1. An Evaluation of the Nation's First Juvenile Mental Health Court for Delinquent Youth With Chronic Mental Health Needs An Evaluation of the Nation's First Juvenile Mental Health Court for Delinquent Youth With Chronic Mental Health Needs Monic P. Behnken, J.D., Ph.D. Iowa State University David E. Arredondo, M.D. Applied Neuroscience Wendy L. Packman, J.D., Ph.D. Pacific Graduate School of Psychology

2. Authors’ Note: This presentation contains material from a forthcoming publication. Full Citation: Behnken, M. P., Arredondo, D. E., & Packman, W. L. (in press). Reduction in recidivism in a juvenile mental health court: A pre- and post-treatment outcome study. Juvenile and Family Court Journal, Summer 2009. Wiley- Blackwell Publishing.

3. What is a Juvenile Mental Health Court? Specialty court model (Goldkamp & Irons-Guynn, 2000) Specialty court model (Goldkamp & Irons-Guynn, 2000) Specific offender population Specific offender population (Poythress, Petrila, McGaha & Boothroyd, 2002) Emphasis on psychiatric treatment Emphasis on psychiatric treatment (Wolff & Pogorzelski, 2005) Voluntary participation (Arredondo et al., 2001) Voluntary participation (Arredondo et al., 2001) Therapeutic Jurisprudence principles Therapeutic Jurisprudence principles (Wexler & Winick, 1991)

4. Santa Clara JMHC - CITA Focuses on interdisciplinary cooperation Focuses on interdisciplinary cooperation Promotes a child-centered, multidisciplinary, and family focused approach to treatment Promotes a child-centered, multidisciplinary, and family focused approach to treatment Provides integrated and coordinated services Provides integrated and coordinated services Culturally sensitive community resources Culturally sensitive community resources Caregivers involved in treatment Caregivers involved in treatment Protects the rights of the child and the community Protects the rights of the child and the community

5. Simplified Traditional Court Structure Judge District Attorney Mental Health Probation Detention Defense Counsel Juvenile Family

6. CITA Structure Juvenile Judge Probation Mental Health District Attorney Defense Counsel FamilySchool Advocates

7. Study Design Demographic characteristics Demographic characteristics Descriptive Statistics Descriptive Statistics Recidivism rates for graduates Recidivism rates for graduates McNemar Tests and Paired T-Tests McNemar Tests and Paired T-Tests Wilcoxon Signed-Rank Test Wilcoxon Signed-Rank Test

8. N = 133 Overall Demographics

9. Demographics 15 years old (11-18) 15 years old (11-18) Race Race 34% Caucasian 33% Hispanic 13% Biracial 9% African American 6% Asian 5% Other Sex Sex 67% male 33% female 58% female single parent home 58% female single parent home 9 th grade 90% with school behavior problems 87% abuse substances 31% gang involvement M Diagnoses = 4 (1-12) M Medication = 2 (1-11) M Offenses = 4 (1-17) 52% exposed to domestic violence

10. Diagnoses ADHD 60.15% Sub. Abuse/Dep. 46.62% Bipolar DO 41.36% Major Dep. DO 34.59% Oppos./Defiant DO 30.08% Adjustment DO 25.56% Mood DO NOS 19.55% Depressive DO NOS 15.54% PTSD15.04% Learning Disorders 15.04% AXIS II features 14.29% Parent/Child Prob13.53% Dysthymic DO 12.03% Conduct DO 12.03% MR/Borderline IQ 9.77% Psychotic DO 8.27% Anxiety DO NOS 6.77% Inter./Explosive DO 6.02% Enuresis/Encopresis5.26% Disruptive Beh. DO 4.51% Reactive/Attach. DO3.76% OCD3.76% Amph Abuse/Dep3.01% Gen. Anxiety DO 3.01%

11. Medications Wellbutrin 24.06% Depakote 22.56% Ritalin 18.80% Risperdal 17.29% Prozac 15.04% Concerta 14.29% Zoloft 14.29% Seroquel 12.78% Lithium 10.53% Strattera 9.77% Klonapin 9.02% Zyprexa 9.02% Adderall 8.27% Paxil 8.27% Trazedone 8.27% Abilify 7.52% Geodon 7.52% Celexa 6.02% Effexor 6.02% Topomax 5.26%

12. Risk Factors Risk Factors For Violence And Psychiatric Disturbance 01020304050607080 Prior Psychiatric Hospitalization 67 (50.38%) Exposure to Domestic Violence 65 (51.88%) Family History of Mental Illness 58 (43.61%) Physical Abuse Victim 54 (40.60%) Prior Suicide Attempt 46 (34.59%) Gang Affiliation 42 (31.58%) Run Away History 40 (30.08%) Self-Mutilation History 39 (29.32%) Sexual Abuse Victim 36 (27.07%) Perpetrates Violence Against Family 34 (25.56%) Partner Violence 17 (12.78%) Family History of Gang Affiliation 7 (5.26%)

13. Most Common Offenses Assault/Battery 56.39% Violation of Probation 44.36% Theft 27.07% Bench Warrant 21.05% Escape from Detention 16.54% Burglary 15.04% Terrorist Threats 13.53% Vandalism 13.53% Dirty Drug Test 12.78% Poss. Dangerous Weapon 12.78% Theft of a Vehicle 12.03% Drug Possession 10.53% Robbery 6.77% Public Dist./Intox. 5.26% Curfew Violation4.51% Sell/Rec Stolen Prop. 4.51% Threatened Officials4.51% Arson 3.76% Runaway 3.76% Car Jacking 2.26%

