Critical Intervention Point: Dispositional Alternatives

Overview of the Intervention Point

After a youth is adjudicated, the juvenile court holds a dispositional hearing to determine the appropriate sanction. This is similar to the sentencing phase in criminal court. At the disposition hearing, dispositional recommendations are presented and the court must determine the most appropriate sanction for the youth. The range of options include community-based placements or referrals (including probation supervision), and institutional-based placements. In 2000, more than 60 percent of all adjudicated delinquents were placed on probation (OJJDP, 2004). An order of probation typically involves other requirements, such as court-ordered participation in treatment, restitution, or weekend placement in a detention facility. The term of probation may be specified or open-ended. Probation officers must report back to the court periodically on a youth’s progress on probation. If the conditions of probation have been successfully met, a judge may terminate the case.

Nearly 25 percent of all delinquency petitions result in the court ordering the youth committed to a residential placement (OJJDP, 2004). These facilities may be publicly or privately operated and have a secure, prison-like environment or a more open setting. In most states, when a judge commits a youth to the state department of juvenile corrections, the state agency is responsible for determining where the youth will be placed and for how long. In other states, the judge controls the type and length of stay, and in these instances, periodic reviews are held to update the court on the youth’s progress in placement. Dispositional options available to the court include community-based placements or referrals (including probation supervision) and institutional-based placements. Specific options include commitment to an institution or a facility, placement in a group or foster home, probation (either regular or intensive supervision), referral to an agency or treatment program, community services, fines or restitution. Very often the court imposes some combination of these sanctions (OJJDP, 2004).

In 2000, formal probation was the most restrictive sanction ordered for 63 percent of all adjudicated cases, and residential placement was ordered for 24 percent of all adjudicated cases (OJJDP, 2004). For the purposes of this model, two dispositional options are reviewed: secure juvenile correctional placement and community probation.

Secure Correctional Placement

The most restrictive sanction a court can impose entails committing a youth to a secure juvenile correctional facility. Correctional facilities serve to impose a sanction on the youth, protect the public, and provide a structured treatment environment (Bilchik, 1998). The characteristics of these facilities are highly variable and can include training schools, ranches, and military-style boot camps. The primary criticisms leveled against traditional state juvenile correctional facilities have been that they are often sterile, are inappropriate to run rehabilitative programs, and foster abuse and mistreatment (Greenwood, Model, Rydel, & Chiesa, 1996). Critics of these facilities have sought to replace them with smaller, community-based programs because, in their estimation, such programs provide a more realistic and naturalistic setting in which youth can learn and apply social and other kinds of skills and allow youth to maintain contact with their families, schools, and communities (Greenwood et al., 1996).

Further, large, congregate care facilities, such as training schools or juvenile boot camps, have not proven especially effective at reducing recidivism (Howell, 1998). Virtually every study examining recidivism among youth sentenced to juvenile correctional facilities in the past three decades has found at least 50 to 70 percent of offenders are rearrested within one to two years of release (Mendel, 2000). A recent examination of recidivism rates among youth in the Alabama Department of Youth Services (DYS) found that 70 percent of all youthful offenders released from DYS during 2001 and 2002 experienced one or more instances of recidivism, with recidivism rates higher for youth incarcerated for longer periods of time (Bogie, Sedano, & Jones, 2005). Concerns about high recidivism rates have resulted in some state juvenile justice systems altering their approach to treating youthful offenders. Much attention has recently been focused on the “Missouri model”—replacing large congregate care facilities with smaller corrections centers and a variety of non-residential programs and services. Other states, such as New York and Ohio, have focused on redirecting funds from traditional juvenile correctional beds to investments in community-based programs and interventions that show significant promise in rehabilitating youth and reducing recidivism. Despite these facts and trends, large numbers of youth continue to be placed in juvenile correctional facilities across the country.

Mental Health Needs and Issues

There is strong empirical evidence that suggests that large numbers of youth in juvenile correctional placement have significant mental health needs. Data obtained from the current OJJDP study suggest that 76.4 percent of youth (72.4% of males and 87.2% of females) in secure correctional facilities have at least one mental health diagnosis. Even after excluding conduct disorder, 70.8 percent  (65.4% of males and 85.2% of females) met criteria for a mental health diagnosis. Disruptive Disorders are most prevalent in secure facilities, followed by Substance Use Disorders and Anxiety Disorders (NCMHJJ, 2005). Youth in secure correctional facilities are also at risk of suicide. Approximately 13 percent of males and 26 percent of females exhibited suicide ideation within four weeks of the Voice DISC-IV interview. Furthermore, almost 26 percent of males and 54 percent of females attempted suicide at some point during their lifetime (NCMHJJ, 2005).

In addition to better data, there is increasing concern about the mental health care and treatment provided to youth in juvenile correctional settings. A 1992 review of the research literature found that the mental health services typically available to youth in the juvenile justice system—when any services are provided—bear little resemblance to what either common sense or empirical research suggests is likely to be effective (Melton & Pagliocca, 1992). Recent investigations by the U.S. Department of Justice, documenting the failure of many juvenile correctional facilities to meet even the most basic mental health needs of youth in their care, suggests that not much has changed over the last decade to improve the overall quality and availability of mental health treatment for youth in juvenile correctional placement.

