examining the juvenile justice population in …...examining the juvenile justice population in...
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Examining the Juvenile Justice Population in California: Part 1
Presenter: William Arroyo, M.D.
Regional Medical Director Los Angeles County Dept. of Mental Health
Co-Facilitators: Dr. Karen Kurasaki & Ms. Sheron Wright
Examining the Juvenile Justice Population in California:
Part 1
Welcome, Introductions & Overview
Pre-Test
Feature Presentation & Q/A
Post-Test
Closing
Examining the Juvenile Justice Population in California: Part 1
Presenter: William Arroyo, M.D.
Regional Medical Director Los Angeles County Dept. of Mental Health
Biography William Arroyo, M.D., is the Medical Director of the Child, Youth, and Family Administration for the Los Angeles County Department of Mental Health (LACDMH) and is a Clinical Assistant Professor of Psychiatry at Keck USC School of Medicine. As Medical Director, he represents LACDMH in program development and policy implementation efforts in the children's mental health arena at the county and state levels. His recent projects have focused on infancy/early childhood mental health and juvenile justice. He also serves as the Principal Investigator of Project ABC, a federal initiative to develop a system of care for young children from birth to age 5. Dr. Arroyo actively serves as a peer reviewer for the Journal of the American Academy of Child and Adolescent Psychiatry; as a board examiner for the American Board of Psychiatry and Neurology; and has served on advisory committees for national mental health technical assistance centers at Portland State University, Georgetown University, and the National Center for Juvenile Justice and Mental Health.
EXAMINING THE JUVENILE JUSTICE POPULATION IN CALIFORNIA: PART I California Institute of Behavioral Health Solutions William Arrroyo, M.D.; Los Angeles County DMH October 29, 2014
OVERVIEW
National and State Profiles of youth in JJ system
State data re: local MH services, use of psychotropic agents among youth in JJ system
Statewide data: suicide attempts among youth in local custody
Cook County study on detained youth and death rates
Nat’l prevalence rates of mental disorders among youth in JJ systems
OVERVIEW (2)
Comprehensive model of JJ/MH: principles (BLUEPRINT)
Cornerstones of BLUEPRINT
Costs-Benefits Analyses of Evidence Based Practices
Resources
Nat’l Profile of Juvenile Offenders in Residential Placement in ‘97,’03,’10
Number
Population Held 1997 2003 2010
All residents (pre- and post-adj)
116,701 109,094 79165
Juvenile offenders
105,055 96,531 70,792
Delinquency 98,813 92,022 67,776
Person offense
35,138 33,170 26,010
Violent offense
26,304 22,039 18,655
Status offenders
6,242 4,509 3,016
Other residents 11,646 12,563 8,373
US Dept of Justice, 2013
Nat’l Profile of Racial/Ethnic Distribution of Juvenile Offenders in
Custody (2010) Race/Ethnicity Number Percent Percent change
1997 - 2010
Total 70,792 100% -33%
White 22,947 32 -42
Minority 47,845 68 -27
Black 28,976 41 -31
Hispanic 15,590 22 -19
Amer. Indian 1236 2 23
Asian 728 1 -67
Other 1315 2 134
US Dept of Justice, 2013
Youth Arrests in CA (2011)
0
20
40
60
80
100
120
White Black Latino AmericanIndian orAlaskanNative
Hawaiianor PacificIslander
Asian Other All youthof color
All youth
Youth arrests
Rate Per 1000 youth
Juvenile Detention Profile Survey – 2nd Qtr 2013 Overall Capacity and ADP
Brd of State and Community Corr, 2013
Juvenile Detention Profile Survey – 2nd Qtr 2013 Overal Capacity and ADP
Brd of State and Community Corr, 2013
County Breakout Report – 2nd Qtr 2013
Facilities and Alternative Detention
Brd of State and Community Corr, 2013
County Breakout Report – 2nd Qtr 2013 Facilities and Alternative Detention (2)
Brd of State and Community Corr, 2013
Mental Health – 2nd Qtr, 2013
