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Addressing the Mental Health and Substance Abuse Needs of Juvenile Justice Involved Youth

Addressing the Mental Health and Substance Abuse Needs of Juvenile Justice Involved Youth Through Systems of Care. Introductory Remarks Simon Gonsoulin Director, NDTAC. About NDTAC. Neglected-Delinquent TA Center (NDTAC)

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Addressing the Mental Health and Substance Abuse Needs of Juvenile Justice Involved Youth

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  1. Addressing the Mental Health and Substance Abuse Needs of Juvenile Justice Involved Youth Through Systems of Care

  2. Introductory RemarksSimon Gonsoulin Director, NDTAC

  3. About NDTAC • Neglected-Delinquent TA Center (NDTAC) • Contract between U.S. Department of Education and the American Institutes for Research • John McLaughlin, Federal Coordinator, Title I, Part D Neglected, Delinquent, or At Risk Program • NDTAC’s Mission: • Develop a uniform evaluation model • Provide technical assistance • Serve as a facilitator between different organizations, agencies, and interest groups

  4. Agenda and Presenters • Sharon Hunt,Deputy Director of Operations, Technical Assistance Partnership for Child and Family Mental Health • LizDoyle, Clinical Director, McHenry County Mental Health Board • Sharon Hunt • Question and Answer Session

  5. Addressing the Mental Health and Substance Abuse Needs of Juvenile Justice Involved Youth Through Systems of Care Sharon Hunt Deputy Director of Operations, Technical Assistance Partnership for Child and Family Mental Health

  6. Systems of Care A system of care is a coordinated network of community-based services and supports that are organized to meet the challenges of children and youth with serious mental health needs and their families. Families and youth work in partnership with public and private organizations so services and supports are effective, build on the strengths of individuals, and address each person’s cultural and linguistic needs. A system of care helps children, youth and families function better at home, in school, in the community and throughout life. Gary Blau, Child, Adolescent and Family Branch, CMHS, SAMHSA

  7. Mental Health and Substance Abuse • An estimated 4.5 to 6.3 million children and youth in the US face mental health challenges. • National survey findings show that 11.5% of youth aged 12-17 received mental health services in an educational setting. • National survey findings show that 5.4 percent of adolescents had past year dependence on or abuse of alcohol and 4.3 percent past year dependence on or abuse of illicit drugs. SAMHSA (2009). Working together to help youth thrive in schools and communities. Briefing for National Children’s Mental Health Awareness Day, May 7, 2009. SAMHSA (2007) National Survey on Drug Use and Health.

  8. Values and Principles for aSystem of Care • Family driven and youth guided • Home and community based • Strength based and individualized • Culturally and linguistically competent • Integrated across systems • Connected to natural helping networks • Data driven, outcomes oriented Adapted from Stroul, B., & Friedman, R. (1986). A system of care for children and youth with severe emotional disturbances (Rev. ed.) Washington, DC: Georgetown University Child Development Center, National Technical Assistance Center for Children's Mental Health. Reprinted by permission.

  9. Family driven means… Families have a primary decision-making role in the care of their own children as well as the policies and procedures governing care for all children in their community, state, tribe, territory and nation.

  10. Family driven means that families take the lead on…. • Choosing supports, services, and providers • Setting goals • Designing and implementing programs • Monitoring outcomes • Determining the effectiveness of all efforts to promote the mental health and well being of children and youth

  11. Youth guided Youth guided means that young people have the right to be empowered, educated, and given a decision-making rolein the care oftheir own lives as well as the policies and procedures governing care for all youth in the community, state, and nation.  This includes giving young people a sustainable voice and the focus should be towards creating a safe environment enabling a young person to gain self sustainability in accordance to the cultures and beliefs they abide by. Further, through the eyes of a youth-guided approach we are aware that there is a continuum of power and choice that young people should have based on their understanding and maturity in this strength based change process. Youth guided also means that this process should be fun and worthwhile.

  12. Cultural and Linguistic Competence • Reduce disparities and enhance cultural and linguistic competence among policy makers, administrators and service providers. • Enhance organizational capacity for cultural and linguistic competence. • Increase awareness and knowledge of factors that contribute to disparities. • Develop specific approaches that contribute to the goal of eliminating disparities.

