California Institute for Mental Health CIMH Evidence-based Mental Health Treatment in the Juvenile Justice System Ass

1. April 3-4, 2003 Garden Grove Assessment in Community Supervision Settings 1 California Institute for Mental Health (CIMH)Evidence-based Mental Health Treatment in the Juvenile Justice SystemAssessment in Community Supervision Settings Lee A. Underwood, Psy.D.

2. April 3-4, 2003 Garden Grove Assessment in Community Supervision Settings 2 OVERVIEW Introduction Defining Co-Occurring Disorders Characteristics of Youth & Other Service Needs Risk Factors Overview Family Factors Individual Factors Culture Gender & Age Factors Typology Factors Neurological Factors Substance Use Factors

3. April 3-4, 2003 Garden Grove Assessment in Community Supervision Settings 3 OVERVIEW (cont�d) Treatment Screening & Assessment Categories of Co-Occurring Disorders Effective Treatment Approaches Multisystemic Therapy (MST) Multidimensional Treatment Foster Care (MTFC) Functional Family Therapy (FFT)

4. April 3-4, 2003 Garden Grove Assessment in Community Supervision Settings 4 INTRODUCTION

5. April 3-4, 2003 Garden Grove Assessment in Community Supervision Settings 5 INTRODUCTION: Juvenile offenders population has steadily increased throughout the nineties (Teplin & McClelland, 1998; Timmons-Mitchell, Brown, Schulz, Webster, Underwood, Semple, 1997) More than 1 million youth come in contact with the juvenile justice system each year More than 100,000 of these are placed in detention and correctional facilities (Cocozza, 1997)

6. April 3-4, 2003 Garden Grove Assessment in Community Supervision Settings 6 INTRODUCTION: Significant increase in the number of youth who are diagnosed with mental health disorders and substance use disorders (Cocozza, 1997; Faenzz & Siegried, 1998) 20-30% of all youth entering the justice system present serious mental disorders and have other service needs (Davis, Bean, Shumcher, & Speigler, 1990; Villiani; 1999)

7. April 3-4, 2003 Garden Grove Assessment in Community Supervision Settings 7 INTRODUCTION: Rates for mental illness in juvenile justice populations is substantially higher than those in the general population (Grisso & Barnum, 2000; Teplin & McClelland, 1998)

8. April 3-4, 2003 Garden Grove Assessment in Community Supervision Settings 8 INTRODUCTION: Timmons-Mitchell et al (1997) found: 29% of population had symptoms of serious mental illness Of which 18% had been in inpatient mental health and/or substance abuse facilities 13.5% had attempted suicide 80% had substance abuse problems

9. April 3-4, 2003 Garden Grove Assessment in Community Supervision Settings 9 INTRODUCTION: With increased deinstitutionalization, there has been increase in reliance on the justice system for mental health care needs (Teplin & McClelland, 1998) Administrators are hampered by a lack of research, insufficient policy development, and inadequate approaches and practices for managing and treating this population (Altschuler, 1996; Burns, 1999; Butterfied, 1998; Hartman, 199)

10. April 3-4, 2003 Garden Grove Assessment in Community Supervision Settings 10 INTRODUCTION: More than 1,000,000 juveniles come in contact with the justice system More than 100,000 are placed in correctional/detention facilities 20-30% present serious mental health disorders and other service needs

11. April 3-4, 2003 Garden Grove Assessment in Community Supervision Settings 11 INTRODUCTION: Ohio study 29% had symptoms of serious mental illness 80% had substance abuse problems 18% of those with serious mental health disorders had previously been in inpatient mental health or substance abuse facilities 13.5% of those with serious mental health disorders had attempted suicide

12. April 3-4, 2003 Garden Grove Assessment in Community Supervision Settings 12 Growing awareness of prevalence Recognition of difficulties in treatment Documentation of greater negative outcomes associated with disorders INTRODUCTION:

13. April 3-4, 2003 Garden Grove Assessment in Community Supervision Settings 13 50.9% of general adult population with mental disorders (Kessler, et. Al., 1996) 73% of jail detainees with serious mental disorders (Abram & Teplin, 1991) 50% of adolescents in the general population (Greenbaum, et al., 1996) 50-90% of adolescents in juvenile justice settings INTRODUCTION:

