JUVENILE REHABILITATION ADMINISTRATION

An Overview of the Continuum of Care and Integrated Treatment Model

Presented by Kelly Dahl

North Sound Systems of Care Training InstituteWestern Washington University

August 25, 2010

Presentation Overview

Juvenile Justice in Washington State

An Overview of JRAOrganizational Structure

Facts and Figures

JRA’s Integrated Treatment ModelResidential and Community Applications

CBT/FFP Basic Principles

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Juvenile Justice in Washington State

Juvenile Justice in Washington State is governed by Title 13 of the Revised Code of Washington (RCW)

The Juvenile Justice Act of 1977 (RCW 13.40) – Intent and Purpose

• Make the juvenile offender accountable for his or her criminal behavior

• Provide due process for juveniles alleged to have committed an offense

• Provide necessary treatment, supervision, and custody for juvenile offenders

• Provide for the handling of juvenile offenders by communities whenever consistent with public safety

• Develop effective standards and goals for the operation, funding, and evaluation of all components of the juvenile justice system and related services at the state and local levels

• Encourage the parents, guardian, or custodian of the juvenile to actively participate in the juvenile justice process

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Determinate Sentencing and Sentencing Guidelines - court sets minimum and maximum sentence determined by offense seriousness and criminal history

“The goal of a determinate sentencing system is to ensure that offenders whose offenses and criminal histories are similar receive substantially similar sentences.” (Juvenile Disposition Manual 2006)

Manifest Injustice sentences – mitigating and aggravating factors may result in sentencing outside of a standard range

“When a court finds that a presumptive sanction would amount to an excessive penalty or would impose a serious and clear danger to society, it may impose a disposition that departs from the standard range.” (Juvenile Disposition Manual 2006)

Continued: Juvenile Justice in Washington State

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A+ 180 weeks to age 21 for all category A+ offenses

A 103 - 129 weeks for all category A offenses

A-15-36

weeks

52-65

weeks

80-100

weeks

103-129

weeks

103-129

weeks

B+15-36

weeks

15-36

weeks

52-65

weeks

80-100

weeks

103-129

weeks

B Local

SanctionsLS

15-36

weeks

15-36

weeks

52-65

weeks

C+ LS LS LS15-36

weeks

15-36

weeks

C LS LS LS LS15-36

weeks

D+ LS LS LS LS LS

D LS LS LS LS LS

E LS LS LS LS LS

0 1 2 3 4 or more

CU

RR

EN

T O

FF

EN

SE

CA

TE

GO

RY

WASHINGTON STATE J UVENILE OFFENDER SENTENCING GRID - STANDARD RANGE

PRIOR ADJ UDICAT IONS

The Community Juvenile Accountability Act of 1997

CJAA is enacted into law “to provide a continuum of community-based programs that emphasize the juvenile offender's accountability for his or her actions while assisting him or her in the development of skills necessary to function effectively and positively in the community in a manner consistent with public safety.” (RCW 13.40.500)

This established Evidence Based Practices funding for:

• Functional Family Therapy (FFT)• Aggression Replacement Training (ART) • Multi Systemic Therapy (MST)• Coordination of Services (COS)

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Continued: Juvenile Justice in Washington State

Evidence Based Practices Outcome Evaluations

Legislatively required evaluation was conducted to see if their

investment in Evidence Based Practices was effective.

Washington State Institute for Public Policy (WSIPP) conducted the

study

August 2002 interim outcome evaluation completed

• Competence in and adherence to an Evidence Based Practice is

critical to the effectiveness of the intervention

• $7.50 of cost benefit*

• 30% recidivism reduction

*Cost Benefit = the savings from avoided crime costs for each tax dollar spent on the program.7

DSHS Mission

Improve the safety and health of individuals, families and communities by providing leadership and establishing and participating in partnerships.

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Protect the public, hold juvenile offenders accountable, and reduce criminal behavior through a continuum of preventative, rehabilitative, and transition programs in residential and community settings

JRA’s overall goal is to enhance public safety by preparing delinquent youth to become confident, competent, responsible adults

JRA Mission

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JRA Organizational Structure

Institution ProgramsOversees 4 institutions and 1 basic training camp.

Community ProgramsManages parole services, six community residential facilities (group homes), and two contracted community programs .

Operations Support ServicesProvides fiscal oversight and operational support to the JRA divisions of Community Programs, Institution Services, and Treatment and Intergovernmental Programs.

Treatment and Intergovernmental ProgramsResponsible for developing treatment program policies and standards. Oversees the Interstate Compact Program.

