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Strengthening Communities-Youth (SCY) Presented by Dr. David Hussey Institute for the Study and Prevention of Violence at Kent State University Strengthening Communities – Youth (SCY) Cuyahoga County SCY project (2002-2007) targeted resources on two child serving systems -- the alcohol and drug addiction services system through the Alcohol and Drug Addiction Services (ADAS) Board, and the juvenile justice system through the Cuyahoga County Juvenile Court. SCY project goals specifically attempted to: improve coordinated system of care infrastructure, facilitate earlier identification of juvenile justice youth with drug and alcohol problems, improve access to needed services, expand service capacity, and address comorbidity issues including the relationship between substance abuse and violence. The project was designed to strengthen and improve the overall system of care, and collaborate with the mental health system of care for juvenile justice youth that present mental health problems. Strengthening Communities – Youth (SCY) CSAT developed the Discretionary grant program to respond to the growing demands for substance abuse treatment and to address gaps in the substance abuse treatment delivery system The SCY project (2002-2007, 3.75 million dollars) serves youth between the ages of 12 and 17 who arrive at the Cuyahoga County Detention Center as a result of a new arrest Youth are screened for substance use by a representative from the Public Defender’s office/Juvenile Division and referred to Catholic Counseling Services for further assessment using the Global Appraisal of Individual Needs (GAIN) Clinical recommendations will be presented to court prior to disposition Once assessed, youth are referred to an appropriate level of care for substance abuse treatment and followed at 3, 6, and 12 months (84% 12 month follow-up rate for study) Detention Center Demographics Based on the Cuyahoga County Court of Common Pleas – Juvenile Court Division 2005 Annual Report, there were a total of 3,102 youth held in the detention center (excludes youth on home detention and in Shelter Care) in 2005 Of these 3,102, 76% were male and 75% were African-American, 21% were Caucasian, 4% were Hispanic, and <1% were of another race Age range = 8 to 17 SCY Demographics For the period April 2003 to March 2007, 232 youth were enrolled in the SCY project Of these 232 youth, 82% were male and 53% were African-American, 29% were Caucasian, 6% were Hispanic/Latino, 11% were biracial/mixed, 1% were of another race Age range=12 to 17, Average age=15.7 years At least 64% are Medicaid eligible About half (54%) live in the city of Cleveland Arraignment Charges 50% 45% 40% 40% 37% 35% 30% 25% 20% 21% 15% 10% 9% 9% 5% 0% Assault/Menacing Property Drug/Alcohol Weapons Domestic Violence Substance Use At intake, over 3/4th of youth (87%) reported using marijuana in the past 90 days At intake, over half (59%) reported using alcohol in the past 90 days Youth reported they were, on average, 13.1 years old the first time they got drunk or used any drugs Mental Health Indices Internal Somatic Depressive Homicidal- Anxiety Traumatic Mental Symptoms Symptoms Suicidal Symptoms Stress Distress Thought Youth Moderate/Severe+ 90 (39%) 117 (50%) 148 (64%) 57 (25%) 103 (44%) 81 (35%) Boys Moderate/Severe^ 64 (34%) 89 (47%) 113 (59%) 42 (22%) 79 (42%) 59 (31%) Girls Moderate/Sever e^ 26 (62%)* 28 (67%)* 35 (83%)* 15 (36%) 24 (57%) 22 (52%)* Behavior Attention Inattentive Hyperactivity Conduct Complexity Deficit Disorder Disorder Disorder Hyperactivity Disorder Youth Moderate /Severe+ 162 (70%) 123 (53%) 95 (41%) 40 (17%) 163 (70%) Boys Moderate/Severe^ 127 (67%) 98 (52%) 73 (38%) 26 (14%) 129 (68%) Girls Moderate/Severe^ 35 (83%)* 25 (59%) 22 (52%) 14 (33%)* 34 (81%) DSM-IV Mental Disorders Diagnosis^ Mood Disorders: depression, cyclothymic, bipolar, dysthymic, mood disorder NOS Generalized Anxiety Disorder Disruptive Disorders: conduct disorder, ADHD, ODD Adjustment Disorder Gender %1 %2 %3 M: 50 69% 22% 26% F: 22 31% 9.5% 52%* Total=72 100% 31% M: 22 65% 9.5% 12% F: 12 35% 5% 29%* Total=34 100% 15% M: 98 77% 42% 52% F: 29 23% 12.5% 69%* Total=127 100% 55% M: 4 100% 2% 2% F: 0 0% 0% 0% Total=4 100% 2% ^ Categories are not mutually exclusive 1 Percentage based on total number with that diagnosis 2 Percentage based on N=232, the total number of SCY youth 3 Percentage based on total number of males (n=190) and total number of females (n=42) *Significantly higher proportion of females vs. males, p<.05 Comorbidity 63% have a DSM-IV mental disorder (are comorbid) in addition to a DSM-IV substance use disorder A significantly higher proportion