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					California Institute for Mental Health (CIMH)
 Evidence-based Mental Health Treatment in
         the Juvenile Justice System


Assessment in Community Supervision Settings

                       Lee A. Underwood, Psy.D.


     April 3-4, 2003           Assessment in Community   1
     Garden Grove                Supervision Settings
    OVERVIEW
   Introduction
   Defining Co-Occurring Disorders
   Characteristics of Youth & Other Service Needs
   Risk Factors
    –   Overview
    –   Family Factors
    –   Individual Factors
    –   Culture
    –   Gender & Age Factors
    –   Typology Factors
    –   Neurological Factors
    –   Substance Use Factors

April 3-4, 2003         Assessment in Community      2
Garden Grove              Supervision Settings
  OVERVIEW (cont’d)
Treatment
    – Screening & Assessment
    – Categories of Co-Occurring Disorders
Effective Treatment Approaches
    – Multisystemic Therapy (MST)
    – Multidimensional Treatment Foster Care
      (MTFC)
    – Functional Family Therapy (FFT)

April 3-4, 2003   Assessment in Community      3
Garden Grove        Supervision Settings
INTRODUCTION




April 3-4, 2003   Assessment in Community   4
Garden Grove        Supervision Settings
    INTRODUCTION:
 Juvenile offenders population has steadily
  increased throughout the nineties (Teplin &
  McClelland, 1998; Timmons-Mitchell,
  Brown, Schulz, Webster, Underwood,
  Semple, 1997)

 More than 1 million youth come in contact
  with the juvenile justice system each year
     – More than 100,000 of these are placed in
       detention and correctional facilities (Cocozza,
       1997)
April 3-4, 2003       Assessment in Community            5
Garden Grove            Supervision Settings
    INTRODUCTION:
 Significant increase in the number of youth
  who are diagnosed with mental health
  disorders and substance use disorders
  (Cocozza, 1997; Faenzz & Siegried, 1998)

           • 20-30% of all youth entering the justice system present
             serious mental disorders and have other service needs
             (Davis, Bean, Shumcher, & Speigler, 1990; Villiani;
             1999)


April 3-4, 2003            Assessment in Community                     6
Garden Grove                 Supervision Settings
    INTRODUCTION:

Rates for mental illness in juvenile
 justice populations is substantially
 higher than those in the general
 population (Grisso & Barnum, 2000;
 Teplin & McClelland, 1998)



April 3-4, 2003   Assessment in Community   7
Garden Grove        Supervision Settings
     INTRODUCTION:

Timmons-Mitchell et al (1997) found:
  – 29% of population had symptoms of
    serious mental illness
        • Of which 18% had been in inpatient
          mental health and/or substance abuse
          facilities
        • 13.5% had attempted suicide
  – 80% had substance abuse problems
 April 3-4, 2003    Assessment in Community      8
 Garden Grove         Supervision Settings
       INTRODUCTION:
 With increased deinstitutionalization, there has
  been increase in reliance on the justice system
  for mental health care needs (Teplin &
  McClelland, 1998)

  – Administrators are hampered by a lack of research,
    insufficient policy development,
    and inadequate approaches and practices for
    managing and treating this population (Altschuler,
    1996; Burns, 1999; Butterfied, 1998; Hartman, 199)


   April 3-4, 2003   Assessment in Community             9
   Garden Grove        Supervision Settings
    INTRODUCTION:

 More than 1,000,000 juveniles come in
  contact with the justice system

 More than 100,000 are placed in
  correctional/detention facilities

 20-30% present serious mental health
  disorders and other service needs
April 3-4, 2003   Assessment in Community   10
Garden Grove        Supervision Settings
     INTRODUCTION:
 Ohio study
    – 29% had symptoms of serious mental illness

    – 80% had substance abuse problems

    – 18% of those with serious mental health
      disorders had previously been in inpatient mental
      health or substance abuse facilities

    – 13.5% of those with serious mental health
      disorders had attempted suicide

 April 3-4, 2003     Assessment in Community              11
 Garden Grove          Supervision Settings
INTRODUCTION:

  Growing awareness of prevalence

  Recognition of difficulties in treatment

  Documentation of greater negative
   outcomes associated with disorders




April 3-4, 2003   Assessment in Community     12
Garden Grove        Supervision Settings
    INTRODUCTION:
 50.9% of general adult population with mental
  disorders (Kessler, et. Al., 1996)

 73% of jail detainees with serious mental
  disorders (Abram & Teplin, 1991)

 50% of adolescents in the general population
  (Greenbaum, et al., 1996)

