Strengthening Strengthening Communities-Youth Communities-Youth

(SCY)(SCY)

Presented byPresented byDr. David HusseyDr. David Hussey

Institute for the Study and Prevention of Violence at Institute for the Study and Prevention of Violence at Kent State UniversityKent State University

Strengthening Communities – Strengthening Communities – Youth (SCY)Youth (SCY)

Cuyahoga County SCY project (2002-2007) targeted resources Cuyahoga County SCY project (2002-2007) targeted resources on two child serving systems -- the alcohol and drug addiction on two child serving systems -- the alcohol and drug addiction services system through the Alcohol and Drug Addiction services system through the Alcohol and Drug Addiction Services (ADAS) Board, and the juvenile justice system through Services (ADAS) Board, and the juvenile justice system through the Cuyahoga County Juvenile Court. SCY project goals the Cuyahoga County Juvenile Court. SCY project goals specifically attempted to: improve coordinated system of care specifically attempted to: improve coordinated system of care infrastructure, facilitate earlier identification of juvenile justice infrastructure, facilitate earlier identification of juvenile justice youth with drug and alcohol problems, improve access to youth with drug and alcohol problems, improve access to needed services, expand service capacity, and address needed services, expand service capacity, and address comorbidity issues including the relationship between substance comorbidity issues including the relationship between substance abuse and violence. The project was designed to strengthen abuse and violence. The project was designed to strengthen and improve the overall system of care, and collaborate with the and improve the overall system of care, and collaborate with the mental health system of care for juvenile justice youth that mental health system of care for juvenile justice youth that present mental health problems.present mental health problems.

Strengthening Communities – YouthStrengthening Communities – Youth (SCY)(SCY)

CSAT developed the Discretionary grant program to respond to CSAT developed the Discretionary grant program to respond to the growing demands for substance abuse treatment and to the growing demands for substance abuse treatment and to address gaps in the substance abuse treatment delivery address gaps in the substance abuse treatment delivery system system

The SCY project (2002-2007, 3.75 million dollars) serves youth The SCY project (2002-2007, 3.75 million dollars) serves youth between the ages of 12 and 17 who arrive at the Cuyahoga between the ages of 12 and 17 who arrive at the Cuyahoga County Detention Center as a result of a new arrestCounty Detention Center as a result of a new arrest

Youth are screened for substance use by a representative from Youth are screened for substance use by a representative from the Public Defender’s office/Juvenile Division and referred to the Public Defender’s office/Juvenile Division and referred to Catholic Counseling Services for further assessment using the Catholic Counseling Services for further assessment using the Global Appraisal of Individual Needs (GAIN)Global Appraisal of Individual Needs (GAIN)

Clinical recommendations will be presented to court prior to Clinical recommendations will be presented to court prior to disposition disposition

Once assessed, youth are referred to an appropriate level of Once assessed, youth are referred to an appropriate level of care for substance abuse treatment and followed at 3, 6, and care for substance abuse treatment and followed at 3, 6, and 12 months (84% 12 month follow-up rate for study)12 months (84% 12 month follow-up rate for study)

Detention Center DemographicsDetention Center Demographics

Based on the Cuyahoga County Court of Based on the Cuyahoga County Court of Common Pleas – Juvenile Court Division 2005 Common Pleas – Juvenile Court Division 2005 Annual Report, there were a total of 3,102 youth Annual Report, there were a total of 3,102 youth held in the detention center (excludes youth on held in the detention center (excludes youth on home detention and in Shelter Care) in 2005 home detention and in Shelter Care) in 2005

Of these 3,102, 76% were male and 75% were Of these 3,102, 76% were male and 75% were African-American, 21% were Caucasian, 4% African-American, 21% were Caucasian, 4% were Hispanic, and <1% were of another racewere Hispanic, and <1% were of another race

