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Transforming Juvenile Justice: Integrating
Systems, Practice, and Policy
Daniel J. Flannery, PhD
Institute for the Study and Prevention of Violence
Kent State University
Behavioral Health and Juvenile Justice

First BH/JJ project 1994-1997; 3 sites in Ohio


Strengthening Communities & Youth


Three new sites exclusively focus on females
Project TAPESTRY


Juvenile offenders with substance use issues
Second BH/JJ project 2004-current; 6 sites in Ohio


State Departments of Mental Health & Youth Services
SAMHSA Funded, Mental Health side
Integrated Co-occurring treatment (ICT)

Pilot projects
2
Behavioral Health and Juvenile Justice
1994-1997
Violent juvenile offenders with serious mental health issues
not treatable by state juvenile justice system
•
•
61% taking 1-3 medications or more at intake
Mood (56%) and behavior disorders (23%) Axis I
Full Psychological Evaluations on n= 88 youth
•
•
•
Significant parent mental health issues
Youth victimization and suicide risk
IQ and Learning Disability issues
3
Strengthening CommunitiesYouth (SCY)
SAMHSA funded initiative (CSAT) with
county office of Justice Affairs, Public
Defender, and Catholic Charities
4
SCY Demographics

N= 232

82% male

53% were African-American, 29% were Caucasian

Average age=15.7 years (range 12-17)

64% were Medicaid eligible

54% lived 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
7
Substance Use
At intake:
 (87%) reported using marijuana in the
past 90 days


(59%) reported using alcohol in the past
90 days
13.1 years old the first time they got
drunk or used any drugs
8
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
^ Categories are not mutually exclusive
1 Percent of total with that diagnosis
2 Percentage of N=232
3 Percent of males (n=190) and of females (n=42)
* higher females vs. males, p<.05
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%
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%)
11
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
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
13
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
14
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
15
General Victimization



Youth reported first time they were
victimized at 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
16
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
High
45.7
Males
Females
17
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
18
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
19
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
20
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.
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
Marijuana
15
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
25
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)
26
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)
27
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
Behavioral Health and Juvenile
Justice 2004- current
Similar population of violent juvenile
offenders (age 10 to 18) in 6 urban and
rural counties
Evidence-based treatment program
Female offenders
On-site data managers
30
Preliminary Data

429 enrolled







Gender



Cuyahoga – 35
Fairfield – 11
Franklin – 119
Logan/Champaign – 189
Montgomery – 57
Union – 18
51.5% male
Average Age = 16 years
64% Caucasian; 29% African-American
31
Victimization Data
Question
Females Males
Has the child ever been physically
abused?
25%
17%
Has the child ever been sexually abused?
36%
6%
Has the child ever had a problem with
substance abuse?
45%
40%
Has the child ever talked about
committing suicide?
52%
38%
Has the child ever attempted suicide?
24%
9%
Has the child ever witnessed domestic
violence?
50%
42%
32
Diagnoses


At intake, 31% of the children were already
on medication for emotional/behavioral
symptoms
At intake, 30% of the youth have cooccurring mental health and substance
abuse diagnoses


Females ODD, Cannabis use, ADHD, bipolar,
PTSD
Males ADHD, Cannabis use, CD, ODD, depression
33
Substance Abuse
Have you ever had an alcoholic beverage?
Yes: 66%
Have you ever been drunk?
Yes: 69%
Have you ever smoked a cigarette?
Yes: 69%
Have you ever smoked marijuana?
Yes: 70%
Have you ever used cocaine?
Yes: 14%
34
Substance Abuse

Average Age of initial use:




Cigarette: 11.8 years
Alcoholic drink: 13.1 years
Marijuana: 13.0 years
Cocaine: 14.6 years
35
Substance Abuse Change

In the past 6 months, how often did
you drink an alcoholic beverage?

Once a month or not at all
Intake: 65%
 6 months: 81%
 Discharge: 80%

36
In the past 30 days, how many days
have you used:
Substance Use Change
30
Average Number of Days
25
20
Alcohol
Cigarettes
15
Marijuana
Cocaine
10
5
0
Intake
6 Months
Discharge
Interval
37
Ohio Scales
Ohio Scales Problem Severity Scale
(lower scores - less problem severity)
30
25
Score
20
Parent
Child
15
Worker
10
5
0
Intake
3 months
6 months
9 months
Discharge
Interval
*statistically significant differences between Intake and last measurement
38
Ohio Scales
Ohio Scales Functioning
(higher scores - greater functioning)
80
70
60
Score
50
Parent
40
Child
Worker
30
20
10
0
Intake
3 months
6 months
9 months
Discharge
Interval
*statistically significant differences between Intake and last measurement
39
Ohio Scales
Ohio Scales Hopefulness
(lower scores - greater hopefulness)
14
12
Score
10
8
Parent
Child
6
4
2
0
Intake
3 months
6 months
9 months
Discharge
Interval
*statistically significant differences between Intake and last measurement
40
Ohio Scales
Ohio Scales Satisfaction With Services
(lower scores - greater satisfaction)
12
10
Score
8
Parent
6
Child
4
2
0
Intake
3 months
6 months
9 months
Discharge
Interval
*statistically significant differences between Intake and last measurement
41
Integrated Co-occurring treatment
(ICT)
42
Home-Based Service
Delivery Model






Location of Service:
Intensive:
Crisis Response
Small caseloads:
Flexible:
Treatment Duration:
Home & Community
2-5 sessions/wk
24/7
3-6 families
Convenient to family
12-24 weeks
43
Results of ICT Study (2001-2002)
ICT Youth


56 youth
25% recidivism rate
Usual Services
Comparison
Group
29 Youth
 72% commitment
rate

Size of
Difference in
commitment
and/or
recidivism rates
Chi Square (1, 29):
17.74
Level of significance:
.001
44
Ohio Scales Gain Scores (2005 – October 2006)
General Clinical Population
(Statewide)
ICT Participants
30 days
180 days
Gain
30 days
180 days
Gain
Problem Severity Adult
28.60
22.74
5.86
31.28
19.38
11.90
Problem Severity Child
23.93
18.85
5.08
30.33
19.48
10.85
Hopefulness Adult
12.29
10.60
1.69
13.52
10.88
2.64
Hopefulness Child
10.60
9.44
1.16
13.09
10.18
2.91
Satisfaction Adult
8.87
6.42
2.45
10.25
7.25
3.00
Satisfaction Child
10.60
8.53
2.07
10.13
8.05
2.08
Functioning Adult
44.98
48.65
3.67
36.20
44.71
8.51
Functioning Child
55.75
59.34
3.59
49.42
58.76
9.34

Total = 27 youth; 3
ODYS Commitments

For "Functioning", the higher the score the better - for all others, the lower
the score the better
Clinical cutoffs= 20 for problem severity and 51 for parent rating
functioning and 60 for youth rated functioning
45
Implications and next steps








Growing population of offenders with MH and SA
issues
Community-based care vs. incarceration
Evidence-based treatment using comprehensive
assessments of risks and strengths
Collaboration across systems can work!
Data driven decisions for practice and policy
Shared vision can help plan for sustainability
Infrastructure and funding for integrated
treatment
Cultural competency matters in treatment
decisions
46