 50-90% of adolescents in juvenile justice
  settings
April 3-4, 2003   Assessment in Community     13
Garden Grove        Supervision Settings
    INTRODUCTION:
 Co-Occurring Substance Use and Disorders
  Among Persons with Mental Disorders

     – 50.9% of general adult population with mental
       disorders (Kessler, et. Al., 1996)

     – 73% of jail detainees with serious mental disorders
       (Abram & Teplin, 1991)

     – 50% of adolescents in the general population
       (Greenbaum, et al., 1996)

     – 50-90% of adolescents in juvenile justice settings
April 3-4, 2003       Assessment in Community               14
Garden Grove            Supervision Settings
DEFINING
CO-OCCURING DISORDERS




 April 3-4, 2003   Assessment in Community   15
 Garden Grove        Supervision Settings
DEFINING CO-OCCURRING
DISORDERS:

Co-occurring disorders defined:
     – Refers to the simultaneous
       experience of mental health and
       substance use disorders
           • These disorders have pronounced
             affects on the thoughts, mood, and
             behaviors of youth



April 3-4, 2003       Assessment in Community     16
Garden Grove            Supervision Settings
DEFINING CO-OCCURRING
DISORDERS:

 Serious diagnosable mental health
  disorders manifests a substantial disorder
  of thought or mood, which that impairs:
     –   Judgment
     –   Behavior
     –   Sense of reality
     –   Ability to handle demands of everyday life
 Causes substantial pain or disability

April 3-4, 2003        Assessment in Community        17
Garden Grove             Supervision Settings
DEFINING CO-OCCURRING
DISORDERS:

 Serious emotional disturbance affects:
     – Family Interactions
     – School Activities
     – Community Activities
 Adjustment problems
     – Manifest as significant emotional or behavioral
       symptoms in response to an identifiable
       psychosocial stressor or stressors

April 3-4, 2003       Assessment in Community            18
Garden Grove            Supervision Settings
DEFINING CO-OCCURRING
DISORDERS:

Often manifest the following
 symptoms:
     –   Mental confusion
     –   Delusional thought processes
     –   Social withdrawal
     –   Unpredictable behavior

 Conduct disorder and other diagnosis
  are common
April 3-4, 2003      Assessment in Community   19
Garden Grove           Supervision Settings
DEFINING CO-OCCURRING
DISORDERS:

Range of mental health disorders
 range within
     – Narrow band – serious mental health
       disorders and formal DSM-IV diagnosis
     – Broad band – severe emotional and
       adjustment problems regarding family,
       school, or community

April 3-4, 2003   Assessment in Community      20
Garden Grove        Supervision Settings
DEFINING CO-OCCURRING
DISORDERS:
 DSM-IV has inherent limitations – there
  can be confusion in identifying disorders

 A precise diagnostic approach is
  necessary

 Appropriate mental health treatment
  interventions are necessary



April 3-4, 2003   Assessment in Community     21
Garden Grove        Supervision Settings
CHARACTERISTICS OF YOUTH
           &
  OTHER SERVICE NEEDS




 April 3-4, 2003   Assessment in Community   22
 Garden Grove        Supervision Settings
  CHARACTERISTICS OF YOUTH &
  OTHER SERVICE NEEDS
  Developmental psychologists are
   concerned with describing and identifying
   behavior that is predictable or common
   for adolescents
       – Example: Experimentation with alcohol or
         marijuana is a common practice among
         adolescents, even though society neither
         views such behavior as desirable or
         condones it
                                     Adapted from: Rosado, L.M. (ed.) (September
                                     2000). Kids are Different…Youth Law Center

April 3-4, 2003       Assessment in Community                                      23
Garden Grove            Supervision Settings
 CHARACTERISTICS OF YOUTH &
 OTHER SERVICE NEEDS
  Much of the behavior exhibited by
   delinquents is behavior that is not normal for
   adolescence

       – Without minimizing offenses, there is recognition
         of the processes that lead to and utilize that
         knowledge to develop programming that assists
         adolescents identify errors in their thought
         processes and see other options to their behavior
                                     Adapted from: Rosado, L.M. (ed.) (September
                                     2000). Kids are Different…Youth Law Center


April 3-4, 2003       Assessment in Community                                      24
Garden Grove            Supervision Settings
  CHARACTERISTICS OF YOUTH &
  OTHER SERVICE NEEDS
  Similarly, unlawful or unacceptable behavior
   may be maladaptive in the larger social context,
   but may seem logical to the adolescent in his or
   her particular contexts (e.g., the peer group or
   family)