of females than males were comorbid (79% v. 60%) Externalizing and Internalizing Disorders by Gender 90% 80% 88% 87% 73% 70% 60% 50% 61% 51% 49% Males 40% 30% 36% 27% 20% 13% 12% 10% 0% At least one Externalizing Externalizing Only At least one Internalizing Females Internalizing Only Both Internalizing and Externalizing Lifetime Charge data (JIMS) SCY youth were, on average, 14.41 years old at the time of their first charge Total charges=2,571 (N=227) On average, SCY youth had been charged with 10.19 (SD=7.30, median=9) offenses (excluding traffic) Misdemeanors accounted for the largest proportion of charges (40%), followed by felonies (30%), traffic offenses (11%), probation violations (10%) and status offenses (9%) Primary Offender Types 62% classified as felons 36% classified as misdemeanants 1% classified as status offenders Did not differ by racial/ethnic group or age at first adjudicated delinquent charge Males (71%) significantly more likely than females (25%) to be classified as felons Youth with Domestic Violence Charges 43% had at least one domestic violence charge 41% had at least one adjudicated domestic violence charge Of the total adjudicated domestic violence charges, 90% were misdemeanor level and 10% were felony level A higher proportion of females than males had adjudicated domestic violence charges Youth with Adjudicated Domestic Violence Charges Youth with DV Youth w/o DV Age at first charge* 14.56 (SD=1.64) 15.19 (SD=1.46) Race 51.9% African American 28.6% Caucasian 7.8% Hispanic 11.7% Bi-Racial 0.0% Other 54.7% African American 29.3% Caucasian 4.7% Hispanic 10.0% Bi-Racial 1.3% Other Gender 81.8% Male 18.2% Female 82.7% Male 17.3% Female Total Delinquent Charges* 8.70 (SD=6.17) 6.25 (SD=5.07) Environmental Risk Scale 38.55 (SD=8.86) 37.74 (SD=8.53) General Victimization Scale 3.67 (SD=3.24) 3.10 (SD=3.03) Substantiated/Indicated Maltreatment 54.5% Yes 43.3% Yes Environmental Risk 100% 90% 80% 40.5 41.8 70% 60% 50% 40% 30% 20% 10% 0% 76.1 74.4 High Moderate 57.7 1.8 Environmental Risk Low 55.0 3.2 Living Risk 22.0 25.6 1.8 0.0 Vocational Risk Social Risk General Victimization On average, youth reported the first time they were victimized they were 11 years old Significantly more females than males report sexual victimization and emotional abuse at the hands of someone close to them or that they trusted Significantly more males than females report being attacked with a weapon General Victimization 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 37.8 26.2 14.3 None 16.5 Moderate 59.5 45.7 Males Females High Child Welfare Involvement (DCFS data) The majority of SCY youth (69%) had at least one allegation of any type of maltreatment (neglect, physical abuse, sexual abuse, emotional maltreatment) Almost half (47%) of youth had a substantiated or indicated maltreatment incident in their lifetime On average, SCY youth were 7.7 years old at the time of first maltreatment allegation Out-of-Home Placements 24% of SCY youth had experienced at least one out-of-home placement (OHP) in their lifetime On average, youth who had experienced any OHP had 3 out-of-home placements (median=2) Most commonly, placement was in foster/adoptive homes or community residential centers Victimization 64% of youth report any victimization on the GAIN 47% of youth had a substantiated/ indicated incident of maltreatment If considered together, 80% of all SCY youth have a history of some type of victimization Cross-system Involvement Juvenile Justice, Alcohol and Drug, Mental Health, Special Education, DCFS 12% of youth were involved with only the juvenile justice and alcohol and drug systems 88% were involved in at least one other system 32% involved in 3 systems, 40% involved in 4 systems, 15% involved in all five systems Cross-system Involvement System involvement in addition to Juvenile Justice and Alcohol and Drug (N=232) N (%) Mental Health 131 (56%) Special Education 67 (29%) DCFS (any contact) Any allegations Any Substantiated/Indicated Out of home placement 173 (75%) 159 (68%) 108 (47%) 56 (24%) Mental Health and Special Education 41 (18%) Mental Health and DCFS 104 (45%) Special Education and DCFS 57 (25%) Mental Health, Special Education, and DCFS 36 (15%) Tapestry Cross System Involvement Tapestry youth cross-system involvement using multiple self report and official data sources. Indicator Tapestry (N= 329 enrolled) Juvenile Justice Substance Abuse 30% ever arrested, 27% have history of probation, 11% ever sentenced to a secure facility. 49% of youth report using at least one substance prior to intake, primarily alcohol, cigarettes and cannabis/hashish. Mental Health 100% of youth have at least one DSM-IV mental disorder, primarily ADHD (49%), Mood Disorders (43%), Oppositional defiant disorder (29%) and Adjustment Disorder (16%). 