The American Juvenile Court as a Therapeutic Court

1. The American Juvenile Courtas a Therapeutic Court Judge Tom C. Rawlings Juvenile Courts, Middle Judicial Circuit State of Georgia tom@sandersville.net www.tomrawlings.com

2. “Recess is over, Your Honor.”

3. Georgia’s Middle Judicial Circuit • Five “Persistent Poverty” Counties in East Central Georgia • Poverty rates > 20% over a 40-year period • Not within any Metropolitan Statistical Area • 2,300 square miles with 100,000 residents

4. Children under 17 accused of a crime. Children under 18 alleged to be deprived (neglected or abused) and who need state protection. Children under 18 accused of a status offense Children accused of a crime but who are incompetent to stand trial The Court’s Jurisdiction

5. 50 40 30 20 10 0 Juvenile Crime by Type, Georgia1996-2000 Percent Person Property Drugs Pers Comm. Mary Mathis, MPH, Mercer University School of Medicine, Sept 2004

6. Role of the Juvenile Court in Foster Care • Primary responsibility of the Court and State to foster children: reunification of the family • To accomplish the goal of stable families requires fit parents • For parents with mental illness and substance abuse, effective mental health services are needed

7. Crimes Foster Care Incompetency “Walk-ins”

8. Poverty and Children • 195 of 200 “persistently poor” counties are rural • In these counties, child poverty rates often exceed 35 % • Rural and urban similarities: • Disproportionately affects minorities and children of single parents • Similar challenges of substance abuse, teen pregnancy and educational failure • Rural Problems: • Funding and service shortages more acute • Save the Children, America’s Forgotten Children: Child Poverty in Rural America, 2003.

9. Mental Health Concerns and Delinquency/Status Offenses • Estimated 15 to 20% rate of severe mental illness among juvenile offenders1 • Less severe mental illness about 40%1 • Parents and caregivers often first seek help from law enforcement • Schools, prohibited from taking long-term punitive action against Special Education students, often turn to juvenile justice system 1.Arredondo, David E. MD et al, Juvenile Mental Health Court: Rationale and Protocols, Juv. And Family Ct. Jnl. 52 (4) Fall 2001 1-19.

10. Juveniles in Detention • Two-thirds of juvenile detention facilities hold youth awaiting mental health treatment 1 • Santa Clara County, California, 2001 detained juveniles2: • 37% severe traumatic experiences • 19% significantly depressed • 10% hopelessness • 9% psychosis • 8% reported suicidal ideation • Medication concerns, including refusal 1. U.S. House of Rep, Comm on Govt. Reform: Incarceration of Youth Who are Waiting for Community Mental Health Services in the United States (July 2004) 2. Arredondo, David E. MD et al, Juvenile Mental Health Court: Rationale and Protocols, Juv. And Family Ct. Jnl. 52 (4) 2001 1-19.

11. Severely Emotionally Disturbed Students • Psycho-educational facility a frequent school assignment in rural areas • Facility location often remote from home, resulting in lengthy travel by bus • The result: poor attendance, continued behavioral disturbances, and referral to the juvenile justice system

13. Foster Care and Mental Health • Infants and toddlers in the child welfare system suffer cognitive and developmental delays 1 • Among the children of rural migrant workers: • 66% have one or more psychiatric diagnoses based on mother or child reports • anxiety disorders most prevalent2 1. Lederman, Cindy S. et al, When the Bough Breaks the Cradle Will Fall: Promoting the Health and Well Being of Infants and Toddlers in Juvenile Court, id, 33-37 2. Kupersmidt, Janis B. et al. J. Am. Acad. Child Adoles Psychiatry 36(2)1997 224-232.

14. Foster Care and Mental Health • Children whose parents abuse drugs and alcohol are nearly three times as likely to be neglected • Children in foster care have higher rates of emotional problems than other children of similar backgrounds Allen & Bissell. Safety and Stability for Foster Children: The Policy Context. The Future of Children 14(1) 49-70 (Packard Foundation 2004).

