1. Research and Evaluation Center Juvenile Justice and Behavioral Health: An Awkward Partnership Jeffrey A. Butts, Ph.D. Director, Research and Evaluation Center John Jay College of Criminal Justice City University of New York September 30, 2011 Presented to the Coalition for Juvenile Justice (CJJ) Northeast Region Conference Changing the Face of Juvenile Justice Manchester, New Hampshire

2. Research and Evaluation Center Quality Juvenile Justice - Maximum use of diversion, consistent with public safety - Least intrusive, in-home services whenever possible - Informal if possible, adjudication as last resort - Effective interventions, backed by research - Youth, families, and system are mutually accountable - Accurate, practical screening and assessment - Systems integration and agency coordination - Data systems that facilitate quality services - Cultural competence and fairness - Family involvement - Community engagement - Youth voice, youth leadership

3. Research and Evaluation Center Behavioral Health / Quality Justice Difficult to manage the inherent tensions between treatment and justice Risk of Legal Coercion to Improve Youth Behavior Risks from Youth Behavior Both place youth at greater risk of future offending and court involvement Example – Panel study of 1,000 8 th graders followed to age 22: Researchers tested the effect of juvenile justice intervention on school success, employment, and adult crime controlling for criminal record, poverty etc. Intervention reduces the chances of high school graduation and adult employment Intervention increases the number of predicted crimes during adult years by a factor of 5 Source: Bernburg and Krohn (2003). Criminology.

4. Research and Evaluation Center Intervene or Not Intervene? Risky behavior during adolescence is normative behavior (e.g., drugs, sexual behavior, misuse of automobiles) Most youth will “age out,” but some will not The challenge is to identify which youth won’t desist “Normative” adolescent behavior by itself should not be used as legal leverage to entangle youth in the formal justice system Inherent tensions between justice and treatment goals are eliminated only when the seriousness of a youth’s law violation justifies the use of coercive intervention (i.e., Scott and Steinberg’s “Limiting Principle”)

5. Research and Evaluation Center How Common is Teen Drug Use? Use in Past Month by 10 th Graders Alcohol Any use 33%Been drunk 18% Source: Monitoring the Future 2007, University of Michigan.

6. Research and Evaluation Center How Common is Teen Drug Use? Use in Past Month by 10 th Graders Any Illicit Drug 17% Source: Monitoring the Future 2007, University of Michigan.

7. Research and Evaluation Center How Common is Teen Drug Use? Use in Past Month by 10 th Graders Any Illicit Drug 17% Abuse/Dependence in Past Year (12-17) Drug 5% Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2006.

8. Research and Evaluation Center How Common is Teen Drug Use? Use in Past Month by 10 th Graders Any Illicit Drug 17% Abuse/Dependence in Past Year (12-17) Incl. Alc. 8% Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2006.

9. Research and Evaluation Center How Common is Teen Drug Use? Use in Past Month by 10 th Graders Source: McReynolds et al. (2008). Crime & Delinquency. Any Illicit Drug 17% Abuse/Dependence in Past Year (12-17) Assessment Center (Abuse in Past Month) Any SUD 11% Any SUD 8% SUD “Substance Use Disorder” General Population Justice-Involved Youth referred to an intake and assessment center soon after a first contact with police.

10. Research and Evaluation Center How Common is Teen Drug Use? Use in Past Month by 10 th Graders Source: Wasserman et al. (2005). Amer. Journal of Public Health. Any Illicit Drug 17% Abuse/Dependence in Past Year (12-17) Drug 5%Any SUD 11% Any SUD 8% Probation Intake (Abuse in Past Month) Any SUD 25% Assessment Center (Abuse in Past Month) General Population Justice-Involved Youth referred to probation intake after initial screening by law enforcement or other agency.

11. Research and Evaluation Center How Common is Teen Drug Use? Use in Past Month by 10 th Graders Source: Aarons et al. (2001). Journal of the Amer. Acad. of Child and Adolesc. Psych. Any Illicit Drug 17% Abuse/Dependence in Past Year (12-17) Drug 5%Any SUD 11% Any SUD 8% Any SUD 25% JJ Supervision Pop. (Abuse in Past Year) Assessment Center (Abuse in Past Month) Probation Intake (Abuse in Past Month) Any SUD 37% General Population Justice-Involved Youth formally involved with a juvenile justice agency; some but not all with previous out-of-home placements.