14. April 3-4, 2003 Garden Grove Assessment in Community Supervision Settings 14 Co-Occurring Substance Use and Disorders Among Persons with Mental Disorders 50.9% of general adult population with mental disorders (Kessler, et. Al., 1996) 73% of jail detainees with serious mental disorders (Abram & Teplin, 1991) 50% of adolescents in the general population (Greenbaum, et al., 1996) 50-90% of adolescents in juvenile justice settings INTRODUCTION:

15. April 3-4, 2003 Garden Grove Assessment in Community Supervision Settings 15 DEFINING CO-OCCURING DISORDERS

16. April 3-4, 2003 Garden Grove Assessment in Community Supervision Settings 16 Co-occurring disorders defined: Refers to the simultaneous experience of mental health and substance use disorders These disorders have pronounced affects on the thoughts, mood, and behaviors of youth DEFINING CO-OCCURRING DISORDERS:

17. April 3-4, 2003 Garden Grove Assessment in Community Supervision Settings 17 Serious diagnosable mental health disorders manifests a substantial disorder of thought or mood, which that impairs: Judgment Behavior Sense of reality Ability to handle demands of everyday life Causes substantial pain or disability

18. April 3-4, 2003 Garden Grove Assessment in Community Supervision Settings 18 Serious emotional disturbance affects: Family Interactions School Activities Community Activities Adjustment problems Manifest as significant emotional or behavioral symptoms in response to an identifiable psychosocial stressor or stressors DEFINING CO-OCCURRING DISORDERS:

19. April 3-4, 2003 Garden Grove Assessment in Community Supervision Settings 19 Often manifest the following symptoms: Mental confusion Delusional thought processes Social withdrawal Unpredictable behavior Conduct disorder and other diagnosis are common DEFINING CO-OCCURRING DISORDERS:

20. April 3-4, 2003 Garden Grove Assessment in Community Supervision Settings 20 Range of mental health disorders range within Narrow band � serious mental health disorders and formal DSM-IV diagnosis Broad band � severe emotional and adjustment problems regarding family, school, or community DEFINING CO-OCCURRING DISORDERS:

21. April 3-4, 2003 Garden Grove Assessment in Community Supervision Settings 21 DSM-IV has inherent limitations � there can be confusion in identifying disorders A precise diagnostic approach is necessary Appropriate mental health treatment interventions are necessary DEFINING CO-OCCURRING DISORDERS:

22. April 3-4, 2003 Garden Grove Assessment in Community Supervision Settings 22 CHARACTERISTICS OF YOUTH & OTHER SERVICE NEEDS

23. April 3-4, 2003 Garden Grove Assessment in Community Supervision Settings 23 CHARACTERISTICS OF YOUTH & OTHER SERVICE NEEDS Developmental psychologists are concerned with describing and identifying behavior that is predictable or common for adolescents Example: Experimentation with alcohol or marijuana is a common practice among adolescents, even though society neither views such behavior as desirable or condones it

24. April 3-4, 2003 Garden Grove Assessment in Community Supervision Settings 24 CHARACTERISTICS OF YOUTH & OTHER SERVICE NEEDS Much of the behavior exhibited by delinquents is behavior that is not normal for adolescence Without minimizing offenses, there is recognition of the processes that lead to and utilize that knowledge to develop programming that assists adolescents identify errors in their thought processes and see other options to their behavior

25. April 3-4, 2003 Garden Grove Assessment in Community Supervision Settings 25 CHARACTERISTICS OF YOUTH & OTHER SERVICE NEEDS Similarly, unlawful or unacceptable behavior may be maladaptive in the larger social context, but may seem logical to the adolescent in his or her particular contexts (e.g., the peer group or family) The development we will be discussing in this module is normative or typical adolescent development Adolescence provides a learner�s permit to adulthood Mistakes will be made and individuals may learn from them

26. April 3-4, 2003 Garden Grove Assessment in Community Supervision Settings 26 CHARACTERISTICS OF YOUTH & OTHER SERVICE NEEDS Individual adolescents develop along different dimensions at different rates Cognitive (Intellectual) Development Identity and Social Development Moral Development Physical Development Competence Development (master of skills)