Age range = 8 to 17Age range = 8 to 17

SCY DemographicsSCY Demographics For the period April 2003 to March 2007, 232 youth were For the period April 2003 to March 2007, 232 youth were

enrolled in the SCY projectenrolled in the SCY project

Of these 232 youth, 82% were male and 53% were African-Of these 232 youth, 82% were male and 53% were African-American, 29% were Caucasian, 6% were Hispanic/Latino, American, 29% were Caucasian, 6% were Hispanic/Latino, 11% were biracial/mixed, 1% were of another race11% were biracial/mixed, 1% were of another race

Age range=12 to 17, Average age=15.7 yearsAge range=12 to 17, Average age=15.7 years

At least 64% are Medicaid eligibleAt least 64% are Medicaid eligible

About half (54%) live in the city of ClevelandAbout half (54%) live in the city of Cleveland

Arraignment ChargesArraignment Charges

21%

40%

9% 9%

37%

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

Assault/Menacing Property Drug/Alcohol Weapons DomesticViolence

Substance UseSubstance Use

At intake, over 3/4At intake, over 3/4thth of youth (87%) reported of youth (87%) reported using marijuana in the past 90 daysusing marijuana in the past 90 days

At intake, over half (59%) reported using alcohol At intake, over half (59%) reported using alcohol in the past 90 daysin the past 90 days

Youth reported they were, on average, 13.1 Youth reported they were, on average, 13.1 years old the first time they got drunk or used years old the first time they got drunk or used any drugsany drugs

Mental Health IndicesMental Health Indices

Internal

Mental

Distress

Somatic

Symptoms

Depressive

Symptoms

Homicidal-

Suicidal

Thought

Anxiety

Symptoms

Traumatic

Stress

Youth Moderate/Severe+ 90 (39%) 117 (50%) 148 (64%) 57 (25%) 103 (44%) 81 (35%)

Boys Moderate/Severe^

Girls Moderate/Severe ̂

64 (34%)

26 (62%)*

89 (47%)

28 (67%)*

113 (59%)

35 (83%)*

42 (22%)

15 (36%)

79 (42%)

24 (57%)

59 (31%)

22 (52%)*

Behavior

Complexity

Attention

Deficit

Hyperactivity

Disorder

Inattentive

Disorder

Hyperactivity

Disorder

Conduct

Disorder

Youth Moderate/Severe+ 162 (70%) 123 (53%) 95 (41%) 40 (17%) 163 (70%)

Boys Moderate/Severe^

Girls Moderate/Severe^

127 (67%)

35 (83%)*

98 (52%)

25 (59%)

73 (38%)

22 (52%)

26 (14%)

14 (33%)*

129 (68%)

34 (81%)

DSM-IV Mental DisordersDSM-IV Mental DisordersDiagnosis^Diagnosis^ GenderGender %%11 %%22 %%33

Mood Disorders: depression, cyclothymic, Mood Disorders: depression, cyclothymic, bipolar, dysthymic, mood disorder NOSbipolar, dysthymic, mood disorder NOS

M: 50M: 50 69%69% 22%22% 26%26%

F: 22F: 22 31%31% 9.5%9.5% 52%*52%*

Total=72Total=72 100%100% 31%31%

Generalized Anxiety DisorderGeneralized Anxiety Disorder M: 22M: 22 65%65% 9.5%9.5% 12%12%

F: 12F: 12 35%35% 5%5% 29%*29%*

Total=34Total=34 100%100% 15%15%

Disruptive Disorders: conduct disorder, Disruptive Disorders: conduct disorder, ADHD, ODDADHD, ODD

M: 98M: 98 77%77% 42%42% 52%52%

F: 29F: 29 23%23% 12.5%12.5% 69%*69%*

Total=127Total=127 100%100% 55%55%

Adjustment DisorderAdjustment Disorder M: 4M: 4 100%100% 2%2% 2%2%

F: 0F: 0 0%0% 0%0% 0%0%

Total=4Total=4 100%100% 2%2%

^ Categories are not mutually exclusive1 Percentage based on total number with that diagnosis2 Percentage based on N=232, the total number of SCY youth3 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

ComorbidityComorbidity

63% have a DSM-IV mental disorder (are 63% have a DSM-IV mental disorder (are comorbid) in addition to a DSM-IV comorbid) in addition to a DSM-IV substance use disordersubstance use disorder

