Policy Practice Reflection Paper
Steve Weber

Nissen, L. (2006). Effective adolescent substance abuse treatment in juvenile justice settings: Practice   and policy recommendations. Child and Adolescent Social Work  Journal, 23(3), 298-315.

The purpose of this article is to increase awareness of the quality of substance abuse treatment interventions used by the juvenile justice system. Additionally, the author suggests several changes in policies that may improve substance abuse treatment outcomes within the juvenile justice system.

Today’s juvenile justice system must handle more problems than just juvenile delinquency. The current system must also work with juveniles who have substance abuse issues, mental illness, and family related problems. Due to underfunding and increased numbers of juveniles entering the system, positive intervention outcomes are decreasing; recidivism rates are rising in many states. Increasingly, the overburdened system cannot accommodate the multi-faceted needs of youth within its care. The obstacles blocking major reform are (a) poor funding, (b) negative public attitudes toward youthful offenders, and (c) current policies that are more punitive than therapeutic. Another issue that prevents the use of more evidence based interventions for treating substance abuse is the unorganized state of today’s juvenile justice system. Entities and organizations at the local, state, and federal levels often have differing policies and philosophies with respect to substance abuse treatment definitions and expected outcomes.

Compared to other available services, substance abuse treatment options are especially lacking for juvenile offenders. Fewer than 10% of youth within the juvenile justice system who need substance abuse treatment ever receive those services. Few of those youth who do receive substance abuse services participate in evidence based interventions. Although the prevalence of juvenile delinquency has decreased in the past few decades, the percentage of delinquents with substance abuse issues has dramatically increased. Studies show that the percentage of juvenile delinquents with substance abuse problems has increased approximately 300% in recent years. State and local detention policies do not usually distinguish between juvenile offenders with substance abuse disorders and those without. Therefore, and even with its current limitations, the juvenile justice system has become the largest provider of publicly funded juvenile substance abuse treatment. The juvenile justice system did not anticipate the increased number of youth who need substance abuse treatment. Only 36% of juvenile detention centers offer any type of substance abuse treatment.

The large increase in the number of delinquent youth with substance abuse issues has resulted in a lack of congruent policies among involved entities. The author suggests that standardized assessment and screening protocols should be in place for all first-time youthful offenders. Depending on the results of those assessments, evidence based interventions should initially be provided in lieu of more commonly used punitive measures. For example, Multi Systemic Therapy (MST) has strong evidence supporting its use for preventing recidivism among first time juvenile offenders. Although not originally designed for addressing substance abuse issues, studies indicate MST is also beneficial to youth with substance abuse issues. Research indicates that MST provides a solid foundation for subsequent substance abuse treatment.

More appropriate interventions will positively impact the delinquent youth themselves, their families, and society as a whole. Improved assessments and interventions for youthful offenders can lower the overall cost incurred by the juvenile and adult justice systems. Studies indicate that lower recidivism rates resulting from MST can save the juvenile and adult justice systems about $9 for every $1 invested in providing the intervention. Although long-term savings are evident, the initial costs for implementing more favorable interventions are substantial and will require shifts in agency and public attitudes in order to provide the additional funding.

Insight One: Appropriate substance abuse treatment for youth within the juvenile justice system is rare. Application One: When I become a social worker, I will likely have clients with substance abuse issues sent to juvenile detention centers. I will follow-up with their caseworker to ensure they are getting proper treatment if needed.

Insight Two: I became more aware of the theory involved in MST. Application Two: Although MST requires specific training for therapists who practice it, I believe I can and will incorporate aspects of its theory into my future practice. Specifically, when working with a delinquent youth, I will do my best to incorporate the youth’s family into the process as much as possible.

Insight Three: Punitive consequences are more common than therapeutic interventions for youthful offenders. Application Three: As a future social worker, I will have regular interactions with juvenile and court officials. I will point out to them the ineffectiveness of punitive consequences compared to more appropriate interventions and consequences considering their ages and offenses.

Insight Four: Public opinion is a major obstacle to juvenile justice policy changes. Application Four: I will advocate for changes as much as possible while I am a busy student. However, I will use my future MSW credentials as a platform for more authoritative advocacy as I speak to community groups in my community concerning the problem.

Insight Five: I learned that MST also provides a good foundation for future substance abuse treatments for youth.   Application Five: I will learn more about this aspect of the theory and possibly incorporate parts of it in interventions with my youthful clients who have substance abuse issues.

