Systemic Self-Regulation: A Framework for Trauma-Informed Services in Residential Juvenile Justice Programs

Most youth detained in juvenile justice facilities have extensive histories of exposure to psychological trauma. Traumatic stress plays a key role in their mental health and behavioral problems and needs, and in their safety and rehabilitation and the security and effectiveness of detention facilities. We provide an overview of the barriers to successful provision of mental health services for youths in juvenile justice facilities, including those involving youth, parents, and juvenile justice residential facility staff and administrators. Next, we discuss the relevance and potential utility of approaching mental health needs using posttraumatic stress disorder (PTSD), and more broadly posttraumatic dysregulation, as an organizing framework. Examples of how a posttraumatic dysregulation perspective can enhance juvenile justice residential facility milieus and services are presented, with an overview of traumatic stress intervention models that have shown promise, or potentially could be deployed, in developing and sustaining trauma-informed juvenile justice facilities.     

Reducing out-of-community placement and recidivism: diversion of delinquent youth with mental health and substance use problems from the justice system

For a number of reasons, researchers and policy makers are now focusing on diversion of youth from the juvenile justice system. This study examines New York State's diversion efforts focused on youth with mental health and substance abuse problems who are at risk of out-of-community placement (N = 2,309). Twelve counties participated in the Mental Health Juvenile Justice (MH/JJ) Diversion Project. Overall, the initiative was successful in reducing out-of-community placement and recidivism for diverted youth. In regression analysis site, services received, and problem-profile variables were important predictors of out-of-community placement. Prior record, prior placement, and significant mental health problems were statistically significant predictors of recidivism. This suggests some contrasts in explaining the results of two important goals of the MH/JJ project. Study results and implications for future research and intervention are discussed.     

Referrals to a mental health criminal justice Liaison and diversion team in the North East of England

There is growing interest in the health correlates of people detained in police custody, and a number of innovations have been introduced to try to meet the complex needs of detainees. The implementation of Criminal Justice Liaison and Diversion (CJL&D) Services commissioned by the Department of Health in England is a substantial part of this investment. In this paper, we describe data from 858 detainees who were referred to the CJL&D service of a busy metropolitan police station in the North East of England. The detainees referred to the service had complex mental health needs, substance misuse and a range of vulnerabilities requiring specific intervention. The effective operation of these teams and how they interface with health and criminal justice systems also depend upon a number of systematic issues that emanate both from within the teams, and from external policy drivers.     

Youth Mental Health First-Aid: Juvenile Justice Staff Training to Assist Youth with Mental Health Concerns

Many youth in juvenile justice settings meet criteria for a mental health condition. Front line staff need to be able to recognize and respond to their needs, but training is often lacking. Youth Mental Health First Aid (YMHFA) is an 8-hour training for adults without mental health education to recognize and assist distressed youth. This study surveyed 1,279 [State blinded] DJS front-line staff trained in YMHFA. Of 338 returned surveys (26% response), 44% reported using YMHFA skills at work, 56% in preventing a crisis, 25% during crises. Respondents rated YMHFA as significantly improving their responsiveness to distressed young people.     

Court outcomes for clients referred to a community mental health court liaison service

Court liaison and diversion services come in a variety of forms, but the similarities and differences between these services are not well characterized. Findings from a six-year audit of the Newcastle (Australia) Mental Health Court Liaison (MHCL) service are reported, including client characteristics, offence and service contact profiles, court outcomes, and interrelationships among these variables. During the audit period, there were 2383 service episodes by 1858 clients (1478 males, 380 females). Drug and alcohol disorders (40.9%) and psychotic disorders (17.0%) were the most prevalent mental health problems, while assault (23.1%), theft (23.1%), offences against justice procedures (15.4%), driving offences (13.4%) and malicious damage to property (8.3%) were the most frequently recorded charges. Among service episodes with a finalized court outcome, 70.0% involved a punishment (bond: 49.5%; jail term: 29.7%). Females were less likely to be punished, but more likely to have their case dismissed under sections of the relevant Act that required further assessment and monitoring. Being married, or having an adjustment or drug and alcohol disorder, were also associated with an increased likelihood of punishment, while clients with a psychotic or bipolar disorder were less likely to be punished. Among clients who were punished, those referred from inpatient mental health services were more likely to receive a non-jail punishment, while unemployed clients were more likely to be jailed. A substantial proportion of clients had court outcomes that required an ongoing involvement with local mental health services. By being part of community mental health services, our MHCL service is able to work efficiently and effectively with the criminal justice system, while facilitating ready access to existing mental health services and continuation of care.     

