JJIE Hub: Reform Trends — Mental Health & Substance Use Disorders

Blueprint for Reform^[1]

This model identifies four cornerstones to enhanced delivery of mental health services to youth in contact with the juvenile justice system and identifies areas for reform. The four cornerstones are:

• collaboration between the juvenile justice and mental health systems;
• identification of youth mental health needs;
• diversion of youth into community-based mental health treatment when appropriate; and treatment.

California Healthy Returns Initiative^[2]

This 2005-2009 initiative was designed to strengthen county juvenile justice systems’ ability to provide health and mental health services for youth and continuity of care when they returned to the community. The following practices were recognized as critical to any systems reform effort to serve this population:

• screening using validated mental health screening tools;
• multidisciplinary teams;
• connecting youth and families to benefits and resources, including health care, housing assistance, and food stamps;
• collaboration and integration across services; and
• funding and resources to sustain multi-disciplinary, collaborative, holistic approaches.

Comprehensive Systems Change Initiative (CSCI)^[3]

The initiative is a collaborative strategic planning model that brings together juvenile justice and mental health systems to identify youth with mental health needs at their earliest point of contact with the juvenile justice system to develop an effective service delivery system to meet their needs. The framework includes^[4]:

• collaboration among all relevant youth-serving agencies and families;
• identification of youth with mental health needs through use of standardized screening and assessment tools;
• diversion of youth from the justice system to community programs where possible; and
• treatment for youth who remain in the system using a continuum of evidence-based mental health services.

Three Pennsylvania counties – Allegheny, Chester, and Erie – began implementing the CSCI model in 2004.^[5]

Reclaiming Futures^[6]

The Reclaiming Futures model unites juvenile courts, probation, adolescent substance abuse treatment, and the community to work together to improve drug and alcohol treatment and connect teens to positive activities and caring adults. The model has six steps (with process and outcome measures attached). They are:

• screening youth for substance abuse problems as soon as possible after they are referred to the juvenile justice system;
• assessment of youth with possible substance abuse problems, using a reputable tool;
• service coordination, using intervention plans designed and coordinated by community teams, including families and agencies;
• “initiation,” defined as at least one service contract within 14 days of a full assessment;
• “engagement,” defined as at least three successful service contacts within 30 days of a youth’s full assessment;
• “transition,” when a youth completes the service plan and agency-based services are gradually withdrawn and youth and families are connected with long-term support.

Integrated Co-Occurring Treatment Model (ICT)

Originating in Akron, Ohio, this is a program for youth with mental health and substance use disorders in the juvenile justice system. Youth are diverted to the program by the court. They are assessed and provided with individual and family therapy, based on a “system of care philosophy” that engages the youth and the family in an intensive home-based treatment program.^[7]

ICT has been implemented in the following sites: Akron, Ohio; Cuyahoga County, Ohio; Kalamazoo, Michigan; McHenry County, Illinois; and in Salinas, California (past site).^[8]

Wraparound Milwaukee

This program is recognized as a model for collaboration. It is a multi-service approach to meeting youth’s needs through the collaboration of the mental health, juvenile justice, child welfare, and education systems and pooled funding. It focuses on the strengths of the family, neighborhood, and community.^[9]

Policy Platform

This policy platform from National Juvenile Justice Network takes a public health lens in addressing the issue of children with mental health challenges rather than focusing on ways to suppress children’s behavior through criminalization. It provides their recommendations for how to keep children with mental health challenges out of the youth legal system and features promising programs and model legislation from around the country.

Comprehensive Community Mental Health Services for Children and their Families Initiative (“Systems of Care Model”)^[10]

In 1992, Congress passed legislation creating this program with the goal of creating a comprehensive array of community-based mental health services and supports that are more effectively delivered to children and their families.

The program is implemented by the Substance Abuse and Mental Health Services Administration (SAMHSA) and encourages multi-agency partnerships between the mental health, juvenile justice, child welfare, and education systems.

Some communities have used this funding to improve the delivery of services to justice-involved youth, such as WrapAround Milwaukee.^[11]

• • In 2007, Washington State passed legislation to implement a wraparound model (HB 1088).^[12]
  • California passed legislation requiring the Department of Youth Authority and the Department of Mental Health to collaborate on training, treatment and medication guidelines for youth with mental illness under the jurisdiction of the Youth Authority.^[13]

Mental Health Screenings

Numerous states have passed legislation that require mental health screenings and assessments. Go here for examples.