27. April 3-4, 2003 Garden Grove Assessment in Community Supervision Settings 27 CHARACTERISTICS OF YOUTH & OTHER SERVICE NEEDS Development in any domain is a gradual, non-linear process, with stops and starts and regressions There are great differences between individual adolescents in the rate of development in any single domain It is impossible to assess a juvenile�s level of development by looking at a single trait, such as size or chronological age, because there is significant variation among individuals in the rate and pattern of development

28. April 3-4, 2003 Garden Grove Assessment in Community Supervision Settings 28 CHARACTERISTICS OF YOUTH & OTHER SERVICE NEEDS Adolescence is a time of important psychological and psycho-social development which affects the way teenagers feel about themselves (identity), their ability to function responsibility on their own (autonomy), their relationships and interpersonal behaviors (intimacy), and their sexual feelings (sexuality).

29. April 3-4, 2003 Garden Grove Assessment in Community Supervision Settings 29 CHARACTERISTICS OF YOUTH & OTHER SERVICE NEEDS Cognitive Changes: Possibilities �Adolescents become better able than children to think about what is possible, instead of limiting thought to what is real� Able to think hypothetically Abstraction �Adolescents become better able to think about abstract concepts�

30. April 3-4, 2003 Garden Grove Assessment in Community Supervision Settings 30 CHARACTERISTICS OF YOUTH & OTHER SERVICE NEEDS Cognitive Changes: Thinking about thinking �Adolescents begin thinking more about the process of thinking; they become more reflective.� Increased introspection, self-consciousness, and intellectualization Thinking in multiple dimensions Considering multiple dimensions and weighing those dimensions before taking a course of action

31. April 3-4, 2003 Garden Grove Assessment in Community Supervision Settings 31 CHARACTERISTICS OF YOUTH & OTHER SERVICE NEEDS Cognitive Changes: Relativity Develop an ability to see things in relative terms Adolescents are more likely to question others� assertions and less likely to accept facts as absolute truths

32. April 3-4, 2003 Garden Grove Assessment in Community Supervision Settings 32 CHARACTERISTICS OF YOUTH & OTHER SERVICE NEEDS Identity Development Adolescents attempt to establish a coherent, stable identity �Trying on� different personalities, interests, and and ways of behaving is a necessary part of the process of putting together an identity Family and Identity

33. April 3-4, 2003 Garden Grove Assessment in Community Supervision Settings 33 CHARACTERISTICS OF YOUTH & OTHER SERVICE NEEDS Identity Development Peers and Identity Need to Belong Peer Pressure Peer recognition, advice, and encouragement, and may be more unconditionally accepting than adults May have an overemphasis on peers Family has a powerful effect on adolescents� basic values and choices Peer pressure can be prosocial

34. April 3-4, 2003 Garden Grove Assessment in Community Supervision Settings 34 CHARACTERISTICS OF YOUTH & OTHER SERVICE NEEDS Autonomy Development Adolescence is a gradual transition to being a self-governing person. The development of independent behavior is a central task of adolescence Physical changes and appearance both enable adolescents to become more autonomous and cause adults to treat them as though they are more autonomous May cause emotional and social disruptions as adolescents change their relationships with family members and develop new roles in the world

35. April 3-4, 2003 Garden Grove Assessment in Community Supervision Settings 35 CHARACTERISTICS OF YOUTH & OTHER SERVICE NEEDS Moral Development Adolescents progress through stages of maturation in terms of moral reasoning and moral behavior. Moral reasoning of the young child � �Pre-conventional� moral reasoning. The focus is on rewards and punishments associated with different courses of action. Young children accept what others say is right or wrong.