  13. Family-Driven, Youth-Guided Systems of Care Look Like

  14. Characteristics of Systems of Care as Systems Reform Initiatives FROMTO Fragmented service delivery Coordinated service delivery Categorical programs/funding Blended resources Limited services Comprehensive service array Reactive, crisis-oriented Focus on prevention/early intervention Focus on “deep end,” restrictive Least restrictive settings Children/youth out-of-home Children/youth within families Centralized authority Community-based ownership Creation of “dependency Creation of “self-help” Pires, S. (2002). Building systems of care: A primer. Washington, D.C.: Human Service Collaborative.

  15. Untreated Mental Health and Substance Abuse Issues

  16. Impact of Mental Health and Substance Abuse on Youth • Sixty to eighty percent of youth entering substance abuse treatment have co-occurring disorders (substance abuse and mental health) • Untreated mental health and/or substance abuse issues may create the following problems for youth: • Increase in criminal behavior • Decrease in school attendance • Increase in mental health and substance abuse symptoms

  17. Co-Occurring Psychiatric Problems Source: CSAT AT 2007 dataset subset to adolescent studies (N=15,254)

  18. Past Year Violence & Crime *Dealing, manufacturing, prostitution, gambling (does not include simple possession or use) Source: CSAT AT 2007 dataset subset to adolescent studies (N=15,254)

  19. Family, Vocational and Mental Health by Substance Severity Age 12-17 Source: NSDUH 2006

  20. Cumulative Recovery Pattern at 30 months 5% Sustained Recovery 37% Sustained 19% Intermittent, Problems currently in recovery 39% Intermittent, currently not in recovery The Majority of Adolescents Cycle in and out of Recovery Source: Dennis et al, forthcoming

  21. High Risk Recovery Environments 100% 10% 20% 30% 40% 50% 60% 70% 80% 90% 0% In home 29% among work/ school peers 52% Regular alcohol use among social peers 61% 17% In home among work/ school peers 67% Regular drug use among social peers 79% Source: CSAT AT Common GAIN Data set

  22. An Integrated Co-occurring Treatment Model in a System of CareLiz DoyleMcHenry County Family CARENDTAC Webinar December 14, 2009

  23. History of Family Child and Adolescent Recovery Experience (CARE) Integrated Co-occurring Treatment (ICT) Program • Substance Abuse and Mental Health Services Administration (SAMHSA) System of Care grant awarded in October 2005 • Targeted population: Youth with co-occurring mental health & substance abuse disorders (one of four populations targeted by Family CARE) • Family and youth involvement - exposed to Integrated Co-Occurring Treatment (ICT) Model at SAMHSA Conferences • SAMHSA planning grant awarded in October 2007 • Established a collaborative community group • Partners: Court Services, Law Enforcement, Psychiatric Inpatient, Mental Health Agencies, Crisis Program, Special Education • Reviewed different models of treatment • ICT Model Selected – June, 2008 • Training started - July 2008 • Goals for ICT Program: • Specialized treatment for mental health & substance abuse • Treatment option for youth being served by Screening, Assessment and Support Services Program • Prevent youth from entering the juvenile justice system; reduce arrests • Reduce hospitalizations and at-risk behaviors

  24. Definition of ICT • Integrated Co-occurring Treatment (ICT) Program is an Evidence-Informed home-based 24/7 treatment model developed to address the specific issues of youth with both mental health and substance abuse issues. • Major Goals: Prevent JJ contacts, decrease substance abuse, and increase positive school, home and community interactions.