Multi-Disciplinary Teams (MDT)

Legislation promoting multi-disciplinary teams in juvenile justice was passed in California in 2005 (SB 570). It established an optional procedure within county juvenile courts to handle youth with serious mental, emotional, or developmental disabilities, and included case review by an MDT.^[14]

West Virginia law requires the Division of Juvenile Services to convene multi-disciplinary treatment teams for youth that have been adjudicated delinquent and are in their custody for a period of examination in the juvenile diagnostic center. The team includes a juvenile probation officer, social worker, parents or guardians, attorneys, school officials, and can include child advocates.^[15]

See Additional Resources »

Litigation has been used as an effective tool for change in many states where conditions in the juvenile facilities were egregious. Some of the resulting consent decrees and settlement agreements have focused on or included youth with mental health needs. Below is an example of one case in which the court ordered comprehensive remedial plans to be implemented to correct many problems in the system, including mental health treatment.

California

• • In the case of Farrell v. Allen, the California Youth Authority (CYA) (now the California Department of Juvenile Justice) was sued due to serious on-going problems with conditions in CYA’s facilities, and entered into a consent decree in 2004^[16]. Subsequently, the Department of Juvenile Justice (DJJ) developed several remediation plans, one of which concerned mental health, and the court ordered that it be implemented. This plan contained many elements including:

• • • • Mental health screenings required at intake and follow-up assessments where significant mental health problems indicated;
      • Staff training in evidence-based psycho-social treatment with selected individuals trained in evidence-based treatment interventions.
      • Mental health leaders in DJJ required to stay current with developments in the field of evidence-based treatments.
      • DJJ required to take measures to support the involvement of families. One evidence-based model recommended was the Family Engagement Model developed by McKay et al. (McKay & Bannon, 2005)^[17]
      • Support should be provided to youth with mental health needs who are returning to the community. One model recommended was the Family Integrated Transitions program.
      • DJJ is to develop a training program for mental and behavioral health staff.

Illinois

• • In the Illinois case of RJ, BW, DF, DG, and MD v. Bishop, youth who were confined in secure Illinois youth centers filed a class action lawsuit against the state Department of Juvenile Justice alleging that the poor conditions and treatment violated their constitutional rights. The complaint specifically addressed mental health treatment problems. The court ordered a remedial plan, which included the following regarding mental health services^[18]:

• • • • screening and assessment upon intake
      • appropriate treatment planning
      • provision of mental health services as determined by the youth’s mental health treatment plan
      • prompt access to mental health professionals
      • appropriate suicide prevention
      • prompt hospitalization of youth when required
      • appropriate substance abuse diagnosis and treatment
      • appropriate aftercare and discharge planning

Ohio

• • In the case of S.H. v. Stickrath, a class action was brought against the Ohio Department of Youth Services (DYS) alleging a system-wide failure regarding conditions of confinement within DYS facilities that led to numerous problems, including depriving youth of adequate mental health care. In a stipulated judgment resolving the claims, DYS was required to^[19]:

• • • • develop and implement a continuum-of-care mental health system that incorporates evidence-based or research-supported promising practices for the assessment and treatment of each youth;
      • ensure that youth have access to necessary inpatient psychiatric treatment at an appropriate facility;
      • redesign and restructure mental health screening, assessment, and referral processes to ensure youth are identified and referred for appropriate, prompt, and effective care;
      • provide youth who are not on the mental health caseload with access to staff trained in identifying mental health needs and providing mental health services to these youth as needed; and
      • expand and strengthen contact with families and clinical staff.

School-Based Diversion

Schools frequently use the police to handle even minor discipline problems, sending many youth into the justice system. Often a student’s unruly behavior is at least in part due to a mental health disorder.