36. April 3-4, 2003 Garden Grove Assessment in Community Supervision Settings 36 CHARACTERISTICS OF YOUTH & OTHER SERVICE NEEDS Moral Development Moral reasoning of the early adolescent � �Conventional� moral reasoning Based on how s/he will be judged by others for behaving in a particular way During junior high school, adolescents become more concerned with impressing their peers. Most adolescents are able to reason at this level in �hypothetical� situations, their actual behavior may not; always reflect their reasoning ability

37. April 3-4, 2003 Garden Grove Assessment in Community Supervision Settings 37 CHARACTERISTICS OF YOUTH & OTHER SERVICE NEEDS Moral Development �Post-Conventional� Moral Reasoning At this stage, the individual begins to view society�s rules as relative and subjective, and questions social conventions In late adolescence or early adulthood, an individual MAY begin to shift from reasoning in terms of social approval to reasoning in terms of important principles, such as justice and fairness

38. April 3-4, 2003 Garden Grove Assessment in Community Supervision Settings 38 CHARACTERISTICS OF YOUTH & OTHER SERVICE NEEDS Moral Development �Post-Conventional� Moral Reasoning (cont�d) BUT post-conventional moral reasoning is relatively rare, even in adults. Most adolescents follow �conventional� moral reasoning, i.e., the reason to be good is to earn social approval and to benefit their relationships with others. Indeed, the importance of peers generally in the lives of adolescents reinforces the influence of peer groups or moral decisions.

39. April 3-4, 2003 Garden Grove Assessment in Community Supervision Settings 39 CHARACTERISTICS OF YOUTH & OTHER SERVICE NEEDS Moral Development Significant factors that shape adolescent�s moral development. Adolescents derive their moral values from: Their families Their peers Their relationships Spiritual influences Popular culture (movies, t.v. shows, music)

40. April 3-4, 2003 Garden Grove Assessment in Community Supervision Settings 40 CHARACTERISTICS OF YOUTH & OTHER SERVICE NEEDS Moral Development Other aspects of adolescent moral reasoning Adolescents are �fairness freaks� The role of gangs

41. April 3-4, 2003 Garden Grove Assessment in Community Supervision Settings 41 CHARACTERISTICS OF YOUTH & OTHER SERVICE NEEDS Physical Development Because of the great variability in individual development, an adolescent who appears physically mature in court � tall, solid, with facial hair � may nevertheless be quite immature in cognitive, social, and moral development. Judgments regarding intellectual ability and other characteristics of individual adolescents should not be based solely on physical appearance.

42. April 3-4, 2003 Garden Grove Assessment in Community Supervision Settings 42 CHARACTERISTICS OF YOUTH & OTHER SERVICE NEEDS Physical Development This may be particularly important when considering program placement � physical appearance. This may be particularly important when considering program placement � physical appearance may have limited value in determining which program is appropriate for a particular youth.

43. April 3-4, 2003 Garden Grove Assessment in Community Supervision Settings 43 CHARACTERISTICS OF YOUTH & OTHER SERVICE NEEDS Physical Development Myth The �raging hormone hypothesis� the hormones completely explain all out-of-control behavior adolescents. Effect of hormones on mood appear to be strongest in early adolescence when hormonal levels are highly variable and characterized by rapid fluctuations, and the effect lessens in later adolescence as hormone levels stabilize. Juveniles who physically mature earlier appear older, they are often treated as if they are more mature psychologically when this is not necessary true.

44. April 3-4, 2003 Garden Grove Assessment in Community Supervision Settings 44 CHARACTERISTICS OF YOUTH & OTHER SERVICE NEEDS Physical Development Myth Adolescents who mature late, especially boys, are often view negatively by their peers and left out of group activities. Those who mature early tend to be at a social advantage.

45. April 3-4, 2003 Garden Grove Assessment in Community Supervision Settings 45 CHARACTERISTICS OF YOUTH & OTHER SERVICE NEEDS Competence Development Adolescents need to be good at something. Achieve competence Many adolescents do not have significant opportunities to experience success

46. April 3-4, 2003 Garden Grove Assessment in Community Supervision Settings 46 CHARACTERISTICS OF YOUTH & OTHER SERVICE NEEDS Learning disabilities Sexual perpetration Criminal conduct Physical, sexual and emotional abuse Personality disorders Pervasive patterns of aggression Hormonal and genetic risk factors Minimal brain damage

47. April 3-4, 2003 Garden Grove Assessment in Community Supervision Settings 47 RISK FACTORS

48. April 3-4, 2003 Garden Grove Assessment in Community Supervision Settings 48 RISK FACTORS:Overview Residential facilities � 75% report having sexual intercourse, compared to 33% in public schools Residential youth reported their first experience had occurred by age 14 4 times more likely to impregnate partner 50% youth in residential treatment centers have been laced in special education classes for learning problems

