1. Strengthening Communities-Youth (SCY) Presented by Dr. David Hussey Institute for the Study and Prevention of Violence at Kent State University

2. Strengthening Communities – Youth (SCY)  Cuyahoga County SCY project (2002-2007) targeted resources on two child serving systems -- the alcohol and drug addiction services system through the Alcohol and Drug Addiction Services (ADAS) Board, and the juvenile justice system through the Cuyahoga County Juvenile Court. SCY project goals specifically attempted to: improve coordinated system of care infrastructure, facilitate earlier identification of juvenile justice youth with drug and alcohol problems, improve access to needed services, expand service capacity, and address comorbidity issues including the relationship between substance abuse and violence. The project was designed to strengthen and improve the overall system of care, and collaborate with the mental health system of care for juvenile justice youth that present mental health problems.

3. Strengthening Communities – Youth (SCY)  CSAT developed the Discretionary grant program to respond to the growing demands for substance abuse treatment and to address gaps in the substance abuse treatment delivery system  The SCY project (2002-2007, 3.75 million dollars) serves youth between the ages of 12 and 17 who arrive at the Cuyahoga County Detention Center as a result of a new arrest  Youth are screened for substance use by a representative from the Public Defender’s office/Juvenile Division and referred to Catholic Counseling Services for further assessment using the Global Appraisal of Individual Needs (GAIN)  Clinical recommendations will be presented to court prior to disposition  Once assessed, youth are referred to an appropriate level of care for substance abuse treatment and followed at 3, 6, and 12 months (84% 12 month follow-up rate for study)

4. Detention Center Demographics  Based on the Cuyahoga County Court of Common Pleas – Juvenile Court Division 2005 Annual Report, there were a total of 3,102 youth held in the detention center (excludes youth on home detention and in Shelter Care) in 2005  Of these 3,102, 76% were male and 75% were African-American, 21% were Caucasian, 4% were Hispanic, and <1% were of another race  Age range = 8 to 17

5. SCY Demographics  For the period April 2003 to March 2007, 232 youth were enrolled in the SCY project  Of these 232 youth, 82% were male and 53% were African-American, 29% were Caucasian, 6% were Hispanic/Latino, 11% were biracial/mixed, 1% were of another race  Age range=12 to 17, Average age=15.7 years  At least 64% are Medicaid eligible  About half (54%) live in the city of Cleveland

7. Arraignment Charges

8. Substance Use  At intake, over 3/4 th of youth (87%) reported using marijuana in the past 90 days  At intake, over half (59%) reported using alcohol in the past 90 days  Youth reported they were, on average, 13.1 years old the first time they got drunk or used any drugs

9. 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%)

10. DSM-IV Mental Disorders Diagnosis^Gender %1%1%1%1 %2%2%2%2 %3%3%3%3 Mood Disorders: depression, cyclothymic, bipolar, dysthymic, mood disorder NOS M: 50 69%22%26% F: 22 31%9.5%52%* Total=72100%31% Generalized Anxiety Disorder M: 22 65%9.5%12% F: 12 35%5%29%* Total=34100%15% Disruptive Disorders: conduct disorder, ADHD, ODD M: 98 77%42%52% F: 29 23%12.5%69%* Total=127100%55% Adjustment Disorder M: 4 100%2%2% F: 0 0%0%0% Total=4100%2% ^ Categories are not mutually exclusive 1 Percentage based on total number with that diagnosis 2 Percentage based on N=232, the total number of SCY youth 3 Percentage based on total number of males (n=190) and total number of females (n=42) *Significantly higher proportion of females vs. males, p<.05

11. 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%)

12. Externalizing and Internalizing Disorders by Gender

13. Lifetime Charge data (JIMS)  SCY youth were, on average, 14.41 years old at the time of their first charge  Total charges=2,571 (N=227)  On average, SCY youth had been charged with 10.19 (SD=7.30, median=9) offenses (excluding traffic)  Misdemeanors accounted for the largest proportion of charges (40%), followed by felonies (30%), traffic offenses (11%), probation violations (10%) and status offenses (9%)

14. 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

15. 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

16. Youth with DV Youth w/o DV Age at first charge* 14.56 (SD=1.64) 15.19 (SD=1.46) Race 51.9% African American 28.6% Caucasian 7.8% Hispanic 11.7% Bi-Racial 0.0% Other 54.7% African American 29.3% Caucasian 4.7% Hispanic 10.0% Bi-Racial 1.3% Other Gender 81.8% Male 18.2% Female 82.7% Male 17.3% Female Total Delinquent Charges* 8.70 (SD=6.17) 6.25 (SD=5.07) Environmental Risk Scale 38.55 (SD=8.86) 37.74 (SD=8.53) General Victimization Scale 3.67 (SD=3.24) 3.10 (SD=3.03) Substantiated/Indicated Maltreatment 54.5% Yes 43.3% Yes Youth with Adjudicated Domestic Violence Charges