  The development we will be discussing in this
   module is normative or typical adolescent
   development

  Adolescence provides a learner’s permit to
   adulthood
    – Mistakes will be made and individuals may
      learn from them       Adapted from: Rosado, L.M. (ed.) (September
                                         2000). Kids are Different…Youth Law Center


April 3-4, 2003            Assessment in Community                                    25
Garden Grove                 Supervision Settings
     CHARACTERISTICS OF YOUTH &
     OTHER SERVICE NEEDS
  Individual adolescents develop along
   different dimensions at different rates
             • Cognitive (Intellectual) Development
             • Identity and Social Development
             • Moral Development
             • Physical Development
             • Competence Development (master of skills)

                                          Adapted from: Rosado, L.M. (ed.) (September
                                          2000). Kids are Different…Youth Law Center

April 3-4, 2003            Assessment in Community                                      26
Garden Grove                 Supervision Settings
CHARACTERISTICS OF YOUTH &
OTHER SERVICE NEEDS
 Development in any domain is a gradual, non-linear
  process, with stops and starts and regressions

 There are great differences between individual
  adolescents in the rate of development in any single
  domain

 It is impossible to assess a juvenile’s level of
  development by looking at a single trait, such as size
  or chronological age, because there is significant
  variation among individuals in the rate and pattern of
  development               Adapted from: Rosado, L.M. (ed.) (September
                                    2000). Kids are Different…Youth Law Center


April 3-4, 2003           Assessment in Community                                27
Garden Grove                Supervision Settings
CHARACTERISTICS OF YOUTH &
OTHER SERVICE NEEDS
 Adolescence is a time of important
   psychological and psycho-social development
   which affects the way teenagers feel about
   themselves (identity), their ability to function
   responsibility on their own (autonomy), their
   relationships and interpersonal behaviors
   (intimacy), and their sexual feelings
   (sexuality).              Adapted from: Rosado, L.M. (ed.) (September
                             2000). Kids are Different…Youth Law Center


April 3-4, 2003     Assessment in Community                                28
Garden Grove          Supervision Settings
    CHARACTERISTICS OF YOUTH &
    OTHER SERVICE NEEDS
 Cognitive Changes:
      1. Possibilities
            –       “Adolescents become better able than
                    children to think about what is possible,
                    instead of limiting thought to what is real”
            –       Able to think hypothetically

      2. Abstraction
            –       “Adolescents become better able to think
                    about abstract concepts”
                                                  Adapted from: Rosado, L.M. (ed.) (September
                                                  2000). Kids are Different…Youth Law Center

  April 3-4, 2003                Assessment in Community                                        29
  Garden Grove                     Supervision Settings
  CHARACTERISTICS OF YOUTH &
  OTHER SERVICE NEEDS
 Cognitive Changes:
       3.     Thinking about thinking
             –      “Adolescents begin thinking more about the
                    process of thinking; they become more
                    reflective.”
             –      Increased introspection, self-consciousness, and
                    intellectualization

       4.     Thinking in multiple dimensions
             –      Considering multiple dimensions and weighing
                    those dimensions before taking a course of
                    action                           Adapted from: Rosado, L.M. (ed.) (September
                                                             2000). Kids are Different…Youth Law Center

  April 3-4, 2003                  Assessment in Community                                        30
  Garden Grove                       Supervision Settings
 CHARACTERISTICS OF YOUTH &
 OTHER SERVICE NEEDS
  Cognitive Changes:
             5. Relativity
                  –   Develop an ability to see things in relative
                      terms
                  –   Adolescents are more likely to question
                      others’ assertions and less likely to accept
                      facts as absolute truths


                                           Adapted from: Rosado, L.M. (ed.) (September
                                           2000). Kids are Different…Youth Law Center


April 3-4, 2003             Assessment in Community                                      31
Garden Grove                  Supervision Settings
CHARACTERISTICS OF YOUTH &
OTHER SERVICE NEEDS
 Identity Development
     – Adolescents attempt to establish a coherent, stable
         identity

     – “Trying on” different personalities, interests, and
         and ways of behaving is a necessary part of the
         process of putting together an identity
     – Family and Identity
                                   Adapted from: Rosado, L.M. (ed.) (September
                                   2000). Kids are Different…Youth Law Center


April 3-4, 2003         Assessment in Community                                  32
Garden Grove              Supervision Settings
CHARACTERISTICS OF YOUTH &
OTHER SERVICE NEEDS
Identity Development
     – Peers and Identity
           • Need to Belong
           • Peer Pressure
                  – Peer recognition, advice, and encouragement, and
                    may be more unconditionally accepting than adults
                  – May have an overemphasis on peers
                     » Family has a powerful effect on adolescents’
                       basic values and choices
                  – Peer pressure can be prosocial
                                              Adapted from: Rosado, L.M. (ed.) (September
                                              2000). Kids are Different…Youth Law Center