  25. Components of Family CARE ICT Program Development of ICT Screening Committee Subset of the Planning Committee Members – Weekly meetings to review admissions and discharges and program challenges; responsible for evaluation. Screening Committee meetings began in September, 2008 ICT Team 3 ICT Therapists; 2 (.25) ICT Supervisors (1 Mental Health and 1 Substance Abuse)

  26. Participants • September 2008 to March 2009 • 18 youth were enrolled • Gender: • 56% Male • 44% Female • Ages: • 11% were 12 years old • 44% were 15 years old • 44% were 16 years old • Ethnicity: • 72% White • 28% Hispanic

  27. Discharge Data • Average length of participation in program: 185 days • Number of discharges in first year: 18 • 15 (83%) successful discharges • 3 (17%) unsuccessful discharges

  28. Positive Outcomes End of First Year: • 67% decreased their substance use from intake to discharge • 67% had more positive interactions in their home/family • 28% had more positive interactions in the community • 17% made positive changes in peers • 55% had more positive interactions in school

  29. Lessons Learned • Older youth with more chronic substance abuse • Youth involved with gangs • Engagement of Schools • Did not understand the Reduction Theory of the ICT Model – wanted total abstinence • Buy-in of psychiatrists

  30. Future Directions • Treating 45 - 60 adolescents in the ICT program per year • Sustaining 4 full-time therapists • Recruiting a Spanish speaking ICT therapist • Soliciting more community referrals • Collecting data and evaluating outcomes

  31. On the Horizon • Further developing: • Family Resource Developers • IFF (Illinois Federation of Families)Parent Group • Peer Leadership Support Group • Peer to Peer Mentoring

  32. Financing/Sustainability Plan • Blended Funding • State Authorized Funding for SASS • Program participants • Medicaid Clients/IL Rule 132 • Private Insurance (if available) • Non Medicaid Billable Services (IL Department of Human Services) • Local Tax Dollars

  33. Contact Information Liz Doyle, LCPC Clinical Director McHenry County Family CARE Crystal Lake, IL (45 miles northwest of Chicago) Telephone: 815-788-4360 Email: ldoyle@mc708.org

  34. Recovery, Resilience and Transformation What is involved? • Rethinking traditional approaches • Strengths-based • Family driven & youth guided • Embracing culture Who is involved? • Youth • Adults • Families • Providers • Communities Transformation Systems of Care Recovery Resilience Fulfilling Potential

  35. Youth in SOC – Positive Education Outcomes • Only 8% of youth in SOC for 12 months had repeated a grade, compared to 15% in the general public • Youth receiving passing grades (C or better) increased from 55% upon entry into services to 66% after 12 months of services • Within one year of entering SOC services, the percentage of youth attending school regularly increased from 75% to 81% SAMHSA (2009). Working together to help youth thrive in schools and communities. Briefing for National Children’s Mental Health Awareness Day, May 7, 2009.

  36. Youth in SOC – Positive Education Outcomes (Continued) After receiving SOC services for 12 months: • There was a 22% reduction in the percentage of youth who changed schools due to emotional and behavioral reasons • Expulsions from school decreased by 2/3 (from 15% at intake to 5%) • Sixteen percent of youth reported significant lower levels of depression and 21% reported significant lower levels of anxiety than when they entered services • Five percent of youth had reported suicide attempts (62% reduction after starting services) US Department of Health and Human Services (www.samhsa.gov) SAMHSA (2009). Working together to help youth thrive in schools and communities. Briefing for National Children’s Mental Health Awareness Day, May 7, 2009.

  37. System of Care Communities of the Comprehensive Community Mental Health Services for Children and Their Families Program Currently Funded Communities Lummi Nation Maine (3 counties) Minnesota (6 counties) Yakima County, WA Blackfeet Tribe, MT Northwest Portland Area Indian Health Board Vermont 3 (statewide) Worcester County, MA Onondaga County, NY Multnomah County, OR Montana & Crow Nation Albany County, NY Minnesota (4 counties) Monroe County, NY Boston, MA Erie County, NY Rhode Island 3 (statewide) Orange County, NY New London County, CT Ingham County, MI Kent County, MI Chautauqua County, NY Nassau County, NY Yankton Sioux Tribe, SD Iowa (10 counties) Madison County, ID Pennsylvania (15 counties) Allegheny County 2, PA Beaver County, PA Kalamazoo County, MI McHenry County, IL Delaware 2 (statewide) Baltimore City, MD Wyoming (statewide) Hamilton County, OH Maryland (9 counties) Butte County, CA Clermont County, OH Champaign County, IL Placer County, CA Southeastern Indiana St. Joseph, MO Northern Kentucky Alamance County, NC Kentucky (statewide) Illinois (3 counties) San Francisco, CA Knox County, TN Alameda County, CA Mecklenburg County, NC Maury County, TN Creek Nation Northwest Georgia Mississippi River Delta area, AR Shelby County, TN Oklahoma (statewide) Seven Generations System of Care, CA New Mexico (3 areas) Los Angeles County, CA Mississippi (statewide) Pascua Yaqui Tribe, AZ Texas (11 counties) Alabama (3 counties) Texas (5 counties) Mississippi (3 counties) Harris County, TX Orange County, FL Sarasota County, FL Miami-Dade County, FL Funded Communities Date Number Hawaiʽi (3 communities) 2004 29 2005–2006 30 2008 18 2009 20 Guam Honolulu, HI

