Connecticut Case Study

Over the last several years, the state of Connecticut has significantly transformed its approach to providing mental health care to youth involved with the juvenile justice system. The impetus for these changes stemmed, in large measure, from the terms of a 2002 Federal court ruling (Emily J. vs. John G. Rowland et al.) in which Connecticut was found to be out of compliance with a 1997 consent decree that called for significant improvements in mental health care for youth in the juvenile justice system (Kids Counsel, 2005). As a result, Connecticut’s Court Support Services Division (CSSD) of the Judicial Branch and the Department of Children and Families embarked upon a three year court-ordered plan to develop and implement a comprehensive system of care for screening, assessing, and providing a broad range of behavioral health services to detained youth. Connecticut used this challenge as an opportunity to engage in a strategic planning process that would result in measurable and positive outcomes. Working with the National Center for Mental Health and Juvenile Justice as part of the Comprehensive Systems Change Initiative, (CSCI) (NCMHJJ, 2005) they formed a multi-system team, comprising representatives from:

• CSSD, which is responsible for juvenile probation and detention services in the state,
• DCF, which is responsible for services provided to youth in juvenile correctional facilities and aftercare services,
• AFCAMP—a parent advocacy group,
• The Tow Foundation, a private foundation with an interest in behavioral health and juvenile justice reform; and
• The Center for Effective Practice, which was created to promote the use of evidence-based behavioral health treatment interventions with Connecticut youth.

It is important to note that shortly after the 2002 ruling, DCF closed its Juvenile Justice Bureau and shifted responsibility for juvenile correctional programs and services to DCF’s Bureau of Behavioral Health, Medicine and Evaluation, emphasizing the need for treatment rather than merely confinement for delinquent youth in the custody of DCF. DCF representatives brought this broadened perspective to the interagency team.

The team began by developing a mission statement that clearly articulated the goals of its work: to develop a coordinated and continuous system of care with sufficient capacity, assessment capability, and program variety to fully address the mental health needs of children involved with the juvenile justice system. They then developed a workplan with clear action goals, including:

• Implement a system-wide, uniform mental health screening process
• Redesign the juvenile court mental health evaluation process
• Match assessment outcomes to appropriate intervention
• Expand evidence-based treatment programs available to youth in the juvenile justice system
• Develop a system to monitor outcomes of screening, assessment, and treatment

Over three years, the team met regularly, involved other interagency groups in their work, and received technical assistance arranged by the NCMHJJ. Through these efforts, the CSCI team was able to accomplish several major goals. These accomplishments include:

• System-wide implementation of the MAYSI-2 in all juvenile detention centers and probation departments. Probation officers and detention staff were extensively trained on the use and interpretation of the MAYSI-2, and CSSD agreed to provide clinical consultation to probation staff in situations where clinical clarification on MAYSI-2 results was necessary. In addition, in response to concerns raised by the Public Defender around client self-incrimination and confidentiality, negotiations occurred between CSSD, DCF, the Office of the Chief Public Defender, and the Office of the Chief State’s Attorney. These discussions resulted in the passage of legislation that ensures the confidentiality of information collected as part of a mental health screen and limits the use of this information for planning and treatment purposes only.
  
  
• The creation of a court-based assessment model for providing expedited mental health evaluations to youth, and the use of clinical coordinators within the courts to foster linkages with community-based service providers. This model was based on the Cook County, Illinois, Juvenile Court Clinic Model, and representatives from Cook County provided on-site technical assistance to the Connecticut team to help them develop their approach.
  
  
• The creation of Multi-Disciplinary Case Review teams who review youth mental health assessment outcomes and match these to the most appropriate interventions. Since their inception in May 2004, over half of all cases presented to the Case Review teams were diverted from residential placement and referred to community-based care.
  
  
• The significant expansion of evidence-based treatment services throughout the state for youth involved with the juvenile justice system. From 2002 to 2005, the state of Connecticut increased the number of Multi-Systemic Therapy (MST) slots from 92 to 398, and expanded MST into all juvenile courts as a dispositional alternative to incarceration. They also introduced other evidence-based treatments, such as Multi-Dimensional Treatment Foster Care, Functional Family Therapy, and Brief Strategic Therapy, and designated treatment slots specifically for juvenile justice youth.
  

The Connecticut experience highlights several critical elements important to successful juvenile justice and mental health collaboration:

• It is necessary to examine all components and elements of the juvenile justice continuum, not just individual points.
• A broad group of stakeholders working together can provide a large and diverse perspective, and offer innovative solutions and ideas.
• Parents and advocates are critical to the process and must be part of the stakeholder group.
• The team must agree on a joint mission and vision in order to move forward.
• A long-term work plan provides enhanced opportunities for innovation.