Behavioral Health and Juvenile Justice
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Transcript of Behavioral Health and Juvenile Justice
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Transforming Juvenile Justice: Integrating Systems,
Practice, and PolicyDaniel J. Flannery, PhD
Institute for the Study and Prevention of ViolenceKent State University
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Behavioral Health and Juvenile Justice First BH/JJ project 1994-1997; 3 sites in Ohio
State Departments of Mental Health & Youth Services
Strengthening Communities & Youth Juvenile offenders with substance use issues
Second BH/JJ project 2004-current; 6 sites in Ohio Three new sites exclusively focus on females
Project TAPESTRY SAMHSA Funded, Mental Health side
Integrated Co-occurring treatment (ICT) Pilot projects
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Behavioral Health and Juvenile Justice 1994-1997
Violent juvenile offenders with serious mental health issues not treatable by state juvenile justice system
• 61% taking 1-3 medications or more at intake• Mood (56%) and behavior disorders (23%) Axis I
Full Psychological Evaluations on n= 88 youth
• Significant parent mental health issues• Youth victimization and suicide risk• IQ and Learning Disability issues
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Strengthening Communities-Youth (SCY)
SAMHSA funded initiative (CSAT) with county office of Justice Affairs, Public Defender, and Catholic Charities
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SCY Demographics N= 232
82% male
53% were African-American, 29% were Caucasian
Average age=15.7 years (range 12-17)
64% were Medicaid eligible
54% lived in the city of Cleveland
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Arraignment Charges
21%
40%
9% 9%
37%
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
Assault/Menacing Property Drug/Alcohol Weapons DomesticViolence
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Substance Use
At intake: (87%) reported using marijuana in the
past 90 days
(59%) reported using alcohol in the past 90 days
13.1 years old the first time they got drunk or used any drugs
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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%)
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DSM-IV Mental DisordersDiagnosis^ Gender %1 %2 %3
Mood Disorders: depression, cyclothymic, bipolar, dysthymic, mood disorder NOS
M: 50 69% 22% 26%F: 22 31% 9.5% 52%*
Total=72 100% 31%Generalized Anxiety Disorder M: 22 65% 9.5% 12%
F: 12 35% 5% 29%*Total=34 100% 15%
Disruptive Disorders: conduct disorder, ADHD, ODD
M: 98 77% 42% 52%F: 29 23% 12.5% 69%*
Total=127 100% 55%Adjustment Disorder M: 4 100% 2% 2%
F: 0 0% 0% 0%Total=4 100% 2%
^ Categories are not mutually exclusive1 Percent of total with that diagnosis2 Percentage of N=2323 Percent of males (n=190) and of females (n=42)* higher females vs. males, p<.05
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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%)
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Externalizing and Internalizing Disorders by Gender
88%
87%
27%
51%
73%
49%
12%13%
61%
36%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
At least oneExternalizing
ExternalizingOnly
At least oneInternalizing
InternalizingOnly
BothInternalizing
andExternalizing
FemalesMales
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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
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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
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Environmental Risk
1.8
57.7
40.5
3.2
55.0
41.8
1.8
22.0
76.1
0.0
25.6
74.4
0%10%20%30%40%50%60%70%80%90%
100%
EnvironmentalRisk
Living Risk VocationalRisk
Social Risk
High
Moderate
Low
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General Victimization
Youth reported first time they were victimized at 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
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General Victimization
45.7
16.5
37.8
59.5
14.3
26.2
0%10%20%30%40%50%60%70%80%90%
100%
Males Females
None
Moderate
High
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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
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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
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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
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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
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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/IndicatedOut 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%)
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Tapestry Cross System Involvement Tapestry youth cross-system involvement using multiple self report and official data sources. Indicator Tapestry (N= 329 enrolled) Juvenile Justice 30% ever arrested, 27% have history of probation, 11% ever sentenced to a
secure facility. Substance Abuse 49% of youth report using at least one substance prior to intake, primarily
alcohol, cigarettes and cannabis/hashish.
Mental Health 100% of youth have at least one DSM-IV mental disorder, primarily ADHD (49%), Mood Disorders (43%), Oppositional defiant disorder (29%) and Adjustment Disorder (16%). 48% (n=219) reported current use of psychotropic medication.
Education
49% of 108 Tapestry youth reported receiving special education classes
Child and Family Services
Year one data (n= 169) 57% of Tapestry youth have at least one allegation of maltreatment: physical abuse (35%), sexual abuse (20%), neglect (46%) or emotional abuse (4%). 18% of Tapestry youth had a history of one or more out of home placements.
Medicaid 88% of youth are Medicaid eligible and have received Medicaid services.