Training school staff and police officers to identify and appropriately respond to youth with mental health needs can decrease referrals to juvenile court, especially when coupled with alternative community-based mental health resources to which youth can be referred instead.^[21]

Mobile Urgent Treatment Team Project (MUTT)^[22]

• This project, pioneered in Milwaukee, Wisconsin, as part of its wraparound program, uses a “mobile urgent response” to school-based incidents involving youth with mental health issues. The program’s key elements are:
  • Training school officials on how to deal with youth with mental health issues; and
  • Ensuring that the mental health system instead of law enforcement responds to incidents by linking schools with mobile mental health crisis teams and community providers.
  • The Mental Health/Juvenile Justice Action Network of the Models for Change initiative has worked with states in the network to develop school-based diversion initiatives based on the MUTT model.^[23]
  • Connecticut developed a school-based diversion initiative to provide mental health crisis teams in three middle schools. They developed a standardized curriculum to train school officials based on the MUTT program that included crisis de-escalation and community referral sources.
  • Ohio implemented its diversion initiative in several schools in two counties.
  • Washington implemented a diversion program in three middle schools for the 2009-2010 school year but did not receive funding to continue it.
  • Program manuals to guide the replication of these models have been developed in Connecticut and Ohio.

Crisis Intervention Teams

• See the section under law enforcement diversion programs.

Written Protocols

• In this approach, schools develop a written protocol for handling student offenses that includes referrals to resources other than law enforcement. The protocol should specify procedures to follow when a student has a special need such as a mental health problem, substance abuse disorder, or developmental disability.^[24]

See Additional Resources »

Law Enforcement Diversion

It is possible to decrease the unnecessary arrest and processing of youth with mental health disorders when law enforcement officers are trained to recognize the signs and symptoms of mental illness, substance abuse, and developmental disabilities in youth and to de-escalate their interactions with them; and by providing access to mental health services and supports for these youth.^[25]

Crisis Intervention Teams ^[26]

• Crisis Intervention Teams (CIT) are composed of officers specially trained to respond to crisis calls involving individuals who may have mental health disorders. Studies have found that CIT programs decrease the need for more aggressive law enforcement responses, reduce officer injuries, and increase referrals to emergency health care.
• Although the teams were developed for adults, the model has been expanded to youth.
• Colorado, Louisiana, and Pennsylvania worked with national experts to create a Crisis Intervention Team for Youth (CIT-Y) training program.^[27]
• All of the school resource officers in Jefferson Parish, LA, received CIT training in 2010 and referrals on minor charges declined by 58 percent.^[28]

Intake Diversion

• An ideal time to screen, identify, and divert youth with mental and/or substance use disorders, is when they go through intake with a juvenile probation officer -- one of their earliest points of contact with the juvenile justice system. However, it is important not to “widen the net,” or to keep youth in the justice system just to receive treatment.^[29]
• In this model, intake probation officers should receive training to recognize the signs and symptoms of mental illness, substance use disorders, and developmental disabilities.

Front-End Diversion Initiative (FEDI) ^[30]

Texas has created a specialized probation diversion program for youth with mental health needs known as the “Front-End Diversion Initiative.” It has been implemented in five demonstration sites in the state and aims to divert youth with identified mental health needs from being adjudicated delinquent.

• The initiative uses specialized juvenile probation officers to work with the youth. They have limited caseloads, undergo substantial mental health training and certification, and provide intense supervision, crisis planning, community service Links, and aftercare planning.^[31]
• The program is for youth who have committed their first offense. If they complete the six-month program successfully, they are not adjudicated delinquent.^[32]
• A study of the initiative’s preliminary outcomes found promising results, and researchers recommended further study.^[33]

See Additional Resources »

Diversion from Secure Detention Prior to Trial

Youth remain in the system but are provided with community alternatives so they do not have to be confined prior to trial in a secure detention facility. These alternatives may not be specifically geared to youth with mental health and substance use disorders but can be utilized to keep them in the community.

Alternatives include outright release or supervised release, with programs such as home detention, electronic monitoring, intensive supervision, day and evening reporting centers, and local residential and treatment programs.

The Juvenile Detention Alternatives Initiative (JDAI)

• The JDAI initiative of the Annie E. Casey Foundation has been quite successful at reducing the number of youth in secure detention in communities all over the country.

Diversion from Incarceration Following Trial

Many effective evidence-based programs have been developed to provide treatment to youth with mental health and substance use disorders in the juvenile justice system. These programs can often be provided in the community in place of securely confining youth in juvenile institutions.

Specialty Courts

Specialty courts are designed to handle a special docket, such as youth with substance abuse, mental health disorders, or both.^[34] Youth may be diverted prior to adjudication or after.

