Transforming Juvenile Justice: Integrating Systems,

Practice, and PolicyDaniel J. Flannery, PhD

Institute 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

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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

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Strengthening Communities-Youth (SCY)

SAMHSA funded initiative (CSAT) with county office of Justice Affairs, Public Defender, and Catholic Charities

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

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Arraignment Charges

21%

40%

9% 9%

37%

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

Assault/Menacing Property Drug/Alcohol Weapons DomesticViolence

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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

Mental Health Indices Internal

Mental Distress

Somatic Symptoms

Depressive Symptoms

Homicidal-Suicidal Thought

Anxiety Symptoms

Traumatic Stress

Youth Moderate/Severe+ 90 (39%) 117 (50%) 148 (64%) 57 (25%) 103 (44%) 81 (35%)

Boys Moderate/Severe^ Girls Moderate/Severe ̂

64 (34%) 26 (62%)*

89 (47%) 28 (67%)*

113 (59%) 35 (83%)*

42 (22%) 15 (36%)

79 (42%) 24 (57%)

59 (31%) 22 (52%)*

Behavior Complexity

Attention Deficit

Hyperactivity Disorder

Inattentive Disorder

Hyperactivity Disorder

Conduct Disorder

Youth Moderate/Severe+ 162 (70%) 123 (53%) 95 (41%) 40 (17%) 163 (70%)

Boys Moderate/Severe^ Girls Moderate/Severe^

127 (67%) 35 (83%)*

98 (52%) 25 (59%)

73 (38%) 22 (52%)

26 (14%) 14 (33%)*

129 (68%) 34 (81%)

DSM-IV Mental DisordersDiagnosis^ Gender %1 %2 %3

Mood Disorders: depression, cyclothymic, bipolar, dysthymic, mood disorder NOS

M: 50 69% 22% 26%F: 22 31% 9.5% 52%*

Total=72 100% 31%Generalized Anxiety Disorder M: 22 65% 9.5% 12%

F: 12 35% 5% 29%*Total=34 100% 15%

Disruptive Disorders: conduct disorder, ADHD, ODD

M: 98 77% 42% 52%F: 29 23% 12.5% 69%*

Total=127 100% 55%Adjustment Disorder M: 4 100% 2% 2%

F: 0 0% 0% 0%Total=4 100% 2%

^ Categories are not mutually exclusive1 Percent of total with that diagnosis2 Percentage of N=2323 Percent of males (n=190) and of females (n=42)* higher females vs. males, p<.05

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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%)

Externalizing and Internalizing Disorders by Gender

88%

87%

27%

51%

73%

49%

12%13%

61%

36%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

At least oneExternalizing

ExternalizingOnly

At least oneInternalizing

InternalizingOnly

BothInternalizing

andExternalizing

FemalesMales

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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

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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

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Environmental Risk

1.8

57.7

40.5

3.2

55.0

41.8

1.8

22.0

76.1

0.0

25.6

74.4

0%10%20%30%40%50%60%70%80%90%

100%

EnvironmentalRisk

Living Risk VocationalRisk

Social Risk

High

Moderate

Low

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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

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General Victimization

45.7

16.5

37.8

59.5

14.3

26.2

0%10%20%30%40%50%60%70%80%90%

100%

Males Females

None

Moderate

High

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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

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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

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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

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

Cross-system Involvement

System involvement in addition to Juvenile Justice and Alcohol and Drug (N=232)

N (%)

Mental Health 131 (56%)

Special Education 67 (29%)

DCFS (any contact)Any allegations

Any Substantiated/IndicatedOut of home placement

173 (75%)159 (68%)108 (47%)56 (24%)

Mental Health and Special Education 41 (18%)

Mental Health and DCFS 104 (45%)

Special Education and DCFS 57 (25%)

Mental Health, Special Education, and DCFS 36 (15%)

Tapestry Cross System Involvement Tapestry youth cross-system involvement using multiple self report and official data sources. Indicator Tapestry (N= 329 enrolled) Juvenile Justice 30% ever arrested, 27% have history of probation, 11% ever sentenced to a

secure facility. Substance Abuse 49% of youth report using at least one substance prior to intake, primarily

alcohol, cigarettes and cannabis/hashish.

Mental Health 100% of youth have at least one DSM-IV mental disorder, primarily ADHD (49%), Mood Disorders (43%), Oppositional defiant disorder (29%) and Adjustment Disorder (16%). 48% (n=219) reported current use of psychotropic medication.

Education

49% of 108 Tapestry youth reported receiving special education classes

Child and Family Services

Year one data (n= 169) 57% of Tapestry youth have at least one allegation of maltreatment: physical abuse (35%), sexual abuse (20%), neglect (46%) or emotional abuse (4%). 18% of Tapestry youth had a history of one or more out of home placements.

