Technical Assistance Partnership for Child and Family Mental Health

JANUARY2002

What is the role of the clinician for youth in the juvenile justice system?

Clinicians play many critical roles to juvenile delinquents and their families as they proceed through the juvenile justice system. The most familiar are screening, assessment, intervening in crises, and making placement/service recommendations. Clinicians are available at the following decision points: arrest, charging, facility intake, initial detention hearing, adjudication, review and planning for aftercare or reentry.

If a youth presents behaviors indicating instability at the time of arrest, the police will take that youth to the hospital for evaluation before bringing him/her to the juvenile intake facility for processing. Once cleared by the medical authority, the youth will be presented at the intake facility.

A referral also may be made to a clinician at the time of intake at the juvenile justice facility. This referral may be made if the youth has a history of mental health or behavioral health needs such as previous hospitalization or treatment for suicidal behavior.

In twenty-five states (Cocozza, J. 2002), the Massachusetts Youth Screening Instrument, Version 2 (MAYSI 2) is being used to screen for mental health needs at admission to detention centers or juvenile corrections facilities. If a child scores in the warning range in two or more domains, s/he is referred for a clinical interview. Further evaluation and/or assessment will be at the discretion of the clinician conducting the interview.

A few states use centralized assessment centers at intake that provide a wealth of information about the youth in the following areas: mental health, education, primary health, and alcohol and drug abuse. Clinicians in these assessment centers gather the detailed information that is then used to determine the next step for the youth with special mental health needs. Whenever possible, youth with serious mental health disorders, who are not chronic offenders and are not alleged to have committed serious crimes against other people, are diverted from the juvenile justice system to the mental health system. When alternative treatment options do not exist, more often than not, the youth is sent to a juvenile institution and a judge orders clinical treatment.

Even if a youth has been given an assessment at the time of intake, a full clinical assessment is generally performed during the diagnostic phase - the period between intake and the youth's adjudicatory hearing. The American Correctional Association and the Council of Juvenile Correctional Administrator's Performance Based Standards require that a mental health assessment occur within the first three days of a youth's entering a facility and that a screening take place within one hour of admission. That clinical assessment or forensic assessment (MHA) is part of a battery of diagnostic tools used to determine the needs of the youth. It also provides a basis for the development of a service plan to be recommended to the judge to best meet the identified needs of the youth.

In addition, in most secure detention sites, a clinician will be called in, if there is not one on staff, for crisis intervention. If a clinician is not available, the youth is generally transported to a local hospital that has appropriate clinicians to respond to the issues at hand.

If a youth is an adjudicated delinquent and is remanded (by court order) to a juvenile correctional facility, there will always be a protocol for treating the youth. In juvenile corrections there are many clinical models and approaches to the delivery of mental health services. In the past four or five years, there has been significant emphasis on clinician-led cross-system training (e.g. Texas Corsicana Residential Treatment Center). Though there have been some concerns expressed, it is generally agreed that both juvenile justice and mental health workers need to develop a better understanding of each other's rolls and how these can complement one another to provide better services.

Some facilities specialize in the treatment of youth with diagnosed mental health problems. They will have their own clinical staff or have on-site clinical staff from the mental health authority. Texas passed legislation requiring that a Ph.D. Psychologist be assigned to every juvenile institution at a ratio of one clinician to forty youth. The newest model I have seen has a psychiatrist overseeing a youth's clinical treatment through videoconferencing while the day-to-day supervision of that treatment is by an on-site master's level psychologist.

It is estimated that eighty percent of the youth in the juvenile justice system in the U.S. have diagnosable mental health issues. (Otto, 1992; Wierson, 1992; Virginia Policy Team, 1994) Of these, an estimated twenty-five to thirty percent have serious mental health problems that require daily and, in some cases, life-long treatment. Although estimates of prevalence of serious mental health disorders are hampered by problems with research and definitions of mental illness, the rate of disorders among youth in the juvenile justice system is usually estimated to be at least twice the rate of mental health disorders in the general public. (Friedman et al., 1996)

One of the biggest problems juvenile justice faces in the treatment of mentally ill youth and those with mental health/behavioral health needs is the difficulty in finding clinicians who want to work with this population. Youth in the juvenile justice system have a reputation for noncompliance and will often require services to follow them to the many placements they are transferred to. Many youth self-medicate with alcohol or illegal drugs when treatment is no longer available, accessible, or mandated or when it is not affordable in their home community. This skews program outcomes and is often seen as a failure of the program rather than one of the peculiar and difficult aspects of serving this population.

December 2001's FAQ addresses evidence-based clinical interventions for juvenile delinquents with serious emotional disorders. It discusses three successful community-based and cost effective clinical models providing an alternative to out-of-home placements (Wraparound Milwaukee and Multi-Systemic Therapy and Functional Family Therapy). These System of Care initiatives offer hope to seriously emotionally disturbed youth in the juvenile justice system. To a youth entering the juvenile justice system, they offer hope that the youth will be diverted to appropriate mental health services, while meeting the juvenile justice mandates. To youth leaving the juvenile justice system, they offer hope of appropriate clinical support to aid their transition into their home communities and to prevent their return to the juvenile justice system.