Juvenile Mental Health Courts

• These courts focus on treatment rather than punishment with the goal of diverting mentally ill youth from detention to community-based mental health services by providing intensive case management and the collaboration of many system stakeholders, including representatives from the juvenile court, probation, prosecution, and defense, mental health service providers, and the youth and their families.^[35]
• A study funded by the National Institute of Justice on the benefits and costs of juvenile mental health courts, and their efficacy in preventing further involvement in the juvenile justice system, is currently underway.^[36]
• York County, PA, established the first mental health court for minors in Pennsylvania in 1998.^[37] There are now 41 juvenile mental health courts in fifteen states.^[38]
• King County, Washington (Seattle) created a mental health treatment court in 2003 to focus on youth with co-occurring mental health and substance use disorders in order to provide a continuum of assessment, treatment, and support for these youth.^[39]
• The National Center for Youth Law has a Juvenile Mental Health Court Initiative in Alameda County, CA that focuses on treatment of these youth and diverting them from jails to community-based alternatives.^[40]

Juvenile Drug Courts

• The number of juvenile drug courts has mushroomed in the last twenty years and there are now 476 juvenile drug courts in operation.^[41]

Effectiveness

• • Studies of juvenile drug courts have been mixed. Some have been encouraging, showing lower recidivism rates and less substance abuse.^[42] However, a recent meta-analysis found that while adult drug courts significantly lowered recidivism rates, juvenile drug courts had relatively small effects on recidivism.^[43]

Concerns^[44]

• • Drug court programs may expose first- or second-time juvenile offenders to peers who have more serious substance abuse addictions and therefore might have a negative influence on recovery.
  • Few studies have examined the long-term effects of drug courts on participants, so it’s unclear if positive results last.
  • Drug courts may widen the net of the justice system.

See Additional Resources »

Litigation over extremely poor conditions in juvenile facilities has led to requirements to use more alternatives to incarceration in some cases.

Lauderdale County, Mississippi

• Disability Rights Mississippi filed a lawsuit to gain access to the Lauderdale County Juvenile Detention Center (LCJDC) in Lauderdale County, Mississippi. After documenting concerns regarding the policies and practices at the detention center, a settlement agreement was reached that included the following^[45]:
  • When youth violate a court order, court staff must consider alternative sanctions to secure detention.
  • Lauderdale County was directed to apply to join Annie E. Casey’s Juvenile Detention Alternatives Initiative (JDAI) to reduce the use of secure detention.

Enroll Youth In Medicaid and CHIP

When they enter the justice system, many youth who are eligible for Medicaid and CHIP are not currently enrolled. Screening them at intake for eligibility, assisting families to enroll, and expediting the process can help these youth to get coverage as early as possible.

• • The Texas Juvenile Probation Commission screens youth for Medicaid eligibility at two points – arrest and during the trial process.^[48]

Avoid Gaps in Medicaid and CHIP Coverage

During transitions in custody, youth often lose Medicaid and CHIP coverage because of the paperwork and documentation requirements and confusion over whether coverage can be maintained.

States can help youth avoid gaps in coverage in a variety of ways:

• Suspend, rather than terminate, coverage of youth in the juvenile justice system so that their coverage can be reinstated more easily at discharge.
• Continue Medicaid and/or CHIP coverage for youth in detention who are awaiting trial.
• Provide a grace period before enrollment lapses so that families have time to collect the necessary information and documentation to maintain coverage.
• Implement the continuous eligibility option that Medicaid allows to keep youth enrolled for 12 months during transitional periods.
• Washington State provides 12-month continuous coverage to youth so that youth who enter and leave a detention facility within a 12-month period remain Medicaid-eligible after release.^[49]

Better Coordination of Coverage with Partner Agencies

At a minimum, state juvenile justice agencies can use the federal matching funds allowed to non-Medicaid agencies to work with Medicaid departments to identify and enroll youth in Medicaid.

Medicaid agencies can train juvenile justice staff on the Medicaid eligibility process so they can assist youth with enrollment and integrate applications for health care coverage into youth discharge planning.

King County, WA

• The King County, Washington Juvenile Court Services Division has used the administrative funds option to reach out to youth and enroll them in Medicaid with the support of the state’s Medicaid department since 1997.^[50]

New Mexico

• Staff at the state Children, Youth, and Families Department (CYFD) who work with justice-involved youth receive training to determine if they are temporarily eligible for Medicaid.
• In 2007, the department created a network of regional transition coordinators to work with justice-involved youth from intake through release. They can help youth and their families determine if they are eligible for Medicaid on a temporary basis and complete full applications for coverage.^[51]
• New Mexico has also streamlined the application process for youth exiting juvenile facilities.^[52]

An ideal approach is to educate agency staff about how the Medicaid, juvenile, and mental health systems work at the state and local levels, including what juvenile justice services Medicaid covers, and coverage eligibility for youth at different points of the juvenile justice system.^[53]

In addition, at least one state has sought to augment coordination through restructuring.

