1. Building a Juvenile Justice System of Care

2. A Juvenile Justice System of Care—A Comprehensive Approach Definition and recognition of the problem Screening and assessment to identify the problem Integrated systems approach Matching both risks & needs to appropriate interventions through a continuum of care that integrates both accountability (e.g., graduated sanctions), social interventions, and treatment interventions Utilizing a strengths-based approach to assessment and service provision Family involvement/engagement Culturally competent/gender appropriate programming Commitment and investment from key stakeholders, interested parties, supervisors, and line-staff

3. Defining Screening & Assessment Screening: A brief process used to identify offenders who have a particular characteristic Assessment: A more thorough investigation into this characteristic to assess the extent and level to which it exists and the appropriate system response it requires Used for multiple purposes—in particular, they are used for two purposes in the juvenile justice system To measure offender risk for reoffending Detention screening tools Risk/need assessment tools To measure whether an offender has any mental health problems and/or substance abuse problems

4. What is Screening for Mental Health & Substance Abuse The problem: Juvenile justice personnel are not trained as mental health professionals or substance abuse counselors—how can they identify the presence of a problem? Solution: Screening Screening=brief process used to identify youth who are at-risk of having disorders that warrant immediate attention, intervention, or more comprehensive review (e.g., Massachusetts Youth Screening Instrument, Version 2: MAYSI-2) Facilitates a “triage” process No special training (or minimal training) is required to administer screening tools Scoring thresholds provide valuable information to “next step”

5. What is Assessment for Mental Health and Substance Abuse? An assessment is completed by certified mental health professionals Substantively, it is a comprehensive examination of: Psychosocial needs and problems Type and extent of mental health and substance use disorders Other issues associated with the disorders Recommendations for treatment Requires much more time than screening Can be administered at regular intervals to measure the impact of recommended supervision levels and treatment programming Many screening and assessment tools exist—therefore, it is critical to choose the tools that are most appropriate for the population on whom it will be used NEW RESOURCES Thomas Grisso, T. Vincent, G., & Seagrave, D. (2005). Mental Health Screening and Assessment in Juvenile Justice. New York: Guilford Press. http://www.umassmed.edu/nysap/about.cfmhttp://www.umassmed.edu/nysap/about.cfm Screening and Assessing Mental Health and Substance Use Disorders Among Youth in the Juvenile Justice System: A Resource Guide for Practitioners http://www.ncjrs.org/pdffiles1/ojjdp/204956.pdfhttp://www.ncjrs.org/pdffiles1/ojjdp/204956.pdf

6. Juvenile Justice Risk Assessment Simultaneously, juvenile justice agencies should also assess a youth’s level of risk by consistently utilizing a standardized risk/need tool Use of the tool provides several advantages: Provides a scoring threshold for level of risk Provides the basis for a case plan for supervision and intervention Serves as the baseline for measuring change in behavior over time Creates a level playing ground for offenders Examples of risk/need tools: Youth Level of Service/Case Management Inventory (Hoge & Andrews, 1995), Washington State Juvenile Court Assessment

7. How Should Screening & Assessment be Used? Screening AssessmentIntervention --Pre- Adjudication: Further assessment & intervention is voluntary --Post- Adjudication: Assessment & Intervention can be mandatory If problem is indicated, offender is referred to more thorough assessment by MH/SA professional DSM-IV Diagnosis Based on the professional’s assessment, appropriate level of treatment is provided—this information is combined with the risk assessment outcome to ensure integrated levels of accountability & treatment

8. When Can Screening & Assessment be Used?

9. Achieving a Comprehensive Response through a Juvenile Justice System of Care

10. Barriers to Providing Effective Services Herz, D. & Poland, A. (2002). Assessing the Need for and Availability of Mental Health Services for Juvenile Offenders http://www.ncc.state.ne.us/documents/other/mental_health.htm Focus groups held with detention facility staff, probation officers, Office of Juvenile Services personnel, and treatment providers Surveys sent to judges, county attorneys, and public defenders Barriers identified by these groups: Few resources/funds Caseload size and time available No standardized process screening and assessment Lack of availability of appropriate services Inappropriate placements Funding drives placements rather than need Delays in Medicaid processing

11. Barriers to Effective Services, Continued Inconsistent quality of treatment services Removal of family from process System’s reactive approach Interagency conflict & turf boundaries Lack of cross-training across juvenile justice and behavioral health Lack of cross-training across juvenile justice agencies Lack of training for providers on antisocial behavior Politics Availability in rural areas Bilingual services/culturally and gender specific services

12. The Solution: Integrating SA, MH, and Justice Responses Requires a shift in organizational cultural thinking in juvenile justice and behavioral health Shared responsibilities rather than a shift from one system to another Utilizing evidence-based programming within a continuum of care to address both risk and need Build programming around youth and family strengths Using a matrix of risk/need as an example

13. Integrating Responses: The Matrix Example Level of Risk Level of Need LowModerateHigh LowDiversion+ prev./educational interventions Traditional probation + prev./educational interventions (ART) Intensive supervision to correctional placement + prev./educational interventions (ART) ModerateDiversion + outpatient/intensive outpatient care Probation + Outpatient/Intensive outpatient care to Drug/MH Courts Drug/MH Courts to Multisystemic Therapy (MST) HighResidential treatment care + restorative justice programming Intensive probation+ outpatient/intensive outpatient care to residential treatment/correctional placement MST to residential care that combines correctional structure & intensive mental health treatment

14. Key Components to Service Delivery Utilizing a strengths-based approach to assessment and service provision Measure youth and family strengths and incorporate them into programming Family involvement/engagement Make family a central component to intervention Have alternatives in mind when incorporating families is not possible Culturally competent/gender appropriate programming Recognize differences and the value of traditional cultural values and beliefs Incorporate individual/group experiences into evidence-based programming

15. Moving Toward a Comprehensive Response

16. What Does it Take? Identification and inclusion of stakeholders Support from policy-makers and agency heads Working agreements across agencies Inclusion and overcoming philosophical differences—finding room for compromise Building trust in the other systems and fulfilling obligations

17. Who are the Stakeholders? (People impacted by a decision or with the ability to impact a decision) Community: Schools, victims, media, local policy makers, state legislators, advocacy organizations, businesses, parents and youth JJ: Police, Detention Personnel, Prosecutors, Defense Attorneys, Judges, Probation Officers, State Juvenile Correctional Agency, and Parole Officers MH & AOD: Healthcare organizations, Substance Abuse Provider Organizations, Mental Health Organizations, State SA and MH Authority

18. Consequences of No Intervention and/or Ineffective Intervention Consequences for System Processing Inappropriate use of detention Swinging pendulum between juvenile justice and behavioral health System conflicts & Funding manipulation Consequences for System Responses Availability of resources and treatment providers Using appropriate levels and types of treatment and accountability Effective outcomes Consequences for Youth Missed opportunities for prevention and to improve youth’s quality of life Missed opportunities Race & gender disparities Serious offenders

19. In Summary, A Comprehensive Response is Critical Because… It increases public safety and enhances public health simultaneously It promotes positive outcomes for offenders, families, and communities It is a more efficient use of resources and is accountable for the impact it is having It stresses resource and experience sharing across systems It increases the likelihood that juvenile justice will reach its intended mission