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California Institute for Mental Health (CIMH) Evidence-based Mental Health Treatment in the Juvenile Justice System Assessment in Community Supervision Settings Lee A. Underwood, Psy.D. OVERVIEW Introduction Defining Co-Occurring Disorders Characteristics of Youth & Other Service Needs

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lee a underwood psy d
California Institute for Mental Health (CIMH)Evidence-based Mental Health Treatment in the Juvenile Justice SystemAssessment in Community Supervision Settings

Lee A. Underwood, Psy.D.

Assessment in Community Supervision Settings

overview
OVERVIEW
  • Introduction
  • Defining Co-Occurring Disorders
  • Characteristics of Youth & Other Service Needs
  • Risk Factors
    • Overview
    • Family Factors
    • Individual Factors
    • Culture
    • Gender & Age Factors
    • Typology Factors
    • Neurological Factors
    • Substance Use Factors

Assessment in Community Supervision Settings

overview cont d
OVERVIEW (cont’d)
  • Treatment
    • Screening & Assessment
    • Categories of Co-Occurring Disorders
  • Effective Treatment Approaches
    • Multisystemic Therapy (MST)
    • Multidimensional Treatment Foster Care (MTFC)
    • Functional Family Therapy (FFT)

Assessment in Community Supervision Settings

introduction

INTRODUCTION

Assessment in Community Supervision Settings

introduction5
INTRODUCTION:
  • Juvenile offenders population has steadily increased throughout the nineties (Teplin & McClelland, 1998; Timmons-Mitchell, Brown, Schulz, Webster, Underwood, Semple, 1997)
  • More than 1 million youth come in contact with the juvenile justice system each year
    • More than 100,000 of these are placed in detention and correctional facilities (Cocozza, 1997)

Assessment in Community Supervision Settings

introduction6
INTRODUCTION:
  • Significant increase in the number of youth who are diagnosed with mental health disorders and substance use disorders (Cocozza, 1997; Faenzz & Siegried, 1998)
      • 20-30% of all youth entering the justice system present serious mental disorders and have other service needs (Davis, Bean, Shumcher, & Speigler, 1990; Villiani; 1999)

Assessment in Community Supervision Settings

introduction7
INTRODUCTION:
  • Rates for mental illness in juvenile justice populations is substantially higher than those in the general population (Grisso & Barnum, 2000; Teplin & McClelland, 1998)

Assessment in Community Supervision Settings

introduction8
INTRODUCTION:
  • Timmons-Mitchell et al (1997) found:
    • 29% of population had symptoms of serious mental illness
      • Of which 18% had been in inpatient mental health and/or substance abuse facilities
      • 13.5% had attempted suicide
    • 80% had substance abuse problems

Assessment in Community Supervision Settings

introduction9
INTRODUCTION:
  • With increased deinstitutionalization, there has been increase in reliance on the justice system for mental health care needs (Teplin & McClelland, 1998)
    • Administrators are hampered by a lack of research, insufficient policy development,

and inadequate approaches and practices for managing and treating this population (Altschuler, 1996; Burns, 1999; Butterfied, 1998; Hartman, 199)

Assessment in Community Supervision Settings

introduction10
INTRODUCTION:
  • More than 1,000,000 juveniles come in contact with the justice system
  • More than 100,000 are placed in correctional/detention facilities
  • 20-30% present serious mental health disorders and other service needs

Assessment in Community Supervision Settings

introduction11
INTRODUCTION:
  • Ohio study
    • 29% had symptoms of serious mental illness
    • 80% had substance abuse problems
    • 18% of those with serious mental health disorders had previously been in inpatient mental health or substance abuse facilities
    • 13.5% of those with serious mental health disorders had attempted suicide

Assessment in Community Supervision Settings

introduction12
INTRODUCTION:
  • Growing awareness of prevalence
  • Recognition of difficulties in treatment
  • Documentation of greater negative outcomes associated with disorders