Illinois

• The state established the Bureau of Interagency Coordination (BIC) in 1999, which created a central point of contact within the Medicaid department for state agencies and counties that provide services to individuals covered by Medicaid.^[54]

Improve Medicaid Coverage for Youth in the Justice System

States can also legislate changes to their Medicaid system that help youth in the justice system get coverage for treatment.

Indiana

On March 11, 2022, Indiana Governor Eric Holcomb signed a major set of juvenile justice policy reforms. Some of the key provisions include expanding pre-court diversion options, limiting the use of detention for children under the age of 12, and developing a statewide plan to collect and track key juvenile justice data. The legislation also requires the creation of new diversion and behavioral grant programs as well as the establishment of a statewide oversight committee to develop policies and plans for implementing the legislative provisions by 2023.

California

• • In 2006, California passed SB 1469 to help youth in the juvenile justice system obtain Medicaid coverage before they are released from secure lockup.
  • For all youth committed to a county juvenile detention facility for more than 30 days, the facility must inform the state Medicaid agency of the child’s name and scheduled date of release, and the agency then must process their application. ^[55]

Washington State

• • In 2007, Washington State passed legislation that directed the Department of Social and Health Services to explore the feasibility of Medicaid payment for youth temporarily placed in a juvenile detention facility.
  • The law also provided a number of additional mechanisms to assist with enrolling youth or reinstating their medical assistance coverage after their release from a facility.^[56]

See Additional Resources »

Formal Agreements and Court Orders

• Where no legal protections are in place to protect youth from self-incrimination, memoranda of understanding can be developed with the stakeholders—e.g., the court, prosecutor’s office, public defenders, juvenile services, public and private mental health agencies—to safeguard youth’s legal interests.^[59]
• In Santa Clara County, CA, members of a multi-disciplinary team that meet weekly for children with behavioral health needs developed a formal process for information-sharing across the range of providers involved with the youth. Other counties have established standing court orders to facilitate the sharing of information.^[60]

Limiting the Use of Screening/Assessment Tools

• Another option is to select screening/assessment tools whose questions will minimize the harm of self-incrimination to youth as much as possible^[61], or to avoid administering certain portions of the tool being used.^[62]

The most secure way to protect youth’s rights against self-incrimination is to enact legislation or court rules that specifically require that information obtained by youth through screening, assessment, evaluation, or treatment as part of their juvenile court case cannot be used against them at any stage of a juvenile or criminal court case.^[63]

While a number of states have passed legislation to protect youth’s rights, most states do not have comprehensive protections against youth self-incrimination during mental health screening, assessment, evaluation, and treatment that cover all stages of the juvenile justice process.

Model Statutory Language

The Juvenile Law Center has developed model statutory language to protect youth from self-incrimination when undergoing screening, assessment, and treatment in the juvenile justice system.^[64]

Enacted Legislation

In their 2007 publication on this topic, the Juvenile Law Center identified four states—Texas, Maryland, Missouri, and Connecticut—that had comprehensive statutory protections or court rules that could be used as models for state legislation.^[65]

Recent examples of legislation enacted to protect youth from self-incrimination include Pennsylvania’s 2008 legislation and legislation enacted in Illinois in 2010.^[66]

See Additional Resources »

Defense attorneys have been raising the issue of juvenile competency to stand trial with increasing frequency in the past decade. During this time period, studies have shown widespread impairments in certain categories of youth, particularly younger individuals and those with low IQs, supporting the need for guidance for courts on how to handle juvenile competency.^[70]

Model Statutory Language

Most states have not developed statutory guidance for courts on how to determine competency and handle the disposition of incompetent youth.^[71] However, as of 2007, at least ten states had passed legislation addressing juvenile competency: Arizona, Colorado, Florida, Georgia, Kansas, Minnesota, Nebraska, Texas, Virginia and Wisconsin.^[72]

Enacted Legislation

Below are examples of legislation enacted on some of the many issues concerning juvenile competency.