April 3-4, 2003              Assessment in Community                                        33
Garden Grove                   Supervision Settings
 CHARACTERISTICS OF YOUTH &
 OTHER SERVICE NEEDS
 Autonomy Development
   – Adolescence is a gradual transition to being a self-
     governing person. The development of
     independent behavior is a central task of
     adolescence
         • Physical changes and appearance both enable
           adolescents to become more autonomous and cause
           adults to treat them as though they are more autonomous
   – May cause emotional and social disruptions as
     adolescents change their relationships with family
     members and develop new roles in the world
                                     Adapted from: Rosado, L.M. (ed.) (September
                                     2000). Kids are Different…Youth Law Center




 April 3-4, 2003          Assessment in Community                                  34
 Garden Grove               Supervision Settings
CHARACTERISTICS OF YOUTH &
OTHER SERVICE NEEDS
 Moral Development
    – Adolescents progress through stages of maturation
      in terms of moral reasoning and moral behavior.

          • Moral reasoning of the young child – “Pre-conventional”
            moral reasoning.

          • The focus is on rewards and punishments associated with
            different courses of action.

          • Young children accept what others say is right or wrong.
                                        Adapted from: Rosado, L.M. (ed.) (September
                                        2000). Kids are Different…Youth Law Center




April 3-4, 2003           Assessment in Community                                     35
Garden Grove                Supervision Settings
CHARACTERISTICS OF YOUTH &
OTHER SERVICE NEEDS
 Moral Development
     – Moral reasoning of the early adolescent –
       “Conventional” moral reasoning
           • Based on how s/he will be judged by others for behaving
             in a particular way

           • During junior high school, adolescents become more
             concerned with impressing their peers.

           • Most adolescents are able to reason at this level in
             “hypothetical” situations, their actual behavior may not;
             always reflect their reasoning ability
                                    Adapted from: Rosado, L.M. (ed.) (September
                                    2000). Kids are Different…Youth Law Center




April 3-4, 2003            Assessment in Community                                36
Garden Grove                 Supervision Settings
       CHARACTERISTICS OF YOUTH &
       OTHER SERVICE NEEDS
 Moral Development

    – “Post-Conventional” Moral Reasoning
          • At this stage, the individual begins to view society’s rules
            as relative and subjective, and questions social
            conventions

          • In late adolescence or early adulthood, an individual
            MAY begin to shift from reasoning in terms of social
            approval to reasoning in terms of important principles,
            such as justice and fairness
                                           Adapted from: Rosado, L.M. (ed.) (September
                                           2000). Kids are Different…Youth Law Center

April 3-4, 2003            Assessment in Community                                       37
Garden Grove                 Supervision Settings
       CHARACTERISTICS OF YOUTH &
       OTHER SERVICE NEEDS
Moral Development
    – “Post-Conventional” Moral Reasoning
      (cont’d)
          • BUT post-conventional moral reasoning is
            relatively rare, even in adults. Most
            adolescents follow “conventional” moral
            reasoning, i.e., the reason to be good is to earn
            social approval and to benefit their relationships
            with others. Indeed, the importance of peers
            generally in the lives of adolescents reinforces
            the influence of peer groups or moral decisions.
                                        Adapted from: Rosado, L.M. (ed.) (September
                                        2000). Kids are Different…Youth Law Center

April 3-4, 2003         Assessment in Community                                       38
Garden Grove              Supervision Settings
CHARACTERISTICS OF YOUTH &
OTHER SERVICE NEEDS
  Moral Development
       – Significant factors that shape adolescent’s moral
         development.

       – Adolescents derive their moral values from:
                  – Their families
                  – Their peers
                  – Their relationships
                  – Spiritual influences
                  – Popular culture (movies, t.v. shows, music)
                                       Adapted from: Rosado, L.M. (ed.) (September
                                       2000). Kids are Different…Youth Law Center


April 3-4, 2003               Assessment in Community                                39
Garden Grove                    Supervision Settings
  CHARACTERISTICS OF YOUTH &
  OTHER SERVICE NEEDS
Moral Development
     – Other aspects of adolescent moral
       reasoning

           • Adolescents are “fairness freaks”

           • The role of gangs
                                       Adapted from: Rosado, L.M. (ed.) (September
                                       2000). Kids are Different…Youth Law Center




