Not Just “Girls Out of Control”

1. Not Just “Girls Out of Control” Comparing Juvenile Court Records, Psychometric Data, and Service Delivery for Adolescent Females Presented by Rigoberto Contreras, M.S. MFCT & Kara Jones, M.A. Pima Prevention Partnership, Tucson AZ JMATE 2010

2. Outline Introduction: Justice-involved female adolescents Juvenile justice system referral to treatment Treatment agency assessment and assignment Addressing gender and cultural challenges

3. Profile of females on probation(Martin, Martin, Dell, Davis, & Guerrieri, 2008) Low socio-economic status, minority, complex histories of trauma and substance abuse. Low academic achievement and low self-esteem. Early unwanted pregnancy and antisocial behavior. Offending at increasingly younger ages; offenses ultimately worsen and become more frequent. Histories of physical and sexual abuse, and child maltreatment. High rates of depression, anxiety, mood disorder, and suicidal ideation. Depressed females three times more likely to commit delinquent acts than non-depressed female juveniles.

4. What does research say about females on probation? By 2007, girls accounted for 29% of all juvenile arrests. From 1985 to 2005, girls’ detention increased by 92%, and probation increased by 88%. Delinquent girls have higher rates of mental health problems than delinquent boys, receive fewer special services, and are more likely to abandon treatment programs. 83% of female juvenile offenders met criteria for as many as 8 psychiatric diagnoses, including high rates of conduct disorder, anxiety, and depression. Higher rates of self-reported abuse among female offenders, primarily emotional and sexual abuse. Related to greater abuse exposure, higher rates of Post-Traumatic Stress Disorder (PTSD) have been documented among female offenders.

5. Juvenile Justice referred youth admitted into treatment in 2009 194 clients in 2009 referred by the juvenile justice system (94% of all clients). 67% identified as Latino/a; 13% as Native American. Male-to-female ratio was three-to-one.

6. Clinical Profiles by Gender 2009 Juvenile Justice involved clients

7. Gender Differences Scales and differences based on GAIN-Intake data for 194 justice-involved clients in 2009.

8. Internal Mental Distress Internal mental distress measures somatic symptoms, anxiety, depression, traumatic stress, and suicide/homicide. Female adolescents have significantly higher rates of internal mental distress.

9. Traumatic Stress Traumatic stress measures symptoms and memories related to past or current trauma. Female adolescents report nearly double the rates of traumatic stress as males. However, one-third of males have symptoms of trauma.

10. Co-occurring Disorders Over half of justice-involved adolescents in treatment have both a substance abuse disorder and mental health disorder. Three-quarters of adolescent females exhibit co-occurring disorders.

11. BOTH Internalizing and Externalizing problems Female adolescents report significantly more symptoms of internalizing co-occurring disorders, but exhibit externalizing disorders at comparable rates to males, and meet diagnostic criteria for both at double the rates of males.

12. About Sin Puertas Adolescent Outpatient Treatment Center Funded with federal grants (CSAT and OJJDP). Began in 2005 to provide MET/CBT-5. Since 2007 has offered multiple evidence-informed outpatient and intensive outpatient treatment types that range from 1 to 15 hours per week. Treatment types range in scope, addressing cognitive behavioral techniques, life skills, family therapy, and mental health problems.

13. How a probation officermakes a referral • Phone interviews with Pima County Court probation officers indicated that the decision to refer a youth to substance abuse treatment is based on: • Drug charges • Positive urinalysis screen • Six-page questionnaire interview with youth and family about drug use, home life, and school • Family drug charges in the justice system • The only mental health screening question is about diagnoses for mental health disorders.

14. Probation officer assessment of treatment need • A spot-check review of justice-referred Sin Puertas clients in 2009 revealed: • Approximately one-third of probation officers did not recommend a specific treatment type. • When a treatment type was recommended, the vast majority of the time was for a less intensive clinical intervention (such as MET/CBT-5). Probation officers rarely recommended more intensive clinical treatment or family therapy.