Youth committed to JRA custody by local juvenile courts have typically:

Committed a serious violent offense, or

Committed a series of minor offenses over time and exhausted local sanctions and interventions, and

Have an average sentence of 40 weeks

JRA Youth Profile

JRA Youth Profile (7/8/10)

3% of youth arrested in WA end up in JRA

Male:Female 11:1

(2004)

Ethnic Breakdown: JRA State (0-17)• White/Non-Hispanic: 45% 73%• African American: 19% 5%• Hispanic: 20% 13%• Native American: 3% 2%• Asian: 4% 7%

Age range of incarcerated: 8-20• 40% (261) are 16 or younger• 52% (343) are 17 and 18 years old

Residential Population Characteristics*

Mental Health: 62% Chemical Dependency: 55% Cognitive Impairment: 43% Sex Offender/Misconduct: 27% Medically Fragile: 3%

Two Issues: 46% Tri-Issue: 38% Quad-Issue: 5%

*January 26, 2010 Snapshot Data

Residential Offense ProfileTypes of Current Offenses:

# % Robbery 154 23.3Assault 142 21.5Burglary 113 17.1Other Sex Offense 60 9.1Rape/Rape of a Child 46 7.0Other Offense 26 3.9Murder/Manslaughter 20 3.0Theft 20 3.0Motor Vehicle Theft 20 3.0Weapon Offense 19 2.9Drug Offense 19 2.9Arson 9 1.4Parole Revocation 6 0.9Malicious Mischief 5 0.8Poss. Stolen Prop. 3 0.5Kidnapping 2 0.3Escape 1 0.2Forgery 1 0.2Criminal Trespass 0 0.0

n=660 July 8, 2010

Youth in JRA care are at the very deep end of the juvenile justice system.

Their service and intervention needs are both acute and complex.

61% are Violent Offenders

18% have 8 or more prior offenses

JRA Facilities and ProgramsInstitutions (598 Beds – actual pop. = 570, 7/8/10)Green Hill School, Chehalis Naselle Youth Camp, NaselleMaple Lane School, Centralia Camp Outlook, ConnellEcho Glen Children’s Center, Snoqualmie

State Community Facilities (92 Beds – actual pop. = 83, 7/8/10)Canyon View, Wenatchee Oakridge, TacomaParke Creek, Ellensburg Ridgeview, Yakima (female)Twin Rivers, Richland Woodinville, Woodinville

Contracted Programs (9 Beds – actual pop. = 7, 7/8/10)Residential Treatment & Care, Spokane (6)Benton/Franklin STTP (Short Term Transition Program) (3)

Functional Family Parole Services (433 Youth, 7/8/10)Region 1, Spokane Region 4, SeattleRegion 2, Yakima Region 5, Tacoma, BremertonRegion 3, Everett, Mount Vernon Region 6, Olympia, Vancouver

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JRA Continuum of Care

Residential Care: 669 youth (7/8/10)Average Length of Stay: 44 Weeks (2010)

Institutions and Basic Training Camp

Community Facilities

Parole: 433 Youth (7/8/10)Range = 4 to 6 monthsSex Offense = 24-36 months

CountyJuvenile Courts:

Youth w/ Criminal offenses committed to

JRA

Residential Placement in

JRA

JRAParole

Residential Services Integrated Treatment Model: Dialectical Behavior Therapy (DBT/CBT)

Aggression Replacement Training ( ART)Moral Reconation Therapy (MRT)Residential Treatment and Care Program

(RTCP); aka Multidimensional Treatment Foster Care (MTFC)

Family Integrated Transitions (FIT) Individual and Group TherapyPsychiatric & Psychological ServicesMedication & Med. ManagementEducation/Vocational TrainingChemical Dependency/Abuse TreatmentSex Offender TreatmentRecreationCultural Programs

Parole ServicesIntegrated Treatment Model Functional Family Parole Functional Family Therapy Family Integrated TransitionsConnected to MH services Medicaid EligibilityLimited contracted MH Transitional ServicesSex Offender TreatmentDASA CD ServicesDDD CoordinationAggression Replacement Training (ART)MentoringCommunity Connections

No Longer Under JRA Jurisdiction

Community Connections / Resources

MHTP:

RSN's: Medicaid Eligible

Private Insurance

No Insurance—Private pay or are unserved

Screening, assessment, & testing for placement, treatment planning & service delivery

(Diagnostic, Chemical Dependency/Abuse, Client History, GAIN-SS, Suicide & Self-Harm Screen, Aggression/Vulnerability)

JRA Placement and Treatment Continuum

Framework for working with youth and their family

Committed to JRA/Placement Determined

• Diagnostic Process

• Institution• Youth Camp• Basic Training Camp• Community Facility

JRA Residential Services

• Screening / Assessment• School / Vocational• CBT/DBT skills training and

coaching• Medical services• Specialized treatment

45 Days before release—Transition meeting w/Family:

• Parole or No Parole• Living arrangements• Service Connections

Functional Family Parole Engage & Motivate

Support and Monitor Services

Generalize Skills

• Whole Family Involved

OUTCOMES

Youth Discharged from JRA

JRA Integrated Treatment Model (ITM)JRA implemented the Integrated Treatment Model (ITM) in 2003 to address the acute and complex treatment needs of youth committed to JRA care. The ITM incorporates best-practice and evidence-based interventions to address the needs of youth and their families from the point of admission through completion of parole aftercare.

