Examining the Juvenile Justice Population in

California: Part 1

Examining the Juvenile Justice Population in California: Part 1

Presenter: William Arroyo, M.D.

Regional Medical Director Los Angeles County Dept. of Mental Health

Co-Facilitators: Dr. Karen Kurasaki & Ms. Sheron Wright

Examining the Juvenile Justice Population in California:

Part 1

Welcome, Introductions & Overview

Pre-Test

Feature Presentation & Q/A

Post-Test

Closing

Pre-Test

Examining the Juvenile Justice Population in California: Part 1

Presenter: William Arroyo, M.D.

Regional Medical Director Los Angeles County Dept. of Mental Health

Biography William Arroyo, M.D., is the Medical Director of the Child, Youth, and Family Administration for the Los Angeles County Department of Mental Health (LACDMH) and is a Clinical Assistant Professor of Psychiatry at Keck USC School of Medicine. As Medical Director, he represents LACDMH in program development and policy implementation efforts in the children's mental health arena at the county and state levels. His recent projects have focused on infancy/early childhood mental health and juvenile justice. He also serves as the Principal Investigator of Project ABC, a federal initiative to develop a system of care for young children from birth to age 5. Dr. Arroyo actively serves as a peer reviewer for the Journal of the American Academy of Child and Adolescent Psychiatry; as a board examiner for the American Board of Psychiatry and Neurology; and has served on advisory committees for national mental health technical assistance centers at Portland State University, Georgetown University, and the National Center for Juvenile Justice and Mental Health.

EXAMINING THE JUVENILE JUSTICE POPULATION IN CALIFORNIA: PART I California Institute of Behavioral Health Solutions William Arrroyo, M.D.; Los Angeles County DMH October 29, 2014

OVERVIEW

National and State Profiles of youth in JJ system

State data re: local MH services, use of psychotropic agents among youth in JJ system

Statewide data: suicide attempts among youth in local custody

Cook County study on detained youth and death rates

Nat’l prevalence rates of mental disorders among youth in JJ systems

OVERVIEW (2)

Comprehensive model of JJ/MH: principles (BLUEPRINT)

Cornerstones of BLUEPRINT

Costs-Benefits Analyses of Evidence Based Practices

Resources

Juvenile Halls/Camps/Ranches

Nat’l Profile of Juvenile Offenders in Residential Placement in ‘97,’03,’10

Number

Population Held 1997 2003 2010

All residents (pre- and post-adj)

116,701 109,094 79165

Juvenile offenders

105,055 96,531 70,792

Delinquency 98,813 92,022 67,776

Person offense

35,138 33,170 26,010

Violent offense

26,304 22,039 18,655

Status offenders

6,242 4,509 3,016

Other residents 11,646 12,563 8,373

US Dept of Justice, 2013

Nat’l Profile of Racial/Ethnic Distribution of Juvenile Offenders in

Custody (2010) Race/Ethnicity Number Percent Percent change

1997 - 2010

Total 70,792 100% -33%

White 22,947 32 -42

Minority 47,845 68 -27

Black 28,976 41 -31

Hispanic 15,590 22 -19

Amer. Indian 1236 2 23

Asian 728 1 -67

Other 1315 2 134

US Dept of Justice, 2013

US Dept of Justice, 2013

Youth Arrests in CA (2011)

0

20

40

60

80

100

120

White Black Latino AmericanIndian orAlaskanNative

Hawaiianor PacificIslander

Asian Other All youthof color

All youth

Youth arrests

Rate Per 1000 youth

Detained Youth in CA (2011)

0

5

10

15

20

25

30

Detained

Rate Per 1000 Youth

0123456789

10

Incarceration

Incarceration

Juvenile Detention Profile Survey – 2nd Qtr 2013 Overall Capacity and ADP

Brd of State and Community Corr, 2013

Juvenile Detention Profile Survey – 2nd Qtr 2013 Overal Capacity and ADP

Brd of State and Community Corr, 2013

County Breakout Report – 2nd Qtr 2013

Facilities and Alternative Detention

Brd of State and Community Corr, 2013

County Breakout Report – 2nd Qtr 2013 Facilities and Alternative Detention (2)

Brd of State and Community Corr, 2013

Rated Capacity and ADP – Juvenile Halls (2nd Qtr, 2013)

Brd of State and Community Corr, 2013

Distribution of Charges in JH’s

Brd of State and Community Corr, 2013

Rated Capacity and ADP – Camps and Ranches (2nd Qtr, 2013)

Brd of State and Community Corr, 2013

Distribution of Charges in Camps

Brd of State and Community Corr, 2013

Mental Health – 2nd Qtr, 2013

Number of Open Mental Health Cases 3912

Number of Juveniles Receiving Psychotropic Medication

1453

Hospitalized Outside Facility for MH Care 2

Suicide Attempts (Qtr) 61 (JH’s)