Number of Open Mental Health Cases 3912
Number of Juveniles Receiving Psychotropic Medication
1453
Hospitalized Outside Facility for MH Care 2
Suicide Attempts (Qtr) 61 (JH’s)
Suicides (Qtr) 0
Brd of State and Community Corr, 2013
Completed Suicides
None reported between 2009 – 2013 (2nd Qtr) in Juvenile Halls and Camps-Ranches
Brd of State and Community Corr, 2013
Cook County Detained Youth, ‘95 – ’98 Longitudinal Study – Early Death
CHARACTERISTICS n %
Sex
Male 1172 64.1
Female 652 35.9
Race/Ethnicity
Black 1005 54.9
Non-hispanic White
296 16.2
Hispanic 524 28.7
Other 4 0.2
Legal Status
Adult court 275 15
Juvenile court 1554 85
AGES n %
10 yo 7 0.4
11 20 1.1
12 87 4.8
13 258 14.1
14 217 11.9
15 498 27.2
16 64 35.2
17 89 4.9
18 9 0.5
Teplin, et.al., 2005
Cook County Detained Youth, ‘95 – ’98, Longitudinal Study – 65 Deaths Within 8.4 years
CHARACTERISTICS of DEAD YOUTH
Race/Ethnicity Male Female
Black 23 7
Non-Hispanic White 7 2
Hispanic 21 5
Other 0 0
Age of death
15-16 yo 8 1
17-18 yo 21 3
19-20 yo 14 5
≥ 21 yo 8 5
Total 51 14
Teplin, et.al., 2005
Summary of Cook County Study
• Mortality rate (MR) among delinquent youth in study >4x than that in general pop
• MR among females was nearly 8x that of general pop
• More than 90% of deaths were homicides from gunshot wounds
• Recent Australian study of young offenders were attributable to OD compared to only 3 deaths in this sample; in this study nearly 97% youth who died of homicide sold drugs
• 20% of US youth (15 – 24 yo) deaths are firearm related while this sample > 90% of deaths were from firearms
Teplin, et. al., 2005
Arroyo, 2001
Incarcerated Youth with PTSD: males vs. females
3 males only
1 females only
1 females + males
Risk Factors for Mental Disorders
Exposure to toxins, eg, alcohol, drugs, infections, in pregnancy
Premature births
Genetic factors
Poverty
Raised in child welfare system
Limited or poor bonding during early childhood
Risk Factors for Mental Disorders (2)
Childhood abuse/neglect
Psychological trauma, eg, exposure to violence
Harsh/inconsistent discipline
Brain trauma (>30% of youth in JJ)
Stressful life events, eg, death of parent, etc.
Parental criminality and psychopathology
Maladaptive peer influences
BLUEPRINT for a COMPREHENSIVE MODEL of
JJ/MH - PRINCIPLES Youth should not have to enter JJ system solely to access MHS or because they have a MH problem
If public safety matters allow, a youth with MH needs should be diverted to evidence based treatment in a community setting
If ensuring public safety is critical, then the least restrictive setting with access to evidence based treatment should be chosen
Skowyra and Cocozza, 2007
BLUEPRINT MODEL – PRINCIPLES (2)
Mental health screens administered in the pre-adjudicatory phase should not be used for legal purposes
MHS should be responsive to gender, ethnicity, race, age, sexual orientation, SES, and faith
MHS should be provided in a developmental context, e.g., not adult-framework
Skowyra and Cocozza, 2007
BLUEPRINT MODEL – PRINCIPLES (3)
Families/caregivers should be partners in treatment decisions and plans
Multiple systems bear responsibility. Planning for JJ youth must be a collaborative effort by all key systems
Services and strategies for JJ youth with MH needs should be routinely evaluated for their effectiveness and outcomes
Skowyra and Cocozza, 2007
Collaboration Organize TK with rep’s from each key agency, including advocates, family members and consumers
Designate leader who has broad understanding of systems
Identify goals and the objectives and strategies to achieve goals
Emphasize strategic planning which achieves both immediate and sustainable plans
Recruit political support
Develop financial plan
Identification
Screen for emergent MH needs
Screen for routine MH needs
Screening instruments should have good psychometric properties and address co-occurring disorders
