1. Population Parameters  Youth in Contact with the Juvenile Justice System About 2.1 million youth under 18 were arrested in 2008 Over 600,000 youth a year are placed in detention centers Over 90,000 youth reside in secure juvenile correctional settings  Mental Health Disorders Among Youth in the General Population 20% have a diagnosable mental disorder 10% have a serious emotional disturbance

2. Large number of youth in the JJ system are experiencing mental health disorders NCMHJJ (2006)70.4 % Teplin et al. (2002)69.0% Wasserman et al. (2002)68.5 % Wasserman, Ko, McReynolds (2004)67.2 % NCMHJJ

3. Types of Disorders by Gender (n=1437)--NCMHJJ Any Disorder 70.4% 66.8 % Males81.0% Females Anxiety Disorder 34.4%26.4 % Males 56.0 % Females Mood Disorders 18.3 % 14.3 % Males29.2 % Females Disruptive Disorder 46.5 %44.9 % Males 51.3 % Females Substance Abuse Disorder46.2 %43.2 % Males55.1 % Females NCMHJJ

4. How Can Systems of Care Respond?  Recognize that youth with mental health needs are found in all child serving systems- especially the juvenile justice system  Commit to partnerships with the juvenile justice system to identify ways to respond at key points of contact  Use grants to create more community-based capacity

5. Why is this so difficult? Lack of a collaborative “history”/difficulties with past collaborations Different goals, philosophies and language Youth have complex needs Youth are often a low priority

6. Critical Intervention Points Places within the juvenile justice system where opportunities exist to improve collaboration, identification, diversion and treatment for youth Secure Placement Probation Supervision Re-Entry Initial Contact and Referral Intake Detention Judicial Processing NCMHJJ

7. Collaboration Opportunities at Critical Intervention Points 1.Initial Contact: Law enforcement and the schools Specialized training for Law Enforcement Expansion of CIT programs to serve youth Crisis services for schools Training of school staff including teachers, counselors, school administrators and school resource officers on prevalence of trauma, behaviors of youth who have experience trauma, de-escalating techniques, triggers of trauma related behaviors Agency led training and supports for families whose children have been known to experience trauma Co-responding with police officer if youth is girl (trauma trained mental health professional or trained family member)

8. Collaboration Opportunities at Critical Intervention Points 2.Intake: “Gatekeeper” to Juvenile Court Creation of diversion mechanisms and programs Employ a validated trauma screening tool for all youth at this point in the process Trained staff to ask trauma informed questions of youth and to identify potential experiences that could have been traumatic to youth---based on young person’s responses and history. The questionnaire or interview should be an objective tool, not a blaming tool. If decision to return to family then follow-up with trauma assessment and services in the community

9. Collaborative Program Examples at Critical Intervention Points 3.Detention: Generally used as a short-term holding facility for youth awaiting adjudication Establishment of linkages with community-based mental health providers for clinical assessments and treatment Trauma assessment provided, if screening warrants. Trauma informed milieu Diversion program placement or services very quickly Re-traumatization can occur in detention – this may be the first separation from family –triggers and stressors in an environment that can be traumatic Accommodations and modifications

10. Collaborative Mental Health/ Juvenile Justice Initiatives 4.Judicial Processing: Adjudication and Disposition Mental Health liaisons placed in juvenile court to provide a mental health “presence” in the court Specialized courts that offer treatment in lieu of placement Judge must have screening/assessment information in order to make best informed decisions Exercise the use of diversion programs(community based)with continuous monitoring versus placement in secure care Specialized court services – girls’ court, drug court, mental health court Courts should have knowledge of each child serving agency’s services and supports (resource binder) – continuum of services/sanctions

11. Collaborative Mental Health/ Juvenile Justice Initiatives 5.Secure Correctional Placement: Most restrictive level of care in the juvenile justice system Emphasize the provision of evidence-based treatments whenever possible Training for all staff on adolescent mental health Trauma informed care models such as Sanctuary Cognitive Behavioral Therapy programming Specialized programming designed for girls Significant coordination of visits and communication between youth and family Great likelihood of re-traumatization Establish a tracking system for girls with a trauma history – seclusion, self injurious behaviors, fights

12. Collaborative Mental Health/ Juvenile Justice Initiatives 6.Probation Supervision: Most common juvenile court disposition Often accompanied with other court-imposed conditions, like treatment Trauma informed probation staff Probation should have contract with specialized community based trauma provider Agency awareness and understanding of trauma Allowances need to be provided youth with trauma history – provide greater interventions Be aware of trauma triggers and determine if a trigger contributed to behaviors that violate probation plan

13. Collaborative Mental Health/ Juvenile Justice Initiatives 7.Re-Entry: The point at which a youth transitions from placement back into the community Think “exit at entry” Provide mental health treatment planning, services and case management to transitioning youth Connect services in facility to like services in community Address trauma issues across risk and protective factors Medication compliance Track behaviors that can be attributed to triggers Prepare the home for the youth’s return and prepare the youth for return home Passes or furloughs are useful tools to aid in reentry

14. Conclusion:  Many youth with mental health needs end up in the juvenile justice system because there are no other options for them  Systems of care can partner with the juvenile justice system to develop and implement strategies that target youth at (or at risk of involvement with) key points of juvenile justice system contact