The results of the current study, which included a survey of facilities included in the study regarding the services they provide to youth in their care, supports this conclusion. While all of the secure facilities in this study reported providing some type of mental health services, the proportion of offenders that actually receive these services was much less (NCMHJJ, 2005). For example, while all secure correctional facilities reported providing youth with medications, only 35 percent of youth in those facilities that met criteria for at least one mental health diagnosis reported receiving medications. The results suggest that many youth in need of mental health services are not receiving these services while in secure correctional settings.

These data also suggest that alcohol and drug abuse treatment is even less likely to be provided by secure correctional facilities. Over 44 percent of youth in secure facilities were diagnosed with a substance use disorder. Of those youth, less than 50 percent received any drug or alcohol treatment while in that facility.

States have taken different approaches for responding to the mental health needs of incarcerated youth. Some states, as evidenced by the U.S. Department of Justice investigations, have simply done nothing, often resulting in lawsuits being filed against the state and corrective action plans imposed to force change (United States Department of Justice, 2003). Other states operate centralized intake or reception centers where youth reside for a designated period of time (sometimes up to 60 days) in order to determine the most appropriate placement for the youth within the system. During this period, youth undergo a series of screens and assessments to determine their individual needs and to identify a placement option that would be most appropriate based on their demonstrated needs. Mental health screening and assessment is an integral part of the general “reception” process to not only identify any immediate needs or crisis, perhaps resulting from a youth’s emotional response to incarceration, (Grisso et al., 2005) but to develop an accurate sense of a youth’s overall mental status and the need for individualized treatment to address these needs.

Building on the concept of centralized reception centers, some states, such as Ohio, Texas, and Florida, have chosen to create corrections-based mental health service delivery systems offering specialized treatment institutions for youth with mental health needs (Underwood, Mullan, & Walte 1997). These institutions, which are part of the state’s overall juvenile correctional system, offer intensive and concentrated mental health services to youth while they complete their sentence. Texas, for example, operates the Corsicana Residential Treatment Center for youth with identified mental health needs. After undergoing comprehensive assessment at the state’s centralized intake center, youth with mental health disorders enter the Emotionally Disturbed Treatment Program (EDTP) at the Corsicana Residential Treatment Center, which is a facility that serves mentally ill youth. Here, youth receive evaluation and intensive treatment services for a 9-month period.

Probation Supervision

Probation supervision is the sanction most often applied to adjudicated youth in a dispositional hearing. Often a judge will impose a period of probation with other conditions, such as participation in community services or treatment, as well as restitution or community service. If a youth is placed on probation, there are numerous ways to link that youth with mental health and other treatment services while they remain in the community. In fact, some communities are using this as an opportunity to provide evidence-based treatments to youth to address their mental health and other treatment needs. Functional Family Therapy and Multi-Systemic Therapy are frequently used with youth who are placed on probation as an alternative to out-of-home placement. For example, the state of Connecticut has aggressively moved to provide more evidence-based treatments and services to youth in lieu of placement. The Connecticut Court Services Division (CCSD) now funds MST programs in all 13 juvenile court districts. These MST “slots” are available to youth who are adjudicated delinquent, placed on probation supervision, and meet certain risk/need criteria using a standardized assessment tool, the Juvenile Assessment Generic (JAG). This use of MST allows youth access to effective treatment in the community, while affording leverage to the juvenile court to ensure that the youth complies with the terms of the disposition. The Indiana Family Project uses FFT with youth who are adjudicated by the court and referred to the program as a condition of probation. Probation officers work with the youth’s therapists to monitor the youth and report back to the court on progress.

The Integrated Co-Occurring Treatment Program in Akron, Ohio, is an intensive home-based model specifically designed to treat mental health and co-occurring substance use disorders among youth referred from the court as a condition of probation, as well as for youth returning to the community from placement. Youth who are referred to the program undergo comprehensive screening and assessment, using standardized instruments to determine mental health and substance abuse needs. Program clinicians are available to youth and their families 24 hours a day, 7 days a week and use a standardized approach to service delivery, including individual and family therapy interventions that focus on skill and asset building while simultaneously focusing on risk reduction.

Another example of an evidence-based intervention that is used as an alternative to secure correctional placement and that can be used with youth who are placed on probation supervision is Multi-Dimensional Treatment Foster Care (MTFC). Developed by the Oregon Social Learning Center in 1983, MTFC is a cost-effective alternative to incarceration for adolescents who have problems with chronic antisocial behavior, emotional disturbance, and delinquency. The Cayuga Home for Children in Auburn, NY, was the first provider in New York State to offer MTFC as an alternative to residential treatment, incarceration, and hospitalization for youth who have problems with chronic antisocial behavior, emotional disturbance, and delinquency. The program is also one of only several nationally accredited MTFC programs in the country. The program objective is to change the negative trajectory of antisocial behavior by improving social adjustments with family members and peer groups through simultaneous and well-coordinated treatments in multiple settings. The program serves youth ages 11–17 who are currently in detention; are at risk for placement in the state’s juvenile correctional system; or are returning home from a correctional placement. They are placed with well-trained and closely supervised host families who provide the youth with a structured and therapeutic living arrangement. Youth participate in a structured daily behavior modification program implemented in the host home, and receive individual therapy and skills-based training. Community families are recruited, trained, and closely supervised to provide youth placed in their care with treatment and intensive supervision at home, in school, and in the community. Host families undergo intensive training and receive on-going support and supervision from the program coordinator. Youth participate in a structured daily behavior modification program and receive individual therapy. School attendance, behavior, and homework completion are closely monitored and interventions are provided in the school as needed. The youth’s biological or adoptive family receive therapy while the youth is participating in MTFC with the ultimate goal of returning the child to the family.