The Overlap Between Juvenile Justice and Mental Health in Connecticut: Healing the Generations October 3, 2013 Abby Anderson, Executive Director, Connecticut Juvenile Justice Alliance Co-chair Keep the Promise Children’s Committee Goals 1. Who is in CT’s juvenile justice system? 1. Kids in the jj system and trauma 1. What trauma looks like in kids 2. Criminalization of kids (trauma and otherwise) 1. Trauma-informed juvenile justice system 1. We can do better 2. We have done better – Lessons from the jj system 3. Proposed next steps 9. Discussion Who are the kids in the jj system? What percentage of the people arrested in Connecticut are under 18? What are the most common charges against kids in Connecticut? What is the gender and racial and ethnic breakdown of the juvenile justice system? Are juvenile arrests increasing or decreasing? They are kids “I don’t fit in.” Anonymous boy at CJTS, 2011 Brick Boy, anonymous artist from Connecticut Juvenile Training School, Fall 2012. MANY of them are kids carrying a lot of pain, suffering and victimization Youth in the juvenile justice system National research shows that 60-90% of youth in detention are estimated to have trauma histories Source: Abram, K. M., Teplin, L. A., Charles, D. R., Longworth, S. L., McClelland, G. M., & Dulcan, M. K. (2004). Posttraumatic stress disorder and trauma in youth in juvenile detention. Archives of General Psychiatry, 61(4), 403-410. Poly-victimization is highly prevalent in juvenile justice populations Analysis of a sample of 1,959 U.S. youth recently admitted to juvenile detention facilities showed that 41% were poly-victims – they’d experienced multiple types of victimization. Source: Ford, J. D., Grasso, D., Hawke, J., & Chapman, J. (in press). Poly-victimization among juvenile justice-involved youths. Child Abuse & Neglect. Connecticut Specific Data Connecticut Juvenile Justice System – 2,200 admitted to detention – >80% report history of trauma Important to note that 20%-25% of youth exposed to trauma will develop symptoms Source: Building a Trauma-informed System of Care for Children in Connecticut, presentation to Sandy Hook Commission, 2012, Robert Franks, PhD, Connecticut Center for Effective Practice, Child Health and Development Institute What are typical reactions to traumatic events? • Overwhelming, unanticipated danger that cannot be mediated/processed • Leads to fight or flight response (normal methods for decreasing external danger) • Results in difficulties in regulating behavior that compromises affective, cognitive and behavioral responses • Leads to loss of internal control and normal functioning Source: Building a Trauma-informed System of Care for Children in Connecticut, presentation to Sandy Hook Commission, 2012, Robert Franks, PhD, Connecticut Center for Effective Practice, Child Health and Development Institute Post-traumatic symptoms in children: Chronic Symptoms Four major symptom areas: • • • • Re-experiencing the trauma Avoidance & fear Increased arousal Decreased responsiveness, numbing and regression Source: Building a Trauma-informed System of Care for Children in Connecticut, presentation to Sandy Hook Commission, 2012, Robert Franks, PhD, Connecticut Center for Effective Practice, Child Health and Development Institute Important Notes • All kids who experience trauma will not develop chronic symptoms. • Only some of those kids who do develop symptoms will have anger or aggression issues. • NOT saying: “All these kids have trauma, so of course they are all violent and angry.” What We Are Saying A lot of kids in the jj system have experienced trauma. For some of them, that trauma has caused chronic changes in their emotions and behaviors that can lead to serious mental health issues. We need to identify and treat those issues like the behavioral health issues they are and treat those children like the victims they are, not like criminals. Traumatic Stress in Children: Risk for Misdiagnosis • Traumatic stress can be a contributing factor and cause of a range of other disorders in children: – – – – – – – – ADHD Anxiety Depression Bipolar Disorder Oppositional Defiant Disorder Conduct Disorder Specific Phobias Learning/academic difficulties Source: Building a Trauma-informed System of Care for Children in Connecticut, presentation to Sandy Hook Commission, 2012, Robert Franks, PhD, Connecticut Center for Effective Practice, Child Health and Development Institute Criminalizing the Pain of Youth That list includes a lot of labels kids in the juvenile justice system carry. Behaviors that are a response to natural trauma look like behaviors of kids who legitimately are acting out. For decades we’ve been asking only, “What’s the matter with you to make you act this way?!” We should be asking, “What’s happened to you to make you act this way?” How often are we “criminalizing” behaviors that are coping mechanisms developed because of victimization and relate to