Kayla Pope, MD, JD Boys Town National Research Hospital December 6, 2012

 National Academy of Sciences Report  Major Themes Punishment v Rehabilitation Focus on developmentally appropriate systems and practices What does that mean?

 Three emerging lines of evidence Developmental neuroscience Epidemiological data on prevalence of mental illness Trauma

 Supreme Court decisions on the treatment of juvenile offenders Roper Graham Miller

 Decisions influenced by research  Key considerations: More impulsive in decision making especially when emotionally charged situations Less capable of taking into consideration future consequences when making decisions More likely to be influenced by external factors including peers

 Several studies in different jurisdictions  Findings consistent 60 to 70% of juvenile offenders have an Axis I diagnosis (anxiety, depression, PTSD, ADHD) Most are never identified and do not receive care Failure to treat leads to greater morbidity and mortality

 Mood Disorder 20%  Anxiety Disorder 22%  Substance Use 51% ( Rates slightly higher among juveniles in adult system )

 High prevalence of abuse and neglect among juvenile offenders- but not well documented  Few facilities screen for trauma  Long thought to be associated with mental health problems but little data to support

 Juvenile Justice Population by gender Females  Severe Physical Abuse- 35%  Moderate Physical Abuse- 76%  Sexual Abuse- 41%  Severe Physical and Sexual Abuse- 21% (Rates highest among white, non-Hispanic females)

 Males: Severe Physical Abuse- 15% Moderate Physical Abuse- 68% Sexual Abuse- 11% Both Severe Physical and Sexual Abuse- 4% (Rates for psychical abuse highest among white males and sexual abuse Hispanic males)

 Females: Moderate Physical Abuse- 74% mental illness (Anxiety, Depression, etc), 37% had a disruptive behavior (ADHD, ODD, CD) Severe Physical Abuse- 80% with a diagnosis, 56% with DBD Sexual Abuse- 88% with a diagnosis, 52% DBD Severe Physical and Sexual Abuse- 92% with a diagnosis and 68% with a DBD

 Males: Moderate Physical Abuse- 77% with a diagnosis, 45% with DBD Severe Physical Abuse- 80% with a diagnosis; 56% with a DBD Sexual Abuse- 88% with a diagnosis; 52% with a DBD Severe Physical Abuse and Sexual Abuse; 92% with a diagnosis and 68% with a DBD

 Parole for Juvenile Offenders  The Use of Seclusion  Evaluating Competency and Restoration