A significantly higher proportion of females A significantly higher proportion of females than males were comorbid (79% v. 60%)than males were comorbid (79% v. 60%)

Externalizing and Internalizing Externalizing and Internalizing Disorders by GenderDisorders by Gender

88%

87%

27%

51%

73%

49%

12%13%

61%

36%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

At least oneExternalizing

ExternalizingOnly

At least oneInternalizing

InternalizingOnly

BothInternalizing

andExternalizing

Females

Males

Lifetime Charge data (JIMS)Lifetime Charge data (JIMS)

SCY youth were, on average, 14.41 years old at the time SCY youth were, on average, 14.41 years old at the time of their first chargeof their first charge

Total charges=2,571 (N=227)Total charges=2,571 (N=227)

On average, SCY youth had been charged with 10.19 On average, SCY youth had been charged with 10.19 (SD=7.30, median=9) offenses (excluding traffic)(SD=7.30, median=9) offenses (excluding traffic)

Misdemeanors accounted for the largest proportion of Misdemeanors accounted for the largest proportion of charges (40%), followed by felonies (30%), traffic charges (40%), followed by felonies (30%), traffic offenses (11%), probation violations (10%) and status offenses (11%), probation violations (10%) and status offenses (9%)offenses (9%)

Primary Offender TypesPrimary Offender Types

62% classified as felons62% classified as felons 36% classified as misdemeanants36% classified as misdemeanants 1% classified as status offenders1% classified as status offenders Did not differ by racial/ethnic group or age Did not differ by racial/ethnic group or age

at first adjudicated delinquent chargeat first adjudicated delinquent charge Males (71%) significantly more likely than Males (71%) significantly more likely than

females (25%) to be classified as felonsfemales (25%) to be classified as felons

Youth with Domestic Violence ChargesYouth with Domestic Violence Charges

43% had at least one domestic violence charge43% had at least one domestic violence charge

41% had at least one adjudicated domestic 41% had at least one adjudicated domestic violence chargeviolence charge

Of the total adjudicated domestic violence Of the total adjudicated domestic violence charges, 90% were misdemeanor level and 10% charges, 90% were misdemeanor level and 10% were felony levelwere felony level

A higher proportion of females than males had A higher proportion of females than males had adjudicated domestic violence charges adjudicated domestic violence charges

Youth with DVYouth with DV Youth w/o DVYouth w/o DV

Age at first charge*Age at first charge* 14.56 (SD=1.64)14.56 (SD=1.64) 15.19 (SD=1.46)15.19 (SD=1.46)

RaceRace 51.9% African American51.9% African American28.6% Caucasian28.6% Caucasian7.8% Hispanic7.8% Hispanic11.7% Bi-Racial11.7% Bi-Racial0.0% Other0.0% Other

54.7% African American54.7% African American29.3% Caucasian29.3% Caucasian4.7% Hispanic4.7% Hispanic10.0% Bi-Racial10.0% Bi-Racial1.3% Other1.3% Other

GenderGender 81.8% Male81.8% Male18.2% Female18.2% Female

82.7% Male82.7% Male17.3% Female17.3% Female

Total Delinquent Charges*Total Delinquent Charges* 8.70 (SD=6.17)8.70 (SD=6.17) 6.25 (SD=5.07)6.25 (SD=5.07)

Environmental Risk ScaleEnvironmental Risk Scale 38.55 (SD=8.86)38.55 (SD=8.86) 37.74 (SD=8.53)37.74 (SD=8.53)

General Victimization ScaleGeneral Victimization Scale 3.67 (SD=3.24)3.67 (SD=3.24) 3.10 (SD=3.03)3.10 (SD=3.03)

Substantiated/Indicated Substantiated/Indicated MaltreatmentMaltreatment

54.5% Yes54.5% Yes 43.3% Yes43.3% Yes

Youth with Adjudicated Domestic Youth with Adjudicated Domestic Violence ChargesViolence Charges