Assessment in Community Supervision Settings

introduction13
INTRODUCTION:
  • 50.9% of general adult population with mental disorders (Kessler, et. Al., 1996)
  • 73% of jail detainees with serious mental disorders (Abram & Teplin, 1991)
  • 50% of adolescents in the general population (Greenbaum, et al., 1996)
  • 50-90% of adolescents in juvenile justice settings

Assessment in Community Supervision Settings

introduction14
INTRODUCTION:
  • Co-Occurring Substance Use and Disorders Among Persons with Mental Disorders
    • 50.9% of general adult population with mental disorders (Kessler, et. Al., 1996)
    • 73% of jail detainees with serious mental disorders (Abram & Teplin, 1991)
    • 50% of adolescents in the general population (Greenbaum, et al., 1996)
    • 50-90% of adolescents in juvenile justice settings

Assessment in Community Supervision Settings

defining co occuring disorders

DEFINING CO-OCCURING DISORDERS

Assessment in Community Supervision Settings

defining co occurring disorders
DEFINING CO-OCCURRING DISORDERS:
  • Co-occurring disorders defined:
    • Refers to the simultaneous experience of mental health and substance use disorders
      • These disorders have pronounced affects on the thoughts, mood, and behaviors of youth

Assessment in Community Supervision Settings

slide17
DEFINING CO-OCCURRING DISORDERS:
  • Serious diagnosable mental health disorders manifests a substantial disorder of thought or mood, which that impairs:
    • Judgment
    • Behavior
    • Sense of reality
    • Ability to handle demands of everyday life
  • Causes substantial pain or disability

Assessment in Community Supervision Settings

defining co occurring disorders18
DEFINING CO-OCCURRING DISORDERS:
  • Serious emotional disturbance affects:
    • Family Interactions
    • School Activities
    • Community Activities
  • Adjustment problems
    • Manifest as significant emotional or behavioral symptoms in response to an identifiable psychosocial stressor or stressors

Assessment in Community Supervision Settings

defining co occurring disorders19
DEFINING CO-OCCURRING DISORDERS:
  • Often manifest the following symptoms:
    • Mental confusion
    • Delusional thought processes
    • Social withdrawal
    • Unpredictable behavior
  • Conduct disorder and other diagnosis are common

Assessment in Community Supervision Settings

defining co occurring disorders20
DEFINING CO-OCCURRING DISORDERS:
  • Range of mental health disorders range within
    • Narrow band – serious mental health disorders and formal DSM-IV diagnosis
    • Broad band – severe emotional and adjustment problems regarding family, school, or community

Assessment in Community Supervision Settings

defining co occurring disorders21
DEFINING CO-OCCURRING DISORDERS:
  • DSM-IV has inherent limitations – there can be confusion in identifying disorders
  • A precise diagnostic approach is necessary
  • Appropriate mental health treatment interventions are necessary

Assessment in Community Supervision Settings

characteristics of youth other service needs

CHARACTERISTICS OF YOUTH & OTHER SERVICE NEEDS

Assessment in Community Supervision Settings

characteristics of youth other service needs23
CHARACTERISTICS OF YOUTH & OTHER SERVICE NEEDS
  • Developmental psychologists are concerned with describing and identifying behavior that is predictable or common for adolescents
    • Example: Experimentation with alcohol or marijuana is a common practice among adolescents, even though society neither views such behavior as desirable or condones it

Adapted from: Rosado, L.M. (ed.) (September 2000). Kids are Different…Youth Law Center

Assessment in Community Supervision Settings

characteristics of youth other service needs24
CHARACTERISTICS OF YOUTH & OTHER SERVICE NEEDS
  • Much of the behavior exhibited by delinquents is behavior that is not normal for adolescence
    • Without minimizing offenses, there is recognition of the processes that lead to and utilize that knowledge to develop programming that assists adolescents identify errors in their thought processes and see other options to their behavior

Adapted from: Rosado, L.M. (ed.) (September 2000). Kids are Different…Youth Law Center

