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Behavioral Health and Juvenile Justice

Transforming Juvenile Justice: Integrating Systems, Practice, and Policy Daniel J. Flannery, PhD Institute for the Study and Prevention of Violence Kent State University. Behavioral Health and Juvenile Justice. First BH/JJ project 1994-1997; 3 sites in Ohio

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Behavioral Health and Juvenile Justice

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  1. Transforming Juvenile Justice: Integrating Systems, Practice, and PolicyDaniel J. Flannery, PhDInstitute for the Study and Prevention of ViolenceKent State University

  2. Behavioral Health and Juvenile Justice • First BH/JJ project 1994-1997; 3 sites in Ohio • State Departments of Mental Health & Youth Services • Strengthening Communities & Youth • Juvenile offenders with substance use issues • Second BH/JJ project 2004-current; 6 sites in Ohio • Three new sites exclusively focus on females • Project TAPESTRY • SAMHSA Funded, Mental Health side • Integrated Co-occurring treatment (ICT) • Pilot projects

  3. Behavioral Health and Juvenile Justice 1994-1997 Violent juvenile offenders with serious mental health issues not treatable by state juvenile justice system • 61% taking 1-3 medications or more at intake • Mood (56%) and behavior disorders (23%) Axis I Full Psychological Evaluations on n= 88 youth • Significant parent mental health issues • Youth victimization and suicide risk • IQ and Learning Disability issues

  4. Strengthening Communities-Youth (SCY) SAMHSA funded initiative (CSAT) with county office of Justice Affairs, Public Defender, and Catholic Charities

  5. SCY Demographics • N= 232 • 82% male • 53% were African-American, 29% were Caucasian • Average age=15.7 years (range 12-17) • 64% were Medicaid eligible • 54% lived in the city of Cleveland

  6. Arraignment Charges

  7. Substance Use At intake: • (87%) reported using marijuana in the past 90 days • (59%) reported using alcohol in the past 90 days • 13.1 years old the first time they got drunk or used any drugs

  8. Internal Somatic Depressive Homicidal - Anxiety Traumatic Mental Symptoms Symptoms Suicidal Symptoms Stress Distress Thought Youth Moderate/Severe+ 90 (39%) 117 (50%) 148 (64%) 57 (25%) 103 (44%) 81 (35%) Boys Moderate/Severe^ 64 (34%) 89 (47%) 113 (59%) 42 (22%) 79 (42%) 59 (31%) Girls Moderate/Sever e^ 26 (62%)* 28 (67%)* 35 (83%)* 15 (36%) 24 (57%) 22 (52%)* Behavior Attention Inattentive Hyperactivity Conduct Complexity Deficit Disorder Disorder Disorder Hyperactivity Disorder Youth Moderate /Severe+ 162 (70%) 123 (53%) 95 (41%) 40 (17%) 163 (70%) Boys Moderate/Severe^ 127 (67%) 98 (52%) 73 (38%) 26 (14%) 129 (68%) Girls Moderate/Severe^ 35 (83%)* 25 (59%) 22 (52%) 14 (33%)* 34 (81%) Mental Health Indices

  9. DSM-IV Mental Disorders ^ Categories are not mutually exclusive 1 Percent of total with that diagnosis 2 Percentage of N=232 3 Percent of males (n=190) and of females (n=42) * higher females vs. males, p<.05

  10. Comorbidity • 63% have a DSM-IV mental disorder (are comorbid) in addition to a DSM-IV substance use disorder • A significantly higher proportion of females than males were comorbid (79% v. 60%)

  11. Externalizing and Internalizing Disorders by Gender

  12. Primary Offender Types • 62% classified as felons • 36% classified as misdemeanants • 1% classified as status offenders • Did not differ by racial/ethnic group or age at first adjudicated delinquent charge • Males (71%) significantly more likely than females (25%) to be classified as felons

  13. Youth with Domestic Violence Charges • 43% had at least one domestic violence charge • 41% had at least one adjudicated domestic violence charge • Of the total adjudicated domestic violence charges, 90% were misdemeanor level and 10% were felony level • A higher proportion of females than males had adjudicated domestic violence charges

  14. Environmental Risk

  15. General Victimization • Youth reported first time they were victimized at 11 years old • Significantly more females than males report sexual victimization and emotional abuse at the hands of someone close to them or that they trusted • Significantly more males than females report being attacked with a weapon

  16. General Victimization

  17. Victimization • 64% of youth report any victimization on the GAIN • 47% of youth had a substantiated/ indicated incident of maltreatment • If considered together, 80% of all SCY youth have a history of some type of victimization

