Lee A. Underwood, Psy.D.

1. 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

2. 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

3. 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

4. INTRODUCTION Assessment in Community Supervision Settings

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. INTRODUCTION: • Growing awareness of prevalence • Recognition of difficulties in treatment • Documentation of greater negative outcomes associated with disorders Assessment in Community Supervision Settings

13. 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

14. 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

15. DEFINING CO-OCCURING DISORDERS Assessment in Community Supervision Settings

16. 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

17. 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

18. 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

19. 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

20. 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

21. 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

22. CHARACTERISTICS OF YOUTH & OTHER SERVICE NEEDS Assessment in Community Supervision Settings

23. 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

24. 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

25. 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

26. 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

27. 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

28. 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

29. 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

30. 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

31. 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

32. 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

33. 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

34. 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

35. 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

36. 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

37. 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

38. 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

39. 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

40. 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

41. 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

42. 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

43. 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

44. 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

45. 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

46. 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

47. RISK FACTORS Assessment in Community Supervision Settings

48. 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

49. 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

50. 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