Assessment in Community Supervision Settings

characteristics of youth other service needs25
CHARACTERISTICS OF YOUTH & OTHER SERVICE NEEDS
  • Similarly, unlawful or unacceptable behavior may be maladaptive in the larger social context, but may seem logical to the adolescent in his or her particular contexts (e.g., the peer group or family)
  • The development we will be discussing in this module is normative or typical adolescent development
  • Adolescence provides a learner’s permit to adulthood
    • Mistakes will be made and individuals may learn from them

Adapted from: Rosado, L.M. (ed.) (September 2000). Kids are Different…Youth Law Center

Assessment in Community Supervision Settings

characteristics of youth other service needs26
CHARACTERISTICS OF YOUTH & OTHER SERVICE NEEDS
  • Individual adolescents develop along different dimensions at different rates
      • Cognitive (Intellectual) Development
      • Identity and Social Development
      • Moral Development
      • Physical Development
      • Competence Development (master of skills)

Adapted from: Rosado, L.M. (ed.) (September 2000). Kids are Different…Youth Law Center

Assessment in Community Supervision Settings

characteristics of youth other service needs27
CHARACTERISTICS OF YOUTH & OTHER SERVICE NEEDS
  • Development in any domain is a gradual, non-linear process, with stops and starts and regressions
  • There are great differences between individual adolescents in the rate of development in any single domain
  • It is impossible to assess a juvenile’s level of development by looking at a single trait, such as size or chronological age, because there is significant variation among individuals in the rate and pattern of development

Adapted from: Rosado, L.M. (ed.) (September 2000). Kids are Different…Youth Law Center

Assessment in Community Supervision Settings

characteristics of youth other service needs28
CHARACTERISTICS OF YOUTH & OTHER SERVICE NEEDS
  • Adolescence is a time of important psychological and psycho-social development which affects the way teenagers feel about themselves (identity), their ability to function responsibility on their own (autonomy), their relationships and interpersonal behaviors (intimacy), and their sexual feelings (sexuality).

Adapted from: Rosado, L.M. (ed.) (September 2000). Kids are Different…Youth Law Center

Assessment in Community Supervision Settings

characteristics of youth other service needs29
CHARACTERISTICS OF YOUTH & OTHER SERVICE NEEDS
  • Cognitive Changes:
      • Possibilities
        • “Adolescents become better able than children to think about what is possible, instead of limiting thought to what is real”
        • Able to think hypothetically
      • Abstraction
        • “Adolescents become better able to think about abstract concepts”

Adapted from: Rosado, L.M. (ed.) (September 2000). Kids are Different…Youth Law Center

Assessment in Community Supervision Settings

characteristics of youth other service needs30
CHARACTERISTICS OF YOUTH & OTHER SERVICE NEEDS
  • Cognitive Changes:
      • Thinking about thinking
        • “Adolescents begin thinking more about the process of thinking; they become more reflective.”
        • Increased introspection, self-consciousness, and intellectualization
      • Thinking in multiple dimensions
        • Considering multiple dimensions and weighing those dimensions before taking a course of action

Adapted from: Rosado, L.M. (ed.) (September 2000). Kids are Different…Youth Law Center

Assessment in Community Supervision Settings

characteristics of youth other service needs31
CHARACTERISTICS OF YOUTH & OTHER SERVICE NEEDS
  • Cognitive Changes:
      • Relativity
        • Develop an ability to see things in relative terms
        • Adolescents are more likely to question others’ assertions and less likely to accept facts as absolute truths

Adapted from: Rosado, L.M. (ed.) (September 2000). Kids are Different…Youth Law Center

Assessment in Community Supervision Settings

characteristics of youth other service needs32
CHARACTERISTICS OF YOUTH & OTHER SERVICE NEEDS
  • Identity Development
    • Adolescents attempt to establish a coherent, stable identity
    • “Trying on” different personalities, interests, and and ways of behaving is a necessary part of the process of putting together an identity
    • Family and Identity

Adapted from: Rosado, L.M. (ed.) (September 2000). Kids are Different…Youth Law Center