17. Environmental Risk

18. General Victimization  On average, youth reported the first time they were victimized they were 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

19. General Victimization

20. 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

21. 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

22. 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

23. 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

24. 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/Indicated Out 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%)

25. Tapestry Cross System Involvement

26. SCY Treatment  Analysis focuses on the youth who completed the 12 month GAIN assessment (“completers”)  167 youth were completers; 142 (85%) of completers had received treatment services  313 treatment placements for 142 youth

27. Substance Problems Scale Over Time  Statistically significant decrease: Intake to 3 months Intake to 3 months Intake to 6 months Intake to 6 months Intake to 12 months Intake to 12 months  Statistically significant increase: 3 months to 6 months 3 months to 6 months

28. Substance Use Over Time

29. Abstinence  Youth reporting abstinence: Intake - 16 youth (7%) Intake - 16 youth (7%) 3 months - 113 youth (49%) 3 months - 113 youth (49%) 6 months - 102 (44%) 6 months - 102 (44%) 12 months - 103 (44%) 12 months - 103 (44%)  Overall, only 18% (n=42) of youth reported abstinence at all follow-up periods (3, 6, and 12 months)

30. 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) 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) 24 (77%) had abstinence corroborated by urine screen data (had all negative screens)

31. Emotional Problems Scale Over Time  Statistically significant decrease: Intake to 3 months Intake to 3 months Intake to 6 months Intake to 6 months Intake to 12 months Intake to 12 months 6 months to 12 months 6 months to 12 months

32. General Crime Scale Over Time  Statistically significant decrease: Intake to 3 months Intake to 3 months Intake to 6 months Intake to 6 months Intake to 12 months Intake to 12 months

33. Recidivism Time Frame Post Enrollment Type Number (Percent) of SCY Youth 3 Months Charges 41 (18.1%) Delinquent Offenses 34 (15.0%) 6 Months Charges 66 (29.1%) Delinquent Offenses 52 (22.9%) 9 Months Charges 82 (36.1%) Delinquent Offenses 65 (28.6%) 12 Months Charges 93 (41.0%) Delinquent Offenses 73 (32.2%)

34. Discussion: SCY Major Findings  Comorbidity rates continue to be very high 63% of youth comorbid for mental health and substance abuse 63% of youth comorbid for mental health and substance abuse Females demonstrate higher rates of mental health impairment and comorbidity (79% versus 60%). Females demonstrate higher rates of mental health impairment and comorbidity (79% versus 60%). Males more likely to be felons (71% versus 25%), evidence higher scores on the General Crime Scale. Males more likely to be felons (71% versus 25%), evidence higher scores on the General Crime Scale.  Lifetime cross-system involvement high 12% of youth involved with only the juvenile justice and AOD systems 12% of youth involved with only the juvenile justice and AOD systems 55% of youth involved with 4 or more child-serving systems 55% of youth involved with 4 or more child-serving systems 29% special education; 18% previous AOD treatment; 41.4% previous mental health treatment 29% special education; 18% previous AOD treatment; 41.4% previous mental health treatment  Victimization 69% of youth have previous child maltreatment allegation; 47% substantiated/indicated; 24% removed from home 69% of youth have previous child maltreatment allegation; 47% substantiated/indicated; 24% removed from home 80% of youth either self-report or have substantiated/indicated victimization or maltreatment histories 80% of youth either self-report or have substantiated/indicated victimization or maltreatment histories Females present with different victimization patterns, greater severity, and higher rates of domestic violence. Females present with different victimization patterns, greater severity, and higher rates of domestic violence.

35. Discussion (continued)  Recidivism rates at 12 months 41% for new charges and 32.2% for adjudications; 14.1% for felonies. Males 7.5x more likely to recidivate. These figures should be compared to other comparable juvenile justice youth. These figures should be compared to other comparable juvenile justice youth.  Significant reductions in substance use frequency, substance use problems, emotional problems, and general crime at 12 months. 18% of youth report abstinence across all three follow-up time points; 44% of youth abstinent during last six months. 18% of youth report abstinence across all three follow-up time points; 44% of youth abstinent during last six months. Of youth who report abstinence across 3, 6, and 12 months, 77% correspondence rate between self- report and drug screens. Of youth who report abstinence across 3, 6, and 12 months, 77% correspondence rate between self- report and drug screens.

36. SCY: Implications and Next Steps  Substance use frequency, substance-related problems, emotional problems, general crime, and environmental risk strongly interconnected and related to treatment outcomes.  Client comorbidity, cross-system involvement, gender differences, and victimization histories (including domestic violence) require earlier, comprehensive, coordinated, and integrated treatment responses.  Heavy reliance on residential treatment may be reduced by strengthening IOP treatment models.  Cuyahoga County is in a strong position to develop and evaluate promising IOP alternatives under the Tapestry system of care umbrella.