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	JANUARY2002 What is the role of the clinician for youth in the juvenile justice system? Clinicians play many critical roles to juvenile delinquents and their families as they proceed through the juvenile justice system. The most familiar are screening, assessment, intervening in crises, and making placement/service recommendations. Clinicians are available at the following decision points: arrest, charging, facility intake, initial detention hearing, adjudication, review and planning for aftercare or reentry. If a youth presents behaviors indicating instability at the time of arrest, the police will take that youth to the hospital for evaluation before bringing him/her to the juvenile intake facility for processing. Once cleared by the medical authority, the youth will be presented at the intake facility. A referral also may be made to a clinician at the time of intake at the juvenile justice facility. This referral may be made if the youth has a history of mental health or behavioral health needs such as previous hospitalization or treatment for suicidal behavior. In twenty-five states (Cocozza, J. 2002), the Massachusetts Youth Screening Instrument, Version 2 (MAYSI 2) is being used to screen for mental health needs at admission to detention centers or juvenile corrections facilities. If a child scores in the warning range in two or more domains, s/he is referred for a clinical interview. Further evaluation and/or assessment will be at the discretion of the clinician conducting the interview. A few states use centralized assessment centers at intake that provide a wealth of information about the youth in the following areas: mental health, education, primary health, and alcohol and drug abuse. Clinicians in these assessment centers gather the detailed information that is then used to determine the next step for the youth with special mental health needs. Whenever possible, youth with serious mental health disorders, who are not chronic offenders and are not alleged to have committed serious crimes against other people, are diverted from the juvenile justice system to the mental health system. When alternative treatment options do not exist, more often than not, the youth is sent to a juvenile institution and a judge orders clinical treatment. Even if a youth has been given an assessment at the time of intake, a full clinical assessment is generally performed during the diagnostic phase - the period between intake and the youth's adjudicatory hearing. The American Correctional Association and the Council of Juvenile Correctional Administrator's Performance Based Standards require that a mental health assessment occur within the first three days of a youth's entering a facility and that a screening take place within one hour of admission. That clinical assessment or forensic assessment (MHA) is part of a battery of diagnostic tools used to determine the needs of the youth. It also provides a basis for the development of a service plan to be recommended to the judge to best meet the identified needs of the youth. In addition, in most secure detention sites, a clinician will be called in, if there is not one on staff, for crisis intervention. If a clinician is not available, the youth is generally transported to a local hospital that has appropriate clinicians to respond to the issues at hand. If a youth is an adjudicated delinquent and is remanded (by court order) to a juvenile correctional facility, there will always be a protocol for treating the youth. In juvenile corrections there are many clinical models and approaches to the delivery of mental health services. In the past four or five years, there has been significant emphasis on clinician-led cross-system training (e.g. Texas Corsicana Residential Treatment Center). Though there have been some concerns expressed, it is generally agreed that both juvenile justice and mental health workers need to develop a better understanding of each other's rolls and how these can complement one another to provide better services. Some facilities specialize in the treatment of youth with diagnosed mental health problems. They will have their own clinical staff or have on-site clinical staff from the mental health authority. Texas passed legislation requiring that a Ph.D. Psychologist be assigned to every juvenile institution at a ratio of one clinician to forty youth. The newest model I have seen has a psychiatrist overseeing a youth's clinical treatment through videoconferencing while the day-to-day supervision of that treatment is by an on-site master's level psychologist. It is estimated that eighty percent of the youth in the juvenile justice system in the U.S. have diagnosable mental health issues. (Otto, 1992; Wierson, 1992; Virginia Policy Team, 1994) Of these, an estimated twenty-five to thirty percent have serious mental health problems that require daily and, in some cases, life-long treatment. Although estimates of prevalence of serious mental health disorders are hampered by problems with research and definitions of mental illness, the rate of disorders among youth in the juvenile justice system is usually estimated to be at least twice the rate of mental health disorders in the general public. (Friedman et al., 1996) One of the biggest problems juvenile justice faces in the treatment of mentally ill youth and those with mental health/behavioral health needs is the difficulty in finding clinicians who want to work with this population. Youth in the juvenile justice system have a reputation for noncompliance and will often require services to follow them to the many placements they are transferred to. Many youth self-medicate with alcohol or illegal drugs when treatment is no longer available, accessible, or mandated or when it is not affordable in their home community. This skews program outcomes and is often seen as a failure of the program rather than one of the peculiar and difficult aspects of serving this population. December 2001's FAQ addresses evidence-based clinical interventions for juvenile delinquents with serious emotional disorders. It discusses three successful community-based and cost effective clinical models providing an alternative to out-of-home placements (Wraparound Milwaukee and Multi-Systemic Therapy and Functional Family Therapy). These System of Care initiatives offer hope to seriously emotionally disturbed youth in the juvenile justice system. To a youth entering the juvenile justice system, they offer hope that the youth will be diverted to appropriate mental health services, while meeting the juvenile justice mandates. To youth leaving the juvenile justice system, they offer hope of appropriate clinical support to aid their transition into their home communities and to prevent their return to the juvenile justice system.

Juvenile Justice and Systems of Care Frequently Asked Questions