 

Migdole, S., & Robbins, J. (2007). Commentary: the role of mental health services in preadjudicated       juvenile detention centers. Journal of the American Academy of Psychiatry and the Law, 35(2),      168-171.

The authors’ purpose of the article is to describe the history and shortcomings of current policies for providing mental health services to preadjucdicated youth in juvenile detention centers. The authors also describe the positive steps taken in recent years for providing mental health services to offending youth.

The authors believe it is important to understand past policies regarding juvenile justice. There were four basic stages. Before 1960, judges were utilized as the parental figures for delinquent youth. Once a youth was arrested, a judge was seen as the primary figure for determining what was best for the offending youth. A shift to due process and a focus on personal rights for youthful offenders began in the 1960’s and continued until the early 1990’s. Court appointed attorneys were first appointed during that time in order to protect the youth’s rights in judicial proceedings. The next phase included a fundamental change in attitude toward juvenile delinquents. A rapid rise in the numbers of offending youth occurred in the 1990’s. There were also instances of great attention placed on young and dangerous super-predators of the time. Beginning in the 1990’s, juvenile detention centers became overwhelmed with the increased incidence and severity of delinquency. Policy makers increasingly believed that some youths could not be rehabilitated. This attitude led to policies of warehousing youth in juvenile detention centers in order to protect society from dangerous behavior. Variations of this attitude are still prevalent today and are hindering progress for forming more effective policies.

Beginning around 2000, policies began to shift from a detention mentality to more proactive policies for providing more community based behavioral and mental health services to youth. Although the current initiatives and goals are worthy, the authors describe how disjointed the efforts have been. There is not a focused effort or plan among organizations and agencies for providing mental health treatment to youth before or after they are placed in detention. The many state and local agencies that provide services utilize varied methods and philosophies. For this reason, and due to limited funding for adequate research, it has been difficult to establish many evidence based practices that current funding policies can provide for.

The questions of which youth have mental health treatment needs and the definition of treatment itself further compound the issue. If the Diagnostic and Statistical Manual of Mental Disorders (DSM) is used as a screening tool to determine the psychotherapeutic needs of offending youth, an estimated 75% of juvenile delinquents can be diagnosed with at least one mental disorder. If these standards are used to determine which youth need treatment, supplying appropriate mental health services to that size of population is not feasible with today’s available resources. In fact, an overly optimistic expansion of available resources could not adequately provide services to that number of youth. The definitions of need, treatment, or both, must be reevaluated.

The authors describe a screening tool named The Massachusetts Youth Screening Instrument (MAYSI) that is now used successfully in some states to properly validate the mental health needs of preadjudicated youth. A valid screening tool, such as the MAYSI, can better pinpoint where to focus resources in order to improve the results of currently available mental health interventions. Although not a total solution, better screening tools could result in higher quality and more personalized interventions with respect to the available resources.

State and local policies are slowly changing to help ensure youth receive the mental health services they need. However, continued progress depends upon increased cooperation between the various agencies as they seek viable solutions for providing effective solutions. Increased cooperation is also necessary in order to develop evidence based interventions as models that can be replicated within all juvenile justice centers.

Insight One: I now understand how the practice of often “warehousing” youth came about. Application One: In the past, I was a member of Blaine County’s Granduated Sanctions Committee (for handling first time youthful offenders). I will join the committee again in the future and advocate more often for supplying mental health services to youthful offenders at the time of their first offense.

Insight Two: Using the DSM alone is not a viable method for assessing youthful offenders’ mental health needs. Application Two: I have obtained an article concerning the validity of the Massachusetts Youth Screening Instrument. I will study it and determine how it, or components of it, might be applied in my county. If it appears useful and practical, I will suggest it to the Graduated Sanctions Committee in the future.

Insight Three: The article reinforced for me the need to clarify the definition of the term “treatment”. The authors reminded me how often the term is used without clear meaning. Application Three: When counseling is suggested for a youth during future meetings of Graduated Sanctions, I will address the issue of the level of treatment. For example, I will find out if the youth’s counseling will involve an LPC or LCSW or if the counseling be with an agency that uses undergraduate degreed individuals as counselors (which is often the case).

Insight Four: Juvenile justice centers are primarily focused on housing youth safely. Application Four: In the future, when I have clients go to detention, I will advocate for them with their juvenile officers to help ensure that they receive necessary counseling while in detention.

Insight Five: Methods and policies for handling young offenders differ widely by location and organization. Application Five: I will become familiar with juvenile delinquency policies and procedures in other counties near my own. If I believe aspects of their policies would prove beneficial to my county’s youth, I will advocate for changes through the Graduated Sanctions Committee.