Assessment in Community Supervision Settings

characteristics of youth other service needs33
CHARACTERISTICS OF YOUTH & OTHER SERVICE NEEDS
  • Identity Development
    • Peers and Identity
      • Need to Belong
      • Peer Pressure
        • Peer recognition, advice, and encouragement, and may be more unconditionally accepting than adults
        • May have an overemphasis on peers
          • Family has a powerful effect on adolescents’ basic values and choices
        • Peer pressure can be prosocial

Adapted from: Rosado, L.M. (ed.) (September 2000). Kids are Different…Youth Law Center

Assessment in Community Supervision Settings

characteristics of youth other service needs34
CHARACTERISTICS OF YOUTH & OTHER SERVICE NEEDS
  • Autonomy Development
    • Adolescence is a gradual transition to being a self-governing person. The development of independent behavior is a central task of adolescence
      • Physical changes and appearance both enable adolescents to become more autonomous and cause adults to treat them as though they are more autonomous
    • May cause emotional and social disruptions as adolescents change their relationships with family members and develop new roles in the world

Adapted from: Rosado, L.M. (ed.) (September 2000). Kids are Different…Youth Law Center

Assessment in Community Supervision Settings

characteristics of youth other service needs35
CHARACTERISTICS OF YOUTH & OTHER SERVICE NEEDS
  • Moral Development
    • Adolescents progress through stages of maturation in terms of moral reasoning and moral behavior.
      • Moral reasoning of the young child – “Pre-conventional” moral reasoning.
      • The focus is on rewards and punishments associated with different courses of action.
      • Young children accept what others say is right or wrong.

Adapted from: Rosado, L.M. (ed.) (September 2000). Kids are Different…Youth Law Center

Assessment in Community Supervision Settings

characteristics of youth other service needs36
CHARACTERISTICS OF YOUTH & OTHER SERVICE NEEDS
  • Moral Development
    • Moral reasoning of the early adolescent – “Conventional” moral reasoning
      • Based on how s/he will be judged by others for behaving in a particular way
      • During junior high school, adolescents become more concerned with impressing their peers.
      • Most adolescents are able to reason at this level in “hypothetical” situations, their actual behavior may not; always reflect their reasoning ability

Adapted from: Rosado, L.M. (ed.) (September 2000). Kids are Different…Youth Law Center

Assessment in Community Supervision Settings

characteristics of youth other service needs37
CHARACTERISTICS OF YOUTH & OTHER SERVICE NEEDS
  • Moral Development
    • “Post-Conventional” Moral Reasoning
      • At this stage, the individual begins to view society’s rules as relative and subjective, and questions social conventions
      • In late adolescence or early adulthood, an individual MAY begin to shift from reasoning in terms of social approval to reasoning in terms of important principles, such as justice and fairness

Adapted from: Rosado, L.M. (ed.) (September 2000). Kids are Different…Youth Law Center

Assessment in Community Supervision Settings

characteristics of youth other service needs38
CHARACTERISTICS OF YOUTH & OTHER SERVICE NEEDS
  • Moral Development
    • “Post-Conventional” Moral Reasoning (cont’d)
      • BUT post-conventional moral reasoning is relatively rare, even in adults. Most adolescents follow “conventional” moral reasoning, i.e., the reason to be good is to earn social approval and to benefit their relationships with others. Indeed, the importance of peers generally in the lives of adolescents reinforces the influence of peer groups or moral decisions.

Adapted from: Rosado, L.M. (ed.) (September 2000). Kids are Different…Youth Law Center

Assessment in Community Supervision Settings

characteristics of youth other service needs39
CHARACTERISTICS OF YOUTH & OTHER SERVICE NEEDS
  • Moral Development
    • Significant factors that shape adolescent’s moral development.
    • Adolescents derive their moral values from:
        • Their families
        • Their peers
        • Their relationships
        • Spiritual influences
        • Popular culture (movies, t.v. shows, music)

Adapted from: Rosado, L.M. (ed.) (September 2000). Kids are Different…Youth Law Center

Assessment in Community Supervision Settings

characteristics of youth other service needs40
CHARACTERISTICS OF YOUTH & OTHER SERVICE NEEDS
  • Moral Development
    • Other aspects of adolescent moral reasoning
      • Adolescents are “fairness freaks”
      • The role of gangs

