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.
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3Oct13presentation - The Connecticut Juvenile Justice Alliance