Youth in the Juvenile Justice System
David A. D’Amora, M.S., LPC, CFC Council of State Governments Justice Center | 1
TURBULENCE OF ADOLESCENCE : THE PERFECT STORM
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Predisposing Factors: The Perfect Storm Puberty
Beliefs
Brain
Peer Pressure
Media
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Brain Differences (Adolescent vs. Adults) • • • •
Affect Regulation Rational Perspective Taking Impulse Control Empathy
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Attachment: Developmental Concerns Biological • Limbic System – Emotional Regulation • Frontal Lobe – emotional, behavioral, reasoning and problem solving (mature at approximately age 23-25) • Frontal lobe also inhibits aggression
• • • • •
Environmental Family Peers School Community Organizations
Fanff & Becker (2006) Council of State Governments Justice Center | 7
Attachment Styles
Avoidant Attachment • Keeps distance from others
Resistant Attachment • Ambivalent towards others
Disorganized Attachment • Externalized behavioral problems and controlling others
Fanff & Becker (2006) Council of State Governments Justice Center | 8
Studies on Prevalence of Mental Illness in Juvenile Justice System Duclos (1988): • American Indian youth detainees; • 49% with > 1 MH or SA disorder; • 12.7% had 2+ disorders; • 8.7% had 3+. Most common dx: • SUD (38%), CD (16.7%), and MDD (10%). • Females higher rates of dx.
VanderStoep, Evens, & Taub (1997):
Shelton (2007; Maryland JJ System):
• High risk of referral of Latino youth to juvenile authorities for behavioral difficulties.
• Used DISC plus <60 cutoff on the C-GAS; • 53% had diagnosable mental disorders on DISC but above C-GAS cut-off; 46% met both criteria; • 26% of youth need immediate MH services; only 14% need restrictive environment by severity and offenses.
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Studies on Prevalence of Mental Illness in Juvenile Justice System Rogers et al. (2001, 2002):
Wasserman et al. (2002):
â&#x20AC;˘ Under-referral of minority youth in detention and incarceration facilities.
â&#x20AC;˘ Assessed 292 detained youth; rates of disorder similar to prior studies. â&#x20AC;˘ High rates disruptive, SUD, anxiety and mood disorders, over 3% report past-month suicide attempt. Council of State Governments Justice Center | 10
Mental Health Disparities Faced by Minority Youth • • • • •
Lack of child MH services (younger populations) Misdiagnosis Increasing rates of psychopathology Access to community-based MH services Access to evidence-based treatments (psychotherapy, pharmacotherapy) • Over-institutionalization (inpatient, commitment, child welfare, juvenile justice)
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Disproportionate Psychosocial Morbidities in Minority Youth School drop-out
• Highest in Latinos (only 40 % graduate from HS)
Teen pregnancy
• High in Latinas and African-Americans
Violence and Criminal Activity
• High in inner citites and reservations
Suicidality Substance Abuse Institutionalization
• African-American males, Latinas, and American Indian youth • Latinos and American Indians particularly
• Rising numbers in child welfare and juvenile justice
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Disparities in Diagnosis Minority youth Over-diagnosis of disruptive disorders and psychoses Diagnosis correlates to minority status
African-American youth
Latino youth
• Over-diagnosis of conduct disorder, psychosis, and substance abuse • Under-diagnosis of mood and personality disorders • African-American youth were more likely to be rated as having a lower ‘level of functioning’ rather than a learning disorder
• More likely to be diagnosed with adjustment disorders, anxiety disorders, and psychotic disorders • Less likely to be diagnosed with ADHD than Non-Hispanic Whites. • Language in evaluation leads to differences in diagnosis with Hispanics, even with bilingual patients.
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Solutions for JJ/MH Crisis • Community-based systems of care model • Evidence-based interventions • Improving access to MH services for minority youth • Culturally competent services
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The Risk-Needs-Responsivity Model Applied to JuvenilesAdding
theWorks
1
• Validated assessment of risk/need is imperative to determine the best interventions. (Risk/Need Principles)
2
• Supervision strategies should correspond with the risk of recidivism. (Risk Principle)
3
• Programming and treatment designed to target criminogenic needs are necessary components of interventions. They should be theorydriven and based on current research. (Need/Treatment Principles)
4
• Individualize intervention strategies to increase the responsiveness of each youth. (Responsivity Principle)
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What the Research Tells Us Works
1
â&#x20AC;˘ Validated assessment of risk/need is imperative to determine the best interventions.
