Integration of juvenile justice and behavioral health

A PHS 795 student discusses an article that addresses both the importance of early intervention in altering health trajectories and the question of efficient allocation of time. Encounter with the juvenile justice system is a “critical moment” for intervention for children with undiagnosed (or untreated) behavioral health issues. It is sometimes quite challenging to integrate systems across large programmatic divides (such as health and education or health and criminal justice). But such integration will become more important as we address the deep determinants of population health. Our classmate writes:

This article discusses integrating child-serving systems to best meet the needs of children whom tend to end up in the juvenile justice system. There is a wealth of research showing that youth who are involved in the juvenile justice system have significantly higher rates of poor mental health and substance use compared to youth of the general population. Subsequently, children who encounter one system, such as the juvenile justice system, mental health services, schools, the child welfare system, or other system, are at higher risk for contact with another system. Despite this, the different systems that address the needs of youth do not seem to work together. This article argues for a more integrated child-serving system that would allow for the early identification of problems and improved access to services.

While reading this article, I was reminded of Dr. John Mullahy’s discussion of time allocation and health. Dr. Mullahy primarily addressed individual time allocation and health. This article got me thinking about allocating time on a larger scale (i.e. how businesses and organizations allocate time) and how collaborations across organizations can minimize time and maximize health in a population. I believe these kinds of collaborations have the potential to dramatically reduce the time devoted by each organization, which also reduces the cost. For example, noticing a child’s poor mental health status and addressing it early may prevent this individuals desire to commit crime, eliminating their contact with the juvenile justice system. Because youth who are arrested are less likely to graduate high school, which we know is associated with several other negative health behaviors, preventing criminal behavior by addressing needs early can improve health long-term for these children. Connecticut has developed what sounds like a very promising approach for improving integration across systems. I look forward to hearing about the effectiveness of Connecticut’s partnerships.

http://jjie.org/better-integrating-behavioral-health-juvenile-justice-systems-will-rescue-more-kids/325050/

 jjie Better Integrating Behavioral Health, Juvenile Justice Systems Will Rescue More Kids

jjie.org

It is now well-known that youth who come into contact with the juvenile justice system have high rates of mental health and substance abuse conditions — rates that far exceed those of the general youth population.

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8 thoughts on “Integration of juvenile justice and behavioral health

  1. Great perspective on how the silo effect offers a great opportunity to focus interventions. I think most compelling was the statement that 90% of youth incarcerated had been exposed to one or more traumatic event. I am completely supportive of more streamlined, collaborative approaches from systems that engage children and youth, but I am also wondering how we might address more upstream issues, like childhood trauma. If we can prevent that in the first place, I suspect we would see incarceration rates decline.
    Missing from this article though, was another issue – the huge disparity in incarceration rates for black males, including youth. I think if we don’t address the underlying racism in our systems (schools, police force, courtrooms, and policymakers) and in ourselves, we aren’t going to change that. I see this as a real problem area, especially concerning in our own Dane County, where the disparity is the highest in the nation, I believe.

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  2. Reading this article I am curious as to what would be the more efficient system change: ensuring that behavioural health specialists are employed at public schools, or incorporating behavioural health into the education of teachers at either the bachelors or masters level. It would obviously be ideal to have behavioural health specialists in every school in case of severe psychological emergencies, but I wonder how feasible this is, particularly in low-income communities (I know most – if not all – schools have guidance counselors, but not social workers or behavioral health specialists). Training teachers in behavioural health could either be mandated (although a teacher’s education load is already getting pretty saturated) or it could be incentivized by the fact that schools are more likely to hire teachers that had behavioural health as a part of their education.

    I’m curious about this question because the article cited the importance of schools asking questions of the trauma in the child’s past and attempting to connect with the behavioural health sector before taking drastic measures and deferring to the juvenile justice system. Perhaps the third option would be to simply include training on the hierarchy of steps when a student acts dangerously or illegally – first go to guidence counselor, who may defer to a behavioural health specialist, who may defer to the juvenile justice system, etc. This seems a bit less efficient then the other two, which take a more hands-on approach, but may also be more cost-effective in an already strapped education system.

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  3. I think Annie has some really great insight here. This article does a good job of presenting new ideas around streamlining behavioral health services, including more efficient access to well-rounded services, but failed to mention two of the most important issues at stake within mental illness: the socio-economic factors related to the justice system and funding designated to mental health services. Before we can even begin to talk about necessary mental health services, we must first address the reasons surrounding why youth are ending up in juvenile justice systems in the first place.

    Additionally, it’s imperative that we look at funding around mental health services. Ever since the Reagan era and the mass cuts in funding for social services (primarily in mental health), our social services sector has never truly recovered. While all the ideas presented in this article seem like they have incredible potential, without enough funding- and in turn capacity- there’s not much we can do to move forward. From what the article described is taking place in Connecticut, the organizations at the state/local level are beginning to make financial investment a priority, but I believe to ultimately make wrap-around mental health services most effective, funding must become a priority at all levels, particularly from the national level down.