Community-based forensic child and adolescent mental health services in England,Scotland and Wales: a national mapping exercise

Aim: We sought to ascertain the current nature of specialist community mental health provision for young people presenting with risk of harm to others or involvement with the youth justice system in England, Wales and Scotland. Methods: Questionnaire-based survey. Results: Fifty-five services were contacted, 48 responded and 35 of these were found to be providing some form of community mental health provision to high-risk young people. Thirteen services provided comprehensive community forensic child and adolescent mental health (FCAMH) services, whilst the remainder offered more ad hoc clinical input. Amongst the comprehensive FCAMH services, staffing, function, commissioning arrangements and population served varied widely. Conclusions: There is patchy geographical provision of comprehensive community FCAMH services across England, Scotland and Wales with heterogeneous commissioning arrangements, staffing and function. Development of a national commissioning strategy for community FCAMH services is required to ensure that the complex needs of high-risk young people are adequately addressed.     

Mentally ill offenders eligible for diversion at local court in New South Wales (NSW), Australia: factors associated with initially successful diversion

Diversion away from the criminal justice system and into mental health treatment services is a key strategy for addressing the well-established burden of mental illness suffered by those presenting to court. While mental health courts, court liaison and court diversion services have been developed in many jurisdictions internationally, there is limited research evidence to support their effectiveness in identifying those with mental health need and achieving successful diversion. The Statewide Community and Court Liaison Service in New South Wales, Australia, identifies mentally ill offenders likely to meet legal eligibility criteria for diversion at the busiest local courts across the state. Utilising data collected by mental health clinicians working in the service, 8317 individuals were identified as being eligible for court diversion on at least one occasion during the study period (1 July 2008 and the 30 June 2015) and 57.3% were subsequently diverted by Magistrates. Successful diversion at this first step was associated with being female, older, of non-Aboriginal and/or Torres Strait Islander background, and having a serious mental illness, replicated when stratified by sex and by Aboriginal and/or Torres Strait Islander background. There may be barriers to mental health diversion at court for individuals with particular socio-demographic characteristics which future service developments may need to take into account.     

Variations in mental health problems, substance use, and delinquency between African American and Caucasian juvenile offenders: implications for reentry services

The incarceration of young people is a growing national problem. Key correlates of incarceration among American youth include mental health problems, substance use, and delinquency. The present study uses a statewide sample of incarcerated youth to examine racial differences in African American and Caucasian juvenile offenders' outcomes related to mental health, substance use, and delinquency. The data indicate that relative to Caucasian offenders, African American offenders report lower levels of mental health problems and substance use but higher levels of delinquent behavior such as violence, weapon carrying, and gang fighting. The data further reveal that African American offenders are more likely than Caucasian offenders to be victims of violence and to experience traumatic events such as witnessing injury and death. Recognition of these patterns may help to improve postrelease services by tailoring or adapting preexisting programs to patterns of risk factors and their relative magnitudes of effect.     

A mixed methods study of the mental health and criminal justice histories of missing persons

Approximately 35,000 people are reported missing each year in Australia; rates elsewhere are even higher, with a recent UK study suggesting that a person goes missing every 2 min. Missing persons place a significant burden on police services; it is interesting, therefore, that very little research attention has been paid to this topic. This mixed methods study aimed to address this significant gap by analysing the mental health and criminal justice histories of a sample of missing persons and comparing them to rates in the general community. The study found that both mental health and criminal justice histories were significantly overrepresented among missing persons compared to those in the general community, and that young people reported missing commonly displayed suicidal behaviour. Results highlight at risk groups and suggest that criminality is much more commonly implicated in missing person incidents than previously thought.     

Information pathways into prison mental health care

Police and court liaison and diversion services provide important specialist mental health input along critical stages of the criminal justice pathway. Effective sharing of information between the services and relevant justice agencies is essential. However, various problems exist with the flow of information between agencies and services across the criminal justice pathway. This service evaluation explored how clinically relevant information is transferred, by drawing on the perspectives of prison health care staff in a large urban UK male prison. A qualitative service evaluation was conducted using semi-structured interviews with a purposive sample of 11 prison staff. The main themes included: gaps in the transfer of essential information, (particularly concerning risk and offending information); information gathering to fill these gaps; the importance of professional relationships, information sharing between agencies; and information solutions. Improving information transfer across the criminal justice pathway could prevent treatment delays and ensure more timely mental health care in prison.     