Risk of recidivism Risk principle â&#x20AC;&#x201C; use standardized and validated measures of risk/need to determine which youth should receive
Risk principle tells us WHO
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What the Research Tells Us Works
1
• Validated assessment of risk/need is imperative to determine the best interventions. (Risk/Need Principles)
2
• Supervision strategies should correspond with the risk of recidivism. (Risk Principle)
3
• Programming and treatment designed to target criminogenic needs are necessary components of interventions. They should be theorydriven and based on current research. (Need/Treatment Principles)
4
• Individualize intervention strategies to increase the responsiveness of each youth. (Responsivity Principle)
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Risk Principle in Action Match risk level with supervision & programming
Programming Higher Risk
Supervision
Juveniles with a higher risk for recidivism should receive more intensive services for a longer period of time
Juveniles with a lower risk for recidivism have fewer problems and do not require intensive services Council of State Governments Justice Center | 18
Risk Principle In Action
Lower Risk Youth Higher Risk Youth Keep lower risk and higher risk youths separate in residential settings and in groups Council of State Governments Justice Center | 19
Violating the Risk Principle Youth at lower risk of recidivism being over supervised and over treated Best option â&#x20AC;&#x201C; no reduction in recidivism
Low risk youth Supervision & Programming
Worst case â&#x20AC;&#x201C; causing harm to the youth
Over treating and supervising disrupts the factors that make the youth at low risk of recidivism Council of State Governments Justice Center | 20
Violating the Risk Principle Youth with a higher risk for recidivism being under supervised and under treated Violating the risk principle for higher risk youth results in increasing in recidivism
Low supervision & no programming High risk youth
Not enough supervision /control to reduce behavior
Not enough intensity of programming to disrupt risk factors Council of State Governments Justice Center | 21
What the Research Tells Us Works
1
• Validated assessment of risk/need is imperative to determine the best interventions. (Risk/Need Principles)
2
• Supervision strategies should correspond with the risk of recidivism. (Risk Principle)
3
• Programming and treatment designed to target criminogenic needs are necessary components of interventions. They should be theorydriven and based on current research. (Need/Treatment Principles)
4
• Individualize intervention strategies to increase the responsiveness of each youth. (Responsivity Principle)
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Need Principle • Identify the criminogenic needs (dynamic factors related to the probability of recidivism) • • • • • •
Antisocial attitudes Influence of antisocial friends/lack of prosocial friends/supports Antisocial personality conducive to criminal behavior Substance abuse Family factors Lack of educational/vocational attainment
• Provide programming to reduce these needs
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Need Principle Needs Targeted & Correlation w ith Ef f ect Size f or Youthf ul Of f enders 0.4 0.3 Reduced Recidivism
0.2 0.1 0
Increased Recidivism
-0.1 Bond Anti Social Peers
Target Self-Esteem
Vague Emotional Problems
Respect Anti Social Thinking
Physical Activity
Criminogenic Needs
Effect Size
Fear of Punishment
-0.2
-0.18
-0.12
-0.09
-0.06
-0.05
-0.03
0.36
Source: Dowden and Andrews, (1999). What Works in Young Offender Treatment: A Meta Analysis. Forum on Correctional Research. Correctional Services of Canada
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The Human Service (Treatment) Principle • Supervision alone will not change behavior • Punishment programs are not effective in changing the behavior • Must provide programming to meet the dynamic risk factors (criminogenic needs) that increase the probability of delinquency • Not all programming will benefit juveniles • Specific curriculum training and/or training in practices Council of State Governments Justice Center | 25
Treatment Principle Cognitive Skills
Cognitive Restructuring
Modeling Effective Programs
Consequences
Rewards
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Cognitive Restructuring Thinking Reports
Functional Analysis
Cost Benefit Analysis
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Cognitive Skills: Tools in the Tool Box Model, Practice, Feedback, Reinforcement
Problem Solving Pro Social Skills
Anger Management Council of State Governments Justice Center | 28
Reinforcements • Rewarding behavior is more effective than punishing • Immediacy • Specific to youth (powerful) • Link reinforcement to behavior/thinking • Explore alternatives
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Effective Programs Have Certain Characteristics • Disrupt delinquent relationships & build natural supportive prosocial relationships • Assist youth in maintaining contact with the family and work to teach family members skills to support youth • Intensity of interventions corresponds with level of risk • Provides for a continuum of care • Have qualified, experienced, dedicated, & educated leadership & staff • Adhere to program fidelity • Establish performance measures and conduct evaluations
• Are stable & have sufficient resources & support
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What the Research Tells Us Works
1
• Validated assessment of risk/need is imperative to determine the best interventions. (Risk/Need Principles)
2
• Supervision strategies should correspond with the risk of recidivism. (Risk Principle)
3
• Programming and treatment designed to target criminogenic needs are necessary components of interventions. They should be theorydriven and based on current research. (Need/Treatment Principles)
4
• Individualize intervention strategies to increase the responsiveness of each youth. (Responsivity Principle)
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Responsivity Principle • Specific responsivity refers to the learning/interaction style of the juveniles which may affect their engagement/success in programming • Youth are not the same! • One size does not fit all • Match youth to staff and program based on certain factors • • • • •
Motivation Mental health Maturity Demographics Cognitive deficiencies
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Evidence-based RNR Practices: Summary Fidelity Validate instruments Assess performance Collect data
Risk Principle Make decisions based on assessments Differentiate programming and supervision based on risk levels
How well Who
Need Principle Treatment Principle
Target the Responsivity criminogenic needs of the youth Supervision alone Principle will not change the to reduce Individualize behaviors recidivism services to increase Provide engagement and programming to success address the dynamic risk Do not treat youth factors as mini-adults
What
How Council of State Governments Justice Center | 33
Principles of Community-Based Systems of Care • • • • • • • • •
Access to comprehensive array of services Individualized services, needs and strengths Services in least restrictive environment Families should be full participants Services are integrated with agency linkages Case management/ coordination Early identification and prevention Smooth transitions to adult services Services sensitive to cultural differences/ needs
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Evidence-Based CommunityBased Interventions • • • • • • • • •
Intensive Case Management Wraparound Services Therapeutic Foster Care Multi-systemic Therapy Partial hospitalization Mobile Crisis Services Mentor services Family psycho-education Improvements in: externalizing, internalizing, family function, reduced restrictive services (inpatient, residential, emergency room visits, etc.)