14. Main CITA Steps Arrest Arrest Mental Health Screen Mental Health Screen Mental Health Assessment Mental Health Assessment Multi-disciplinary Team Multi-disciplinary Team CITA CITA Court Ordered Probation Court Ordered Probation Mental Health Treatment Mental Health Treatment

15. Interventions Psychoeducation Psychoeducation Domestic Violence/Teen Batterers Domestic Violence/Teen Batterers Anger Management Anger Management Parenting Parenting Job Training Job Training Independent Living Skills Independent Living Skills Problem Solving Problem Solving Victim Awareness Victim Awareness Substance Abuse Substance Abuse

16. Interventions Medical Medical Neurological Evaluation Neurological Evaluation Psychiatric Evaluation Psychiatric Evaluation Medication Evaluation Medication Evaluation Medical/Dental Evaluation Medical/Dental Evaluation School School Individualized Education Program Individualized Education Program Regular School Attendance Regular School Attendance

17. Interventions Court Ordered Sanctions Court Ordered Sanctions Drug Testing Drug Testing Restraining Order Restraining Order Restitution Restitution Community Service Community Service Electronic Monitoring Electronic Monitoring Home Detention Home Detention

18. Interventions Psychological Psychological Individual Individual Group Group Therapeutic Behavior Services Therapeutic Behavior Services Family Family Intensive Home Services Intensive Home Services Wraparound services Wraparound services Settings Community Outpatient Group Home Residential Juvenile Hall Ranch

19. N = 64 Graduates’ Recidivism

20. Overall Offense History Number of Offenses Before CITA Admission Mean2.98 SD2.05 Lower Limit/Upper Limit0/11 Number of Offenses After CITA Admission Mean1.14 SD1.41 Lower Limit/Upper Limit0/6 Difference in Number of Offenses Before and After CITA Admission Mean1.84*** SD2.26 ***Significant T-Test p value <.001 ***Significant McNemar Test p value <.001

21. Offense Pre-Admission Offenses Post-Admission Offenses McNemar’s Test p Values Violent Offenses Assault/Battery34 (53.13%)7 (10.94%)<.001*** Att. Kidnapping1 (1.56%)00.317* Burglary8 (12.50%)3 (4.69%)0.096* Carjacking1 (1.56%)00.317* Hit & Run01 (1.56%)0.317 a Indecent Exposure2 (3.13%)00.157* Obstr/Resist Arrest1 (1.56%) 1.000 Pos. Dng. Weapon9 (14.06%)1 (1.56%)0.011*** Reckless Driving1 (1.56%)00.317* Robbery01 (1.56%)0.317 a Stalking1 (1.56%)00.317* Threat. Officers01 (1.56%)0.317 a Terrorist Threats7 (10.94%)1 (1.56%)0.034*** *** Significant Change at p <.05 * Change trends in the positive direction a Post admission increases

22. Offense Pre-Admission Offenses Post-Admission Offenses McNemar’s Test p Values Property Crimes Arson2 (3.13%)00.157* Forgery1 (1.56%)00.317* Sell/Rec Stol Prop 3 (4.69%)1 (1.56%)0.317* Theft18 (28.13%)5 (7.81%)0.002*** Theft (Vehicle)4 (6.25%)1 (1.56%)0.180* Vandalism11 (17.19%)1 (1.56%)0.002*** *** Significant Change at p <.05 * Change trends in the positive direction a Post admission increases

23. Offense Pre-Admission Offenses Post-Admission Offenses McNemar’s p Values Miscellaneous Offenses Bench Warrant6 (9.38%)4 (6.25%)0.527* Curfew Viol.03 (4.69%)0.083 a DUI2 (3.13%)00.157* Drug Poss.2 (3.13%)5 (7.81%)0.257 a Escape/Detention8 (12.50%)5 (7.81%)0.405* Dirty Drug Test6 (9.38%)5 (7.81%)0.739* Pub. Dist./Intox.3 (4.69%)2 (3.13%)0.564* Runaway01 (1.56%)0.317 a Viol. of Prob.18 (28.13%) 1.000 *** Significant Change at p <.05 * Change trends in the positive direction a Post admission increases

24. Interval Differences Number of Days Between First Documented Offense and CITA Admission Mean552.08 (18.4 months) SD560.93 Lower Limit/Upper Limit298/500 Number of Days Between CITA Admission and CITA Graduation Mean698.32 (23.26 months) SD465.71 Lower Limit/Upper Limit512/751 Interval Difference in Time Before and After CITA Admission Mean-146.24 (4.87 months)* SD764.15 Lower Limit/Upper Limit-331/-94 * Marginally significant Wilcoxon Signed-Rank p value =.072

25. Summary Risk factors for offending Risk factors for offending Mental illness Mental illness Family/Environment Family/Environment Prior arrest Prior arrest 99% recidivism while on traditional probation 99% recidivism while on traditional probation

26. Summary Reduced Recidivism Reduced Recidivism Assault & Battery Assault & Battery Violent Threats Violent Threats Possession of a Dangerous Weapon Possession of a Dangerous Weapon Theft Theft Vandalism Vandalism Results trended toward reductions in other offenses Results trended toward reductions in other offenses

27. Researcher Comments Multidisciplined but not integrated Multidisciplined but not integrated Different documentation standards Different documentation standards Not all files available Not all files available No recidivism data past age 18 No recidivism data past age 18

28. Researcher Comments CITA participation appears linked to decreased recidivism CITA participation appears linked to decreased recidivism Violent offenses reduced Violent offenses reduced Effective multi-disciplinary cooperation is possible Effective multi-disciplinary cooperation is possible Cost effective alternative Cost effective alternative Humane treatment of mentally ill Humane treatment of mentally ill