Suicides (Qtr) 0

Brd of State and Community Corr, 2013

Open MH Cases – JH’s/Camps

Brd of State and Community Corr, 2009-13

Psychotropic Medications – JH’s/Camps

Brd of State and Community Corr, 2009-13

Suicide Attempts – JH’s/Camps

Brd of State and Community Corr, 2009-13

Completed Suicides

None reported between 2009 – 2013 (2nd Qtr) in Juvenile Halls and Camps-Ranches

Brd of State and Community Corr, 2013

Cook County Detained Youth, ‘95 – ’98 Longitudinal Study – Early Death

CHARACTERISTICS n %

Sex

Male 1172 64.1

Female 652 35.9

Race/Ethnicity

Black 1005 54.9

Non-hispanic White

296 16.2

Hispanic 524 28.7

Other 4 0.2

Legal Status

Adult court 275 15

Juvenile court 1554 85

AGES n %

10 yo 7 0.4

11 20 1.1

12 87 4.8

13 258 14.1

14 217 11.9

15 498 27.2

16 64 35.2

17 89 4.9

18 9 0.5

Teplin, et.al., 2005

Cook County Detained Youth, ‘95 – ’98, Longitudinal Study – 65 Deaths Within 8.4 years

CHARACTERISTICS of DEAD YOUTH

Race/Ethnicity Male Female

Black 23 7

Non-Hispanic White 7 2

Hispanic 21 5

Other 0 0

Age of death

15-16 yo 8 1

17-18 yo 21 3

19-20 yo 14 5

≥ 21 yo 8 5

Total 51 14

Teplin, et.al., 2005

Teplin, et.al., 2005

Teplin, et.al., 2005

COOK COUNTY STUDY DETAINED vs. NAT’L GEN POP

Summary of Cook County Study

• Mortality rate (MR) among delinquent youth in study >4x than that in general pop

• MR among females was nearly 8x that of general pop

• More than 90% of deaths were homicides from gunshot wounds

• Recent Australian study of young offenders were attributable to OD compared to only 3 deaths in this sample; in this study nearly 97% youth who died of homicide sold drugs

• 20% of US youth (15 – 24 yo) deaths are firearm related while this sample > 90% of deaths were from firearms

Teplin, et. al., 2005

Juvenile Justice Youth NCMHJJ Study (2007)

70.4% Youth with Mental Disorder

NCMHJJ, 2007

Arroyo, 2001

Incarcerated Youth with PTSD: males vs. females

3 males only

1 females only

1 females + males

Risk Factors for Mental Disorders

Exposure to toxins, eg, alcohol, drugs, infections, in pregnancy

Premature births

Genetic factors

Poverty

Raised in child welfare system

Limited or poor bonding during early childhood

Risk Factors for Mental Disorders (2)

Childhood abuse/neglect

Psychological trauma, eg, exposure to violence

Harsh/inconsistent discipline

Brain trauma (>30% of youth in JJ)

Stressful life events, eg, death of parent, etc.

Parental criminality and psychopathology

Maladaptive peer influences

BLUEPRINT for a COMPREHENSIVE MODEL of

JJ/MH - PRINCIPLES Youth should not have to enter JJ system solely to access MHS or because they have a MH problem

If public safety matters allow, a youth with MH needs should be diverted to evidence based treatment in a community setting

If ensuring public safety is critical, then the least restrictive setting with access to evidence based treatment should be chosen

Skowyra and Cocozza, 2007

BLUEPRINT MODEL – PRINCIPLES (2)

Mental health screens administered in the pre-adjudicatory phase should not be used for legal purposes

MHS should be responsive to gender, ethnicity, race, age, sexual orientation, SES, and faith

MHS should be provided in a developmental context, e.g., not adult-framework

Skowyra and Cocozza, 2007

BLUEPRINT MODEL – PRINCIPLES (3)

Families/caregivers should be partners in treatment decisions and plans

Multiple systems bear responsibility. Planning for JJ youth must be a collaborative effort by all key systems

Services and strategies for JJ youth with MH needs should be routinely evaluated for their effectiveness and outcomes

Skowyra and Cocozza, 2007

FOUR CORNERSTONES OF BLUEPRINT MODEL

COLLABORATION

Collaboration Organize TK with rep’s from each key agency, including advocates, family members and consumers

Designate leader who has broad understanding of systems

Identify goals and the objectives and strategies to achieve goals

Emphasize strategic planning which achieves both immediate and sustainable plans

Recruit political support

Develop financial plan

IDENTIFICATION

Identification

Screen for emergent MH needs

Screen for routine MH needs

Screening instruments should have good psychometric properties and address co-occurring disorders