April 3-4, 2003       Assessment in Community                                        40
Garden Grove            Supervision Settings
 CHARACTERISTICS OF YOUTH &
 OTHER SERVICE NEEDS
– Physical Development
   •      Because of the great variability in individual
          development, an adolescent who appears
          physically mature in court – tall, solid, with
          facial hair – may nevertheless be quite
          immature in cognitive, social, and moral
          development. Judgments regarding
          intellectual ability and other characteristics of
          individual adolescents should not be based
          solely on physical appearance.
                                         Adapted from: Rosado, L.M. (ed.) (September
                                         2000). Kids are Different…Youth Law Center

 April 3-4, 2003          Assessment in Community                                      41
 Garden Grove               Supervision Settings
  CHARACTERISTICS OF YOUTH &
  OTHER SERVICE NEEDS
– Physical Development
   •      This may be particularly important when
          considering program placement – physical
          appearance. This may be particularly
          important when considering program
          placement – physical appearance may have
          limited value in determining which program is
          appropriate for a particular youth.
                                       Adapted from: Rosado, L.M. (ed.) (September
                                       2000). Kids are Different…Youth Law Center


 April 3-4, 2003        Assessment in Community                                      42
 Garden Grove             Supervision Settings
         CHARACTERISTICS OF YOUTH &
         OTHER SERVICE NEEDS
–     Physical Development
     •      Myth
           –      The “raging hormone hypothesis” the hormones completely
                  explain all out-of-control behavior adolescents.
           –      Effect of hormones on mood appear to be strongest in
                  early adolescence when hormonal levels are highly
                  variable and characterized by rapid fluctuations, and the
                  effect lessens in later adolescence as hormone levels
                  stabilize.
           –      Juveniles who physically mature earlier appear older, they
                  are often treated as if they are more mature psychologically
                  when this is not necessary true.
                                                Adapted from: Rosado, L.M. (ed.) (September
                                                2000). Kids are Different…Youth Law Center

    April 3-4, 2003              Assessment in Community                                      43
    Garden Grove                   Supervision Settings
 CHARACTERISTICS OF YOUTH &
 OTHER SERVICE NEEDS
– Physical Development
      •      Myth
            –     Adolescents who mature late, especially boys, are
                  often view negatively by their peers and left out of
                  group activities.
            –     Those who mature early tend to be at a social
                  advantage.


                                            Adapted from: Rosado, L.M. (ed.) (September
                                            2000). Kids are Different…Youth Law Center


April 3-4, 2003              Assessment in Community                                      44
Garden Grove                   Supervision Settings
   CHARACTERISTICS OF YOUTH &
   OTHER SERVICE NEEDS
  – Competence Development
        •         Adolescents need to be good at something.

              –      Achieve competence

              –      Many adolescents do not have significant
                     opportunities to experience success



                                             Adapted from: Rosado, L.M. (ed.) (September
                                             2000). Kids are Different…Youth Law Center


April 3-4, 2003               Assessment in Community                                      45
Garden Grove                    Supervision Settings
 CHARACTERISTICS OF YOUTH
 & OTHER SERVICE NEEDS
 Learning disabilities
 Sexual perpetration
 Criminal conduct
 Physical, sexual and emotional abuse
 Personality disorders
 Pervasive patterns of aggression
 Hormonal and genetic risk factors
 Minimal brain damage

April 3-4, 2003   Assessment in Community   46
Garden Grove        Supervision Settings
RISK FACTORS




April 3-4, 2003   Assessment in Community   47
Garden Grove        Supervision Settings
RISK FACTORS:
Overview
  Residential facilities – 75% report having
   sexual intercourse, compared to 33% in
   public schools
       – Residential youth reported their first experience
         had occurred by age 14
       – 4 times more likely to impregnate partner

  50% youth in residential treatment centers
   have been laced in special education
   classes for learning problems
April 3-4, 2003        Assessment in Community               48
Garden Grove             Supervision Settings
RISK FACTORS:
Overview
  Minority youth are treated differently than
   majority youth within the juvenile justice
   system (Department of Justice 1999)
       – Approximately two-thirds of studies examined
         showed racial and/or ethnic status influences
         decision-making in at least urban jurisdictions
       – When controlling for offense, African-American
         youth will enter detention and correctional
         facilities two times higher than cases involving
         Caucasian youth
April 3-4, 2003        Assessment in Community              49
Garden Grove             Supervision Settings
RISK FACTORS:
Overview
 Homicide rates for young African-
  American males is:
       – 4-5 times higher than African-American
         females
       – 5-8 times higher than young Caucasian
         males
       – 16-22 times higher than young Caucasian
         females (Snyder & Sickmund, 1995)
April 3-4, 2003    Assessment in Community     50
Garden Grove         Supervision Settings
RISK FACTORS:
Overview