trauma or are manifestations of other mental health issues? Racial Disparities You won’t be surprised to learn that in the recent study by Ford, Grasso and Hawke of 1,959 youth recently admitted to detention, 72% were male and 79% black or Latino. Racial make-up of CT’s juvenile justice system: 34% Black 18% Hispanic Racial make-up of CT as a whole: 11% Black 14% Hispanic Sources: CSSD and DCF Criminalizing Youth in School Criminalizing Youth Already in Our Care Arrests of youth in DCF placement? •448 in 2012 •190 in January-June 2013 Source: DCF. Data include arrests that occur at a placement, as well as at other settings, including schools or during a home pass. What about accountability? Not saying behavior is OK. Accountability must go both ways. When a young person who has been victimized repeatedly reacts in a way that is completely logical and appropriate given his or her life experience but that is incompatible with societal and legal norms, we need to respond. Do we need to respond with the justice system? And who’s holding US responsible for not meeting that child’s need sooner? Especially in situations like when a child is ALREADY in DCF’s system? WE failed that child first. Why is he or she the one paying the price? So what can we do? Huge movement now throughout the country to create Trauma-Informed Juvenile Justice Systems How do trauma-informed services benefit juvenile justice systems? • Universal precautions: Screening enables youth & staff to understand how trauma-related survival coping leads to (preventable) behavior problems while the youth is in care • Anticipatory Guidance: Evidence-based youth/caregiver/staff-friendly education about what youths, caregivers, attorneys/advocates, and court, law enforcement, and service providers can do together to prevent survival coping from endangering youths and their communities Source: Trauma Informed Juvenile Justice Systems: Science, Practice & Policy: A Mental Health Perspective presentation by Dr. Julian Ford, University of Connecticut School of Medicine at National Juvenile Justice Network Forum, July 2013 Why are trauma-informed juvenile justice systems a good investment? • Public Safety: Children and their communities are safer if not trapped in chronic survival mode • Economics: Reducing frequency/duration and severity of youth justice system-involvement can increase lifetime productivity and decrease the burden of crime/violence-related costs born by local and national government, schools, health care providers, and businesses Source: Trauma Informed Juvenile Justice Systems: Science, Practice & Policy: A Mental Health Perspective presentation by Dr. Julian Ford, University of Connecticut School of Medicine at National Juvenile Justice Network Forum, July 2013 Agree with that. But… PROBLEM… SOLUTION? OR, SOLUTION! Why does this matter? • Not the point/purpose of the juvenile justice system philosophically • Not what the juvenile justice system is designed to do programmatically Trauma-Focused Treatment in a State System of Care: Is It Worth the Cost? • Followed 90 matched sets of kids in Delaware diagnosed with PTSD for 365 days and determined how much the mental health services they received cost • Half got TF-CBT, the other half received outpatient services as usual The findings? “Two times more money was spent on low-end mental health services received by the TF-CBT group than the control group, and five times more money was spent on high-end mental health services received by the control group than the TF-CBT group in that year.” Total spent on control group during the year = $337,489.55 Total spent on TF-CBT group during the year = $185,761.87 “These data suggest that providing evidence-based traumafocused outpatient treatment to children with traumarelated problems may offset the eventual need for services that are more restrictive and costly.” Source: Greer, D., Grasso, D., Cohen, A., Webb, C. (January 19, 2013) Trauma-Focused Treatment in a State System of Care: Is It Worth the Cost? Administration and Policy in Mental Health and Mental Health Services Research. But that’s Delaware, not Connecticut! Can it work here? We’ve invested in the front end of the juvenile justice system In 1999, CT’s juvenile justice system invested $300,000 in non-residential, family-focused treatment programs In 2012, CT’s juvenile justice system invested $39 million in non-residential, family-focused treatment programs Has it worked? Has it worked? Has it worked? State of Connecticut Juvenile Justice Expenditures1 Change from FY2001-02 to FY 2011-12 (Adjusted for Inflation) FY 2001-2002 FY 2001-2002 current dollars2 FY 2011-20124 adjusted for inflation3 Department of Children And Families – Juvenile Services $ 61.6 $ 77.9 $ 59.6 Judicial Department - Court Support Services Division Total Juvenile Justice Budget $ 49.5 $ 60.8 $ 77.4 $111.1 $138.8 $137.0 Chart taken from Juvenile Justice Reform in Connecticut: How Collaboration and Commitment Improved Outcomes for Youth, written by Richard Mendel for the Justice Policy Institute and funded by The Tow Foundation. March 2013. (All other footnotes can be found on the last slide of this presentation) There’s room to do more • Help more youth • Improve public safety • Save more money Ideas about how to start • Reduce school based arrests – MOAs – Legislation around School Resource Officers • Encourage intra and inter-agency collaboration • Budget prioritizing Reduce school-based arrests • Children with mental health need are at high risk of arrest. Schools are a good place to combat that. Nearly 3,000 CT students were arrested at school in 2011. Memorandums of Agreement between schools and police (CT Voices for Children) – – – – Who does what? Graduated Sanctions Rubrics JJAC tools – template MOA and graduated sanctions Adult Decisions report Recommendations – specific steps • Significantly expand access to trauma services that are culturally and linguistically competent • Require DCF to examine its continuum of services, continuous quality control and contracting procedures that have led to so many arrests of children in care and to develop a plan to significantly reduce those arrests Recommendations – systemic changes • Require and reward cooperation between and across state agencies – Issues don’t occur in silos – agencies must partner effectively – Now agencies have to think, “Is that OUR job?” (i.e., autism, diversion, prevention) – Kids and families fall through the cracks – Blended funding streams? – Juvenile Justice is an “exclusionary factor” for voluntary services • Develop a strong children’s mental health implementation plan – Ensure jj kids aren’t left out • Ensure there are ways to divert kids away from juvenile justice • Look at specific needs of and continuum of services for girls • Push for and support better data systems to ensure strategic planning and decision-making is data-driven Recommendations – systemic changes • Budgets – State and local level focus and emphasis on front-end interventions. ALWAYS the first cut, but that is a short-sighted option – DCF philosophically agrees, moved away from out of state and congregate care with plan to reinvest savings into front-end community based services. They saved the money – the money was all swept from DCF’s budget through rescissions - $80 million – DCF also worked with Office of Healthcare Advocate to hold insurance companies accountable and ensure they pay when children and families have insurance. The goal was to invest those funds back into services. Those funds were swept through rescissions- $3 million The Juvenile Justice and Mental Health Community Gets Active • The past few decades have seen improvement in the stigma that people with mental health issues face. • Kids in the juvenile justice system, however, continue to face extremely negative perceptions and get little sympathy. • It’s time for mental health providers to claim these kids and advocate for them. Contact Info: Abby Anderson, Executive Director Connecticut Juvenile Justice Alliance [email protected] 203-579-2727 ext. 321 Footnotes from Slide About CT’s JJ Budgets: All figures reflect spending from the Connecticut General Fund, and exclude contributions from the federal government or from private funders. 1 FY 02 actual expenditures are derived from the Connecticut General Assembly's Office of Fiscal Analysis, Appropriations Committee Budget FY 04 and FY 05, available online at http://www.cga.ct.gov/ofa/Documents/year/APPJF/2004APPJF20030325_Appropriations%20Committee%20Budget%20FY%2004%20-%20FY%2005.pdf. DCF budget figures found on pp. 292 - 293; CSSD budget figures on pp. 376-377. 2 Inflation adjustment made using GDP deflator, which finds that $1 U.S. dollar in 2001 is worth same as 1.249 dollars in 2011, due to inflation. Data from Bureau of Economic Analysis, U.S. Department of Commerce (using a website called Arrepim -- http://stats.areppim.com/calc/calc_usdlrxdeflator.php). 3 FY 12 actual expenditures are derived from DCF's Current Services Budget (BR-1PB) Report for FY 14 & FY 15 and Judicial Branch Current Services Budget (BR-1PB) Report for FY 14 & FY 15. Data provided via email by Rachel Welch and Phoenix Ronan, Office of Fiscal Analysis, Connecticut General Assembly, September 2012. 4 Juvenile justice administrative expenditures at the Department of Children and Families were not accounted for in a separate "administration" category in FY 02. 5 Youthful Offender Services represent a new line item in the CSSD budget to cover programs and services for 16and 17-year-oldsadded to the juvenile caseload as a result of Connecticut’s Raise the Age law. 6 Chart taken from Juvenile Justice Reform in Connecticut: How Collaboration and Commitment Improved Outcomes for Youth, written by Richard Mendel for the Justice Policy Institute and funded by The Tow Foundation. March 2013.