Developmental Immaturity

• Not all states accept developmental immaturity as a reason for incompetence, but California is one of the states that does.^[73]
• Virginia does not permit a finding of incompetency based solely on age or developmental factors.^[74]

Factors in Determining Competency

• Alaska’s statute on youth competency specifically outlines the youth’s functional abilities that the court should consider in making a competency determination.^[75]
• Maryland’s statute defines broader “cognitive concepts” the court should consider, rather than functional abilities.^[76]

Counsel for Juveniles

• Louisiana law entitles youth to counsel prior to and during competency evaluations.^[77]

Self-incriminating Information

• Louisiana and Alaska provide protections for youth from the use of self-incriminating statements they may have made during competency evaluations in court proceedings against them.^[78]

See Additional Resources »

Many states are now using standardized mental health screenings and assessments.

• Two thousand sites in 47 states have registered to use the Massachusetts Youth Screening Instrument – Second Version (MAYSI-2) and of these states 44 are using the MAYSI-2 statewide in all intake, detention, and/or juvenile corrections programs facilities.^[79] It is also being used in other countries and has been translated into 15 languages.^[80]
• The Voice Diagnostic Interview Schedule for Children (Voice DISC) was being used in juvenile justice settings in 13 states as of 2007.^[81]

A number of states have passed legislation that requires mental health screenings and assessments. Some examples:

Minnesota

• Minnesota requires statewide mental health screening for all youth in the juvenile justice system found to be delinquent.^[82] Where indicated, a diagnostic assessment must then be conducted.^[83]

Nevada

• Nevada requires detained youth to be screened for mental health and substance use disorders while awaiting a detention hearing.^[84] The screening method must be “based on research” and be “reliable and valid.”^[85]

Texas

• Texas requires juvenile probation departments throughout the state to administer a mental health screening instrument that they select to all youth who have been formally referred to the probation department.^[86] The Department uses the MAYSI-2 assessment instrument within 48 hours of admission to detention.^[87]

See Additional Resources »

In a number of states, the conditions inside juvenile facilities were so bad that lawsuits were filed to force needed changes. In several cases, this resulted in new requirements for mental health screening and assessment.

California

• In the case of Farrell v. Allen, the California Youth Authority (CYA) (now the California Department of Juvenile Justice) was sued due to serious ongoing problems with conditions in CYA’s facilities, and entered into a consent decree in 2004.^[88] Subsequently, the Department of Juvenile Justice (DJJ) developed several remediation plans, one of which concerned mental health, and the court ordered that it be implemented. The following actions had to be taken regarding screening and assessment:^[89]
  • All youth must receive a mental health screening within 48 hours of intake to identify mental health issues and other treatment needs.
  • Results must be reviewed by a psychologist no later than the next business day.
  • If the mental health screening indicates significant mental health problems, then a clinical evaluation must be completed by a mental health professional to assess further treatment needs.
  • A number of standardized, validated instruments were recommended, though not required, including the MAYSI-2, Suicide Ideation Questionnaires, and VOICE-DISC.

Illinois

• In the case of RJ, BW, DF, DG, and MD v. Bishop, youth who were confined in secure Illinois Youth Centers filed a class action lawsuit against the Illinois Department of Juvenile Justice alleging that the poor conditions and treatment violated their constitutional rights. The complaint specifically addressed mental health treatment problems. The Court ordered a remedial plan created, which included a requirement that screening and assessment be done upon reception of the youth in the facility.^[90]

Lauderdale County, Mississippi

• Disability Rights Mississippi filed a lawsuit to gain access to the Lauderdale County Juvenile Detention Center (LCJDC) in Lauderdale County, Mississippi. After documenting concerns regarding the policies and practices at the detention center, a settlement agreement was reached that included the following requirements:^[91]
  • All youth must have a MAYSI-2 screening immediately upon admission.
  • If youth have urgent mental health issues, they must be immediately evaluated by a mental health professional or taken to the emergency room.
  • Adequate mental health services must be provided to all youth with a mental health diagnosis or serious mental health need, as indicated by the MAYSI-2.

New Orleans, Louisiana

• In 2009, a class action suit was brought against the city of New Orleans for federal constitutional and statutory violations due to extremely unsafe and unsanitary conditions at the Youth Study Center (YSC) in New Orleans. A consent decree was reached in 2010, and then further modified in 2011, requiring that YSC take a number of actions, including the following steps related to screening and assessment^[92]:
  • All admissions staff be trained on administering the MAYSI-2 screening instrument.
  • Staff will properly file the results of the MAYSI-2 and flag for follow-up where appropriate.
  • A psychiatrist or appropriately credentialed medical practitioner will assess all youth who score in a problematic range on the MAYSI-2 and assess all youth who have major psychotic issues.
  • All youth with behavioral health needs will be referred for interventions in a timely fashion.

