION PLAN: The action [treatment] plan is derived from the results of the CANS assessment; the plan individually addresses actionable needs and underdeveloped strength of the youth. • MONTHLY SERVICE REPORT (MSR): Provide an update on the current status of the client and what services are being utilized. • CLOSING FORM: States reason for closing and tracks what community based services will continue after MHJJ program has ended.

17. MHJJ Forms Start Initial CANS / Action Plan in Website NOTE: At any point, it is possible that the youth may be prematurely discharged from MHJJ. If this occurs, complete the closing CANS and Closing Form in the Website Closing Form and Closing CANS

18. THE LIAISON: ASSESSMENT AND TRACKING PROGRESS • Because the liaison is generally not providing services other than linkage to the youth, it is imperative that the liaison have ongoing direct contact with the youth and caregiver. • The liaison can also request permission to speak to the youth’s service providers. • Information from the family and the service providers will assist the liaison in completing the 3 and 6 month CANS and the monthly service reports.

19. VITAL ROLE OF THE MHJJ CANS • The CANS is a structured tool used in MHJJ as a functional mental health assessment, a service planning application and an outcomes tracking tool. • As a decision-making tool, the CANS guides the liaison in designing an individualized action plan linking the youth to wrap-around services that will address the needs and build the strengths of the youth. • As an outcomes measure, the CANS serves as a case monitoring/quality assurance device for the MHJJ program.

20. The CANS in Action Planning • The MHJJ treatment plan, also known as Action Plan, is formulated directly from the initial CANS assessment. The Action Plan should address every need of 2 and 3 on the CANS. • Leveraging strengths of the client and caregiver: the Action Plan can also include services that enhance the youth’s already develostrengths. • The CANS serves as a tool to integrate information about the your and enhance communication among service providers.

21. MHJJ Services Following are the types of services that may be put in place as part of the MHJJ Action Plan: • Case management and support Court advocacy • Counseling/therapy linkage • Psychiatric services linkage • Psychological assessment • Educational Advocacy • Educational service linkage • Job training linkage • Recreational facilities/activities linkage

22. MHJJ Website and Data Collection All assessment forms are entered into the MHJJ website (mhjj@northwestern.edu), which is managed by the MHJJ evaluation team at Northwestern University.

23. When do I call the Department of Mental Health (DMH) vs. Northwestern University? Northwestern • MHJJ program requirements • Clinical questions about a youth: eligibility, exceptions, case closures • Extension Requests • New and Departing Staff Website Access Issues, including : • Difficulty entering extension requests • Inability to access the Forms • Passwords, Resets • Data Entry Issues • Human Subjects Training Requirements • CANS Certification • Data requests – annual report, region/agency specific data • Assent/Consent Forms: e.g. Refusal to sign • New and Departing Staff Department of Mental Health Contact Information: Candice Cuevas 312-814-0956candice.cuevas@northwestern.edu Contact Information: Chris Villa, 312-503-9990 christopher.villa@northwestern.edu or Tracy Fehrenbach, t-fehrenbach@northwestern.edu