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Juvenile Justice and Behavioral Health: An Awkward Partnership Jeffrey A. Butts, Ph.D. Director, Research and Evaluation Center John Jay College of Criminal Justice City University of New York September 30, 2011 Presented to the

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Juvenile justice and behavioral health an awkward partnership

Juvenile Justice and Behavioral Health:

An Awkward Partnership

Jeffrey A. Butts, Ph.D.Director, Research and Evaluation Center

John Jay College of Criminal Justice

City University of New YorkSeptember 30, 2011

Presented to the

Coalition for Juvenile Justice (CJJ) Northeast Region Conference

Changing the Face of Juvenile Justice

Manchester, New Hampshire


Juvenile justice and behavioral health an awkward partnership

Quality Juvenile Justice

  • Maximum use of diversion, consistent with public safety

  • Least intrusive, in-home services whenever possible

  • Informal if possible, adjudication as last resort

  • Effective interventions, backed by research

  • Youth, families, and system are mutually accountable

  • Accurate, practical screening and assessment

  • -Systems integration and agency coordination

  • - Data systems that facilitate quality services

  • Cultural competence and fairness

  • Family involvement

  • Community engagement

  • Youth voice, youth leadership


Juvenile justice and behavioral health an awkward partnership

Behavioral Health / Quality Justice

  • Difficult to manage the inherent tensions between treatment and justice

  • Example –

  • Panel study of 1,000 8th graders followed to age 22:

  • Researchers tested the effect of juvenile justice intervention on school success, employment, and adult crime controlling for criminal record, poverty etc.

  • Intervention reduces the chances of high school graduation and adult employment

  • Intervention increases the number of predicted crimes during adult years by a factor of 5

  • Source: Bernburg and Krohn (2003). Criminology.

Risk of Legal Coercion to Improve Youth Behavior

Risks from Youth Behavior

  • Both place youth at greater risk of future offending and court involvement


Juvenile justice and behavioral health an awkward partnership

Intervene or Not Intervene?

  • Risky behavior during adolescence is normative behavior (e.g., drugs, sexual behavior, misuse of automobiles)

  • Most youth will “age out,” but some will not

  • The challenge is to identify which youth won’t desist

  • “Normative” adolescent behavior by itself should not be used as legal leverage to entangle youth in the formal justice system

  • Inherent tensions between justice and treatment goals are eliminated only when the seriousness of a youth’s law violation justifies the use of coercive intervention (i.e., Scott and Steinberg’s “Limiting Principle”)


Juvenile justice and behavioral health an awkward partnership

How Common is Teen Drug Use?

Been drunk 18%

Alcohol Any use 33%

Use in Past Month by 10th Graders

Source: Monitoring the Future 2007, University of Michigan.


Juvenile justice and behavioral health an awkward partnership

How Common is Teen Drug Use?

Any Illicit Drug 17%

Use in Past Month by 10th Graders

Source: Monitoring the Future 2007, University of Michigan.


Juvenile justice and behavioral health an awkward partnership

How Common is Teen Drug Use?

Any Illicit Drug 17%

Use in Past Month by 10th Graders

Abuse/Dependence in Past Year (12-17)

Drug 5%

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2006.


Juvenile justice and behavioral health an awkward partnership

How Common is Teen Drug Use?

Any Illicit Drug 17%

Use in Past Month by 10th Graders

Abuse/Dependence in Past Year (12-17)

Incl. Alc. 8%

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2006.


Juvenile justice and behavioral health an awkward partnership

Assessment Center

(Abuse in Past Month)

How Common is Teen Drug Use?

Any Illicit Drug 17%

Use in Past Month by 10th Graders

Abuse/Dependence in Past Year (12-17)

Any SUD 8%

SUD “Substance Use Disorder”

General PopulationJustice-Involved

Youth referred to an intake and assessment center soon after a first contact with police.

Any SUD 11%

Source: McReynolds et al. (2008). Crime & Delinquency.


Juvenile justice and behavioral health an awkward partnership

Assessment Center

(Abuse in Past Month)

Probation Intake

(Abuse in Past Month)

How Common is Teen Drug Use?

Any Illicit Drug 17%

Use in Past Month by 10th Graders

Abuse/Dependence in Past Year (12-17)

Any SUD 8%

General PopulationJustice-Involved

Drug 5%

Any SUD 11%

Youth referred to probation intake after initial screening by law enforcement or other agency.

Any SUD 25%

Source: Wasserman et al. (2005). Amer. Journal of Public Health.


Juvenile justice and behavioral health an awkward partnership

Assessment Center

(Abuse in Past Month)

Probation Intake

(Abuse in Past Month)

JJ Supervision Pop.

(Abuse in Past Year)

How Common is Teen Drug Use?

Any Illicit Drug 17%

Use in Past Month by 10th Graders

Abuse/Dependence in Past Year (12-17)

Any SUD 8%

General PopulationJustice-Involved

Drug 5%

Any SUD 11%

Any SUD 25%

Youth formally involved with a juvenile justice agency; some but not all with previous out-of-home placements.

Any SUD 37%

Source: Aarons et al. (2001). Journal of the Amer. Acad. of Child and Adolesc. Psych.