  18. Child Welfare Involvement (DCFS data) • The majority of SCY youth (69%) had at least one allegation of any type of maltreatment (neglect, physical abuse, sexual abuse, emotional maltreatment) • Almost half (47%) of youth had a substantiated or indicated maltreatment incident in their lifetime • On average, SCY youth were 7.7 years old at the time of first maltreatment allegation

  19. Out-of-Home Placements • 24% of SCY youth had experienced at least one out-of-home placement (OHP) in their lifetime • On average, youth who had experienced any OHP had 3 out-of-home placements (median=2) • Most commonly, placement was in foster/adoptive homes or community residential centers

  20. Cross-system Involvement • Juvenile Justice, Alcohol and Drug, Mental Health, Special Education, DCFS • 12% of youth were involved with only the juvenile justice and alcohol and drug systems • 88% were involved in at least one other system • 32% involved in 3 systems, 40% involved in 4 systems, 15% involved in all five systems

  21. Cross-system Involvement

  22. Tapestry Cross System Involvement

  23. Substance Problems Scale Over Time • Statistically significant decrease: • Intake to 3 months • Intake to 6 months • Intake to 12 months • Statistically significant increase: • 3 months to 6 months

  24. Substance Use Over Time

  25. Abstinence • Youth reporting abstinence: • Intake - 16 youth (7%) • 3 months - 113 youth (49%) • 6 months - 102 (44%) • 12 months - 103 (44%) • Overall, only 18% (n=42) of youth reported abstinence at all follow-up periods (3, 6, and 12 months)

  26. Urinalysis Data • Of 42 youth who reported abstinence on the GAIN at 3, 6, and 12 months, 31 had urine screen data available • Of these 31 youth: • 7 (23%) did not have corroborating urine screen data (had positive screens) • 24 (77%) had abstinence corroborated by urine screen data (had all negative screens)

  27. Emotional Problems Scale Over Time Statistically significant decrease: • Intake to 3 months • Intake to 6 months • Intake to 12 months • 6 months to 12 months

  28. General Crime Scale Over Time • Statistically significant decrease: • Intake to 3 months • Intake to 6 months • Intake to 12 months

  29. Behavioral Health and Juvenile Justice 2004- current Similar population of violent juvenile offenders (age 10 to 18) in 6 urban and rural counties Evidence-based treatment program Female offenders On-site data managers

  30. Preliminary Data • 429 enrolled • Cuyahoga – 35 • Fairfield – 11 • Franklin – 119 • Logan/Champaign – 189 • Montgomery – 57 • Union – 18 • Gender • 51.5% male • Average Age = 16 years • 64% Caucasian; 29% African-American

  31. Victimization Data

  32. Diagnoses • At intake, 31% of the children were already on medication for emotional/behavioral symptoms • At intake, 30% of the youth have co-occurring mental health and substance abuse diagnoses • Females ODD, Cannabis use, ADHD, bipolar, PTSD • Males ADHD, Cannabis use, CD, ODD, depression

  33. Substance Abuse

  34. Substance Abuse • Average Age of initial use: • Cigarette: 11.8 years • Alcoholic drink: 13.1 years • Marijuana: 13.0 years • Cocaine: 14.6 years

  35. Substance Abuse Change • In the past 6 months, how often did you drink an alcoholic beverage? • Once a month or not at all • Intake: 65% • 6 months: 81% • Discharge: 80%

  36. In the past 30 days, how many days have you used:

  37. Ohio Scales *statistically significant differences between Intake and last measurement

  38. Ohio Scales *statistically significant differences between Intake and last measurement

  39. Ohio Scales *statistically significant differences between Intake and last measurement

  40. Ohio Scales *statistically significant differences between Intake and last measurement

  41. Integrated Co-occurring treatment (ICT)

  42. Home-Based ServiceDelivery Model • Location of Service: Home & Community • Intensive: 2-5 sessions/wk • Crisis Response 24/7 • Small caseloads: 3-6 families • Flexible: Convenient to family • Treatment Duration: 12-24 weeks

  43. Implications and next steps • Growing population of offenders with MH and SA issues • Community-based care vs. incarceration • Evidence-based treatment using comprehensive assessments of risks and strengths • Collaboration across systems can work! • Data driven decisions for practice and policy • Shared vision can help plan for sustainability • Infrastructure and funding for integrated treatment • Cultural competency matters in treatment decisions

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