Adapted from: Rosado, L.M. (ed.) (September 2000). Kids are Different…Youth Law Center

Assessment in Community Supervision Settings

characteristics of youth other service needs41
CHARACTERISTICS OF YOUTH & OTHER SERVICE NEEDS
  • Physical Development
    • Because of the great variability in individual development, an adolescent who appears physically mature in court – tall, solid, with facial hair – may nevertheless be quite immature in cognitive, social, and moral development. Judgments regarding intellectual ability and other characteristics of individual adolescents should not be based solely on physical appearance.

Adapted from: Rosado, L.M. (ed.) (September 2000). Kids are Different…Youth Law Center

Assessment in Community Supervision Settings

characteristics of youth other service needs42
CHARACTERISTICS OF YOUTH & OTHER SERVICE NEEDS
  • Physical Development
    • This may be particularly important when considering program placement – physical appearance. This may be particularly important when considering program placement – physical appearance may have limited value in determining which program is appropriate for a particular youth.

Adapted from: Rosado, L.M. (ed.) (September 2000). Kids are Different…Youth Law Center

Assessment in Community Supervision Settings

characteristics of youth other service needs43
CHARACTERISTICS OF YOUTH & OTHER SERVICE NEEDS
  • Physical Development
    • Myth
      • The “raging hormone hypothesis” the hormones completely explain all out-of-control behavior adolescents.
      • Effect of hormones on mood appear to be strongest in early adolescence when hormonal levels are highly variable and characterized by rapid fluctuations, and the effect lessens in later adolescence as hormone levels stabilize.
      • Juveniles who physically mature earlier appear older, they are often treated as if they are more mature psychologically when this is not necessary true.

Adapted from: Rosado, L.M. (ed.) (September 2000). Kids are Different…Youth Law Center

Assessment in Community Supervision Settings

characteristics of youth other service needs44
CHARACTERISTICS OF YOUTH & OTHER SERVICE NEEDS
  • Physical Development
    • Myth
      • Adolescents who mature late, especially boys, are often view negatively by their peers and left out of group activities.
      • Those who mature early tend to be at a social advantage.

Adapted from: Rosado, L.M. (ed.) (September 2000). Kids are Different…Youth Law Center

Assessment in Community Supervision Settings

characteristics of youth other service needs45
CHARACTERISTICS OF YOUTH & OTHER SERVICE NEEDS
  • Competence Development
    • Adolescents need to be good at something.
      • Achieve competence
      • Many adolescents do not have significant opportunities to experience success

Adapted from: Rosado, L.M. (ed.) (September 2000). Kids are Different…Youth Law Center

Assessment in Community Supervision Settings

characteristics of youth other service needs46
CHARACTERISTICS OF YOUTH & OTHER SERVICE NEEDS
  • Learning disabilities
  • Sexual perpetration
  • Criminal conduct
  • Physical, sexual and emotional abuse
  • Personality disorders
  • Pervasive patterns of aggression
  • Hormonal and genetic risk factors
  • Minimal brain damage

Assessment in Community Supervision Settings

risk factors

RISK FACTORS

Assessment in Community Supervision Settings

risk factors overview
RISK FACTORS:Overview
  • Residential facilities – 75% report having sexual intercourse, compared to 33% in public schools
    • Residential youth reported their first experience had occurred by age 14
    • 4 times more likely to impregnate partner
  • 50% youth in residential treatment centers have been laced in special education classes for learning problems

Assessment in Community Supervision Settings

risk factors overview49
RISK FACTORS:Overview
  • Minority youth are treated differently than majority youth within the juvenile justice system (Department of Justice 1999)
    • Approximately two-thirds of studies examined showed racial and/or ethnic status influences decision-making in at least urban jurisdictions
    • When controlling for offense, African-American youth will enter detention and correctional facilities two times higher than cases involving Caucasian youth

