Cornerstone #1: Collaboration

Recommended Actions

1.1  The juvenile justice and mental health systems must recognize that many youth in the juvenile justice system are experiencing significant mental health problems and that responsibility for effectively responding to these youth lies with both the mental health and juvenile justice systems.

1.2  The juvenile justice and mental health systems should engage in a collaborative and comprehensive planning effort to thoroughly understand the extent of the problem at each critical stage of juvenile justice processing, and to identify joint ways to respond. Once there is a recognition of the problem and a commitment to change, the juvenile justice and mental health systems must engage in a comprehensive and strategic planning process and develop key goals, objectives, and strategies for addressing the identified problems. Many states have conducted their own mental health prevalence studies among youth in the juvenile justice system to document the extent of the problem in their own state, to set the stage for the development of a strategic plan or the implementation of new interventions, and to generally draw attention to the issue. Often, these reports are the result of an interagency task force or committee that is charged with examining the situation and developing recommendations for improvement. States such as Virginia, Texas, Ohio, Nebraska, Minnesota, and Delaware have all conducted their own mental health studies among youth in the juvenile justice system and used the results to call for changes and improvements in the way the state identifies and responds to these youth. Jointly collecting data and using the data to document the extent of a problem and justify why improvements and new resources are necessary can be an effective way of bringing about necessary change. Frequently, these efforts increase the visibility of this population of youth and serve as a catalyst for change.

1.3  Any collaboration between the juvenile justice and mental health systems should include family members and caregivers. Families are a critical stakeholder who should be involved in any collaboration designed to improve mental health identification and treatment services for youth in contact with the juvenile justice system. Family-run organizations can also serve as important allies in any attempt to bring attention to critical issues, cultivate political will, and draw new resources to a problem. Families can contribute to systems or policy level work by providing reality-based, culturally relevant information from a unique perspective (Osher & Hunt, 2002). Families can also influence political and policy-making processes in ways that other policy workers or system administrators cannot (Koyanagi & Feres-Merchant, 2000).

In addition to having family members involved with system-level collaboration, a growing number of juvenile justice and mental health systems are recruiting and training family members as case managers, advocates, and service brokers to work with families whose children become involved with the juvenile justice system (Osher & Hunt, 2002). This changing role is, in large measure, due to the System of Care movement and the work that has been done within the System of Care communities to increase the role of families in planning, delivering, and evaluating children’s mental health services.

For example, the Jefferson County, Alabama, Family Court Diagnostic and Assessment unit, which was established with a Federal system of care grant, serves as a diversion program for youth at risk of court involvement and out of home placement. The program provides mental health screening, assessment, and services to youth referred from probation intake or family court, and has clinical staff within the court to work immediately with referred youth and families. In addition to clinical staff, the Unit employs a family advocate who is present for the initial intake and screening process and works with families to explain the process and answer any questions they might have about the program and the system. These paid parent advocates also participate in service planning meetings with families and offer respite care on the weekends, if children and parents “need a break” from each other.

Family-run organizations can also be used to provide training to juvenile justice personnel to help them better understand the family perspective and potential opportunities for families to be educated about the system, its processes, and protocols. These organizations are ideally suited to provide training to the juvenile justice system on how to create a climate that encourages family participation. Families know their child best and can provide information that is critical to keeping the child stable and safe. For example, families who are actively involved can offer information on:

• The child’s diagnosis and treatment history, including the use of medication;
• The strengths and needs of their child;
• The family’s capacity to participate in treatment;
• Circumstances that affect their child’s well-being;
• Their child’s patterns of responding to people and events in their surroundings;
• Their child’s education history and status, including their IEP if the child is enrolled in special education services; and
• Transition and on-going support services essential for successful and permanent re-entry to the community (Osher & Hunt, 2000).

The adversarial nature of the juvenile justice system often intimidates families, especially if they are unfamiliar with the system and anxious about the future of their child (Osher & Hunt, 2002). By the time many families reach the juvenile justice system, they are quite often in crisis. If families are unfamiliar with what to expect and are not provided basic information about the system, their options, or ways in which they can be involved, the likelihood of cooperation and participation is low. Training juvenile justice staff to better understand the perspective of families and to identify ways to take advantage of parental expertise can result in a calmer and more productive interaction. When families are fully informed about the juvenile justice system and understand its parameters, they can help to make responsible recommendations and decisions for their own child (Smeltsor, 1999).

1.4  The juvenile justice and mental health systems should identify funding mechanisms to support the implementation of key strategies at critical stages of juvenile processing to better identify and respond to the mental health needs of youth. Both systems should explore the possibility of using existing funds more creatively, by blending or better integrating funding streams or initiating new jointly funded efforts. In addition, systems should commit to exploring new funding available at the local, state, and national levels that could be used to support joint initiatives.