Juvenile justice and behavioral health an awkward partnership

Assessment Center

(Abuse in Past Month)

Probation Intake

(Abuse in Past Month)

Urban Juv Detention

JJ Supervision Pop.

(Abuse in Past Year)

(Abuse in Past 6 Months)

How Common is Teen Drug Use?

Any Illicit Drug 17%

Use in Past Month by 10th Graders

Abuse/Dependence in Past Year (12-17)

Any SUD 8%

General PopulationJustice-Involved

Any SUD 11%

Drug 5%

Any SUD 25%

Any SUD 37%

Serious juvenile offenders held in the secure detention center of Cook County (Chicago) Illinois.

Any SUD 49%

Source: Teplin et al. (2002). Archives of General Psychiatry


Juvenile justice and behavioral health an awkward partnership

Clearly, Drug Problems are More Common the Deeper One Looks into the Juvenile Justice Process

In a sense, drug-using youth accumulate in the “deep end” of the juvenile justice system…

  • Why?

  • Do drug issues increase the seriousness of criminal behavior by juvenile offenders?

  • Do drug issues increase the coerciveness of the legal response to juvenile offenders?


Juvenile justice and behavioral health an awkward partnership

Consider this…


Juvenile justice and behavioral health an awkward partnership

Recall, rate of substance use disorders among all U.S. 12-17 year-olds.

- SAMHSA (2006)

8%

100%

What proportion have a substance use disorder?

- McReynolds et al. (2008)

11%

Youth at a Juvenile Assessment Center


Juvenile justice and behavioral health an awkward partnership

50%

Recall, rate of substance use disorders among all U.S. 12-17 year-olds.

- SAMHSA (2006)

8%

100%

About half of all arrested youth are referred to juvenile court authorities.

- Juvenile Court Statistics, OJJDP

Of these, what proportion have a substance use disorder?

- Wasserman et al. (2005)

25%

11%

Youth at a Juvenile Assessment Center

Youth Referred to Juvenile Probation


Juvenile justice and behavioral health an awkward partnership

Recall, rate of substance use disorders among all U.S. 12-17 year-olds.

- SAMHSA (2006)

20%

8%

100%

About 20 percent of all court referred youth are held in secure detention at some point.

- Juvenile Court Statistics, OJJDP

Of these, what proportion have a substance use disorder?

- Teplin et al. (2002)

25%

11%

49%

Youth at a Juvenile Assessment Center

Youth Referred to Juvenile Probation

Youth Held in Secure Detention


Juvenile justice and behavioral health an awkward partnership

Recall, rate of substance use disorders among all U.S. 12-17 year-olds.

- SAMHSA (2006)

8%

100%

When they first enter the juvenile system, the prevalence of substance abuse among young offenders is similar to other teens.

Substance-abusing offenders, however, are more likely to be retained through to the more restrictive stages of justice processing.

The preponderance of drug-abusing youth in the deep end of the justice system is a function of how case decisions are made. Drug-abusing youth are treated more coercively.

Thus, they are a larger subgroup by the end of the juvenile justice process.

25%

11%

49%

Youth at a Juvenile Assessment Center

Youth Referred to Juvenile Probation

Youth Held in Secure Detention


Juvenile justice and behavioral health an awkward partnership

Youth with Identified Drug Issues are Handled More Coercively in the Juvenile Justice System

  • This may be an accurate and legitimate use of resources if drug-using youth are higher-risk and in need of stronger sanctions.

  • Just what type of drug users are referred to the juvenile justice system?


Juvenile justice and behavioral health an awkward partnership

Substance Use Disorders

Among Youth Referred to a Juvenile Assessment Center

Among Youth Referred to Juvenile Probation Intake

Abuse Disorders (past month)

Alcohol 2%

Marijuana 4%

Other drug 1%

Dependence Disorders

Alcohol 1%

Marijuana 5%

Other drug 1%

No Disorder Detected89%

Abuse Disorders (past month)

Alcohol 7%

Marijuana10%

Other drug 3%

Dependence Disorders

Alcohol 3%

Marijuana13%

Other drug 4%

No Disorder Detected75%

Source: McReynolds et al. (2008)

Source: Wasserman et al. (2005)


Juvenile justice and behavioral health an awkward partnership

Substance Use Disorders

  • 10%-25% of youthful offenders have substance use issues that could be called problematic – either abuse or dependence

  • Most of these substance use issues (80%-90% involve alcohol and marijuana only


Juvenile justice and behavioral health an awkward partnership

The Key Policy Question:

How Serious Does a Teen’s Use of Alcohol and Marijuana Have to be to Pose a Greater Threat to his or her Future than the Threat Posed by Juvenile Court Adjudication and the Criminal Record that may Follow?