Evaluating liaison and diversion schemes: an analysis of health,criminal and economic data

Introduction: Liaison and Diversion (L&D) currently serves 50% of the population of England. L&D relies on modified working practices with key delivery partners, especially the police. Service evaluation data is thus presented from both police and health services. Method: A before and after intervention review of 3 months of operational data of L&D in Cornwall focusing on health, criminal and economic outcomes. Results: After L&D intervention individuals’ contact with the police as either victim or perpetrator reduced significantly. Implications: Preliminary findings suggest that L&D enabled reduced use of police and criminal justice resources. National reporting procedures may be unable to demonstrate the multi-agency impact if criminal justice data are not considered within the outcome data-set. Recommendations echo international observations that specifying outcome measures and the consistent definition of L&D services would enable generalisation of findings.     

MENTAL HEALTH AND JUVENILE ARRESTS: CRIMINALITY,CRIMINALIZATION, OR COMPASSION?*

Juveniles in secure confinement allegedly suffer from more mental health problems than their peers. This may reflect background and behavioral characteristics commonly found in clients of both mental health and juvenile justice systems. Another explanation is that mental disorders increase the risk of arrest. These interpretations were tested on a sample of Pittsburgh boys (n = 736). Findings indicate that arrested youth exhibit more attention deficit hyperactivity (ADH) problems, oppositional defiant (OD) problems, and nondelinquent externalizing symptoms prior to their first arrests compared to their never‐arrested peers. However, arrested and nonarrested youth score similarly on prior affective and anxiety problems and internalizing symptoms. Net of delinquency, substance use, and other selection factors, internalizing problems lower the risk of subsequent arrest, whereas OD problems and nondelinquent externalizing symptoms increase it. ADH problems have no effect on arrest net of delinquency and substance use. These findings lend only partial support to the criminalization hypothesis. Whereas some mental health symptoms increase the risk of arrest, others elicit more cautious or compassionate official responses.     

Interventions with arsonists and young fire setters: A survey of the national picture in England and Wales

Objectives . Arson is a serious problem that has high costs in both financial and non‐financial terms. It is important that effective provision to intervene with arsonists and young fire setters is available. Method . A national survey was conducted of organizations delivering interventions to arsonists and young fire setters. This survey included fire and rescue services, probation areas, youth offending services, forensic mental health units, several government departments, and the National Association for the Care and Resettlement of Offenders. The survey was followed by site visits to eight organizations to conduct interviews with relevant staff. Results . The majority of interventions for children and adolescents were provided by fire and rescue services, often in conjunction with local youth offending services. Some forensic mental health units provided interventions, but no specialist provision for arsonists appeared to be available in either the prison or probation services. The site visits and interviews revealed areas of good practice across the organizations visited, and highlighted areas where developments might be made to improve services. Conclusions . The findings are discussed in light of the available literature, and recommendations made for future practice.     

Conditional openness: young people define practices for successful child protection interventions

Taking the reforms of child protection legislation that have occurred since the 1980s as a backdrop, this paper considers young people’s perspectives on the factors that facilitated their engagement with child protection services and the barriers they perceived to effective service delivery. Drawing on findings from a New Zealand study of young people’s experience of multiple service use (child protection, mental health, youth justice and remedial education), the paper identifies that that rather than being ‘resistant’ or ‘hostile’ to statutory child protection intervention, young people reported a ‘conditional openness’. This conditional openness was characterised by three themes: communication; continuity and consistency; and contextual and cultural responsiveness. Interventions with these characteristics activated this conditional openness allowing effective interventions to occur. Using a series of case studies, comprising interviews and agency case file records; the paper considers the experiences of 109 young people (12–17 years) as well as those of the ‘person most knowledgeable;’ an adult nominated by young people because they knew the young person’s situation well.     

Demographic and clinical characteristics of 1092 consecutive police custody mental health referrals

The 43 police forces in England and Wales have made over 13 million arrests in the last decade. Yet, despite this high volume criminal justice system activity, and evidence of substantial health morbidity across the criminal justice pathway, mental health services in police custody have only been patchily developed, and the literature in this area is limited. Referrals (n = 1092) to a pilot mental health service operating across two police stations in a London borough were examined over an 18-month period in 2012/2013. The referred group had high levels of mental health and substance misuse problems (including acute mental illness, intoxication and withdrawal), self-harm, suicide risk and vulnerability (including intellectual disability), with some important gender differences. Although this work has limitations, the findings are broadly consistent with the small existing literature and they confirm the need for services that are sufficiently resourced to meet the presenting needs.     