15. Children Deemed Incompetent • Incompetence may result from: • Severe mental illness • Mental retardation • Immaturity • Once declared incompetent, no punitive measures (detention, probation, etc) may be taken • Result: Problem children in a “no-man’s land” of agency responsibility

16. Family/ Children Services Mental Health Juvenile Justice Schools Who Provides the Services?

17. Juvenile Courts: Reluctant Mental Health Gatekeepers • Necessity of Managing Mental Health Care and Substance Abuse Problems. • Necessary for reunification of families • Necessary to meet court’s mission of treatment and rehabilitation

18. Court-based interventions that focus on chronic negative behaviors over a period of time in conjunction with mandatory treatment. Experts provide treatment and Court ensures compliance through sanctions. The Juvenile Court asa “Therapeutic” Court Conference of State Court Administrators, “Position Paper on Therapeutic Courts” (1999), available at http://cosca.ncsc.dni.us/PositionPapers/therapeuticcourts.pdf

19. Judicial collaboration is regarded as more important than judicial independence; and achieving desired outcomes more important than a fair process free of undue influence on the judge The Juvenile Court asa “Therapeutic” Court Conference of State Court Administrators, “Position Paper on Therapeutic Courts” (1999), available at http://cosca.ncsc.dni.us/PositionPapers/therapeuticcourts.pdf

20. They work—individuals successfully treated do not re-offend, or do so at a much lower rate, thus saving money and public resources; They require and promote collaboration by courts and judges with other agencies and professionals; They compel individuals to respect the system and participate in the treatment services offered or face swift consequences, which is regarded as a superior form of accountability to traditional sentences Source: COSCA report, supra The Juvenile Court asa “Therapeutic” Court

21. Drug Courts Mental Health Courts Some juvenile courts have created specialized juvenile mental health or drug courts Exist predominantly in urban areas with a “critical mass” of clients and providers Source: COSCA report, supra “Therapeutic” Courts

22. Addressing the Problems: A Practical Approach • Courts must take a clinical approach to the situation, and mental health providers must consider the court process in making recommendations • Courts and mental health providers must work together to accomplish the broader goal of treatment and rehabilitation

23. A Beginning in Romania: Instanţa Pentru Minori

24. 30 25 20 15 10 5 0 Child/Adolescent Age at Evaluation 30 25 20 Number 15 10 5 0 9 10 11 12 13 14 15 16 17 Age Central State Hospital, Milledgeville, GA. C & A Forensic Eval, Jan-Oct 15, 2004

25. C & A Personality Pathology 8 7 6 5 Number of Diagnoses 4 3 2 1 0 Borderline Schizotypal Personality DO NOS Central State Hospital, Milledgeville, GA. C & A Forensic Eval, Jan-Oct 15, 2004

26. IQ Scoring 35 30 25 20 Percent 15 10 5 0 110-119 90-109 120 + 80-89 70-79 55-69 40-54 Intelligence Quotient WISC-III Central State Hospital, Milledgeville, GA. C & A Forensic Eval, Jan-Oct 15, 2004

27. Mood Disorders 12 10 8 6 Number 4 2 0 Dysthymia Major Dep Depressive Cyclothymia DO NOS Central State Hospital, Milledgeville, GA. C & A Forensic Eval, Jan-Oct 15, 2004

28. Juvenile Court Charges 60 Status 50 Personal 40 Property 30 Sexual 20 Drug 10 0 Central State Hospital, Milledgeville, GA. C & A Forensic Eval, Jan-Oct 15, 2004

29. Discharge Diagnoses by Percent 25 Conduct Disorder, 20 Adolescent Onset Oppositional Defiant 15 Disorder Percent ADHD 10 Conduct DO- Childhood onset 5 Disruptive Behavior Disorder NOS 0 Number Central State Hospital, Milledgeville, GA. C & A Unit, Apr-Jun2004

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