MH assessments to be completed by qualified personnel

Risk assessments can be completed concurrently

Diversion Determine public safety risk

Pre- and post- adjudication diversion may include MH courts, Drug courts

Consider diversion at every key decision making point within the judicial decision making process

Consider intensive supervision plus treatment as an alternative to secure facilities

Effective treatment resources must be available in community

JUDICIAL PROCESSING

DETENTION

INITIAL CONTACT & REFERRAL

SECURE PLACEMENT

COMM RE-ENTRY

PROBATION SUPERVISION

INTAKE

CRITICAL INTERVENTION POINTS

Skowyra and Cocozza, 2007

Treatment

Treatment Should be evidenced based whether in secure facilities or in community

Examples

- Multisytemic Therapy

- Functional Family Therapy

- Multidimensional Treatment Foster Care

- Cognitive Behavior Therapy (depression, trauma)

- Brief Strategic Family Therapy

- Aggression Replacement Therapy

Treatment (2)

Other Examples:

- Dialectical Behavior Therapy

- Psychotropic Medications

Family involvement is critical

Gender specific services

Co-occurring mental and substance use treatment approach

Cost-Benefit Analyses of Evidence Based Practices (dollars)

Program Total benefits

Taxpayer benefits

Non-taxpayer benefits

Costs Benefits minus costs

Benefit to cost ratio

FFT (in St Inst)

61,374 12,982 48,392 (3,332) 58,043 18.42

FFT (on prob)

37,587 9,510 28,077 (3,333) 34,254 11.28

ART (on prob)

35,329 8,727 26,602 (1,540) 33,788 22,94

MTFC 39,094 8,875 30,218 (8,059) 31,035 4.85

MST 34,067 7,700 26,367 (7,522) 26,548 4.53

MDFT for Subst

21,125 5,725 15,400 (5,835) 15,289 3.62

Washington State Institute for Public Policy, 2013

Cost-Benefit Analyses of Evidence Based Practices (dollars) - 2

Program Total Benefits

Taxpayer Benefits

Non-taxpayer benefits

Costs Benefits minus costs

Benefit to cost ratio

MST for Subst JO

22,235 4,286 17,949 (7,528) 14,708 2.95

Drug Court

14,692 3,810 10,882 (3,154) 11,539 4.66

Drug trtmt JO

6,717 2,078 4,639 (3,704) 3,013 1.81

Scared Straight

(12,932) (3,259) (9,673) (66) (12,998) n/e

Washington State Institute for Public Policy, 2013

RESOURCES Bell; Disproportionate minority contact (DMC); www.burnsinstitute.org

California Commission on Juvenile Justice (2009); JJ Operational Master Plan; Blueprint for an Outcome Oriented JJ System; http://67.199.72.34/php/Information/JJOMPFinalReport.pdf

CMHDA and CPOC: Multi-Association Joint Committee; Placement Options for Aggressive Juvenile Justice Youth with Severe Mental Illness: County Challenges (March, 2007)

CPOC and CMHDA; Costs of Incarcerating Youth with Mental Illness; http://www.cpoc.org/assets/Data/costs%20of%20incarcerating%20youth%20with%20mental%20illness.pdf

Kraus and Arroyo; Amer Acad of Child and Adolescent Psychiatry; Monograph on Juvenile Justice Reform; http://www.aacap.org/App_Themes/AACAP/docs/clinical_practice_center/systems_of_care/JJmonograph1005.pdf

Resources (2) California Standards Authority; Mentally Ill Juveniles in Local Custody (2011); http://www.cdcr.ca.gov/COMIO/docs/Mentaly_Ill_Juveniles_In_Local_Custody.pdf

Models for Change: Systems Reform in Juvenile Justice; http://www.modelsforchange.net/index.html

National Center on Mental Health and Juvenile Justice; www.ncmhjj.org

Skowyra and Cocozza, 2007; Blueprint for Change: A Comprehansive Model for the Identification of Youth with Mental Health Needs in the Juvenile Justice System; http://www.ncmhjj.com/wp-content/uploads/2013/12/Blueprint.pdf

US Department of Justice, Office of Justice Programs, Office of JJ and Delinquency Prevention; http://www.ojjdp.gov/index.html

Wasserman, et.al; Mental Health Assessments in Juvenile Justice: Report on Consensus Conference; JAmAcadChAdolPsychiatry; July, 2003

Washington State Institute for Public Policy, 2013; Cost-Benefit Analyses; http://www.wsipp.wa.gov/BenefitCost?topicId=1

Questions

Post-Test

Thank You!