Assessment in Community Supervision Settings

risk factors overview50
RISK FACTORS:Overview
  • Homicide rates for young African-American males is:
    • 4-5 times higher than African-American females
    • 5-8 times higher than young Caucasian males
    • 16-22 times higher than young Caucasian females (Snyder & Sickmund, 1995)

Assessment in Community Supervision Settings

risk factors overview51
RISK FACTORS:Overview
  • Society fails to protect people from the crimes they fear by resisting opportunities to alleviate the poverty that breeds them (Reiman, 1990)

Assessment in Community Supervision Settings

risk factors family environment
RISK FACTORS:Family & Environment
  • Consistent family factors implicated in mental health and juvenile justice populations include:
    • Poor parent-child relationships
    • Neglect
    • Coercive child-rearing (Patterson, 1982)
    • Lack of warmth and affection
    • Inconsistent parenting

Assessment in Community Supervision Settings

risk factors family environment53
RISK FACTORS:Family & Environment
  • Consistent family factors implicated in mental health and juvenile justice populations include (cont’d):
    • Violence
    • Sexual abuse
    • Disrupted attachments
    • Parental substance abuse (American Academy of Child and Adolescent Psychiatry, 1997)

Assessment in Community Supervision Settings

risk factors family environment54
RISK FACTORS:Family & Environment
  • Other family characteristics:
    • Familial antisocial behavior or values
    • History of criminal behavior by members
    • Harsh parental discipline
    • Family conflict (Tolan & Loeer, 1993)
    • Lack of parental monitoring

Assessment in Community Supervision Settings

risk factors individual factors
RISK FACTORS:Individual Factors
  • Youth in corrections facilities acknowledge:
    • Higher levels of emotional distress including pervasive feelings of depression and anxiety

Assessment in Community Supervision Settings

risk factors individual factors56
RISK FACTORS:Individual Factors
  • When compared to public school counterparts, youth in the juvenile justice system exhibit:
    • 3 times more likelihood to report pervasive feelings of sadness
    • 2 ½ times more likely to report feelings of nervousness or being upset
    • 2 times more likely to report feelings of discouragement and hopelessness

Assessment in Community Supervision Settings

risk factors individual factors57
RISK FACTORS:Individual Factors
  • When compared to public school counterparts, youth in the juvenile justice system exhibit (cont’d):
    • 1 ½ times more likely to experience feelings of stress and dissatisfaction with their personal lives (Fulkerson et al., 1996)
    • Males are 2 times more likely to report deliberate self-injury
    • Males are five times more likely to attempt suicide

Assessment in Community Supervision Settings

risk factors culture
RISK FACTORS:Culture
  • 35% of youth in juvenile justice system live in “underclass” neighborhoods
  • Correlations with delinquency in these neighborhoods include:
    • Lack of legitimate job opportunities
    • Increase social isolation
    • Poor schools
    • Weak community organizations (Wilson, 1987)

Assessment in Community Supervision Settings

risk factors gender age factors
RISK FACTORS:Gender & Age Factors
  • Among serious index crimes:
    • Males are 3 times more likely to commit property crimes than females and 8 times more violent crimes (Livingston, 1992)
    • Smallest difference in index crimes is found in larceny offenses, however males still outnumber females two to one
    • Young children have diminished ability to commit serious crimes and their victims are often other children

Assessment in Community Supervision Settings

risk factors gender age factors60
RISK FACTORS:Gender & Age Factors
  • As there is an increased need to assert one’s manhood, there is an increase in violations of the law (e.g., stealing, fighting, joyriding, vandalism)
  • As youth mature, there is a universal pattern showing a decrease in criminal behavior (Hirshci & Gottfredson, 1983)

Assessment in Community Supervision Settings

risk factors typology factors
RISK FACTORS:Typology Factors
  • Seven groups of offenders focused over time on the patter (e.g., beginning, persistence, and ending) of delinquent behavior
    • Stable non-delinquents
    • Starters (transition from no delinquency to involvement in minor delinquency)
    • Stable moderately serious offenders (consistent delinquency over time)