Environmental RiskEnvironmental Risk

1.8

57.7

40.5

3.2

55.0

41.8

1.8

22.0

76.1

0.0

25.6

74.4

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

EnvironmentalRisk

Living Risk VocationalRisk

Social Risk

High

Moderate

Low

General VictimizationGeneral Victimization

On average, youth reported the first time they On average, youth reported the first time they were victimized they were 11 years oldwere victimized they were 11 years old

Significantly more females than males report Significantly more females than males report sexual victimization and emotional abuse at the sexual victimization and emotional abuse at the hands of someone close to them or that they hands of someone close to them or that they trustedtrusted

Significantly more males than females report Significantly more males than females report being attacked with a weaponbeing attacked with a weapon

General VictimizationGeneral Victimization

45.7

16.5

37.8

59.5

14.3

26.2

0%10%

20%30%

40%50%60%

70%80%90%

100%

Males Females

None

Moderate

High

Child Welfare Involvement (DCFS data)Child Welfare Involvement (DCFS data)

The majority of SCY youth (69%) had at least The majority of SCY youth (69%) had at least one allegation of any type of maltreatment one allegation of any type of maltreatment (neglect, physical abuse, sexual abuse, (neglect, physical abuse, sexual abuse, emotional maltreatment)emotional maltreatment)

Almost half (47%) of youth had a substantiated Almost half (47%) of youth had a substantiated or indicated maltreatment incident in their or indicated maltreatment incident in their lifetimelifetime

On average, SCY youth were 7.7 years old at On average, SCY youth were 7.7 years old at the time of first maltreatment allegationthe time of first maltreatment allegation

Out-of-Home PlacementsOut-of-Home Placements

24% of SCY youth had experienced at least one 24% of SCY youth had experienced at least one out-of-home placement (OHP) in their lifetime out-of-home placement (OHP) in their lifetime

On average, youth who had experienced any On average, youth who had experienced any OHP had 3 out-of-home placements (median=2)OHP had 3 out-of-home placements (median=2)

Most commonly, placement was in Most commonly, placement was in foster/adoptive homes or community residential foster/adoptive homes or community residential centerscenters

VictimizationVictimization

64% of youth report any victimization on 64% of youth report any victimization on the GAINthe GAIN

47% of youth had a substantiated/ 47% of youth had a substantiated/ indicated incident of maltreatmentindicated incident of maltreatment

If considered together, 80% of all SCY If considered together, 80% of all SCY youth have a history of some type of youth have a history of some type of victimizationvictimization

Cross-system InvolvementCross-system Involvement Juvenile Justice, Alcohol and Drug, Mental Juvenile Justice, Alcohol and Drug, Mental

Health, Special Education, DCFSHealth, Special Education, DCFS

12% of youth were involved with 12% of youth were involved with onlyonly the the juvenile justice and alcohol and drug systemsjuvenile justice and alcohol and drug systems

88% were involved in at least one other system88% were involved in at least one other system

32% involved in 3 systems, 40% involved in 4 32% involved in 3 systems, 40% involved in 4 systems, 15% involved in all five systemssystems, 15% involved in all five systems

Cross-system InvolvementCross-system Involvement

System involvement System involvement in addition toin addition to Juvenile Justice and Juvenile Justice and Alcohol and Drug (N=232)Alcohol and Drug (N=232)

N (%)N (%)

Mental HealthMental Health 131 (56%)131 (56%)

Special EducationSpecial Education 67 (29%)67 (29%)

DCFS (any contact)DCFS (any contact)Any allegationsAny allegations

Any Substantiated/IndicatedAny Substantiated/IndicatedOut of home placementOut of home placement

173 (75%)173 (75%)159 (68%)159 (68%)108 (47%)108 (47%)56 (24%)56 (24%)

Mental Health and Special EducationMental Health and Special Education 41 (18%)41 (18%)

Mental Health and DCFSMental Health and DCFS 104 (45%)104 (45%)

Special Education and DCFSSpecial Education and DCFS 57 (25%)57 (25%)

Mental Health, Special Education, and DCFSMental Health, Special Education, and DCFS 36 (15%)36 (15%)

Tapestry Cross System InvolvementTapestry Cross System Involvement Tapestry youth cross-system involvement using multiple self report and official data sources.

