By Melissa Capers

Each year, juvenile justice systems in the United States encounter youth with critical needs that extend well beyond the walls of the courtroom—or the detention center. These often include substance abuse and mental illness—problems that the justice system is not designed to address.

To assist state and local governments in developing a response to these needs, SAMHSA recently joined with the National Institute on Drug Abuse (NIDA) and the Office of Justice Programs within the U.S. Department of Justice to co-sponsor a National Policy Academy on Improving Services for Youth with Mental Health and Co-Occurring Substance Use Disorders Involved with the Juvenile Justice System. The purpose of the meeting was to provide an opportunity for multidisciplinary teams to create or expand strategic plans that are designed to integrate systems and coordinate services for justice-involved youth with mental health and co-occurring substance use disorders.

Eight teams were chosen from more than 50 applicants, each representing a state or local jurisdiction, to attend the Policy Academy, held in June. Each team comprised administrators from state and county mental health departments and substance abuse service systems, juvenile justice and probation officials, and individuals who themselves had gone through the juvenile justice system—or watched family members do so. Teams could also bring additional representatives—from the judiciary, child welfare, and education systems, and the public defender's office.

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In addition to breakout sessions where individual teams worked on their action plans, the Policy Academy included panel presentations on numerous topics of interest to participants. These included effective treatment interventions, diversion and re-entry programs, program implementation and sustainability, and special issues for girls, sexual minority youth, youth of color, and youth with mental health needs in schools.

Emerging evidence suggests that co-occurring mental and addictive disorders appear to be widespread among youth in the juvenile justice system. In his welcoming remarks, SAMHSA Administrator Charles G. Curie, M.A., A.C.S.W., reported on a Northwestern University study headed by Linda A. Teplin, Ph.D., and funded by SAMHSA, other Federal agencies, and multiple private foundations.

"This longitudinal study on over 1,800 youth detained in Cook County, IL, found that nearly two-thirds of males and nearly three-quarters of females met diagnostic criteria for at least one mental health disorder . . . [and] approximately half of the youth had a substance use disorder," he said.

Gail Wasserman, Ph.D., of the Center for the Promotion of Mental Health in Juvenile Justice at Columbia University, NY, told participants, "A recent examination of all youth suicides in Utah found that 80 percent had contact with the juvenile justice center in the 12 months prior to their death." According to Dr. Wasserman, youth in the juvenile justice system report higher rates of suicide attempts than do their peers, suggesting a concentrated need for mental health services among youth in the juvenile justice system.

Fortunately, efforts across the country have begun to demonstrate measurable progress in meeting the complex needs of justice-involved youth. Several themes were echoed at the Policy Academy.

• Understanding of the complexities of co-occurring disorders among justice-involved youth is growing. Wilson Compton, M.D., M.P.E, Director of NIDA's Division of Epidemiology, Services and Prevention Research, described the Criminal Justice-Drug Abuse Treatment Research Studies (CJ-DATS). This ongoing, multisite research program is designed to test and generate knowledge about integrated models of substance abuse treatment for incarcerated individuals, including juveniles.

Through its nine research centers, including two centers focused on adolescents in the juvenile justice system, and a coordinating center located at the University of Maryland-College Park, CJ-DATS fosters linkages between researchers, criminal justice professionals, and substance abuse treatment providers at the Federal, state, local, and community level; brings science-to-service models; and will generate new knowledge about what works best for incarcerated individuals with substance abuse disorders.

David Stewart, Ph.D., of the University of Washington's Division of Public Behavioral Health and Justice Policy, provided an overview of the shared factors that predispose youth to both mental illness and substance abuse—including family history and environmental factors. He also described the potential interaction between these disorders: "Mental illness can cause impaired self-regulation, which further predisposes a youth to substance abuse; substance-induced impairment negatively impacts mental health, or wreaks havoc on a youth's home life, which in turn worsens mental health."

• Effective evidence-based treatment models have been identified. Three family-centered treatment models—Functional Family Therapy, Multisystemic Therapy, and Oregon Treatment Foster Care—are showing measurable success across multiple sites in reducing re-arrest rates, improving family and school functioning, decreasing mental health symptoms, reducing placements, and saving costs, according to Scott Henggeler, Ph.D., of the Family Services Research Center of Charleston, SC. NIDA's CJ-DATS will generate additional data regarding Functional Family Therapy.

• Interest in providing appropriate treatment for justice-involved youth extends beyond the treatment community. Conveying interest from the Department of Justice, Deputy Assistant Attorney General Lizette Benedi, J.D., recalled the founding principles of the juvenile justice system: "the belief that virtually all youth can be rehabilitated; that with the proper support and discipline, they can become productive, successful members of their communities."

The Honorable Patricia Clark, judge at the King County Superior Court in Seattle, described efforts by the American Bar Association and other groups to amend the Judicial Canon of Ethics to support more clearly the involvement of juvenile judges in developing resources to address the needs of youth with mental or addictive disorders in the juvenile justice system.

• It is possible to coordinate diverse systems and funding streams to meet the needs of justice-involved youth with co-occurring disorders. Bruce Kamradt, M.S.W., Director of Wraparound Milwaukee in Wisconsin, reported on his program's history and success. Originally funded in 1995 through a Systems-of-Care grant from SAMHSA's Center for Mental Health Services, Wraparound Milwaukee was chosen by the President's New Freedom Commission on Mental Health in 2003 as an exemplary model in the delivery of services to children with serious emotional and behavioral needs. Wraparound Milwaukee provides families one-stop access to more than 80 services for children with serious emotional disturbances and their families. Through pooled funding from child welfare, juvenile justice, Medicaid, and mental health systems, Wraparound Milwaukee provides cost-effective, comprehensive, and individualized care to children with serious emotional disturbances.

Since its inception, Wraparound Milwaukee has contributed to a decrease in the average daily residential treatment population (from 375 to 50); a reduction in psychiatric inpatient days (from 5,000 to less than 200 days per year); and reduced Juvenile Court commitments (from 385 to 285 per year). The average monthly per child cost of Wraparound Milwaukee's comprehensive system of care is $4,200—considerably less than the monthly cost of residential treatment ($7,200), correctional placement ($6,000), or psychiatric inpatient care ($18,000).

As the Policy Academy ended, each team shared its preliminary vision: for some teams, next steps include implementing or expanding a model program; for others, more training, education, and data collection are necessary.

For more information on Criminal and Juvenile Justice, visit SAMHSA's Web site at www.samhsa.gov. 

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