Monic P. Behnken, J.D., Ph.D. Iowa State University David E. Arredondo, M.D. Applied Neuroscience

1. An Evaluation of the Nation's First Juvenile Mental Health Court for Delinquent Youth With Chronic Mental Health Needs Monic P. Behnken, J.D., Ph.D. Iowa State University David E. Arredondo, M.D. Applied Neuroscience Wendy L. Packman, J.D., Ph.D. Pacific Graduate School of Psychology

2. Authors’ Note: This presentation contains material from a forthcoming publication. Full Citation: Behnken, M. P., Arredondo, D. E., & Packman, W. L. (in press). Reduction in recidivism in a juvenile mental health court: A pre- and post-treatment outcome study. Juvenile and Family Court Journal, Summer 2009. Wiley-Blackwell Publishing.

3. What is a Juvenile Mental Health Court? • Specialty court model (Goldkamp & Irons-Guynn, 2000) • Specific offender population (Poythress, Petrila, McGaha & Boothroyd, 2002) • Emphasis on psychiatric treatment (Wolff & Pogorzelski, 2005) • Voluntary participation (Arredondo et al., 2001) • Therapeutic Jurisprudence principles (Wexler & Winick, 1991)

4. Santa Clara JMHC - CITA • Focuses on interdisciplinary cooperation • Promotes a child-centered, multidisciplinary, and family focused approach to treatment • Provides integrated and coordinated services • Culturally sensitive community resources • Caregivers involved in treatment • Protects the rights of the child and the community

5. Simplified Traditional Court Structure

6. CITA Structure

7. Study Design • Demographic characteristics • Descriptive Statistics • Recidivism rates for graduates • McNemar Tests and Paired T-Tests • Wilcoxon Signed-Rank Test

8. Overall Demographics N = 133

9. 15 years old (11-18) Race 34% Caucasian 33% Hispanic 13% Biracial 9% African American 6% Asian 5% Other Sex 67% male 33% female 58% female single parent home 9th grade 90% with school behavior problems 87% abuse substances 31% gang involvement M Diagnoses = 4 (1-12) M Medication = 2 (1-11) M Offenses = 4 (1-17) 52% exposed to domestic violence Demographics

10. ADHD 60.15% Sub. Abuse/Dep. 46.62% Bipolar DO 41.36% Major Dep. DO 34.59% Oppos./Defiant DO 30.08% Adjustment DO 25.56% Mood DO NOS 19.55% Depressive DO NOS 15.54% PTSD 15.04% Learning Disorders 15.04% AXIS II features 14.29% Parent/Child Prob 13.53% Dysthymic DO 12.03% Conduct DO 12.03% MR/Borderline IQ 9.77% Psychotic DO 8.27% Anxiety DO NOS 6.77% Inter./Explosive DO 6.02% Enuresis/Encopresis 5.26% Disruptive Beh. DO 4.51% Reactive/Attach. DO 3.76% OCD 3.76% Amph Abuse/Dep 3.01% Gen. Anxiety DO 3.01% Diagnoses

11. Wellbutrin 24.06% Depakote 22.56% Ritalin 18.80% Risperdal 17.29% Prozac 15.04% Concerta 14.29% Zoloft 14.29% Seroquel 12.78% Lithium 10.53% Strattera 9.77% Klonapin 9.02% Zyprexa 9.02% Adderall 8.27% Paxil 8.27% Trazedone 8.27% Abilify 7.52% Geodon 7.52% Celexa 6.02% Effexor 6.02% Topomax 5.26% Medications

12. Risk Factors For Violence And Psychiatric Disturbance Family History of Gang Affiliation 7 (5.26%) Partner Violence 17 (12.78%) Perpetrates Violence Against Family 34 (25.56%) Sexual Abuse Victim 36 (27.07%) Self-Mutilation History 39 (29.32%) Run Away History 40 (30.08%) Gang Affiliation 42 (31.58%) Prior Suicide Attempt 46 (34.59%) Physical Abuse Victim 54 (40.60%) Family History of Mental Illness 58 (43.61%) Exposure to Domestic Violence 65 (51.88%) Prior Psychiatric Hospitalization 67 (50.38%) 0 10 20 30 40 50 60 70 80 Risk Factors

13. Most Common Offenses Assault/Battery 56.39% Violation of Probation 44.36% Theft 27.07% Bench Warrant 21.05% Escape from Detention 16.54% Burglary 15.04% Terrorist Threats 13.53% Vandalism 13.53% Dirty Drug Test 12.78% Poss. Dangerous Weapon 12.78% Theft of a Vehicle 12.03% Drug Possession 10.53% Robbery 6.77% Public Dist./Intox. 5.26% Curfew Violation 4.51% Sell/Rec Stolen Prop. 4.51% Threatened Officials 4.51% Arson 3.76% Runaway 3.76% Car Jacking 2.26%

14. Main CITA Steps • Arrest • Mental Health Screen • Mental Health Assessment • Multi-disciplinary Team • CITA • Court Ordered Probation • Mental Health Treatment

15. Interventions • Psychoeducation • Domestic Violence/Teen Batterers • Anger Management • Parenting • Job Training • Independent Living Skills • Problem Solving • Victim Awareness • Substance Abuse

16. Interventions • Medical • Neurological Evaluation • Psychiatric Evaluation • Medication Evaluation • Medical/Dental Evaluation • School • Individualized Education Program • Regular School Attendance

17. Interventions • Court Ordered Sanctions • Drug Testing • Restraining Order • Restitution • Community Service • Electronic Monitoring • Home Detention

18. Interventions • Psychological • Individual • Group • Therapeutic Behavior Services • Family • Intensive Home Services • Wraparound services • Settings • Community Outpatient • Group Home • Residential • Juvenile Hall • Ranch

19. Graduates’ Recidivism N = 64

20. Overall Offense History

21. *** Significant Change at p < .05 * Change trends in the positive direction a Post admission increases

22. *** Significant Change at p < .05 * Change trends in the positive direction a Post admission increases

23. *** Significant Change at p < .05 * Change trends in the positive direction a Post admission increases

24. Interval Differences

25. Summary • Risk factors for offending • Mental illness • Family/Environment • Prior arrest • 99% recidivism while on traditional probation

26. Summary • Reduced Recidivism • Assault & Battery • Violent Threats • Possession of a Dangerous Weapon • Theft • Vandalism • Results trended toward reductions in other offenses

27. Researcher Comments • Multidisciplined but not integrated • Different documentation standards • Not all files available • No recidivism data past age 18

28. Researcher Comments • CITA participation appears linked to decreased recidivism • Violent offenses reduced • Effective multi-disciplinary cooperation is possible • Cost effective alternative • Humane treatment of mentally ill