48% (n=219) reported current use of psychotropic medication. Education 49% of 108 Tapestry youth reported receiving special education classes Child and Family Services Year one data (n= 169) 57% of Tapestry youth have at least one allegation of maltreatment: physical abuse (35%), sexual abuse (20%), neglect (46%) or emotional abuse (4%). 18% of Tapestry youth had a history of one or more out of home placements. Medicaid 88% of youth are Medicaid eligible and have received Medicaid services. SCY Treatment Analysis focuses on the youth who completed the 12 month GAIN assessment (“completers”) 167 youth were completers; 142 (85%) of completers had received treatment services 313 treatment placements for 142 youth Substance Problems Scale Over Time Statistically significant decrease: Intake to 3 months Intake to 6 months Intake to 12 months Statistically significant increase: 3 months to 6 months 4 3.5 3 2.5 2 1.5 1 0.5 0 3.7 1.6 0.9 Intake 3mo 1.3 6mo Substance problem s in the past m onth 12mo Substance Use Over Time 40 35 35.7 30 25 Alcohol 20 Drunkeness 15 Marijuana 10 5 8.3 5.9 0 Intake 8.3 1.9 1 3mo 10.9 2.4 1.5 6mo 11.8 2.5 1.4 12mo Abstinence Youth reporting abstinence: Intake - 16 youth (7%) 3 months - 113 youth (49%) 6 months - 102 (44%) 12 months - 103 (44%) Overall, only 18% (n=42) of youth reported abstinence at all follow-up periods (3, 6, and 12 months) Urinalysis Data Of 42 youth who reported abstinence on the GAIN at 3, 6, and 12 months, 31 had urine screen data available Of these 31 youth: 7 (23%) did not have corroborating urine screen data (had positive screens) 24 (77%) had abstinence corroborated by urine screen data (had all negative screens) Emotional Problems Scale Over Time Statistically significant decrease: Intake to 3 months Intake to 6 months Intake to 12 months 6 months to 12 months 0.25 0.2 0.21 0.15 0.15 0.15 0.1 0.13 0.05 0 Intake 3mo 6mo Emotional Problems over time 12mo General Crime Scale Over Time Statistically significant decrease: Intake to 3 months Intake to 6 months Intake to 12 months 4 3.5 3 2.5 2 1.5 1 0.5 0 3.39 0.64 Intake 3mo 0.72 6mo General Crime over time 0.62 12mo Recidivism Time Frame Post Enrollment Type Number (Percent) of SCY Youth Charges 41 (18.1%) Delinquent Offenses 34 (15.0%) Charges 66 (29.1%) Delinquent Offenses 52 (22.9%) Charges 82 (36.1%) Delinquent Offenses 65 (28.6%) Charges 93 (41.0%) Delinquent Offenses 73 (32.2%) 3 Months 6 Months 9 Months 12 Months Discussion: SCY Major Findings Comorbidity rates continue to be very high Lifetime cross-system involvement high 63% of youth comorbid for mental health and substance abuse Females demonstrate higher rates of mental health impairment and comorbidity (79% versus 60%). Males more likely to be felons (71% versus 25%), evidence higher scores on the General Crime Scale. 12% of youth involved with only the juvenile justice and AOD systems 55% of youth involved with 4 or more child-serving systems 29% special education; 18% previous AOD treatment; 41.4% previous mental health treatment Victimization 69% of youth have previous child maltreatment allegation; 47% substantiated/indicated; 24% removed from home 80% of youth either self-report or have substantiated/indicated victimization or maltreatment histories Females present with different victimization patterns, greater severity, and higher rates of domestic violence. Discussion (continued) Recidivism rates at 12 months 41% for new charges and 32.2% for adjudications; 14.1% for felonies. Males 7.5x more likely to recidivate. These figures should be compared to other comparable juvenile justice youth. Significant reductions in substance use frequency, substance use problems, emotional problems, and general crime at 12 months. 18% of youth report abstinence across all three follow-up time points; 44% of youth abstinent during last six months. Of youth who report abstinence across 3, 6, and 12 months, 77% correspondence rate between selfreport and drug screens. SCY: Implications and Next Steps Substance use frequency, substance-related problems, emotional problems, general crime, and environmental risk strongly interconnected and related to treatment outcomes. Client comorbidity, cross-system involvement, gender differences, and victimization histories (including domestic violence) require earlier, comprehensive, coordinated, and integrated treatment responses. Heavy reliance on residential treatment may be reduced by strengthening IOP treatment models. Cuyahoga County is in a strong position to develop and evaluate promising IOP alternatives under the Tapestry system of care umbrella.