Sometimes new funding is made available that encourages multi-system collaboration. For example, the 2005 SAMHSA funding announcement for the System of Care initiative, which represents the Federal government’s largest investment in children’s mental health services, encouraged applicants to consider prioritizing different populations of youth in their grant applications, including youth in the juvenile justice system. This unprecedented encouragement provides a unique opportunity for more of a juvenile justice focus within systems of care, and provides the opportunity for the mental health system to involve the juvenile justice system in planning for how these resources could be used to provide services to justice-involved youth.

Another example is the Harris County, Texas, Special Needs Diversionary program. This program is funded by the Texas Correctional Office on Offenders with Medical and Mental Impairments (TCOOMMI) and the Texas Juvenile Probation Commission, and administered jointly by the Harris County Juvenile Probation Department and the Mental Health Mental Retardation Authority of Harris County. This collaborative funding arrangement allows the county to employ teams of probation officers and mental health practitioners who jointly staff and manage cases. WrapAround Milwaukee is a managed care model that blends funds from the county juvenile justice, child welfare, mental health, and education agencies to provide a range of services to youth with emotional and behavioral needs who are at risk of out of home placement. Savings from the reduction in costly residential placements are re-directed into the program to support prevention and early intervention services.

1.5 The juvenile justice and mental health systems should collaborate at every key stage of juvenile justice processing, from initial contact with law enforcement to re-entry. The juvenile justice system must be viewed in its entirety, as a continuum, and not as a series of discrete and isolated points. Collaboration between the juvenile justice and mental health systems must occur at each of these key stages.

There are examples of collaboration all along the juvenile justice continuum. For example, The Alabama Juvenile Court Liaison program is a statewide initiative that provides clinical liaisons to work exclusively with youth and families who come to the attention of the juvenile court and have mental health needs. The liaisons are employed by the community mental health center and serve as a link between juvenile justice and mental health by identifying needs, explaining issues to the court, and brokering services. New York State’s Mobile Mental Health Teams are a collaborative between the Office of Mental Health and the Office of Children and Family Services designed to enhance the provision of mental health services to youth in the state’s juvenile correctional facilities. Clinical staff, employed by the Office of Mental Health, provide on-site clinical services to youth residing in secure juvenile correctional facilities throughout the state. Rhode Island’s Project Hope is a collaborative re-entry initiative between the state’s Department of Children, Youth and Families, Division of the Children’s Behavioral Health and Education, and the state’s Division of Juvenile Probation and Corrections. The program targets youth with mental health needs who are transitioning from the state’s juvenile correctional facility back to their homes and communities.

1.6 The juvenile justice and mental health systems should jointly evaluate any program or service delivery strategy aimed at improving the identification and treatment of mental health needs among youth in the juvenile justice system. Effective mental health programs and services for youth in the juvenile justice system not only ensure that youth receive the care they need, but can potentially result in cost-savings by reducing delinquency and youth interaction with the juvenile justice system. In order to determine the effectiveness of any new program or service strategy, it is essential that an evaluation component be built into the program from the beginning. Evaluation data, both process and outcome, can help systems determine the degree to which any new initiative is successful in meeting its stated goals and objectives, and whether any changes or modifications are necessary. Systems can use evaluation data to jointly lobby for new or continued resources, and system improvements are often more successful than those working in isolation.

The Juvenile Justice Evaluation Center (JJEC) is an on-line resource designed to assist juvenile justice practitioners, policymakers, and state agency administrators with the assessment and evaluation of programs for youth in the juvenile justice system. A range of program areas are provided, including aftercare programs, alternatives to detention and secure confinement, and community-based programs, among others. Performance measures are defined for each type of program to be evaluated as well as a summary of the state of evaluation research for each type of juvenile justice program. Of particular note is their publication (available on-line), Evaluation Issues in Mental Health Programming in the Juvenile Justice System.

1.7  Cross-training should be available for staff from the juvenile justice and mental health systems to provide opportunities for staff to learn more about each system, to understand phrases and terms common to each system, and to participate in exercises and activities designed to enhance systems collaboration.  System change cannot exist solely as assurances at the top levels of the participating agencies; it must penetrate to the line-worker level if it is to make a real difference (National GAINS Center, 1999). Cross-training staff from the juvenile justice and mental health systems, for example, allows for the exchange of perspectives relating to the treatment and supervision of youth with mental health needs. The National GAINS Center developed a cross-training curriculum that focuses on increasing collaboration among professionals in the fields of mental health, substance abuse, and juvenile justice when working with youth with co-occurring disorders. This curriculum has been used to train staff in many communities across the country and offers practical information and strategies for reducing barriers across systems and providing a common ground from which to go forward.