  38. System of Care Communities of the Comprehensive Community Mental Health Services for Children and Their Families Program Graduated Communities Passamaquoddy Tribe, ME New Hampshire (3 regions) King County, WA Maine (4 counties) Vermont 1 (statewide) Sault Ste. Marie Tribe, MI Vermont 2 (statewide) Clark County, WA Bismarck, Fargo, & Minot, ND Worcester, MA Rhode Island 1 (statewide) Rhode Island 2 (statewide) Mid-Columbia Region (4 counties), OR Wisconsin (6 counties) Clackamas County, OR Sacred Child Project, ND Bridgeport, CT Westchester County, NY Lane County, OR Oglalla Sioux Tribe, SD Willmar, MN Idaho Mott Haven, NY Detroit, MI New York, NY Northern Arapaho Tribe, WY Burlington County, NJ Cuyahoga County, OH South Philadelphia, PA Milwaukee, WI United Indian Health Service, CA Allegheny County 1, PA Chicago, IL Lake County, IN Lyons, Riverside, & Proviso, IL Nebraska (22 counties) Southern Consortium & Stark County, OH Delaware 1 (statewide) Glenn County, CA Marion County, IN Montgomery County, MD Lancaster County, NE Alexandria, VA Denver area, CO Napa & Sonoma Counties, CA Rural Frontier, UT East Baltimore, MD Charleston, WV Sacramento County, CA St. Charles County, MO Washington, DC Contra Costa County, CA Southeastern Kansas St. Louis, MO Eastern Kentucky San Francisco, CA Urban Trails, Oakland, CA Edgecombe, Nash, & Pitt Counties, NC Colorado (4 counties) Sedgwick County, KS Clark County, NV North Carolina (11 counties) Southwest Missouri Nashville, TN North Carolina (11 counties) Monterey, CA Navajo Nation South Carolina (3 counties & Catawba Nation) California 5 (Riverside, San Mateo, Santa Cruz, Solano, & Ventura Counties) Greenwood, SC Oklahoma (5 counties) Santa Barbara County, CA Charleston, SC Gwinnett & Rockdale Counties, GA Choctaw Nation, OK Hinds County, MS Birmingham, AL San Diego County, CA Ft. Worth, TX Las Cruces, NM Pima County, AZ El Paso County, TX Travis County, TX Southeastern Louisiana Hillsborough County, FL West Palm Beach, FL Broward County, FL Funded Communities Fairbanks Native Association, AK Date Number Wai'anae & Leeward, HI 1993–1994 22 1997–1998 23 1999–2000 22 2002–2003 25 Guam Yukon Kuskokwim Delta Region, AK Puerto Rico

  39. How to Engage SOC • Go to TA Partnership website (www.tapartnership.org) or SAMHSA’s website to see list of SOC grantees (http://mentalhealth.samhsa.gov/cmhs/childrenscampaign/grantcomm.asp) • Contact your state children’s mental health director to get contact for the SOC. • Contact the project director at the SOC to discuss ways to collaborate. • Bring your resources to the table.

  40. SOC Resources Technical Assistance Partnership for Child and Family Mental Health website: www.tapartnership.org Pires, S. (2002). Building systems of care: A primer. Washington, D.C.: Human Service Collaborative. Youth Involvement in Systems of Care http://www.tapartnership.org/docs/Youth_Involvement.pdf

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