MH assessments to be completed by qualified personnel
Risk assessments can be completed concurrently
Diversion Determine public safety risk
Pre- and post- adjudication diversion may include MH courts, Drug courts
Consider diversion at every key decision making point within the judicial decision making process
Consider intensive supervision plus treatment as an alternative to secure facilities
Effective treatment resources must be available in community
JUDICIAL PROCESSING
DETENTION
INITIAL CONTACT & REFERRAL
SECURE PLACEMENT
COMM RE-ENTRY
PROBATION SUPERVISION
INTAKE
CRITICAL INTERVENTION POINTS
Skowyra and Cocozza, 2007
Treatment Should be evidenced based whether in secure facilities or in community
Examples
- Multisytemic Therapy
- Functional Family Therapy
- Multidimensional Treatment Foster Care
- Cognitive Behavior Therapy (depression, trauma)
- Brief Strategic Family Therapy
- Aggression Replacement Therapy
Treatment (2)
Other Examples:
- Dialectical Behavior Therapy
- Psychotropic Medications
Family involvement is critical
Gender specific services
Co-occurring mental and substance use treatment approach
Cost-Benefit Analyses of Evidence Based Practices (dollars)
Program Total benefits
Taxpayer benefits
Non-taxpayer benefits
Costs Benefits minus costs
Benefit to cost ratio
FFT (in St Inst)
61,374 12,982 48,392 (3,332) 58,043 18.42
FFT (on prob)
37,587 9,510 28,077 (3,333) 34,254 11.28
ART (on prob)
35,329 8,727 26,602 (1,540) 33,788 22,94
MTFC 39,094 8,875 30,218 (8,059) 31,035 4.85
MST 34,067 7,700 26,367 (7,522) 26,548 4.53
MDFT for Subst
21,125 5,725 15,400 (5,835) 15,289 3.62
Washington State Institute for Public Policy, 2013
Cost-Benefit Analyses of Evidence Based Practices (dollars) - 2
Program Total Benefits
Taxpayer Benefits
Non-taxpayer benefits
Costs Benefits minus costs
Benefit to cost ratio
MST for Subst JO
22,235 4,286 17,949 (7,528) 14,708 2.95
Drug Court
14,692 3,810 10,882 (3,154) 11,539 4.66
Drug trtmt JO
6,717 2,078 4,639 (3,704) 3,013 1.81
Scared Straight
(12,932) (3,259) (9,673) (66) (12,998) n/e
Washington State Institute for Public Policy, 2013
RESOURCES Bell; Disproportionate minority contact (DMC); www.burnsinstitute.org
California Commission on Juvenile Justice (2009); JJ Operational Master Plan; Blueprint for an Outcome Oriented JJ System; http://67.199.72.34/php/Information/JJOMPFinalReport.pdf
CMHDA and CPOC: Multi-Association Joint Committee; Placement Options for Aggressive Juvenile Justice Youth with Severe Mental Illness: County Challenges (March, 2007)
CPOC and CMHDA; Costs of Incarcerating Youth with Mental Illness; http://www.cpoc.org/assets/Data/costs%20of%20incarcerating%20youth%20with%20mental%20illness.pdf
Kraus and Arroyo; Amer Acad of Child and Adolescent Psychiatry; Monograph on Juvenile Justice Reform; http://www.aacap.org/App_Themes/AACAP/docs/clinical_practice_center/systems_of_care/JJmonograph1005.pdf
Resources (2) California Standards Authority; Mentally Ill Juveniles in Local Custody (2011); http://www.cdcr.ca.gov/COMIO/docs/Mentaly_Ill_Juveniles_In_Local_Custody.pdf
Models for Change: Systems Reform in Juvenile Justice; http://www.modelsforchange.net/index.html
National Center on Mental Health and Juvenile Justice; www.ncmhjj.org
Skowyra and Cocozza, 2007; Blueprint for Change: A Comprehansive Model for the Identification of Youth with Mental Health Needs in the Juvenile Justice System; http://www.ncmhjj.com/wp-content/uploads/2013/12/Blueprint.pdf
US Department of Justice, Office of Justice Programs, Office of JJ and Delinquency Prevention; http://www.ojjdp.gov/index.html
Wasserman, et.al; Mental Health Assessments in Juvenile Justice: Report on Consensus Conference; JAmAcadChAdolPsychiatry; July, 2003
Washington State Institute for Public Policy, 2013; Cost-Benefit Analyses; http://www.wsipp.wa.gov/BenefitCost?topicId=1