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Substance Problems Scale Over Time
1.31.6
0.9
3.7
00.5
11.5
22.5
33.5
4
Intake 3mo 6mo 12mo
Substance problems in the past month
Statistically significant decrease: Intake to 3 months Intake to 6 months Intake to 12 months
Statistically significant increase: 3 months to 6 months
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Substance Use Over Time
8.3
35.7
8.310.9 11.8
2.52.41.91.41.51
5.905
10152025303540
Intake 3mo 6mo 12mo
AlcoholDrunkenessMarijuana
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Abstinence
Youth reporting abstinence: Intake - 16 youth (7%) 3 months - 113 youth (49%) 6 months - 102 (44%) 12 months - 103 (44%)
Overall, only 18% (n=42) of youth reported abstinence at all follow-up periods (3, 6, and 12 months)
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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) 24 (77%) had abstinence corroborated
by urine screen data (had all negative screens)
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Emotional Problems Scale Over Time
0.130.150.15
0.21
0
0.05
0.1
0.15
0.2
0.25
Intake 3mo 6mo 12mo
Emotional Problems over time
Statistically significant decrease: Intake to 3 months Intake to 6 months Intake to 12 months 6 months to 12 months
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General Crime Scale Over Time
0.620.720.64
3.39
00.5
11.5
22.5
33.5
4
Intake 3mo 6mo 12mo
General Crime over time
Statistically significant decrease: Intake to 3 months Intake to 6 months Intake to 12 months
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Behavioral Health and Juvenile Justice 2004- current
Similar population of violent juvenile offenders (age 10 to 18) in 6 urban and rural counties Evidence-based treatment program
Female offenders On-site data managers
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Preliminary Data
429 enrolled Cuyahoga – 35 Fairfield – 11 Franklin – 119 Logan/Champaign – 189 Montgomery – 57 Union – 18
Gender 51.5% male
Average Age = 16 years 64% Caucasian; 29% African-American
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Victimization Data
Question Females MalesHas the child ever been physically abused?
25% 17%
Has the child ever been sexually abused? 36% 6%
Has the child ever had a problem with substance abuse?
45% 40%
Has the child ever talked about committing suicide?
52% 38%
Has the child ever attempted suicide? 24% 9%
Has the child ever witnessed domestic violence?
50% 42%
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Diagnoses
At intake, 31% of the children were already on medication for emotional/behavioral symptoms
At intake, 30% of the youth have co-occurring mental health and substance abuse diagnoses Females ODD, Cannabis use, ADHD, bipolar,
PTSD Males ADHD, Cannabis use, CD, ODD, depression
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Substance Abuse
Have you ever had an alcoholic beverage? Yes: 66%
Have you ever been drunk? Yes: 69%
Have you ever smoked a cigarette? Yes: 69%
Have you ever smoked marijuana? Yes: 70%
Have you ever used cocaine? Yes: 14%
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Substance Abuse
Average Age of initial use: Cigarette: 11.8 years Alcoholic drink: 13.1 years Marijuana: 13.0 years Cocaine: 14.6 years
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Substance Abuse Change
In the past 6 months, how often did you drink an alcoholic beverage? Once a month or not at all
Intake: 65% 6 months: 81% Discharge: 80%
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In the past 30 days, how many days have you used:
Substance Use Change
0
5
10
15
20
25
30
Intake 6 Months Discharge
Interval
Ave
rage
Num
ber o
f Day
s
AlcoholCigarettesMarijuanaCocaine
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Ohio ScalesOhio Scales Problem Severity Scale(lower scores - less problem severity)
0
5
10
15
20
25
30
Intake 3 months 6 months 9 months Discharge
Interval
Scor
e ParentChildWorker
*statistically significant differences between Intake and last measurement
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Ohio ScalesOhio Scales Functioning
(higher scores - greater functioning)
0
10
20
30
40
50
60
70
80
Intake 3 months 6 months 9 months Discharge
Interval
Scor
e ParentChildWorker
*statistically significant differences between Intake and last measurement
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Ohio Scales
Ohio Scales Hopefulness(lower scores - greater hopefulness)
0
2
4
6
8
10
12
14
Intake 3 months 6 months 9 months Discharge
Interval
Scor
e
ParentChild
*statistically significant differences between Intake and last measurement
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Ohio ScalesOhio Scales Satisfaction With Services
(lower scores - greater satisfaction)
0
2
4
6
8
10
12
Intake 3 months 6 months 9 months Discharge
Interval
Scor
e
ParentChild
*statistically significant differences between Intake and last measurement
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Integrated Co-occurring treatment (ICT)
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Home-Based ServiceDelivery Model
Location of Service: Home & Community
Intensive: 2-5 sessions/wk Crisis Response 24/7 Small caseloads: 3-6 families Flexible: Convenient to
family Treatment Duration: 12-24 weeks
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ICT Youth Usual Services Comparison
Group
Size of Difference in commitment
and/or recidivism rates
56 youth 25% recidivism rate
29 Youth 72% commitment rate
Chi Square (1, 29): 17.74 Level of significance: .001
Results of ICT Study (2001-2002)
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Ohio Scales Gain Scores (2005 – October 2006)General Clinical Population
(Statewide) ICT Participants
30 days 180 days Gain 30 days 180 days Gain
Problem Severity Adult 28.60 22.74 5.86 31.28 19.38 11.90
Problem Severity Child 23.93 18.85 5.08 30.33 19.48 10.85
Hopefulness Adult 12.29 10.60 1.69 13.52 10.88 2.64
Hopefulness Child 10.60 9.44 1.16 13.09 10.18 2.91
Satisfaction Adult 8.87 6.42 2.45 10.25 7.25 3.00
Satisfaction Child 10.60 8.53 2.07 10.13 8.05 2.08
Functioning Adult 44.98 48.65 3.67 36.20 44.71 8.51
Functioning Child 55.75 59.34 3.59 49.42 58.76 9.34
Total = 27 youth; 3 ODYS Commitments
For "Functioning", the higher the score the better - for all others, the lower the score the better
Clinical cutoffs= 20 for problem severity and 51 for parent rating functioning and 60 for youth rated functioning
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Implications and next steps
Growing population of offenders with MH and SA issues
Community-based care vs. incarceration Evidence-based treatment using comprehensive
assessments of risks and strengths Collaboration across systems can work! Data driven decisions for practice and policy Shared vision can help plan for sustainability Infrastructure and funding for integrated treatment Cultural competency matters in treatment decisions