Juvenile Justice

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Juvenile Justice Mental Health InitiativeChris
Bray, Director Juvenile Services
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MinnesotaJuvenile Justice Mental Health
Screening Data 2005(DHS)

• In 2005, 14,785 new juvenile probation entries.
  9594 youth in
• detention or found delinquent met screening
  criteria
• 56 (5334/9594) completed screens
• 71 (3772/5334) were referred for assessment
• 11 (1107/9594) not screened for known reasons
• 12 (1158/9594) not screened, reason unknown

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The Initiative

• Initiated by the Commissioner of Corrections
• A partnership between Minnesota Department of
  Corrections and Human Services Division of
  Childrens Mental Health
• Participation and support from the Departments of
  Education, Health, Public Safety, and Courts
  Administration
• Local organizations juvenile justice, mental
  health, social services, family advocacy,
  providers

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The Initiative

• The goal To develop system changes and create
  strategies for implementation that improve
  outcomes for justice involved youth with mental
  health or co-occurring disorders
• The vehicles An Interagency Advisory Task Force
  comprised of state and local stakeholders A
  collection of national and local data and
  previous work and statewide Focus Groups
• The model A Blueprint for Change from the
  National Center for Mental Health and Juvenile
  Justice

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InitiativeCriteria for Recommendations

• The recommendations will positively impact
  outcomes for justice involved youth with mental
  health or co-occurring disorders.
• The issues that are chosen require systems
  change.
• It is realistic to think that changes as a result
  of the recommendations can be implemented.
• First round recommendations and implementation
  plans can be ready by January 2009.
• The recommendations will enhance not duplicate
  the efforts of others.
• The results of the Initiative work can be
  measured.
• Recommendations will contribute to the reduction
  of overrepresentation and disparities in the
  system.

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Focus Groups

• Included 25 counties throughout the state and
  several organizations
• Focus group members included corrections,
  mental health, social services, schools
• Family advocates
• Judges
• Prosecutors and Public Defenders

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Focus Groups

• Four themes emerged from our review of data, work
• previously completed and focus groups
• across the state
• The need for data that will better inform the
  work
• The need for post screening consistency and
  coordination
• The need to engage parents as partners
• Greater access to evidenced-based,
  community-based services

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Recommendation IIncrease Data Collection

• Clarify definitions for data collection related
  to the mental health screen and establish an
  electronic system for collecting the data in CSTS
  throughout the state - Reporting is not uniform.
• Add existing data collection requirements that
  will provide aggregate outcome data Outcomes
  are not currently tracked.
• Assemble a team of data experts from each of the
  relevant state agencies to examine existing data
  related to disproportionality in each of the
  systems Currently such information is not
  shared.

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Recommendation II Model Post Screening
Coordination

• Most counties are screening for mental health
  issues
• Once a screen has been administered, practices
  vary across the state
• Develop a model for Post Screening coordination
• Provide incentives to encourage statewide use
• Develop outcomes and measure the results

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Model Post Screening Coordination Youth Found to
be Delinquent
Youth Enters the Juvenile Justice System through
Court Intake
Delinquency Hearing and Finding of Delinquency
Template Court Order at hearing that orders the
screen, Diagnostic Assessment if the score on the
screen meets the threshold and orders case back
for disposition if involuntary. The threshold
for being screened in is recommended by DHS.
DA needed Voluntary Self Referral only Requires
tracking (A)
DA needed and involuntary (C)
DA needed Voluntary but needs help (B)
System Navigator Explains the screen/DA
process Assists families with the DA Assists
families with payment Links families to
services Finds interpreters if needed Assists
families with navigating county and
community-based agencies Tracks progress in A, B,
C
IF DA NEEDED AND INVOLUNTARY
Diagnostic Assessment Triggers Disposition
Hearing and YLS Assessment Low risk, low MH needs
minimal intervention Low risk, high MH needs
voluntary referral with tracking High risk, high
MH needs court ordered treatment
interventions High risk, low MH needs court
ordered correctional interventions
Dispositional Hearing Assessment results are
reported to the judge (DA and YLS) Interventions
based on the assessments are recommended
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Model Post Screening Coordination Youth Entering
Detention
System Navigator Informs Parents Purpose of
screening process Their rights Voluntary process
until a finding of delinquency
Initial Detention Hearing
If Parent Agrees to Screening
If Parent does Not Agree to Screening
Proceed to delinquency hearing pre-disposition
For serious cases ask for screen at Initial
hearing

• Screen is administered
• Results of screen are reviewed with parents
• If screen meet s the threshold for DA then DA
  could be done in detention with parental
  permission

• Results of the Mental Health Screen are shared
  with parents
• If the results meet the threshold then a DA is
  recommended to the parents
• Caution scores on two or more scales
• Warning score on one or more scales
• Suicide ideation score
• The System Navigator helps parents set up
  services/DA while youth is in detention.
• If parents refuse the DA, the results of the
  screen are not shared with or shown to the judge
  prior to a finding of delinquency unless the
  youth appears to be in serious distress. If that
  is the case, the judge can be asked to order the
  screen at the Initial hearing, Once there is a
  finding of delinquency, broad statements can be
  made to the judge, the mental health screen
  indicates a need for further diagnostic
  assessment.