Juvenile justice and behavioral health an awkward partnership

The Juvenile Justice System Reacts to Two Dimensions of Youth Behavior

  • Severity of substance abuse

  • Severity of all other criminal behavior


Juvenile justice and behavioral health an awkward partnership

Total Population of Youth Offenders


Juvenile justice and behavioral health an awkward partnership

Total Population of Youth Offenders


Juvenile justice and behavioral health an awkward partnership

Severity of Criminal Behavior

Total Population of Youth Offenders


Juvenile justice and behavioral health an awkward partnership

Severity of Drug-Using Behavior

Total Population of Youth Offenders


Juvenile justice and behavioral health an awkward partnership

Minor offenses, but with drug abuse and dependence

Repeat violent offender with long-term serious drug use

Relatively serious offenses, with some drug abuse

Severity of Drug-Using Behavior

Serious and violent offender with no apparent drug use

No serious offenses, never used drugs

Severity of Criminal Behavior

When Does Legal Coercion Become Harmful?


Juvenile justice and behavioral health an awkward partnership

If we combine the two dimensions…

Severity of Drug-Using Behavior

Severity of Criminal Behavior

When Does Legal Coercion Become Harmful?


Juvenile justice and behavioral health an awkward partnership

Coercion for Treatment?

Coercion for Public Safety

Treatment

IatrogenicRisk

Maximum Intervention

When is it appropriate to use the justice system to coerce youth into compliance, knowing that coercion itself present risks to their future?

How far down into less serious offenses can coercion be used before we introduce “iatrogenic” risks – making things worse?

Severity of Drug-Using Behavior

Minimum Intervention

Justice

Severity of Criminal Behavior

When Does Legal Coercion Become Harmful?


Juvenile justice and behavioral health an awkward partnership

Coercion for Treatment?

Coercion for Public Safety

  • Iatrogenic Risk Could be Eliminated With Perfect and Objective Knowledge of 4 Factors:

  • Actual harm caused by a youth’s current drug use

  • Trajectory and impact of future drug use

  • Methods for selecting and delivering treatment

  • The effectiveness and behavioral impact of treatment

  • Our Knowledge Will Never Be Perfect

Treatment

IatrogenicRisk

Maximum Intervention

Severity of Drug-Using Behavior

Minimum Intervention

Justice

Severity of Criminal Behavior

When Does Legal Coercion Become Harmful?


Juvenile justice and behavioral health an awkward partnership

Coercion for Treatment?

Coercion for Public Safety

Treatment

IatrogenicRisk

Maximum Intervention

To the extent we have only imperfect knowledge, our willingness to use coercion for treatment goals alone should be limited to very serious drug problems.

Severity of Drug-Using Behavior

Minimum Intervention

Justice

Severity of Criminal Behavior

When Does Legal Coercion Become Harmful?


Juvenile justice and behavioral health an awkward partnership

Coercion for Treatment?

Coercion for Public Safety

Treatment

IatrogenicRisk

Maximum Intervention

Injustice

Severity of Drug-Using Behavior

Minimum Intervention

Justice

Severity of Criminal Behavior

When Does Legal Coercion Become Harmful?


Juvenile justice and behavioral health an awkward partnership

In Juvenile Justice, Behavioral Health Intervention for Substance Abuse Must Be…

  • Largely community-based, non-coercive

  • Designed for the vast majority of youth who are drug using, sometimes abusing, but not drug dependent

  • Ready to address a wide range of drug use but still appropriate for the 90% of youthful offenders who use only alcohol and marijuana

  • Designed to avoid unwarranted legal coercion by providing services, activities and supports that are actually appealing to non-mandated, voluntary clients

  • Free of any financial incentives that lead to excess use of formal adjudication and court-ordered treatment


Juvenile justice and behavioral health an awkward partnership

Jeffrey A. Butts, Ph.D.John Jay College of Criminal JusticeCity University of New [email protected]/recwww.jeffreybutts.net


Juvenile justice and behavioral health an awkward partnership

Aarons, Gregory A., Sandra A. Brown, Richard L. Hough, Ann F. Garland, and Patricia A. Wood (2001). Prevalence of Adolescent Substance Use Disorders across Five Sectors of Care. Journal of the American Academy of Child and Adolescent Psychiatry, 40(4): 419–26.Bernburg, Jón Gunnar and Marvin D. Krohn (2003). Labeling, Life Chances, and Adult Crime: The Direct and Indirect Effects of Official Intervention in Adolescence on Crime in Early Adulthood.” Criminology 41(4): 1287-1318.McReynolds, Larkin S., Gail A. Wasserman, Robert E. DeComo, Reni John, Joseph M. Keating, and Scott Nolen (2008). Psychiatric disorder in a juvenile assessment center. Crime & Delinquency, 54(2): 313-334.Substance Abuse and Mental Health Services Administration (2007). National Survey on Drug Use and Health. Rockville, MD: Substance Abuse and Mental Health Services Administration.Teplin, Linda A., Karen M. Abram, Gary M. McClelland, Mina K. Dulcan, and Amy A. Mericle (2002). Psychiatric Disorders in Youth in Juvenile Detention. Archives of General Psychiatry, 59(Dec): 1133-1143.Wasserman, Gail A., Larkin S. McReynolds, Susan J. Ko, Laura M. Katz, and Jennifer R. Carpenter (2005). Gender Differences in Psychiatric Disorders at Juvenile Probation Intake. American Journal of Public Health, 95(1): 131-137.

References


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