Medicaid 88% of youth are Medicaid eligible and have received Medicaid services.

Substance Problems Scale Over Time

1.31.6

0.9

3.7

00.5

11.5

22.5

33.5

4

Intake 3mo 6mo 12mo

Substance problems in the past month

Statistically significant decrease: Intake to 3 months Intake to 6 months Intake to 12 months

Statistically significant increase: 3 months to 6 months

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Substance Use Over Time

8.3

35.7

8.310.9 11.8

2.52.41.91.41.51

5.905

10152025303540

Intake 3mo 6mo 12mo

AlcoholDrunkenessMarijuana

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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)

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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)

Emotional Problems Scale Over Time

0.130.150.15

0.21

0

0.05

0.1

0.15

0.2

0.25

Intake 3mo 6mo 12mo

Emotional Problems over time

Statistically significant decrease: Intake to 3 months Intake to 6 months Intake to 12 months 6 months to 12 months

General Crime Scale Over Time

0.620.720.64

3.39

00.5

11.5

22.5

33.5

4

Intake 3mo 6mo 12mo

General Crime over time

Statistically significant decrease: Intake to 3 months Intake to 6 months Intake to 12 months

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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

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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

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Victimization Data

Question Females MalesHas the child ever been physically abused?

25% 17%

Has the child ever been sexually abused? 36% 6%

Has the child ever had a problem with substance abuse?

45% 40%

Has the child ever talked about committing suicide?

52% 38%

Has the child ever attempted suicide? 24% 9%

Has the child ever witnessed domestic violence?

50% 42%

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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

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Substance Abuse

Have you ever had an alcoholic beverage? Yes: 66%

Have you ever been drunk? Yes: 69%

Have you ever smoked a cigarette? Yes: 69%

Have you ever smoked marijuana? Yes: 70%

Have you ever used cocaine? Yes: 14%

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Substance Abuse

Average Age of initial use: Cigarette: 11.8 years Alcoholic drink: 13.1 years Marijuana: 13.0 years Cocaine: 14.6 years

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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%

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

Substance Use Change

0

5

10

15

20

25

30

Intake 6 Months Discharge

Interval

Ave

rage

Num

ber o

f Day

s

AlcoholCigarettesMarijuanaCocaine

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Ohio ScalesOhio Scales Problem Severity Scale(lower scores - less problem severity)

0

5

10

15

20

25

30

Intake 3 months 6 months 9 months Discharge

Interval

Scor

e ParentChildWorker

*statistically significant differences between Intake and last measurement

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Ohio ScalesOhio Scales Functioning

(higher scores - greater functioning)

0

10

20

30

40

50

60

70

80

Intake 3 months 6 months 9 months Discharge

Interval

Scor

e ParentChildWorker

*statistically significant differences between Intake and last measurement

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Ohio Scales

Ohio Scales Hopefulness(lower scores - greater hopefulness)

0

2

4

6

8

10

12

14

Intake 3 months 6 months 9 months Discharge

Interval

Scor

e

ParentChild

*statistically significant differences between Intake and last measurement

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Ohio ScalesOhio Scales Satisfaction With Services

(lower scores - greater satisfaction)

0

2

4

6

8

10

12

Intake 3 months 6 months 9 months Discharge

Interval

Scor

e

ParentChild

*statistically significant differences between Intake and last measurement

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Integrated Co-occurring treatment (ICT)

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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

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ICT Youth Usual Services Comparison

Group

Size of Difference in commitment

and/or recidivism rates

56 youth 25% recidivism rate

29 Youth 72% commitment rate

Chi Square (1, 29): 17.74 Level of significance: .001

Results of ICT Study (2001-2002)

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Ohio Scales Gain Scores (2005 – October 2006)General Clinical Population

(Statewide) ICT Participants

30 days 180 days Gain 30 days 180 days Gain

Problem Severity Adult 28.60 22.74 5.86 31.28 19.38 11.90

Problem Severity Child 23.93 18.85 5.08 30.33 19.48 10.85

Hopefulness Adult 12.29 10.60 1.69 13.52 10.88 2.64

Hopefulness Child 10.60 9.44 1.16 13.09 10.18 2.91

Satisfaction Adult 8.87 6.42 2.45 10.25 7.25 3.00

Satisfaction Child 10.60 8.53 2.07 10.13 8.05 2.08

Functioning Adult 44.98 48.65 3.67 36.20 44.71 8.51

Functioning Child 55.75 59.34 3.59 49.42 58.76 9.34

Total = 27 youth; 3 ODYS Commitments

For "Functioning", the higher the score the better - for all others, the lower the score the better

Clinical cutoffs= 20 for problem severity and 51 for parent rating functioning and 60 for youth rated functioning

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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