49. April 3-4, 2003 Garden Grove Assessment in Community Supervision Settings 49 RISK FACTORS:Overview Minority youth are treated differently than majority youth within the juvenile justice system (Department of Justice 1999) Approximately two-thirds of studies examined showed racial and/or ethnic status influences decision-making in at least urban jurisdictions When controlling for offense, African-American youth will enter detention and correctional facilities two times higher than cases involving Caucasian youth

50. April 3-4, 2003 Garden Grove Assessment in Community Supervision Settings 50 RISK FACTORS:Overview Homicide rates for young African-American males is: 4-5 times higher than African-American females 5-8 times higher than young Caucasian males 16-22 times higher than young Caucasian females (Snyder & Sickmund, 1995)

51. April 3-4, 2003 Garden Grove Assessment in Community Supervision Settings 51 RISK FACTORS:Overview Society fails to protect people from the crimes they fear by resisting opportunities to alleviate the poverty that breeds them (Reiman, 1990)

52. April 3-4, 2003 Garden Grove Assessment in Community Supervision Settings 52 RISK FACTORS:Family & Environment Consistent family factors implicated in mental health and juvenile justice populations include: Poor parent-child relationships Neglect Coercive child-rearing (Patterson, 1982) Lack of warmth and affection Inconsistent parenting

53. April 3-4, 2003 Garden Grove Assessment in Community Supervision Settings 53 RISK FACTORS:Family & Environment Consistent family factors implicated in mental health and juvenile justice populations include (cont�d): Violence Sexual abuse Disrupted attachments Parental substance abuse (American Academy of Child and Adolescent Psychiatry, 1997)

54. April 3-4, 2003 Garden Grove Assessment in Community Supervision Settings 54 RISK FACTORS:Family & Environment Other family characteristics: Familial antisocial behavior or values History of criminal behavior by members Harsh parental discipline Family conflict (Tolan & Loeer, 1993) Lack of parental monitoring

55. April 3-4, 2003 Garden Grove Assessment in Community Supervision Settings 55 RISK FACTORS:Individual Factors Youth in corrections facilities acknowledge: Higher levels of emotional distress including pervasive feelings of depression and anxiety

56. April 3-4, 2003 Garden Grove Assessment in Community Supervision Settings 56 RISK FACTORS:Individual Factors When compared to public school counterparts, youth in the juvenile justice system exhibit: 3 times more likelihood to report pervasive feelings of sadness 2 � times more likely to report feelings of nervousness or being upset 2 times more likely to report feelings of discouragement and hopelessness

57. April 3-4, 2003 Garden Grove Assessment in Community Supervision Settings 57 RISK FACTORS:Individual Factors When compared to public school counterparts, youth in the juvenile justice system exhibit (cont�d): 1 � times more likely to experience feelings of stress and dissatisfaction with their personal lives (Fulkerson et al., 1996) Males are 2 times more likely to report deliberate self-injury Males are five times more likely to attempt suicide

58. April 3-4, 2003 Garden Grove Assessment in Community Supervision Settings 58 RISK FACTORS:Culture 35% of youth in juvenile justice system live in �underclass� neighborhoods Correlations with delinquency in these neighborhoods include: Lack of legitimate job opportunities Increase social isolation Poor schools Weak community organizations (Wilson, 1987)

59. April 3-4, 2003 Garden Grove Assessment in Community Supervision Settings 59 RISK FACTORS:Gender & Age Factors Among serious index crimes: Males are 3 times more likely to commit property crimes than females and 8 times more violent crimes (Livingston, 1992) Smallest difference in index crimes is found in larceny offenses, however males still outnumber females two to one Young children have diminished ability to commit serious crimes and their victims are often other children

60. April 3-4, 2003 Garden Grove Assessment in Community Supervision Settings 60 RISK FACTORS:Gender & Age Factors As there is an increased need to assert one�s manhood, there is an increase in violations of the law (e.g., stealing, fighting, joyriding, vandalism) As youth mature, there is a universal pattern showing a decrease in criminal behavior (Hirshci & Gottfredson, 1983)