 Society fails to protect people from
  the crimes they fear by resisting
  opportunities to alleviate the
  poverty that breeds them (Reiman,
  1990)

April 3-4, 2003   Assessment in Community   51
Garden Grove        Supervision Settings
 RISK FACTORS:
 Family & Environment
Consistent family factors implicated in
 mental health and juvenile justice
 populations include:
     – Poor parent-child relationships
     – Neglect
     – Coercive child-rearing (Patterson, 1982)
     – Lack of warmth and affection
     – Inconsistent parenting
April 3-4, 2003    Assessment in Community        52
Garden Grove         Supervision Settings
 RISK FACTORS:
 Family & Environment
 Consistent family factors implicated in
  mental health and juvenile justice
  populations include (cont’d):
     –   Violence
     –   Sexual abuse
     –   Disrupted attachments
     –   Parental substance abuse (American Academy
         of Child and Adolescent Psychiatry, 1997)

April 3-4, 2003       Assessment in Community         53
Garden Grove            Supervision Settings
 RISK FACTORS:
 Family & Environment
Other family characteristics:
     – Familial antisocial behavior or values
     – History of criminal behavior by
       members
     – Harsh parental discipline
     – Family conflict (Tolan & Loeer, 1993)
     – Lack of parental monitoring
April 3-4, 2003   Assessment in Community       54
Garden Grove        Supervision Settings
RISK FACTORS:
Individual Factors
 Youth in corrections facilities
  acknowledge:
       – Higher levels of emotional distress
         including pervasive feelings of
         depression and anxiety


April 3-4, 2003    Assessment in Community     55
Garden Grove         Supervision Settings
 RISK FACTORS:
 Individual Factors
 When compared to public school
  counterparts, youth in the juvenile justice
  system exhibit:
   – 3 times more likelihood to report pervasive
     feelings of sadness
   – 2 ½ times more likely to report feelings of
     nervousness or being upset
   – 2 times more likely to report feelings of
     discouragement and hopelessness

 April 3-4, 2003     Assessment in Community       56
 Garden Grove          Supervision Settings
 RISK FACTORS:
 Individual Factors
 When compared to public school
  counterparts, youth in the juvenile justice
  system exhibit (cont’d):
    – 1 ½ times more likely to experience feelings of
      stress and dissatisfaction with their personal lives
      (Fulkerson et al., 1996)
    – Males are 2 times more likely to report deliberate
      self-injury
    – Males are five times more likely to attempt
      suicide
 April 3-4, 2003      Assessment in Community                57
 Garden Grove           Supervision Settings
RISK FACTORS:
Culture
  35% of youth in juvenile justice system live
   in “underclass” neighborhoods

  Correlations with delinquency in these
   neighborhoods include:
       –   Lack of legitimate job opportunities
       –   Increase social isolation
       –   Poor schools
       –   Weak community organizations (Wilson, 1987)

April 3-4, 2003        Assessment in Community           58
Garden Grove             Supervision Settings
RISK FACTORS:
Gender & Age Factors
 Among serious index crimes:
    – Males are 3 times more likely to commit
      property crimes than females and 8 times
      more violent crimes (Livingston, 1992)

    – Smallest difference in index crimes is found in
      larceny offenses, however males still
      outnumber females two to one

    – Young children have diminished ability to
      commit serious crimes and their victims are
      often other children
April 3-4, 2003      Assessment in Community            59
Garden Grove           Supervision Settings
RISK FACTORS:
Gender & Age Factors
 As there is an increased need to assert
  one’s manhood, there is an increase in
  violations of the law (e.g., stealing,
  fighting, joyriding, vandalism)

 As youth mature, there is a universal
  pattern showing a decrease in criminal
  behavior (Hirshci & Gottfredson, 1983)