New York

• The Civil Rights Division of the United States Department of Justice sued the state of New York over conditions of confinement at four juvenile facilities in New York. They entered into a settlement agreement with New York, which required the state to:^[93]
  • have a qualified mental health professional screen each youth admitted to a facility;
  • assess each youth for mental health issues, if indicated as necessary by their screening; and
  • refer youth at immediate risk of harm to a mental health professional without delay.

Numerous community-based treatment programs have been studied and found to be more effective than secure confinement in reducing the number of youth who reoffend.^[94] Some effective evidence-based models for youth with mental health needs and/or substance abuse disorders include:

Multisystemic Therapy (MST)

An intensive family- and community-based treatment program for chronic and violent juvenile offenders. Therapists work with the family to address all the environmental systems affecting the youth --their homes and families, schools and teachers, neighborhoods and friends.^[95] In its 2012 report, the Washington State Institute for Public Policy (WSIPP) found that MST had a net benefit for Washington taxpayers of $24,751 per youth treated.^[96]

Functional Family Therapy (FFT)

A family-based treatment program for delinquent youth at risk for placement in a juvenile facility. FFT focuses on improving family communication and supportiveness while decreasing intense dysfunctional behavior patterns.^[97] In its 2012 report, Washington State Institute for Public Policy (WSIPP) found that FFT had a net benefit for Washington taxpayers of $30,706 per treated youth.^[98]

Multi-Dimensional Treatment Foster Care (MDTFC)

A foster program used as an alternative to institutionalization where community families are recruited, trained, and closely supervised to provide youth with treatment and intensive supervision at home, in school, and in the community. MDTFC uses a behavior modification program and provides youth with structured daily feedback.^[99] In its 2012 report, the Washington State Institute for Public Policy (WSIPP) found that MDTFC had a net benefit for Washington taxpayers of $31,276 per treated youth.^[100]

Various types of psychosocial therapy are also being used to treat youth with mental health needs. The therapy is generally provided by trained professionals such as psychiatrists, psychologists, social workers, or counselors. Some examples of effective programs include:

Cognitive Behavioral Therapy (CBT)

A psychotherapy treatment program that is a problem-focused approach to help youth identify and change the dysfunctional beliefs, thoughts, and patterns of behavior that contribute to their behavior. Studies have found CBT to be effective in changing problem behavior and reducing recidivism.^[101]

Aggression Replacement Therapy (ART)

This program is targeted at youth with a history of serious aggression and anti-social behavior. It teaches youth techniques to control impulsiveness and anger and use more appropriate pro-social behavior. Studies have found ART to be effective in reducing recidivism and problem behavior and increasing social skills.^[102]

Medication has been found to be effective in treating certain disorders in youth, such as attention deficit hyperactivity disorders (ADHD), depression, and certain anxiety disorders. This treatment can enable many youth to remain in the community safely.^[103]

A traumatic experience is an event that threatens one’s life, safety, or well-being, including emotional and physical assaults, abuse, and neglect. Many youth in the juvenile justice system have been exposed to community and family violence and/or been threatened with or been the direct target of violence. This trauma can impact children’s development and health throughout their lives and needs to be considered when selecting effective treatment for youth in the juvenile justice system.

Identifying Youth with Trauma

Assessments have been developed to identify and track trauma histories, such as the Traumatic Events Screening Inventory (Davis et al., 2000; Ford et al., 2000), and to identify mental health and behavior symptoms and disorders related to traumatic experiences, such as the UCLA Posttraumatic Stress Disorder Reaction Index (Steinberg, Brymer, Decker, and Pynoos, 2004).^[104]

Treating Trauma

A number of evidence-based practices have been developed specifically to treat youth impacted by trauma. Cognitive behavioral treatment models are considered to be one of the best by the Centers for Disease Control.^[105] Click to download a comprehensive list of treatment programs.