Assessment in Community Supervision Settings

risk factors typology factors62
RISK FACTORS:Typology Factors
  • Seven groups of offenders focused over time on the patter (e.g., beginning, persistence, and ending) of delinquent behavior (cont’d)
    • Escalators (escalation in seriousness of offense over time)
    • Stable highly serious offenders (frequent and serious offending over time)
    • De-escalators (de-escalation in serious of offenses over time)
    • Desisters (cessation in delinquency)

Assessment in Community Supervision Settings

risk factors neurological factors
RISK FACTORS:Neurological Factors
  • Youth with hyperactivity and impulsivity are likely to be abused by adults in their families (Lewis, 1992)
    • These youth may have difficulty in:
      • Planning
      • Attention
      • Abstract reasoning
      • Foresight
      • Judgment
      • Self-monitoring
      • Motor control

(Giancola, Martin, Tarter, Pelham, & Moss 1996)

Assessment in Community Supervision Settings

risk factors substance use factors
RISK FACTORS:Substance Use Factors
  • Youth in residential facilities are much more likely than their public school counterparts to report using:
    • Amphetamines and inhalants (2 times higher)
    • Marijuana and prescription drugs (2 ½ times higher)
    • Sedatives (3 times higher)

Assessment in Community Supervision Settings

risk factors substance use factors65
RISK FACTORS:Substance Use Factors
  • Youth in residential facilities are much more likely than their public school counterparts to report using (cont’d):
    • LSD, hallucinogens, and opiates (4 times higher)
    • Cocaine (6 times higher)
    • Injected drugs (5 ½ times higher)
    • Alcohol and drugs before or during school (3 times higher)

Assessment in Community Supervision Settings

treatment

TREATMENT

Assessment in Community Supervision Settings

treatment67
TREATMENT:
  • Acceptance of emotional and mental health issues
  • Acceptance of criminal behavior by taking responsibility for hurt behavior
  • Resolution of past victimization
  • Development of victim empathy and victim awareness

Assessment in Community Supervision Settings

treatment68
TREATMENT:
  • Recognition that self-serving worldviews must be restructured
  • Dismantling of regressed fears and anxieties

Assessment in Community Supervision Settings

treatment69
TREATMENT:
  • Implement relapse prevention techniques across all situations
  • Identify emotional triggers and manage angry outbursts
  • Creation of life skills

Assessment in Community Supervision Settings

treatment70
TREATMENT:
  • Acceptance that cure is optimal and condition management is forever
  • Development of prosocial and problem-solving skills
  • Identify family limitations

Assessment in Community Supervision Settings

treatment screening assessment
TREATMENT – Screening & Assessment:
  • Defining Screening
    • Conducted to identify adolescents who require additional attention
    • Provides opportunities for the treatment provider to better understand the psychological functioning of the youth
    • Generally, does not provide psychiatric diagnoses

Assessment in Community Supervision Settings

treatment screening assessment72
TREATMENT – Screening & Assessment:
  • Defining Screening (cont’d)
    • Is generally the first in a sequence of different assessment and intervention strategies
    • Should be used with all youth entering the juvenile justice system

Assessment in Community Supervision Settings

treatment screening assessment73
TREATMENT – Screening & Assessment:
  • Goals of Screening
    • Determine current level of mental health and substance use functioning
    • Identify and isolate manifested variables of youth with histories of violent offenses
    • Identify youth with cognitive deficiencies and educational deprivation

Assessment in Community Supervision Settings

treatment screening assessment74
TREATMENT – Screening & Assessment:
  • Goals of Screening (cont’d)
    • Identify youth who may be unwilling or unable to engage and establish in therapeutic relationships
    • Isolate factors which are related to primary and secondary gains of mental illness, substance use and on-going criminal behavior

Assessment in Community Supervision Settings

treatment screening assessment75
TREATMENT – Screening & Assessment:
  • Defining Assessment
    • Conducted after gathering critical information
    • A comprehensive analysis of psychological, psychosocial and other needs
    • More sensitive to “red flags”
    • Narrows the problem or strength with the ultimate goal of ruling out extraneous variables that may serve as false positives