Lessons Learned

Failure to adhere to and competently deliver evidence-based intervention models can, in fact, be counter productive

Success requires strict model adherence with supporting quality assurance and consultation

Environment is critically important to achieving positive outcomes. JRA is working hard to establish residential environments that make possible and support therapeutic intervention

JRA INTEGRATED TREATMENT MODELThe 5 Critical Functions of Treatment

JRA Treatment Services

EVIDENCE BASED SERVICES:Dialectical Behavioral Therapy Functional Family ParoleCognitive Behavioral Therapy Functional Family Therapy Aggression Replacement Training MentoringFamily Integrative Transitions (FIT)

MODES OF TREATMENTIndividual CounselingGroup Skills TrainingMilieu Treatment

SPECIALIZED TREATMENT OTHER SERVICESMental Health Psychiatric Substance Abuse Medical/DentalSex Offender EducationVocational Training Recreation

What the ITM Creates

A uniform set of skills

Behavioral targets that are clearly identified and addressed in a systematic fashion

Addresses youth and family issues in the context in which they occur

Identifies the role of staff across the continuum-of-care

Treatment approaches that vary based on the youth and family needs

Treatment plans are individualized Multidisciplinary Team approach across continuum

JRA Integrated Treatment Model

Principles – teaching, shaping, coaching, and reinforcing positive behavior

Developing skills for socially responsible living

Institutions:

Assess treatment needsBegin process of adaptive skill development

Community Residential Facilities:

Transition youth and practice skills in a community setting

Parole Aftercare:

Support for generalization and maintenance of skills Engagement of families in youth rehabilitation

Finding Treatment Priorities

Mental Health

Substance Abuse

Offense (Robbery)

Family Issues

TREATMENT

HIERARCHY

A. Recent (or Historic) Parasuicidal Ideation, Threats, or Behavior.

B. Recent (or Historic) Aggressive Ideation, Threats, or Behavior.

C. Recent (or Historic) Escape Ideation, Threats, or Behavior.

D. Recent or Current Treatment-Interfering Behaviors.

E. Significant Quality of Life issues.

INITIAL CUE

VULNERABILITIESTARGET

BEHAVIOR

CONSEQUENCESLINKS

Analyze the chain of eventsmoment-to-moment over time (Behavior

Chain Analysis)

Function and Other Drivers

Understanding the Problem

BCA

Vulnerabilities

Cue

Links

Target Behavior

Outcomes

Substance Abuse

CBT/DBT Skill Modules

Mindfulness or ObservingYouth who are impulsive, Excessively judgmental, Easily

distracted, Rigid thinkers, Youth who have difficulty solving problems

Interpersonal EffectivenessUnstable relationships, History of loss and grief issues, Poor

peer selection, Lack of respect, and Lack of social skills Emotion Regulation

Intense anger, Intense shame, Emotional instability, and Low tolerance to frustration

Distress ToleranceEgregious suicide behavior, Acts of aggression, Impulsive self destructive behavior, Substance abuse or addiction, and

Compulsive criminal behavior Problem Solving

Anger, Aggression, and Social skills

Treatment Planning Summary

Mental Health

Substance Abuse

Family Issues

TREATMENT

HIERARCHY

Substance Abuse

State the TargetDescribe the FunctionPick Skills with Similar

FunctionIdentify Steps to Block

OutcomesIdentify Steps to Increase

Skillful BehaviorIdentify Cue Management

Plan

ITP

BCA

Vulnerabilities

Cue

Links

Target Behavior

Outcomes

Function and Other Drivers

Robbery

Linked ProcessesClient History Review &Behavior Chain AnalysisFlo

w s

hou

ld b

e v

isib

le

Our Daily Interactions with our Clients

Drives Content & Structure of

Integrated Treatment Plan

Determine Content for

Intervention PlanSkill Selection

Treatment Focus

Functional Family Parole

CORE PRINCIPLES

Working Alliance

Relational (Family) Focus

Strength Based

Respect

Matching

Advantages of Family Focus

Issues arise through family and can begin to be solved there

With the family involved, changes can happen quicker...

IF we can engage and motivate them

Family can support youth more effectively than youth on his/her own

Involvement is the first step toward persuasion…

MATCHING is a fundamental requisite for effectively engaging and changing families

Match to the phase of your responsibility - Do the right thing at the right time.

Match outcome goals to the family – Identify and strategize steps to become functional and positive within their own culture, communities, realities, etc.

