|Blueprint for Change: A Comprehensive Model for the Identification and Treatment of Youth with Mental Health Needs in Contact with the Juvenile Justice System|
|By National Center for Mental Health and Juvenile Justice|
Every day, hundreds of thousands of youth cycle in and out of state and local juvenile justice systems throughout the country. They are seen in probation offices, juvenile detention centers, juvenile courts, and correctional facilities each day. Many of these youth have lives that have been marred by poverty, violence, substance abuse, academic disadvantage, and delinquent behavior. Further, we now know that the vast majority of these youth, up to 70 percent, suffer from mental health disorders, with at least 20 percent experiencing disorders so severe that their ability to function is significantly impaired. Their illnesses include major depression, bipolar disorder, conduct disorder, attention deficit/hyperactivity disorder, anxiety disorder, and other potentially debilitating conditions. Frequently, a youth’s disruptive or inappropriate behavior is the result or a symptom of a mental health disorder that has gone undetected and untreated. For some youth, contact with the juvenile justice system is often the first and only chance to get help. For others, it is the last resort after being bounced from one system to another. All too frequently, however, the opportunity to intervene early is wasted and youth end up in a system that is ill-equipped to help them, frustrating juvenile justice administrators and leaving youth without access to the treatment they need to get better. The crisis is real and the need to respond is more pressing than ever.
Juvenile justice systems across the country are struggling to take action. Some jurisdictions have formed partnerships with the mental health system to increase accessibility to community-based mental health services for these youth; other jurisdictions have created mental health treatment capacity within their juvenile justice systems; others have done very little simply because there has been a lack of information available about how best to respond.
Recognizing the problem, the Federal Office of Juvenile Justice and Delinquency Prevention launched their largest investment ever in mental health research in 2000, aimed at providing the field with guidance to help address this problem, and to ultimately improve the lives and well-being of children and youth with mental health needs who end up in the country’s juvenile justice system. The National Center for Mental Health and Juvenile Justice, working in partnership with the Council of Juvenile Correctional Administrators, was awarded the contract for this work in 2001, and set out to complete the required tasks, which included:
Organization of the Model
To develop the Model, it was necessary to establish a framework to guide the effort. First, a set of Core Principles were developed to serve as the underpinning and guide all subsequent efforts to improve the coordination and delivery of mental health screening, assessment, and treatment for youth in contact with the juvenile justice system. These principles represent the foundation on which a system can be built that is committed and responsive to addressing the mental health needs of youth in its care. They include:
The need for improved collaboration between the juvenile justice and mental health systems.
The need for improved and systematic strategies for identifying mental health needs among youth in contact with the juvenile justice system.
The need for more opportunities for youth to be appropriately diverted into effective community-based mental health treatment.
The need for youth in contact with the juvenile justice system to have access to effective treatment to meet their needs.
A critical piece of the Model is the inclusion of recommended actions—over 30 detailed suggestions providing guidance and direction to the field on how to address each of the Cornerstones. Examples of efforts that have already been made in the field to address these issues are included as well.
Finally, these Cornerstones were juxtaposed against Critical Intervention Points within the juvenile justice continuum that present opportunities to improve collaboration, identification, diversion, and treatment strategies for youth with mental health needs. The Critical Intervention Points include:
The Model was informed by the most comprehensive study of mental health problems conducted to date among youth in the juvenile justice system: 1437 youth in three different states in three types of juvenile justice settings—detention, corrections, and community-based programs. No single previous study conducted among youth in the juvenile justice system has examined the mental health problems and needs of youth in multiple states and in multiple juvenile justice settings, using standardized instruments to collect data.
The results of the study, which were incorporated into the Model, confirmed that, regardless of level of care or geographic region of the country, the majority of youth in the juvenile justice system meet criteria for at least one mental health diagnosis. Overall, 70.4 percent of youth were diagnosed with at least one mental health disorder, with girls experiencing a higher rate of disorders (81%) when compared to males (66.8%). For many of the youth in the study, their mental health status was complicated by the presence of more than one disorder. Of those youth who were diagnosed with a mental health disorder, 79.1 percent met criteria for at least one other mental health diagnosis. The majority of youth who met criteria for a mental health diagnosis were also diagnosed with a co-occurring substance use disorder. Among those youth with at least one mental health diagnosis, approximately 60 percent also met criteria for a substance use disorder.
While much of what it is presented in the document will have implications for policymakers, clinicians, and line staff, the Model is primarily oriented to state and county juvenile justice and mental health administrators and program directors who are responsible for establishing, modifying, and overseeing services affecting youth with mental health needs in contact with the juvenile justice system. The Model is a not a clinical implementation document; rather, it serves as a “change agent” to spur new thinking and the subsequent development of improved strategies to better identify mental health needs among youth in the juvenile justice system, as well as to improve the delivery of services to these youth.
The Comprehensive Model was developed in conjunction with a Model Development Workgroup, which comprised national mental health and juvenile justice experts and researchers, who provided guidance and direction to the National Center for Mental Health and Juvenile Justice as we embarked on this project. This Workgroup met regularly over the four years of the project to provide feedback, suggestions, and recommendations for how best to approach, implement, and refine every aspect of this project. In addition, the final draft of the Comprehensive Model was circulated to a group of national Expert Reviewers, including mental health and juvenile justice administrators, policymakers, practitioners, advocates, and youth who provided final comments on the draft.
This challenging project has culminated in the first ever systematic review of the juvenile justice system in its entirety—from intake to re-entry—to identify ways in which mental health service delivery strategies can be strengthened. The premise, however, is not complicated: stronger partnerships between the juvenile justice and mental health systems can result in better screening and assessment mechanisms at key points of juvenile justice contact, enhanced diversion opportunities for youth with mental health needs to be treated in the community, and increased access to effective mental health treatment. This Model provides a detailed blueprint for how to achieve these goals. What it cannot do, however, is actually effect the change. This can only be accomplished by the leaders in the juvenile justice and mental health fields who have been struggling to develop solutions to meet the needs of these youth. This document provides them the tool to move forward. The energy, hard work and political will to actually make this happen must come from them.
Reprinted from: National Center for Mental Health and Juvenile Justice
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