Youth justice conferencing and indigenous over-representation in the Queensland juvenile justice system: a micro-simulation case study

Restorative justice conferencing for young offenders is firmly established in Australian juvenile justice, and legislated conferencing schemes are operating in all Australian states and territories. While there is some variation in the terms used to describe restorative justice conferences (e.g., family group conferencing, family conferencing, or youth justice conferencing), there is much more consistency in how the conferencing process is managed across Australian jurisdictions. In Queensland youth justice conferencing is a process that brings together an offender, the victim and their supporters to discuss the harm caused by the offending behaviour and provide the young person with an opportunity to take responsibility for his or her behaviour and make amends. This paper begins by briefly sketching the development of restorative justice conferencing in Queensland and describes the Juvenile Justice Simulation Model (JJSM), a micro-simulation model developed for criminal justice policy analysis in Queensland, Australia. We use this micro-simulation model to conduct an experimental exploration of the effects that youth justice conferencing has on system-wide outcomes for indigenous young people. The model simulates the impact of interventions up until 2011 on the number of finalised youth justice court appearances. Our results indicate that youth justice conferencing is unlikely to reduce the over-representation of indigenous young people in the juvenile justice system. The simulations demonstrated that, by the 2011, youth justice conferencing would result in a 12.5% decrease in finalised court appearances. Unfortunately, this decrease was more apparent for non-indigenous young people (13.7% decrease in court appearances) than for indigenous young people, who had a 10.5% decrease in court appearances. This differential impact of conferencing is due to the different court appearance profiles between indigenous and non-indigenous young offenders, with indigenous young people initiating offending at an earlier age and offending more frequently than non-indigenous young offenders.     

Juvenile Mental Health Court: Rationale and Protocols

Under the sponsorship of the judiciary, the Santa Clara County, California Juvenile Court, in partnership with the Juvenile Mental Health Department and a technical assistance agency (SOLOMON), has pioneered a Juvenile Mental Health Court for seriously mentally ill children who have become involved in the criminal justice system. The judiciary, probation department, district attorney, public defender, county counsel, and service providers have collectively embarked upon the implementation of a modern approach to mental health diagnosis, triage, and treatment services for youth and families who come in contact with the justice system as a result of the combination of serious mental illness and juvenile delinquency. This article presents the court's rationale and protocols.     

Mental health,substance use,and offending patterns among Native American youth in juvenile detention

Research has shown that youthful offenders in the juvenile justice system report an array of substance use and emotional and other mental health needs. The current study closely examined these issues in a large national sample (n = 539) of Native American youth drawn from the Survey of Youth in Residential Placement. Results demonstrated that frequent substance use was associated with the likelihood of being detained for a drug offense, while emotional and mental health needs were associated with detention for the most serious offenses. These results highlight the need for comprehensive substance use and other mental health assessments for Native American youth in the juvenile justice system.     

Exploring the Impacts of Racial Disparity Within the American Juvenile Justice System

The racial disparity in the American juvenile justice system impacts the lives of many youth of color. Youth of color constitute 34% of the U.S. population, however, they make up 62% of the youth charged in the juvenile justice system. The cycle of racial inequality and imprisonment are factors influenced by residential segregation and policing practices. Juvenile justice involvement leads to poorer physical and mental health in youth, stymied social outcomes, poorer familial relationships, decreased graduation and employment rates, increased rates in violence, and long-term negative future outcomes. The article advocates for mental health treatment and family services to be incorporated within incarcerated settings. Clinical strategies and future direction are discussed to begin to combat these various adverse impacts.     

The social,relational and mental health characteristics of justice-involved men in the south-west England

The aim of this article is to describe the social, relational and mental health characteristics of a sample of offenders serving prison or community sentences in the south-west England. About 100 adult male offenders were screened for anxiety and depressive disorders, post-traumatic stress disorder (PTSD), drug and alcohol dependence, and likely personality disorder using validated instruments. Fifty-eight per cent of the sample reported at least one common mental health problem, of these only 26% reported receiving treatment. Participants exposed to traumatic events and/or participants with past mental health problems were more likely to score positive for current common mental health problems. Our study identified factors that may increase the risk of a first episode or recurrent anxiety and/or depression for offenders. Health and criminal justice services should create partnerships and develop interventions that address the risk factors which lead and/or contribute to offenders' mental health difficulties.