61. April 3-4, 2003 Garden Grove Assessment in Community Supervision Settings 61 RISK FACTORS:Typology Factors Seven groups of offenders focused over time on the patter (e.g., beginning, persistence, and ending) of delinquent behavior Stable non-delinquents Starters (transition from no delinquency to involvement in minor delinquency) Stable moderately serious offenders (consistent delinquency over time)

62. April 3-4, 2003 Garden Grove Assessment in Community Supervision Settings 62 RISK FACTORS:Typology Factors Seven groups of offenders focused over time on the patter (e.g., beginning, persistence, and ending) of delinquent behavior (cont�d) Escalators (escalation in seriousness of offense over time) Stable highly serious offenders (frequent and serious offending over time) De-escalators (de-escalation in serious of offenses over time) Desisters (cessation in delinquency)

63. April 3-4, 2003 Garden Grove Assessment in Community Supervision Settings 63 RISK FACTORS:Neurological Factors Youth with hyperactivity and impulsivity are likely to be abused by adults in their families (Lewis, 1992) These youth may have difficulty in: Planning Attention Abstract reasoning Foresight Judgment Self-monitoring Motor control (Giancola, Martin, Tarter, Pelham, & Moss 1996)

64. April 3-4, 2003 Garden Grove Assessment in Community Supervision Settings 64 RISK FACTORS:Substance Use Factors Youth in residential facilities are much more likely than their public school counterparts to report using: Amphetamines and inhalants (2 times higher) Marijuana and prescription drugs (2 � times higher) Sedatives (3 times higher)

65. April 3-4, 2003 Garden Grove Assessment in Community Supervision Settings 65 RISK FACTORS:Substance Use Factors Youth in residential facilities are much more likely than their public school counterparts to report using (cont�d): LSD, hallucinogens, and opiates (4 times higher) Cocaine (6 times higher) Injected drugs (5 � times higher) Alcohol and drugs before or during school (3 times higher)

66. April 3-4, 2003 Garden Grove Assessment in Community Supervision Settings 66 TREATMENT

67. April 3-4, 2003 Garden Grove Assessment in Community Supervision Settings 67 TREATMENT: Acceptance of emotional and mental health issues Acceptance of criminal behavior by taking responsibility for hurt behavior Resolution of past victimization Development of victim empathy and victim awareness

68. April 3-4, 2003 Garden Grove Assessment in Community Supervision Settings 68 TREATMENT: Recognition that self-serving worldviews must be restructured Dismantling of regressed fears and anxieties

69. April 3-4, 2003 Garden Grove Assessment in Community Supervision Settings 69 TREATMENT: Implement relapse prevention techniques across all situations Identify emotional triggers and manage angry outbursts Creation of life skills

70. April 3-4, 2003 Garden Grove Assessment in Community Supervision Settings 70 TREATMENT: Acceptance that cure is optimal and condition management is forever Development of prosocial and problem-solving skills Identify family limitations

71. April 3-4, 2003 Garden Grove Assessment in Community Supervision Settings 71 TREATMENT � Screening & Assessment: Defining Screening Conducted to identify adolescents who require additional attention Provides opportunities for the treatment provider to better understand the psychological functioning of the youth Generally, does not provide psychiatric diagnoses

72. April 3-4, 2003 Garden Grove Assessment in Community Supervision Settings 72 TREATMENT � Screening & Assessment: Defining Screening (cont�d) Is generally the first in a sequence of different assessment and intervention strategies Should be used with all youth entering the juvenile justice system

73. April 3-4, 2003 Garden Grove Assessment in Community Supervision Settings 73 TREATMENT � Screening & Assessment: Goals of Screening Determine current level of mental health and substance use functioning Identify and isolate manifested variables of youth with histories of violent offenses Identify youth with cognitive deficiencies and educational deprivation

74. April 3-4, 2003 Garden Grove Assessment in Community Supervision Settings 74 TREATMENT � Screening & Assessment: Goals of Screening (cont�d) Identify youth who may be unwilling or unable to engage and establish in therapeutic relationships Isolate factors which are related to primary and secondary gains of mental illness, substance use and on-going criminal behavior