Match to the clients - Do what it takes for them to feel you are working hard to respect and understand them, their language, norms, etc.

mismatch results in “resistance”

Engagement

Motivation

ENGAGEMENT and MOTIVATION GOALS

Address and Reduce Negativity, Blame and Hopelessness

Create a Relational Focus

Maintain Balanced Alliance with all Participants

Help the Family see Different and More Productive Solutions

FFP SkillsChange Focus – from individual to relational

Relationship building – humor, curiosity, acknowledgement, strength based statements

Point processingSequencingInterrupting/Diverting

Change Meaning – from blame and negativity to noble but misguided intent

Re-labelReframeThemes

What is Reframing?

Reframing is an Interpersonal Process in which the you take the lead in suggesting that a problem behavior may not necessarily only have a malevolent motive; instead it could also include a more positive (but very misguided) intent.

How to do it…

1. Validate/ AcknowledgeThe people involved and “the problem”Validate the emotion/pain the “bad behavior” produced

2. Reframe motive, intention, goal, underlying emotional state—it’s not giving reasons or excusing behavior

3. Assess acceptability/fit

4. Change/continue

Moving from Engagement and Motivation to Support and Monitor

If we’ve consistently matched to, established a balanced alliance, created a relational focus, decreased negativity and blaming and created a sense of hope…

We will also have created a motivational and informational base, which results in having the necessary credibility to match the youth/family to a program or offer recommendations that will help them make or continue necessary changes

Support and Monitor goals/activities

Activities:• Monitor and support change • Structure supportive activities• Encourage and reinforce family

members (and providers?)• Be an advocate of effective

services/programs

Goals:• Move to less active role• Support family and change agent• Ensure program has effective

change process and element• Eliminate barriers

Support and Monitor Service and Activity Plans

Support Activities Employment Spiritual Related Youth oriented

recreation/leisure Family oriented

recreation/leisure Any significant, regularly

occurring activity that impacts risk/protective factors

Monitor Services Education Treatment

Mental health, YSO, Drug/Alcohol, FFT, FIT, MST, ART

Mentoring Employment Training

Generalization Phasegoals/activities/focus

Activities:• use the community• maintain community contacts• family case manager role• target generalization change

based on relational assessment

Focus:• relationships between the family and community• using assessment knowledge

Goals:• become active again• reinforce positive

change• help generalize change

GeneralizeSupport & Monitor

PRERELEASE

PREP

POS I T I VE

TERMI NAT I ON

Engage & Motivate

Link to…Gen

’liza

tio

nEvidence-Based or other

Change Program

Link

to…

Maintain Facility Treatment Plan (no additional services)

Gen’lization

Linking to Change ProgramLinking skills learned in facility to community context

Support and Monitor Program and Fit of Skills to Community Context

Relapse Prevention

1. Identify situations where problem may occur

2. Identify strategies to use when problem reoccurs

3. Predict the problem to reoccur (The best predictor of

future behavior is past behavior)

4. Repetitive skill use and reinforcement helps build

expectation that new skills will work in similar/different

situations over time

The OutcomesCognitive Behavioral Therapy in Residential Care Since implementing the Integrated Treatment Model, JRA has seen a 60% reduction in assaultive behavior in institutions and similar reductions in calls from living units for security staff assistance, also reductions in self-harm behavior

Dialectical Behavioral Therapy (DBT) and it’s related skill sets is the primary cognitive-behavioral intervention used with youth in JRA residential care. A 2002 WSIPP study of JRA youth involved in a DBT pilot-program at Echo Glen Children’s Center shows a 15% reduction in 18 month felony recidivism. However, a future study with a larger sample size is needed to determine conclusively if DBT reduces recidivism

Family Integrative Therapy (FIT) is an intervention for youth with co-occurring mental health and substance abuse disorders that uses a combination of evidence-based approaches involving youth and their families. The program begins in residential care and continues when youth are released to parole supervision. A 2004 WSIPP study shows a 33.5% reduction in felony recidivism for youth involved in FIT and future cost savings of $3.15 for each dollar spent

Functional Family Parole (FFP) In a recent study conducted by the University of Indiana, 30 percent of youth who received FFP from highly adherent counselors were convicted of a new felony within 12-months of release compared with 35 percent of the matched control group. An 18 month post release study is being finalized

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SPECIAL THANKS TO…

DAN SCHAUB, JRA Mental Health Program Administrator

LAURIE HART, JRA FFP Program Administrator

PAMALA SACKS-LAWLAR, JRA Substance Abuse Administrator

LISA MCALLISTER, JRA FFT Quality Assurance Administrator

DR. HENRY SCHMIDT, Former JRA Clinical Director

…FOR THEIR HELP AND INPUT INTO THIS PRESENTATION