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Evidence-Based Preventive Interventions • In-home therapeutic early childhood interventions with at-risk low income mothers, using visiting nurses: Prevention of conduct disorder and SED (Olds, Elmira Project, and others) • In-home interventions with families reported to child protection (Zeanah, New Orleans, and others): Reduce abuse and prevent repeat of abuse with siblings • Preventive Interventions for internalizing disorders • Primary Mental Health project (K through 3) • Adolescent suicide prevention (many) • Adolescent Self-injurious behavior (many)
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Surgeon General’s Report on Youth Violence: Effective Strategies Primary Prevention: Universal • Skills Training • Behavior modification and reinforcement • Building school capacity • Continuous progress programs • Cooperative learning • Positive youth development programs Council of State Governments Justice Center | 37
Surgeon General’s Report on Youth Violence: Effective Strategies Secondary Prevention: Selected/ At-Risk • Parent training • Home visitation • Moral reasoning • Social problem solving • Thinking skills
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Surgeon General’s Report on Youth Violence: Effective Strategies Tertiary Intervention: Indicated • Social perspective taking, role taking • Multimodal interventions (include. MST) • Behavioral interventions • Skills training • Marital and family therapy • Wrap-around services Council of State Governments Justice Center | 39
Interventions Lacking EvidenceBased Support • Residential treatment • Therapeutic group homes • Inpatient treatment • Outcomes depend on follow-up community services
• Boot camps • DARE and “scared straight” Programs
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Evidence-Based Treatment Modalities Psychopharmacotherapy (over 400 studies) ADHD, depression, anxiety, OCD, psychosis, PDD’s, bipolar disorder, eating disorders
Cognitive-behavioral therapy (over 700 studies) Depression, anxiety, OCD, aggression/ CD
Interpersonal therapy Depression, anxiety
Behavioral therapy/ parent training (over 200 studies) PDD’s, conduct disorder, ADHD
Family therapy (over 100 studies) Substance abuse, conduct disorder
Problem: Access for public MH, underserved communities, and minority youth.
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Questions?