Improving Care for Traumatized Youth

Congress established the National Child Traumatic Stress Network in 2000 to raise the standard of care and improve access to services for child victims of trauma.^[106]

Many jurisdictions are now using evidence-based practices. Below is a sampling of some using particular programs or who have adopted specific policies on evidence-based practices:

• Washington State’s Juvenile Rehabilitation Administration (JRA) created the “Integrated Treatment Model” to address the mental health needs of their youth. The model incorporated evidence-based components of Cognitive Behavioral Therapy, Dialectical Behavior Therapy, and Functional Family Therapy to treat youth from the time of entry to a secure facility until release. The JRA also redesigned its aftercare program to focus on families and trained parole counselors in Functional Family Parole, which is based on Functional Family Therapy.^[107]
• Several states, including Connecticut, Ohio, Pennsylvania, and Colorado, have created centers to increase the use of evidence-based practices in treating youth with mental health disorders. They help communities by providing information, assistance, and training.^[108]
• Many of the comprehensive reform programs utilized in several states make use of evidence-based practices.

Oregon

• Oregon requires that certain state agencies, including the Oregon Youth Authority, spend at least 75% of state money that they receive for programs on “evidence-based programs.”^[109]

Pennsylvania

• In 2012, Pennsylvania amended the Purpose Clause of its Juvenile Act to emphasize evidence-based practices, stating that evidence-based practices should be employed “whenever possible and, in the case of a delinquent child, by using the least restrictive intervention that is consistent with the protection of the community, the imposition of accountability for offenses committed and the rehabilitation, supervision and treatment needs of the child.”^[110]

Tennessee

• Tennessee passed a law in 2007 requiring state agencies to ensure that state-funds for juvenile justice programs are spent only on evidence-based programs.^[111]

Washington

• Washington State has been in the forefront of states aggressively moving towards the use of evidence-based treatment programs for youth in the mental health, child welfare, and juvenile justice systems. Most recently, Washington enacted into law H.B. 2536 in 2012.^[112]
  • The specific intent of the law was to increase the use of “evidence-based and research-based practices” for youth in the above-referenced systems.
  • It directs that a baseline assessment be done of the evidence and research-based programs currently being used, their cost, and recommendations for a reallocation of resources towards such programs.
  • It also provides for monitoring and quality control to ensure fidelity to the evidence and research-based programs.

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In lawsuits arising out of extremely poor conditions in juvenile facilities, some settlement agreements have mandated particular types of treatment programs.

New York

• The Civil Rights Division of the United States Department of Justice sued the state of New York over conditions of confinement at four juvenile facilities in New York. They entered into a settlement agreement with New York which specified that the state had to provide an effective behavioral treatment program based on evidence-based principles for youth with mental health needs. It also required those treating the youth to consider a history of trauma in treatment planning^[113].

Mental health training, education, and workforce enhancement initiative ^[114]

Cross-State Initiative

• The MacArthur Models for Workforce Development Strategic Innovation Group (SIG) is developing a mental health education and training package for juvenile justice agency staff to improve their basic understanding of mental illness in youth and their skills in dealing with youth with mental health issues. Connecticut, Illinois, Ohio, Texas, and Washington will implement the program in at least one juvenile justice setting – probation, juvenile court, detention, or corrections.

Workforce Collaborative on Evidence-Based Practices ^[115]

Louisiana

• • Louisiana, as part of the MacArthur Models for Workforce Development SIG, is creating a multi-system collaborative to meet the challenges of recruiting, retaining, training, and educating individuals working with children at risk of or involved in the juvenile justice system.

Virginia

• • Virginia legislation requires the state Board of Juvenile Justice to develop regulations to plan for mental health, substance abuse, and other therapeutic treatment services for youth returning from a commitment to a juvenile justice facility.^[116]

National

• • Many jurisdictions have chosen to implement intensive treatment services for youth with mental health issues, such as Multisystemic Therapy (MST) and Functional Family Therapy (FFT), which have proven successful with justice-involved youth.

Pennsylvania

• • “Peer advocates” are being used in the Pennsylvania juvenile justice systems and in other states. This service uses peers to help family members of justice-involved youth navigate the system.^[117]
  • In Philadelphia, the Mental Health Association in Southeast Pennsylvania’s Parent Involved Network (PIN), provides several services to help families navigate the child-serving systems and to orient juvenile probation officers on working with families.^[118]

Colorado

• • Colorado passed HB 07-1057 in 2007, which established three family advocacy demonstration programs for youth with mental health or co-occurring disorders who are at-risk or already involved in the juvenile justice system.^[119]

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