April 3-4, 2003   Assessment in Community   60
Garden Grove        Supervision Settings
RISK FACTORS:
Typology Factors
    Seven groups of offenders focused over
     time on the patter (e.g., beginning,
     persistence, and ending) of delinquent
     behavior
         – Stable non-delinquents
         – Starters (transition from no delinquency to
           involvement in minor delinquency)
         – Stable moderately serious offenders
           (consistent delinquency over time)
April 3-4, 2003         Assessment in Community          61
Garden Grove              Supervision Settings
RISK FACTORS:
Typology Factors
    Seven groups of offenders focused over
     time on the patter (e.g., beginning,
     persistence, and ending) of delinquent
     behavior (cont’d)
         – Escalators (escalation in seriousness of
           offense over time)
         – Stable highly serious offenders (frequent and
           serious offending over time)
         – De-escalators (de-escalation in serious of
           offenses over time)
         – Desisters (cessation in delinquency)
April 3-4, 2003        Assessment in Community             62
Garden Grove             Supervision Settings
RISK FACTORS:
Neurological Factors
     Youth with hyperactivity and impulsivity are
      likely to be abused by adults in their families
      (Lewis, 1992)
          – These youth may have difficulty in:
                  •   Planning
                  •   Attention
                  •   Abstract reasoning
                  •   Foresight
                  •   Judgment
                  •   Self-monitoring
                  •   Motor control
                  (Giancola, Martin, Tarter, Pelham, & Moss 1996)


April 3-4, 2003                  Assessment in Community            63
Garden Grove                       Supervision Settings
RISK FACTORS:
Substance Use Factors
 Youth in residential facilities are much
  more likely than their public school
  counterparts to report using:
       – Amphetamines and inhalants (2 times
         higher)
       – Marijuana and prescription drugs (2 ½
         times higher)
       – Sedatives (3 times higher)
April 3-4, 2003     Assessment in Community      64
Garden Grove          Supervision Settings
RISK FACTORS:
Substance Use Factors
  Youth in residential facilities are much more
   likely than their public school counterparts to
   report using (cont’d):
       –   LSD, hallucinogens, and opiates (4 times higher)
       –   Cocaine (6 times higher)
       –   Injected drugs (5 ½ times higher)
       –   Alcohol and drugs before or during school (3
           times higher)


April 3-4, 2003         Assessment in Community           65
Garden Grove              Supervision Settings
TREATMENT




 April 3-4, 2003   Assessment in Community   66
 Garden Grove        Supervision Settings
 TREATMENT:
Acceptance of emotional and mental
 health issues
Acceptance of criminal behavior by
 taking responsibility for hurt behavior
Resolution of past victimization
Development of victim empathy and
 victim awareness
April 3-4, 2003   Assessment in Community   67
Garden Grove        Supervision Settings
 TREATMENT:
Recognition that self-serving
 worldviews must be restructured

Dismantling of regressed fears
 and anxieties

April 3-4, 2003   Assessment in Community   68
Garden Grove        Supervision Settings
 TREATMENT:
Implement relapse prevention
 techniques across all situations

Identify emotional triggers and
 manage angry outbursts

Creation of life skills

April 3-4, 2003   Assessment in Community   69
Garden Grove        Supervision Settings
 TREATMENT:
Acceptance that cure is optimal and
 condition management is forever

Development of prosocial and
 problem-solving skills

Identify family limitations

April 3-4, 2003   Assessment in Community   70
Garden Grove        Supervision Settings
 TREATMENT –
 Screening & Assessment:
Defining Screening
     – Conducted to identify adolescents who
       require additional attention
     – Provides opportunities for the treatment
       provider to better understand the
       psychological functioning of the youth
     – Generally, does not provide psychiatric
       diagnoses

April 3-4, 2003    Assessment in Community        71
Garden Grove         Supervision Settings
 TREATMENT –
 Screening & Assessment:
Defining Screening (cont’d)
     – Is generally the first in a sequence
       of different assessment and
       intervention strategies
     – Should be used with all youth
       entering the juvenile justice system

April 3-4, 2003   Assessment in Community     72
Garden Grove        Supervision Settings
 TREATMENT –
 Screening & Assessment:
 Goals of Screening
     – Determine current level of mental health and
       substance use functioning
     – Identify and isolate manifested variables of
       youth with histories of violent offenses
     – Identify youth with cognitive deficiencies and
       educational deprivation



April 3-4, 2003       Assessment in Community           73
Garden Grove            Supervision Settings
 TREATMENT –
 Screening & Assessment:
Goals of Screening (cont’d)
     – Identify youth who may be unwilling or
       unable to engage and establish in
       therapeutic relationships
     – Isolate factors which are related to
       primary and secondary gains of mental
       illness, substance use and on-going
       criminal behavior
April 3-4, 2003    Assessment in Community      74
Garden Grove         Supervision Settings
 TREATMENT –
 Screening & Assessment:
 Defining Assessment
     – Conducted after gathering critical information
     – A comprehensive analysis of psychological,
       psychosocial and other needs
     – More sensitive to “red flags”
     – Narrows the problem or strength with the
       ultimate goal of ruling out extraneous variables
       that may serve as false positives