Indicator Tapestry (N= 329 enrolled)

Juvenile Justice 30% ever arrested, 27% have history of probation, 11% ever sentenced to a secure facility.

Substance Abuse 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 TreatmentSCY Treatment

Analysis focuses on the youth who Analysis focuses on the youth who completed the 12 month GAIN completed the 12 month GAIN assessment (“completers”)assessment (“completers”)

167 youth were completers; 142 (85%) of 167 youth were completers; 142 (85%) of completers had received treatment completers had received treatment servicesservices

313 treatment placements for 142 youth313 treatment placements for 142 youth

Substance Problems Scale Over TimeSubstance Problems Scale Over Time

1.31.6

0.9

3.7

00.5

11.5

22.5

33.5

4

Intake 3mo 6mo 12mo

Substance problems in the past month

Statistically significant decrease:Statistically significant decrease: Intake to 3 monthsIntake to 3 months Intake to 6 monthsIntake to 6 months Intake to 12 monthsIntake to 12 months

Statistically significant increase:Statistically significant increase: 3 months to 6 months3 months to 6 months

Substance Use Over TimeSubstance Use Over Time

8.3

35.7

8.310.9 11.8

2.52.41.9

1.41.515.9

0

5

10

15

20

25

30

35

40

Intake 3mo 6mo 12mo

Alcohol

Drunkeness

Marijuana

AbstinenceAbstinence

Youth reporting abstinence:Youth reporting abstinence: Intake - 16 youth (7%)Intake - 16 youth (7%) 3 months - 113 youth (49%) 3 months - 113 youth (49%) 6 months - 102 (44%) 6 months - 102 (44%) 12 months - 103 (44%)12 months - 103 (44%)

Overall, only 18% (n=42) of youth reported Overall, only 18% (n=42) of youth reported abstinence at all follow-up periods (3, 6, abstinence at all follow-up periods (3, 6, and 12 months)and 12 months)

Urinalysis DataUrinalysis Data

Of 42 youth who reported abstinence on Of 42 youth who reported abstinence on the GAIN at 3, 6, and 12 months, 31 had the GAIN at 3, 6, and 12 months, 31 had urine screen data availableurine screen data available

Of these 31 youth:Of these 31 youth: 7 (23%) did not have corroborating urine 7 (23%) did not have corroborating urine

screen data (had positive screens)screen data (had positive screens) 24 (77%) had abstinence corroborated by 24 (77%) had abstinence corroborated by

urine screen data (had all negative screens)urine screen data (had all negative screens)

Emotional Problems Scale Over TimeEmotional Problems Scale Over Time

0.130.15

0.15

0.21

0

0.05

0.1

0.15

0.2

0.25

Intake 3mo 6mo 12mo

Emotional Problems over time

Statistically significant decrease:Statistically significant decrease: Intake to 3 monthsIntake to 3 months Intake to 6 monthsIntake to 6 months Intake to 12 monthsIntake to 12 months 6 months to 12 months6 months to 12 months

General Crime Scale Over TimeGeneral Crime Scale Over Time

0.620.720.64

3.39

00.5

11.5

22.5

33.5

4

Intake 3mo 6mo 12mo

General Crime over time

Statistically significant decrease:Statistically significant decrease: Intake to 3 monthsIntake to 3 months Intake to 6 monthsIntake to 6 months Intake to 12 monthsIntake to 12 months

RecidivismRecidivism

Time Frame Post EnrollmentTime Frame Post Enrollment TypeType Number (Percent) of Number (Percent) of SCY YouthSCY Youth

3 Months3 MonthsChargesCharges 41 (18.1%)41 (18.1%)

Delinquent OffensesDelinquent Offenses 34 (15.0%)34 (15.0%)

6 Months6 MonthsChargesCharges 66 (29.1%)66 (29.1%)

Delinquent OffensesDelinquent Offenses 52 (22.9%)52 (22.9%)