15. Treatment assignment for all justice-referred youth in 2009 After clinical assessment and staffing of justice-referred youth, there were statistically significant gender differences in the determined need for mental health treatment services.

16. What do researchers recommend?(Cauffman, 2008) Effective prevention efforts should target the mental health needs of at-risk females before they lead to chronic behavior problems. Once girls with mental health problems come into the juvenile justice system diverting them to community-based treatment programs would not only improve their individual outcomes, but allow the juvenile justice system to focus on cases that present the greatest risk to public safety. Gender-specific treatment methods can be effective for female offenders, especially when treatment targets multiple aspects of offenders’ lives, including family and peer environments.

17. AAFT* Grant 2007 * Assertive Adolescent & Family Treatment Beginning of Mental Health treatment in conjunction with Substance Abuse Treatment at Sin Puertas. A-CRA (Adolescent Community Reinforcement Approach) Co-Occurring Therapy (Group, individual, and family treatment for youth to address substance abuse and mental health ) Development of a standardized clinical intake process. Use of GRRS (GAIN Recommendation and Referral Summary) for clinical purposes/Certified Clinical GAIN Interpreter.

18. What was included in Clinical Intake • Interview with client, parent/caregiver, probation or referral source and other parties who have worked with client (i.e., school personnel, CPS, other treatment providers). • Forms Created: • Mental Status Exam • Developmental History • Substance Use/Abuse • Family Needs Screen • GAIN-Q (GAIN Quick Screen, 10 pages) • “The 960”—court record of charges and sanctions

19. What we learned from A-CRA & Co-Occurring Therapy Females needed more individualized group sessions—More than once a week as received in Co-Occurring Therapy. High percentage of females presented with need for trauma services. Parent education of mental health and substance abuse was needed. Need for culturally appropriate services, including services in Spanish Need for appropriate referral sources, especially for psychiatric/psychological evaluation and trauma services. Training of Probation Officers/Referral Sources in regards to services offered at Sin Puertas and the need for clinical intake before client is placed in treatment.

20. What was done? • Collaboration/Referrals for Psychiatric Evaluation • Southern Arizona Mental Health Center • CPS • Probation if youth is arrested or sent to residential treatment • Collaboration/Referrals for Medication • El Rio Health Center • Catholic Social Services • Southern Arizona Mental Health Center • Collaboration/Referrals for Trauma • Tu Nidito • Assist Families with Arizona Health Care Cost Containment System (AHCCCS) Application

21. Gender-Specific Services • Development of Girls Trauma Group • Three nights a week, three hours a night • Once a week parent educational and support group • Curriculum based on VOICES, Substance Abuse Treatment for Persons with Co-Occurring Disorders TIP 42 and Substance Abuse Treatment: Addressing the Special Needs of Women TIP 51 • Therapist with experience in Trauma, Co-Occurring Disorders, and High Risk Behaviors • Bilingual services • Culturally appropriate services

22. Take-away Points Juvenile justice system does not have adequate tools to assess mental health needs. Importance of assessment at the treatment center level. Gender-specific services—especially Girls Trauma—are needed to fully address female adolescent substance use and mental health issues.

23. References Cauffman, E. (2008). Understanding the female offender. The Future of Children, 18(2), 119-142. Cruise, K, Marsee, M, Dandreaux, D, & DePrato, D. (2006). Mental health screening of female juvenile offenders:. J Child Fam Stud, 16, 615-621. Martin, D, Martin, M, Dell, R, Davis, C, & Guerrieri, K. (2008). Profile of incarcerated juveniles:. Adolescence, 43(171), 607-622. Robinson, L. United States Government Accountability Office, GAO. (2009). Ojjdp efforts related to girls’ delinquency (GAO-09-721R). Washington, DC.

24. Contact us Rigoberto Contreras, M.S. MFCT Clinical Services Manager rcontreras@thepartnership.us 520-791-2711 x3106 Kara Jones, M.A. Program Evaluator kjones@thepartnership.us 520-791-2711 x1428