April 3-4, 2003       Assessment in Community             75
Garden Grove            Supervision Settings
 TREATMENT –
 Screening & Assessment:
Goals of Assessment
     – Examine the level and extent of mental
       health and substance use problems
     – Identify other psychosocial or
       psychological problems that may
       enhance the symptoms of mental
       health and substance use problems


April 3-4, 2003    Assessment in Community      76
Garden Grove         Supervision Settings
 TREATMENT –
 Screening & Assessment:
Goals of Assessment (cont’d)
     – Determine the extent that the youth’s
       family may be useful in treatment, their
       motivation, and ability to maintain family
       warmth and boundaries
     – Provide diagnosis and baseline
       treatment planning


April 3-4, 2003     Assessment in Community         77
Garden Grove          Supervision Settings
TREATMENT –
Screening & Assessment:
 Needs Assessment                 Risk Assessment
     – Rehabilitation Needs            – Levels of security
     – Drives Treatment                – All points of system
       Planning                        – Recommendations to
     – Describes youth’s                 court
       functioning                     – Decision-making
                                       – Dangerous to
                                         community
                                       – Court appearance

April 3-4, 2003      Assessment in Community               78
Garden Grove           Supervision Settings
 TREATMENT –
 Screening & Assessment:
 Type of instrument (screening vs.
  assessment)
 Population (age, reading ability)
 Form of administration (self report,
  structured interview, clinician-rated,
  computer scoring vs. manual scoring)
 Credentialing/training required
 Life areas covered
 Cultural specificity
 Reliability/validity

April 3-4, 2003   Assessment in Community   79
Garden Grove        Supervision Settings
TREATMENT –
Categories of Co-Occurring Disorders:
 A heterogeneous population
 They have high rates of co-morbidity
 Females who display mental health and
  substance use disorders have high rates
  of depression

 Some manifest deviant sexual arousal
  patterns

 Fail to benefit from traditional
  psychotherapies; C-B-T has shown
  promise
April 3-4, 2003   Assessment in Community   80
Garden Grove        Supervision Settings
TREATMENT –
Categories of Co-Occurring Disorders:
 Affective-based
 Anxiety-based
 Psychotic-based
 Behavior-based
 Co-Occurring-based
 Personality-based

April 3-4, 2003   Assessment in Community   81
Garden Grove        Supervision Settings
TREATMENT –
Categories of Co-Occurring Disorders:
Affective-based
     – Refers to long-standing, chronic
       mood states that generally affect
       all aspects of an adolescent’s life
           • May involve a significant elevation of
             mood state or depressed states and
             may occur as full or partial episodes

April 3-4, 2003        Assessment in Community        82
Garden Grove             Supervision Settings
TREATMENT –
Categories of Co-Occurring Disorders:
Anxiety-based
     – Refers to the experiences of
       nervousness, tension,
       apprehension, and fear
           • Experiences may be real or imagined
             and may affect concentration and
             daily performance as well as impair
             physical ability

April 3-4, 2003       Assessment in Community      83
Garden Grove            Supervision Settings
TREATMENT –
Categories of Co-Occurring Disorders:
Psychotic-based
     – Refers to a disintegration of
       thinking processes, affecting
       cognitive functioning, perception,
       judgment and mood
           • Involves inability to distinguish
             external reality from internal beliefs

April 3-4, 2003        Assessment in Community        84
Garden Grove             Supervision Settings
TREATMENT –
Categories of Co-Occurring Disorders:
Behavior-based
     – Refers to a cluster of law-breaking,
       intrusive and invasive behaviors
           • Often evidenced by disordered
             conduct and aggressions



April 3-4, 2003       Assessment in Community   85
Garden Grove            Supervision Settings
TREATMENT –
Categories of Co-Occurring Disorders:
Co-Occurring Mental Health &
 Substance Use–based
     – Refers to simultaneous experience
       of these disorders
           • Have pronounced affects on the
             thoughts, mood and behaviors of
             adolescents

April 3-4, 2003       Assessment in Community   86
Garden Grove            Supervision Settings
TREATMENT –
Categories of Co-Occurring Disorders:
Personality-based
     – Refers to pervasive patterns of
       functioning that affect cognitive,
       perception, mood and behavior
           • Impact affect the behavior of
             adolescents as they experience
             difficulties that are deeply rooted in
             their personality

April 3-4, 2003        Assessment in Community        87
Garden Grove             Supervision Settings
           CONCLUSION




April 3-4, 2003   Assessment in Community   88
Garden Grove        Supervision Settings

				
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