9 Months9 MonthsChargesCharges 82 (36.1%)82 (36.1%)

Delinquent OffensesDelinquent Offenses 65 (28.6%)65 (28.6%)

12 Months12 MonthsChargesCharges 93 (41.0%)93 (41.0%)

Delinquent OffensesDelinquent Offenses 73 (32.2%)73 (32.2%)

Discussion: SCY Major FindingsDiscussion: SCY Major Findings Comorbidity rates continue to be very highComorbidity rates continue to be very high

63% of youth comorbid for mental health and substance abuse63% of youth comorbid for mental health and substance abuse Females demonstrate higher rates of mental health impairment and Females demonstrate higher rates of mental health impairment and

comorbidity (79% versus 60%).comorbidity (79% versus 60%). Males more likely to be felons (71% versus 25%), evidence higher Males more likely to be felons (71% versus 25%), evidence higher

scores on the General Crime Scale.scores on the General Crime Scale. Lifetime cross-system involvement highLifetime cross-system involvement high

12% of youth involved with only the juvenile justice and AOD systems12% of youth involved with only the juvenile justice and AOD systems 55% of youth involved with 4 or more child-serving systems55% of youth involved with 4 or more child-serving systems 29% special education; 18% previous AOD treatment; 41.4% previous 29% special education; 18% previous AOD treatment; 41.4% previous

mental health treatmentmental health treatment VictimizationVictimization

69% of youth have previous child maltreatment allegation; 47% 69% of youth have previous child maltreatment allegation; 47% substantiated/indicated; 24% removed from homesubstantiated/indicated; 24% removed from home

80% of youth either self-report or have substantiated/indicated 80% of youth either self-report or have substantiated/indicated victimization or maltreatment historiesvictimization or maltreatment histories

Females present with different victimization patterns, greater severity, Females present with different victimization patterns, greater severity, and higher rates of domestic violence.and higher rates of domestic violence.

Discussion Discussion (continued)(continued)

Recidivism rates at 12 months 41% for new Recidivism rates at 12 months 41% for new charges and 32.2% for adjudications; 14.1% for charges and 32.2% for adjudications; 14.1% for felonies. Males 7.5x more likely to recidivate.felonies. Males 7.5x more likely to recidivate. These figures should be compared to other These figures should be compared to other

comparable juvenile justice youth.comparable juvenile justice youth. Significant reductions in substance use Significant reductions in substance use

frequency, substance use problems, emotional frequency, substance use problems, emotional problems, and general crime at 12 months.problems, and general crime at 12 months. 18% of youth report abstinence across all three 18% of youth report abstinence across all three

follow-up time points; 44% of youth abstinent during follow-up time points; 44% of youth abstinent during last six months. last six months.

Of youth who report abstinence across 3, 6, and 12 Of youth who report abstinence across 3, 6, and 12 months, 77% correspondence rate between self-months, 77% correspondence rate between self-report and drug screens.report and drug screens.

SCY: Implications and Next StepsSCY: Implications and Next Steps

Substance use frequency, substance-related problems, Substance use frequency, substance-related problems, emotional problems, general crime, and environmental emotional problems, general crime, and environmental risk strongly interconnected and related to treatment risk strongly interconnected and related to treatment outcomes.outcomes.

Client comorbidity, cross-system involvement, gender Client comorbidity, cross-system involvement, gender differences, and victimization histories (including differences, and victimization histories (including domestic violence) require earlier, comprehensive, domestic violence) require earlier, comprehensive, coordinated, and integrated treatment responses.coordinated, and integrated treatment responses.

Heavy reliance on residential treatment may be reduced Heavy reliance on residential treatment may be reduced by strengthening IOP treatment models.by strengthening IOP treatment models.

Cuyahoga County is in a strong position to develop and Cuyahoga County is in a strong position to develop and evaluate promising IOP alternatives under the Tapestry evaluate promising IOP alternatives under the Tapestry system of care umbrella.system of care umbrella.