 

Myers, D., & Farrell, A. (2008). Reclaiming lost opportunities: Applying public health models in juvenile   justice. Children and Youth Services Review, 30(10), 1159-1177.

The purpose of the article is to compare the original intent of the U.S. juvenile justice system with currently implemented policies. Additionally, the authors propose a strategy for modifying the system so it is more congruent with its original intent.

The legal system in the United States changed in 1899 with respect to how juvenile offenders were treated. Before that time there was no separation between adults and juveniles in the criminal court system. Additionally, before the juvenile justice system was established, youthful and adult offenders were often imprisoned in the same facilities. The rationales behind the policy changes were that rehabilitating juveniles was easier because they were still developing and that extenuating circumstances in their environment could be the cause of their misbehavior. On the other hand, adult offenders were thought of as already well ingrained with their antisocial behavior and were solely responsible for their behaviors. Separate judicial systems were created with the belief that juveniles could and should be rehabilitated during their developmental stages. Additionally, housing juveniles and adult offenders together in the same prisons created problems and was cause for concern at the time.

Despite the original focus for rehabilitating youth, today’s system is moving further away from that focus to one that is more punitive. This shift is evident by the increasing number of youth in detention even though the prevalence of violent crimes committed by youth has decreased in recent decades. The public’s fear of high profile youthful offenders is one reason the policies are more punitive than in prior years. The increased rate is also due to the current policy of using detention as punishment for such things as chronic truancy and running away from home. A case can be made that the juvenile justice system has criminalized family dysfunction.

The authors propose that juvenile delinquency should be considered as a public health concern. This perspective would allow for the implementation of a true medical model. Although certain aspects of current juvenile justice policies loosely follow a medical model perspective, the punitive side of the system negates the positive aspects of any medical model focus. A true medical model would include broad preventative measures focused on the entire population of youth. In addition, highly targeted preventative measures should be applied to all high-risk segments of youthful populations. Finally, when delinquency occurs despite the application of preventative measures, evidence based interventions and services should be provided to offending youth on a personal and customized basis. The medical model approach would remove many of the punitive components within the current juvenile justice system. Although a true medical model represents a change in philosophy, it does not mean that detention for some offending youth would cease to exist. Instead, the medical model would utilize detention, when required for the safety of the youth or society, as one aspect of a highly targeted intervention still focused on rehabilitation.

The proposed medical model for the juvenile justice system includes (a) strengths and needs based approaches, (b) active involvement of the family, (c) cooperation and collaboration among involved agencies, (d) flexible and highly individualized services in natural settings, and (e) focus on community and cultural context. When the punitive aspects of today’s policies are removed and replaced with a true medical model, lower offending and recidivism rates will occur. This fact is documented by research studies involving several communities that have implemented a very structured medical model within their juvenile justice system. Not only does the medical model result in decreased delinquency and recidivism rates, the medical model offers communities significant financial savings with respect to detention costs and associated expenditures. However, perhaps the most important benefit achieved with a true medical model is the overall increase of the quality of life for the offending youth, their families, and the community as a whole.

Insight One: I was surprised to learn that the original juvenile justice system was less punitive than today’s system. Application One: As I stated earlier, in the future I will have frequent contact with juvenile and county court officials. I will remind these officials, whenever possible, of the need for rehabilitation in lieu of punishment.

Insight Two: Applying a true medical model to the juvenile justice system is a more logical approach. Application Two: From my past experience, I can see how many at-risk youth progress to the offending stage while receiving few, if any, preventative services. As a future social worker in my community, I will address this lack of services with the local committees and organizations I belong to.

Insight Three: I was aware youth could be sent to detention for excessive truancy. However, I never thought about it before in the context of how that action criminalizes youth due to family dysfunction. Application Three: In the past I have been in court with truant youth who faced possible detention. When I am in that situation again, I will use a more grounded understanding for how wrong it is to use detention for such purposes.

Insight Four: Multi Systemic Therapy is an important component of a medical model for the juvenile justice system. Application Four: In my future practice,I will incorporate the therapy’s basic theory for involving a delinquent youth’s family in the therapeutic process as much as possible.

Insight Five: Applying a medical model to the juvenile justice system requires cooperation between the various involved agencies. Application Five: From my prior experiences I can attest to how often agencies do not have sufficient collaboration and cooperation with each other. While serving on various community committees in the future, I will use my increased skill as a social worker to find ways to increase collaboration and cooperation.