12. Research and Evaluation Center How Common is Teen Drug Use? Use in Past Month by 10 th Graders Source: Teplin et al. (2002). Archives of General Psychiatry Any Illicit Drug 17% Abuse/Dependence in Past Year (12-17) Drug 5%Any SUD 11% Any SUD 8% Any SUD 25% JJ Supervision Pop. (Abuse in Past Year) Assessment Center (Abuse in Past Month) Probation Intake (Abuse in Past Month) Any SUD 37% Urban Juv Detention (Abuse in Past 6 Months) Any SUD 49% General Population Justice-Involved Serious juvenile offenders held in the secure detention center of Cook County (Chicago) Illinois.

13. Research and Evaluation Center Why? 1.Do drug issues increase the seriousness of criminal behavior by juvenile offenders? 2.Do drug issues increase the coerciveness of the legal response to juvenile offenders? Clearly, Drug Problems are More Common the Deeper One Looks into the Juvenile Justice Process In a sense, drug-using youth accumulate in the “deep end” of the juvenile justice system…

14. Research and Evaluation Center Consider this…

15. Research and Evaluation Center Youth at a Juvenile Assessment Center What proportion have a substance use disorder? - McReynolds et al. (2008) 11% 100% Recall, rate of substance use disorders among all U.S. 12-17 year-olds. - SAMHSA (2006) 8%

16. Research and Evaluation Center Youth at a Juvenile Assessment Center Of these, what proportion have a substance use disorder? - Wasserman et al. (2005) 11% 100% Youth Referred to Juvenile Probation 25% About half of all arrested youth are referred to juvenile court authorities. - Juvenile Court Statistics, OJJDP 50% Recall, rate of substance use disorders among all U.S. 12-17 year-olds. - SAMHSA (2006) 8%

17. Research and Evaluation Center Youth at a Juvenile Assessment Center 11% 100% Youth Referred to Juvenile Probation 25% About 20 percent of all court referred youth are held in secure detention at some point. - Juvenile Court Statistics, OJJDP Of these, what proportion have a substance use disorder? - Teplin et al. (2002) Youth Held in Secure Detention 49% 20% Recall, rate of substance use disorders among all U.S. 12-17 year-olds. - SAMHSA (2006) 8%

18. Research and Evaluation Center Youth at a Juvenile Assessment Center 11% 100% Youth Referred to Juvenile Probation 25% When they first enter the juvenile system, the prevalence of substance abuse among young offenders is similar to other teens. Substance-abusing offenders, however, are more likely to be retained through to the more restrictive stages of justice processing. Youth Held in Secure Detention 49% The preponderance of drug-abusing youth in the deep end of the justice system is a function of how case decisions are made. Drug-abusing youth are treated more coercively. Recall, rate of substance use disorders among all U.S. 12-17 year-olds. - SAMHSA (2006) 8% Thus, they are a larger subgroup by the end of the juvenile justice process.

19. Research and Evaluation Center This may be an accurate and legitimate use of resources if drug-using youth are higher-risk and in need of stronger sanctions. Just what type of drug users are referred to the juvenile justice system? Youth with Identified Drug Issues are Handled More Coercively in the Juvenile Justice System

20. Research and Evaluation Center Substance Use Disorders Abuse Disorders (past month) Alcohol 2% Marijuana 4% Other drug 1% Dependence Disorders Alcohol 1% Marijuana 5% Other drug 1% No Disorder Detected89% Among Youth Referred to a Juvenile Assessment Center Source: McReynolds et al. (2008) Abuse Disorders (past month) Alcohol 7% Marijuana10% Other drug 3% Dependence Disorders Alcohol 3% Marijuana13% Other drug 4% No Disorder Detected75% Among Youth Referred to Juvenile Probation Intake Source: Wasserman et al. (2005)

21. Research and Evaluation Center 10%-25% of youthful offenders have substance use issues that could be called problematic – either abuse or dependence Most of these substance use issues (80%-90% involve alcohol and marijuana only Substance Use Disorders

22. Research and Evaluation Center The Key Policy Question: How Serious Does a Teen’s Use of Alcohol and Marijuana Have to be to Pose a Greater Threat to his or her Future than the Threat Posed by Juvenile Court Adjudication and the Criminal Record that may Follow?

23. Research and Evaluation Center The Juvenile Justice System Reacts to Two Dimensions of Youth Behavior Severity of substance abuse Severity of all other criminal behavior

24. Research and Evaluation Center Total Population of Youth Offenders

25. Research and Evaluation Center

26. Total Population of Youth Offenders

27. Research and Evaluation Center Severity of Criminal Behavior Total Population of Youth Offenders

28. Research and Evaluation Center Severity of Drug-Using Behavior Total Population of Youth Offenders

29. Research and Evaluation Center Severity of Drug-Using Behavior Severity of Criminal Behavior No serious offenses, never used drugs Repeat violent offender with long-term serious drug use Serious and violent offender with no apparent drug use Minor offenses, but with drug abuse and dependence Relatively serious offenses, with some drug abuse When Does Legal Coercion Become Harmful?