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Model Post Screening Coordination

• Develop decision rules response policies
• What scores on what scales will be used to signal
  youth is in need of staff response
• Caution? Warning? Both?
• What program response will occur for youth
  meeting decision rule?
• Assessment? Immediate staff precautions?
  Emergency referral

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Model Post Screening CoordinationCombine the YLS
and Screen Score

• Low Risk--------------------------------------
  -------------------High Risk
• A Continuum of Mental Health Need and Risk
  Levels Among the Juvenile Justice Population

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Model Post Screening Coordination

• Use the court process for timely results
• Upon a finding of delinquency, use a template
  court order to order the screen and diagnostic
  assessment for youth who are screened in.
• For youth requiring a diagnostic assessment, use
  a disposition hearing to provide the judge with a
  case history including results of YLS, diagnostic
  assessment, and recommendations for treatment of
  mental health needs
• Re-screen on a regular basis

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Model Post Screening CoordinationMultidisciplinar
y Teams

• Establish a Navigator Function within a lead
  agency to guide the youth and family through the
  process (corrections, mental health, and/or
  social service)
• Use a multidisciplinary team to develop a case
  plan and determine funding streams for services
  for those youth who are assessed and in need of
  services.
• Establish methods for tracking to ensure that
  youth are screened, assessed and treated when
  appropriate.

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Model Post Screening Coordination

• Establish systematic, ongoing training to school
  resource officers, corrections, social service,
  and mental health professionals on justice
  involved youth with mental health or co-occurring
  disorders
• Provide web-based education and training
  materials for use with youth, parents, and
  community-based and government agencies
• Assess the potential for re-deploying existing
  resources to fund components of the Initiative.
  Some components will not require funding

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Recommendation IIIEvidenced-based,
Community-based Interventions

• Expand the use of evidenced-based,
  community-based mental health treatment
  interventions i.e., MST, using grants and pilot
  sites
• Bureau of Justice Corrections and Mental Health
  Collaboration Project grant
• Pilot the model for post screening coordination
  and to fund evidenced-based, community-based
  mental health services for justice involved youth
  in Becker, Mahnomen, Clearwater counties, and the
  White Earth Indian reservation.
• The Initiative provided a grant writer to the
  White Earth Reservation so they could apply for a
  federal Substance Abuse and Mental Health
  Administration grant (SAMHSA) to assess and
  program for Fetal Alcohol Spectrum Disorders.
• The application was successful.

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Mental Health Intervention

• Linda Hansen, M.A., L.P.
• Mental Health Coordinator
• Dakota County Community Corrections

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Mental Illness

• Difficulty in thinking, feeling, behaving, and
  relating that impacts your ability to function at
  home, school/work, and in the community
• One of the drivers

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What the research says

• National Center for Mental Health and Juvenile
  Justice (NCMHJJ) www.ncmhjj.com/Blueprint
• A Blueprint for Change Improving the System
  Response to Youth with Mental Health Needs
  Involved with The Juvenile Justice System
  (Kathleen Skowyra, Joseph J. Cocozza, Ph.D)
• 65-70 of youth in Juvenile Justice meet criteria
  for a mental health diagnosis
• 25 so severe that their ability to function is
  significantly impaired

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Dakota County Juvenile Center

• 100 cases were randomly selected within a year
• 97/100 had documented diagnoses other than or in
  addition to Conduct Disorder
• Good News/Bad News

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More Dakota County Progress

• Juvenile Detention Alternatives Initiative (JDAI)
• Classification Risk Assessment Instrument (RAI)
• Alternatives to Detention
• New Mental Health Processes
• Screening/Assessment
• Suicide Precaution Procedure
• Treatment Plans
• Treatment
• Collaboration with Social Services, Police,
  Schools, Community

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Recommended Approaches to Addressing These Needs
Blueprint for Change by Kathleen R. Skowyra and
Joseph J. Cocozza,Ph.D

• Underlying Principles - to be respectful of youth
  and responsive to their mental health needs
• Cornerstones
• Collaboration - the need for improved
  collaboration between the juvenile justice and
  mental health systems
• Identification - the need for improved and
  systematized strategies for identifying mental
  health needs among youth in contact with the
  juvenile justice system
• Diversion - the need for more opportunities for
  youth to be appropriately diverted into effective
  community-based mental health treatment
• Treatment - the need for youth in contact with
  the juvenile justice system to have access to
  effective treatment to meet their needs

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Dakota Countys Progress
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Risk Areas
Criminal Personality
School/ Employment
Criminal Charges
Case Plan
Home Parents
Mental Health
Friends
Community Involvement
Behavior Management Skills
Drug Use
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Risk Areas
Criminal Personality
School / Employment
Case Plan
Criminal Charges
Home Parents
Mental Health
Friends
Community Involvement
Behavior Management Skills
Drug Use
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Project ASSIST Ramsey County

• Ed Frickson, M.S., L.P.
• Mental Health Supervisor
• Ramsey County Human Services

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Ramsey County Project ASSIST

• Early intervention model that encompasses Child
  Protection and Juvenile Corrections
• Screening Assessment Care Coordination model
• Community/Home Based MH professionals

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Males/Females with Cautions or Warnings (n
2603)
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of screened youth by race (n2603)
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Angry/Irritable
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Depressed/Anxious
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Somatic Complaints
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Alcohol/Drugs
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Suicide Ideation
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Thought Disturbance (males only n1910)
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Traumatic Event(s)
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Ramsey County Project ASSIST

• Next Steps
• - On site MH Assessment Satellite
• - Diagnostic Assessments,
• Psychological Evaluations Care
• Coordination
• - Parent Engagement
• - TF-CBT

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Comments/Questions