75. April 3-4, 2003 Garden Grove Assessment in Community Supervision Settings 75 TREATMENT � Screening & Assessment: Defining Assessment Conducted after gathering critical information A comprehensive analysis of psychological, psychosocial and other needs More sensitive to �red flags� Narrows the problem or strength with the ultimate goal of ruling out extraneous variables that may serve as false positives

76. April 3-4, 2003 Garden Grove Assessment in Community Supervision Settings 76 TREATMENT � Screening & Assessment: Goals of Assessment Examine the level and extent of mental health and substance use problems Identify other psychosocial or psychological problems that may enhance the symptoms of mental health and substance use problems

77. April 3-4, 2003 Garden Grove Assessment in Community Supervision Settings 77 TREATMENT � Screening & Assessment: Goals of Assessment (cont�d) Determine the extent that the youth�s family may be useful in treatment, their motivation, and ability to maintain family warmth and boundaries Provide diagnosis and baseline treatment planning

78. April 3-4, 2003 Garden Grove Assessment in Community Supervision Settings 78 TREATMENT � Screening & Assessment: Needs Assessment Rehabilitation Needs Drives Treatment Planning Describes youth�s functioning Risk Assessment Levels of security All points of system Recommendations to court Decision-making Dangerous to community Court appearance

79. April 3-4, 2003 Garden Grove Assessment in Community Supervision Settings 79 TREATMENT � Screening & Assessment: Type of instrument (screening vs. assessment) Population (age, reading ability) Form of administration (self report, structured interview, clinician-rated, computer scoring vs. manual scoring) Credentialing/training required Life areas covered Cultural specificity Reliability/validity

80. April 3-4, 2003 Garden Grove Assessment in Community Supervision Settings 80 TREATMENT � Categories of Co-Occurring Disorders: A heterogeneous population They have high rates of co-morbidity Females who display mental health and substance use disorders have high rates of depression Some manifest deviant sexual arousal patterns Fail to benefit from traditional psychotherapies; C-B-T has shown promise

81. April 3-4, 2003 Garden Grove Assessment in Community Supervision Settings 81 TREATMENT � Categories of Co-Occurring Disorders: Affective-based Anxiety-based Psychotic-based Behavior-based Co-Occurring-based Personality-based

82. April 3-4, 2003 Garden Grove Assessment in Community Supervision Settings 82 TREATMENT � Categories of Co-Occurring Disorders: Affective-based Refers to long-standing, chronic mood states that generally affect all aspects of an adolescent�s life May involve a significant elevation of mood state or depressed states and may occur as full or partial episodes

83. April 3-4, 2003 Garden Grove Assessment in Community Supervision Settings 83 TREATMENT � Categories of Co-Occurring Disorders: Anxiety-based Refers to the experiences of nervousness, tension, apprehension, and fear Experiences may be real or imagined and may affect concentration and daily performance as well as impair physical ability

84. April 3-4, 2003 Garden Grove Assessment in Community Supervision Settings 84 TREATMENT � Categories of Co-Occurring Disorders: Psychotic-based Refers to a disintegration of thinking processes, affecting cognitive functioning, perception, judgment and mood Involves inability to distinguish external reality from internal beliefs

85. April 3-4, 2003 Garden Grove Assessment in Community Supervision Settings 85 TREATMENT � Categories of Co-Occurring Disorders: Behavior-based Refers to a cluster of law-breaking, intrusive and invasive behaviors Often evidenced by disordered conduct and aggressions

86. April 3-4, 2003 Garden Grove Assessment in Community Supervision Settings 86 TREATMENT � Categories of Co-Occurring Disorders: Co-Occurring Mental Health & Substance Use�based Refers to simultaneous experience of these disorders Have pronounced affects on the thoughts, mood and behaviors of adolescents

87. April 3-4, 2003 Garden Grove Assessment in Community Supervision Settings 87 TREATMENT � Categories of Co-Occurring Disorders: Personality-based Refers to pervasive patterns of functioning that affect cognitive, perception, mood and behavior Impact affect the behavior of adolescents as they experience difficulties that are deeply rooted in their personality

88. April 3-4, 2003 Garden Grove Assessment in Community Supervision Settings 88 CONCLUSION