Assessment in Community Supervision Settings

treatment screening assessment76
TREATMENT – Screening & Assessment:
  • Goals of Assessment
    • Examine the level and extent of mental health and substance use problems
    • Identify other psychosocial or psychological problems that may enhance the symptoms of mental health and substance use problems

Assessment in Community Supervision Settings

treatment screening assessment77
TREATMENT – Screening & Assessment:
  • Goals of Assessment (cont’d)
    • Determine the extent that the youth’s family may be useful in treatment, their motivation, and ability to maintain family warmth and boundaries
    • Provide diagnosis and baseline treatment planning

Assessment in Community Supervision Settings

treatment screening assessment78
Needs Assessment

Rehabilitation Needs

Drives Treatment Planning

Describes youth’s functioning

Risk Assessment

Levels of security

All points of system

Recommendations to court

Decision-making

Dangerous to community

Court appearance

TREATMENT – Screening & Assessment:

Assessment in Community Supervision Settings

treatment screening assessment79
TREATMENT – Screening & Assessment:
  • Type of instrument (screening vs. assessment)
  • Population (age, reading ability)
  • Form of administration (self report, structured interview, clinician-rated, computer scoring vs. manual scoring)
  • Credentialing/training required
  • Life areas covered
  • Cultural specificity
  • Reliability/validity

Assessment in Community Supervision Settings

treatment categories of co occurring disorders
TREATMENT – Categories of Co-Occurring Disorders:
  • A heterogeneous population
  • They have high rates of co-morbidity
  • Females who display mental health and substance use disorders have high rates of depression
  • Some manifest deviant sexual arousal patterns
  • Fail to benefit from traditional psychotherapies; C-B-T has shown promise

Assessment in Community Supervision Settings

treatment categories of co occurring disorders81
TREATMENT – Categories of Co-Occurring Disorders:
  • Affective-based
  • Anxiety-based
  • Psychotic-based
  • Behavior-based
  • Co-Occurring-based
  • Personality-based

Assessment in Community Supervision Settings

treatment categories of co occurring disorders82
TREATMENT – Categories of Co-Occurring Disorders:
  • Affective-based
    • Refers to long-standing, chronic mood states that generally affect all aspects of an adolescent’s life
      • May involve a significant elevation of mood state or depressed states and may occur as full or partial episodes

Assessment in Community Supervision Settings

treatment categories of co occurring disorders83
TREATMENT – Categories of Co-Occurring Disorders:
  • Anxiety-based
    • Refers to the experiences of nervousness, tension, apprehension, and fear
      • Experiences may be real or imagined and may affect concentration and daily performance as well as impair physical ability

Assessment in Community Supervision Settings

treatment categories of co occurring disorders84
TREATMENT – Categories of Co-Occurring Disorders:
  • Psychotic-based
    • Refers to a disintegration of thinking processes, affecting cognitive functioning, perception, judgment and mood
      • Involves inability to distinguish external reality from internal beliefs

Assessment in Community Supervision Settings

treatment categories of co occurring disorders85
TREATMENT – Categories of Co-Occurring Disorders:
  • Behavior-based
    • Refers to a cluster of law-breaking, intrusive and invasive behaviors
      • Often evidenced by disordered conduct and aggressions

Assessment in Community Supervision Settings

treatment categories of co occurring disorders86
TREATMENT – Categories of Co-Occurring Disorders:
  • Co-Occurring Mental Health & Substance Use–based
    • Refers to simultaneous experience of these disorders
      • Have pronounced affects on the thoughts, mood and behaviors of adolescents

Assessment in Community Supervision Settings

treatment categories of co occurring disorders87
TREATMENT – Categories of Co-Occurring Disorders:
  • Personality-based
    • Refers to pervasive patterns of functioning that affect cognitive, perception, mood and behavior
      • Impact affect the behavior of adolescents as they experience difficulties that are deeply rooted in their personality

Assessment in Community Supervision Settings

conclusion
CONCLUSION

Assessment in Community Supervision Settings

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