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  4. This was a very interesting and informative article. I agree that we need to integrate services in behavioral health and the juvenile justice system to be able to help our youth. The issue of behavioral health and young people “acting out” go together. I am interested in seeing how we can help our youth with these issues before they come into contact with juvenile justice system. But I understand that that may not always be possible, therefore, all the systems should be working with each other. All the systems should work as partners with one another, which is a challenge normally, as the article states. I think many times, what happens is once the young people come into contact with the juvenile justice system, it’s the attitudes that act as a barrier against these youths when it comes to providing them with proper help. They are labeled/seen as deviants, their acts become stigmatized, and sometimes are seen as damaged-goods that no one wants to get involved and truly help. So on top of improving the systems, we also need change in people’s attitudes.

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  5. I enjoyed this article and the comments that have been posted thus far. As a recent graduate from University of Wisconsin’s law school this topic hits close to home for me. During my three years if law school I had to take a number of required criminal law classes as part of the school’s curriculum. The juvenile justice system needs to more efficient with their resources for mental health care if they want to reduce the incarceration rate for juveniles, however it does not start here. The problem occurs within the prisons themselves because often juveniles are treated in the same regard as adults who are incarcerated, however have years beyond their maturity. I think that in order to reduce the number of juveniles who have mental illness, substance abuse issues or who have been exposed to these traumatic events, we need to make sure that these child offenders are being treated for their crimes as well in regards to their appropriate age group. There are two children’s facilities in Wisconsin, Lincoln Hills School for Boys and Copper Lake School for Girls, where they are under going investigations for abuse of power as well as physical abuse and neglect. Often times, when a juvenile is punished for another incident that they committed inside the prison, they are sent to the SHU (Solitary Housing Unit). If a juvenile is in the SHU they have their privileges revoked and they are not allowed to attend any sessions including therapy, school, or even group activities like outdoor recreational time. While this may work for adults who are incarcerated in order to deduce them from acting out again, this is not how the juvenile centers should run. We know from many studies that juveniles brains are not fully developed until they are young adults and thus why they are not given the same freedoms that one earns when they reach such age. If we ever want to see these numbers go down, there needs to be reform that takes place directly within the Department of Corrections. I understand that the shared article talks about other issues such as other child serving systems, however, this is one that I can personally speak on from my time in law school and while working in a criminal clinic at UW’s Frank J. Remington Center.

    Lastly, here is an article if anyone is interested in reading more about Juvenile issues within Lincoln Hills School and Copper Lake School: http://www.postcrescent.com/story/news/investigations/2016/05/13/explained-wisconsins-youth-prison-scandal/83714726/

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  6. I found this article particularly interesting as my partner currently works as an educator. This article did a wonderful job of efficiently laying out the current state of the juvenile justice systems, as well as how we can better integrate behavioral specialists better into the framework of schools. My first reaction to this article relates strongly to interventions we see to reduce police brutality which is to invest in better training for police officers assigned in deescalation techniques, trauma informed care and interviewing, and behavioral health backgrounds. Sadly, police officers are more prevalent in some schools than counselors and are often the folks who are called to respond to “acting out” which for many teens is a presentation of acute psychological distress. Police officers also serve as a critical pipeline to the juvenile criminal justice system for teens. If we could invest more resources in educating officers who already serve in schools while working the redistribute funds toward funding more counsellors and ideally a behavioral specialist for individual schools or districts, I think we could begin to avoid as many teens having both interactions with a juvenile justice system and behavioral health needs. I think the goals of interventions like these should focus on how we help teens before they become involved in the criminal justice system, how do we support their behavioral and mental health needs both inside and outside of school, and what is it about our communities now that is meaning so many teens are in the juvenile justice system without trauma informed care and mental health support that evidence shows they need.

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  7. The sentence, “Systems work best when individuals stop asking ‘What’s wrong with this child?’ and start asking ‘What happened to this child?’” really stood out to me. As we have learned several times in class, we need to address the social determinants to get to the root cause of the problem (or as far down as we can get with our resources). I think that once providers start asking these questions and have a better idea of what the underlying factor are, collaboration with diverse professionals is essential. The article talks about how behavioral health services providers include youth/family members, pediatricians, early education providers, and probation officers. So, there is a huge potential to work with diverse people to tackle on these root problems, but these stakeholders need to have the same common agenda. The collective impact approach can really make a difference in this population. If the stakeholders have different ultimate goals or use different language styles, the collaboration may not be effective. Dr. Remington stressed the importance of working with members of the community, and I think that mental health is a topic that needs to be addressed from diverse stakeholders to really tackle to complexity of the problem. It can be a very sensitive topic to talk about, which is why training is important.

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  8. Great article, and excellent comments! In PHS 780 I am currently exploring the options for setting up a drug court in Langlade County, and I have to say, I see a lot of parallels between the logic of drug courts and the argument posed in this article. Drug courts not only link offenders with mental health care, job training, and family counseling, there is also literature that demonstrates they are cost effective because they reduce recidivism rates. However, as Annie and others have correctly identified, this really is an intervention that is pretty far downstream, and all of these sectors need to work together to identify at risk children and teens and provide the resources they need to prevent involvement in the justice system. Like Erin, I too was struck by the line “Systems work best when individuals stop asking ‘What’s wrong with this child?’ and start asking ‘What happened to this child?’” After all we have studied this semester this far, I would argue that this could be applied to adults as well. My own bias is that the criminal justice system, both for juveniles and adults, should employ diverse sectors to work towards reintegrating offenders back into their communities in meaningful ways.

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