30. Research and Evaluation Center Severity of Drug-Using Behavior Severity of Criminal Behavior If we combine the two dimensions… When Does Legal Coercion Become Harmful?

31. Research and Evaluation Center Severity of Drug-Using Behavior Severity of Criminal Behavior Minimum Intervention Maximum Intervention Justice Treatment Coercion for Public Safety Iatrogenic Risk Coercion for Treatment? When is it appropriate to use the justice system to coerce youth into compliance, knowing that coercion itself present risks to their future? How far down into less serious offenses can coercion be used before we introduce “iatrogenic” risks – making things worse? When Does Legal Coercion Become Harmful?

32. Research and Evaluation Center Severity of Drug-Using Behavior Severity of Criminal Behavior Minimum Intervention Maximum Intervention Justice Treatment Coercion for Public Safety Iatrogenic Risk Iatrogenic Risk Could be Eliminated With Perfect and Objective Knowledge of 4 Factors: 1.Actual harm caused by a youth’s current drug use 2.Trajectory and impact of future drug use 3.Methods for selecting and delivering treatment 4.The effectiveness and behavioral impact of treatment Our Knowledge Will Never Be Perfect Coercion for Treatment? When Does Legal Coercion Become Harmful?

33. Research and Evaluation Center Severity of Drug-Using Behavior Severity of Criminal Behavior Minimum Intervention Maximum Intervention Justice Treatment Coercion for Public Safety Iatrogenic Risk Coercion for Treatment? To the extent we have only imperfect knowledge, our willingness to use coercion for treatment goals alone should be limited to very serious drug problems. When Does Legal Coercion Become Harmful?

34. Research and Evaluation Center Severity of Drug-Using Behavior Severity of Criminal Behavior Minimum Intervention Maximum Intervention Justice Treatment Iatrogenic Risk Injustice Coercion for Public Safety Coercion for Treatment? When Does Legal Coercion Become Harmful?

35. Research and Evaluation Center In Juvenile Justice, Behavioral Health Intervention for Substance Abuse Must Be… Largely community-based, non-coercive Designed for the vast majority of youth who are drug using, sometimes abusing, but not drug dependent Ready to address a wide range of drug use but still appropriate for the 90% of youthful offenders who use only alcohol and marijuana Designed to avoid unwarranted legal coercion by providing services, activities and supports that are actually appealing to non-mandated, voluntary clients Free of any financial incentives that lead to excess use of formal adjudication and court-ordered treatment

36. Research and Evaluation Center Jeffrey A. Butts, Ph.D. John Jay College of Criminal Justice City University of New York jbutts@jjay.cuny.edu www.jjay.cuny.edu/rec www.jeffreybutts.net

37. Research and Evaluation Center Aarons, Gregory A., Sandra A. Brown, Richard L. Hough, Ann F. Garland, and Patricia A. Wood (2001). Prevalence of Adolescent Substance Use Disorders across Five Sectors of Care. Journal of the American Academy of Child and Adolescent Psychiatry, 40(4): 419–26. Bernburg, Jón Gunnar and Marvin D. Krohn (2003). Labeling, Life Chances, and Adult Crime: The Direct and Indirect Effects of Official Intervention in Adolescence on Crime in Early Adulthood.” Criminology 41(4): 1287-1318. McReynolds, Larkin S., Gail A. Wasserman, Robert E. DeComo, Reni John, Joseph M. Keating, and Scott Nolen (2008). Psychiatric disorder in a juvenile assessment center. Crime & Delinquency, 54(2): 313-334. Substance Abuse and Mental Health Services Administration (2007). National Survey on Drug Use and Health. Rockville, MD: Substance Abuse and Mental Health Services Administration. Teplin, Linda A., Karen M. Abram, Gary M. McClelland, Mina K. Dulcan, and Amy A. Mericle (2002). Psychiatric Disorders in Youth in Juvenile Detention. Archives of General Psychiatry, 59(Dec): 1133-1143. Wasserman, Gail A., Larkin S. McReynolds, Susan J. Ko, Laura M. Katz, and Jennifer R. Carpenter (2005). Gender Differences in Psychiatric Disorders at Juvenile Probation Intake. American Journal of Public Health, 95(1): 131-137. References