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Thank You Join our distribution list to receive CSG Justice Center project updates! www.csgjusticecenter.org/subscribe www.nationalreentryresourcecenter.org
The presentation was developed by members of the Council of State Governments Justice Center staff. The statements made reflect the views of the authors, and should not be considered the official position of the Justice Center, the members of the Council of State Governments, or the funding agency supporting the work. Citations available for statistics presented in preceding slides available on CSG Justice Center web site. Council of State Governments Justice Center | 43
IMPACTâ&#x20AC;&#x2122;S ASSESSMENT AND SERVICEMATCHING PROCESS
Dave Bonaiuto IMPACT Manager Assessment, Quality Assurance, and Process Improvement Boulder County IMPACT 303-441-1308 dbonaiuto@bouldercounty.org
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Upfront Assessment and Service Matching 12/19/2012 Intake at JAC
Level of Risk
Need Profile
Case Planning
Intervention
Evidence-based Programs: FFT
CJRA High
Moderate
CJRA Prescreen
MST
Full Assessment and Services Matrix to address:
School Free Time Employment Relationships Family Alcohol and Drugs Mental Health Attitudes and Behaviors Aggression Skills
Community Review Team
Specialized Therapeutic Services: TF-CBT MET-CBT Other services to be determined
Non-Therapeutic Support Services: Mentoring Case Management
Low
Community Supervision Pro-social Activities Other Support Services to be determined
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Colorado Juvenile Risk Assessment (CJRA) â&#x20AC;˘ The pre-screen determines a risk level for re-offending; combining a youthâ&#x20AC;&#x2122;s criminal history and social history: Social History Score Criminal History Score
0 to 5
6 to 9
10 to 18
0 to 2
Low
Low
Moderate
3 to 4
Low
Moderate
High
5 to 7
Low
Moderate
High
8 to 31
Moderate
High
High
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Colorado Juvenile Risk Assessment (CJRA) Full Assessment • Assesses the dynamic areas of need most likely to reduce a youth’s level of risk • 10 Domains School
Alcohol and Drugs
Free Time
Mental Health
Employment
Attitudes/Behaviors
Relationships
Aggression
Family
Skills
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Structured Decision Making Process • Review Colorado Juvenile Risk Assessment (CJRA) results • Level of risk • Areas of need • Protective factors/strengths
• • • •
Identify responsivity issues Prioritize needs Explore possible services Match available services to the level of risk, prioritized needs, and responsivity issues • Monitor progress, reassess youth, and adjust plan as determined by the CJRA results
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Cynthea (14) • Main Stream School • Lives with Maria (mom) and Lou (stepfather) and 3 sisters (1 older, 2 younger) • Motor Vehicle Trespassing and Burglary • CJRA score: High • Criminal risk = 6 • Social need = 10
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AREAS OF NEED • • • • • •
School Relationships Family Attitudes/Behaviors Aggression Skills
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SCHOOL • • • • • • •
Does not believe school is encouraging Not involved/interested in school activities Behavior Recent suspensions Attendance/Truancy Grades Uncertain if youth will graduate
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RELATIONSHIPS WITH NON-FAMILY • • • • • •
Lacks positive adult relationships Lacks pro-social community ties Lacks pro-social friends Admires anti-social peers Emulates anti-social peers Rarely resists going along with anti-social peers
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FAMILY • • • • • • • •
Family history Sibling history Financial strain on family Lack of extended support network Conflict within the home Supervision Following home rules Rewards and consequences
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ALCOHOL AND DRUGS • Substance use that • • • • •
• • • •
Causes family conflict Causes health problems Disrupts education Interferes with keeping pro-social friends Contributes to criminal behavior
Diagnoses for substance abuse Diagnoses for substance dependent/addicted Not attending treatment Unsuccessful substance use treatment Council of State Governments Justice Center | 54
MENTAL HEALTH • • • • • • • •
Suicide attempt(s) Suicidal thoughts Physical abuse Sexual abuse Victim of neglect Diagnosis Not taking medication Not attending treatment
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ATTITUDES AND BEHAVIORS • • • • • •
Excited or stimulated by behaviors Impulsive Lacks insight during high risk situations Conditional respect for property Conditional respect for authority Minimizes, denies, justifies, or blames others for behavior
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AGGRESSION • • • •
Gets upset over small things Negative/hostile view of the intentions of others Believes verbal aggression is appropriate Believes physical aggression is appropriate
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SKILLS • • • • • • • • •
Consequential thinking Goal setting Identifying problem behaviors Lacks pro-social skills when dealing with difficult situations Lacks basic social skills Lacks skills in dealing with feelings and emotions Can’t identify internal triggers Lacks techniques to control impulsive behavior Lacks alternatives to aggression
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PROTECTIVE FACTORS/STRENGTHS • • • • • • • • •
Enrolled full time Somewhat values education Connects with school staff Highly interested in employment Connected with family Parents disapprove of behavior Parents open to support Opportunities for family involvement Believes he will be successful Council of State Governments Justice Center | 59
School
Skills
• Does not believe school is encouraging
• Consequential thinking
• Not involved/interested in school activities
• Identifying problem behaviors
• Behavior
• Lacks pro-social skills with difficult situations
• Recent suspensions
• Lacks basic social skills
• Attendance/Truancy
• Lacks skills in dealing with feelings and emotions
• Grades
• Can’t identify internal triggers
• Uncertain if youth will graduate
• Lacks techniques to control impulsive behavior
Relationships
Attitudes/Behaviors
• Lacks positive adult relationships
• Excited or stimulated by behaviors
• Lacks pro-social community ties
• Impulsive
• Lacks pro-social friends
• Lacks insight during high risk situations
• Admires anti-social peers
• Conditional respect for property
• Emulates anti-social peers
• Conditional respect for authority
• Rarely resists going along with anti-social peers
• Minimizes, denies, justifies, or blames others
Family
Aggression
• Family history
• Gets upset over small things
• Financial strain on family
• Negative/hostile view of the intentions of others
• Lack of extended support network
• Believes verbal aggression is appropriate
• Conflict within the home
• Believes physical aggression is appropriate
• Supervision • Following home rules/rewards and consequences
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