A State Policymakers' Guide to Federal Health Reform: Part I: Anticipating How Federal Health Reform Will Affect State Roles

Examines how federal healthcare reform will affect states' tools and roles in connecting people to services, promoting coordination and integration, improving care for those with complex needs, being results-oriented, and increasing efficiencies

Nebraska\u27s Community-based Aid Mental Health Services

Evidence-Based Practices Brief #5 Research finds that mental health symptoms are prevalent amongst youths in the juvenile justice system (Teplin et al. 2015), with clinical prevalence rates as high as 70% (Vincent et al., 2008), compared with an estimated 9 to 22% of the general population (Shubert & Mulvey, 2014). Studies have found that the prevalence rates of mental health disorders increases at each juvenile justice system point—with prevalence rates lowest when examining youth at intake (e.g., probation or family court) and becoming greater as we examine later system points, such as diversion (Wylie & Rufino), detention, and post-adjudicatory correctional facilities (Wasserman et al. 2010)

Evaluation of Lancaster County Early Assessment Process

In January 2009, Lancaster County implemented an early screening and assessment process. The goal of this pilot project was to ensure consistent processing of juvenile offenses, especially for very young offenders, and to ensure that youth were matched to the most appropriate early intervention. The Juvenile Justice Institute was invited to evaluate the effectiveness of this early intervention. Little is known about the effect this project has had on official juvenile court processing of youth, so another important question is how this early process has impacted the overall number of youth entering the Lancaster County juvenile justice system. To evaluate the overall effect of the early screening process, we examined: 1) the process itself, 2) data on youth referred to the early screening process, and 3) trends in Lancaster County’s juvenile justice system. We analyzed three aspects of the process itself including: how long it takes a case to progress through the early assessment program, the assessment instrument utilized, and legal aspects related to this intervention. One important finding is that this early intervention is not available to all Lancaster County youth. Another key finding is that often the prosecuting attorney’s decision did not coincide with the Assessment Specialist’s recommendation. Most importantly, we found that this early intervention did not increase the number of youth entering the juvenile justice system in Lancaster County; nor did it increase the number of younger children being brought into the system. Trend data indicate that as Lancaster County becomes more reliant on alternative programs like the early assessment program, the number of youth officially processed through the courts has declined. This trend has not been consistently downward, and has fluctuated from year to year, so Lancaster County should remain vigilant and reexamine this baseline data in a few years

The decision to remarry and the ethic of care : a qualitative study of formerly divorced females

The purpose of this qualitative study was to examine commitment processes for second marriages for females. Gilligan's ethic of care developmental stage model provided the theoretical framework for the analysis of the data. This framework assumes that as individuals are confronted with new experiences, they move from a cognitive level of caring for self first, to caring for others first, to caring for self and others equally. The primary research question focused on whether females used qualitatively different cognitive levels of care in deciding to marry the first time and deciding to marry the second time. Other research questions were concerned with whether levels of ambivalence and conflict surrounding commitment during the courtship relationship in second marriages would be different for females who showed such a qualitative shift and those who did not. The data were gathered from 23 formerly divorced females who had been remarried less than three years. Through an intensive interview, interviewees were asked to reconstruct their reasons for deciding to marry the first time and their reasons for deciding to marry the second time. Using a scoring manual developed for the research project, three independent judges classified the responses as representing one of five levels of care. Objective measures of conflict and ambivalence about commitment to the relationship in second marriages were also obtained at the time of the interview

Crisis Response Programs FY 2015-2020

There are a significant proportion of youth with mental and behavioral health issues, often undiagnosed or untreated, that may contribute to problems at school, home, and within the community. Families and others may not know how to best handle the crisis and often turn to law enforcement or emergency departments to assist; however, this can lead to unintended negative outcomes for youth. To best address crises, the Substance Abuse and Mental Health Services Administration (SAMHSA) states that communities should have a well-developed continuum of crisis services. Crisis services are “no-wrong-door” safety net services that are available for “anyone, anywhere and anytime” (SAMSHA, 2020, p. 8). If interested in learning more about best practices in a crisis continuum of care, we suggest the reader obtain The National Guidelines for Behavioral Health Crisis Care – A Best Practice Toolkit (SAMSHA, 2020), which provides guidelines for implementation and evaluation of crisis services. Crisis response programs are one cog in a continuum of crisis services. In Nebraska, most crisis response services are currently provided by Nebraska Systems of Care through the Regions (with the exception of Region 6). Some services, however, are supported with funds from the Nebraska Community-based Juvenile Services Aid program (CBA). While the focus of the current report are CBA-funded programs in counties that are located in Region 6, we also describe evidence-based models utilized nationally (i.e., Crisis Intervention Teams; Mobile Crisis Services). Currently, only two crisis response programs are funded by CBA; however, this may increase if the Systems of Care SAMSHA grant awarded to the state is not renewed. Overall, the crisis response programs that are the subject of this report are effectively working with law enforcement, keeping youth in crisis in the community and not detention/hospitals, and establishing crisis plans with youth to reduce the risk of crisis in the future

Nebraska Juvenile Diversion Programs 2012 to 2015

In Nebraska, approximately 4,000 youth are referred to a juvenile diversion program annually. From 2012 to 2015, the majority of cases (87.0%) referred to juvenile diversion programs involved a law violation. Data from juvenile diversion programs indicates that Black youth are referred to diversion at twice the rate at which they appear in the population, whereas Asian and Native American youth are under-represented in juvenile diversion. Ideally we would examine how this compares to juveniles stopped by law enforcement for law violations, but this data is not consistently available in Nebraska. Without access to law enforcement stops, the underlying reasons for these patterns are unclear. To ensure equitable access to diversion, we recommend that Nebraska consistently collect data on law enforcement stops, referrals and citations. Of the cases referred to juvenile diversion, only 61% successfully divert out of the official court process. Failing to enroll in the program appears to be a primary obstacle. Once youth enroll in a program, their chances of success jump by eleven percentage points, to 72%. To encourage youth to divert out of the system, programs should examine the primary reason cited for failure to enroll. It is important to investigate the reasons that prevent youth and families from successfully enrolling in the local juvenile diversion program. The majority of the youth have only been referred to diversion one time (93.8%, n = 9,866). While some youth have been referred twice (5.9%, n = 619), three times (0.3%, n = 29), four times (0.1%, n = 3), and one youth was referred five times (0.1%, n = 1). Overall success rates for completing diversion varied across all counties and ranged from 50 to 100%, which may be attributed to the variation in the number of youth served within each county (i.e. counties that handle few cases), but may also reflect the programs and practices of the diversion program. To determine how effective diversion programming is at reducing subsequent offending, we examined law violations that occurred after the youth’s final time in diversion. Because many juvenile cases are sealed records, the Juvenile Justice Institute requested and received permission through the Nebraska Courts and the Nebraska Supreme Court, to ensure that we captured accurate information on new law violations. We examined rates of recidivism at three time periods: within 2-3 years post completion; within 1-2 years post completion and 6 months to 1 year post completion. Across all three time periods, rates of recidivism significantly differed by discharge reason. Specifically, youth who were successfully discharged from diversion were significantly less likely to recidivate than those who did not successfully complete the program. This was true whether the youth failed to complete the program because of a new law violation or failing to meet the program requirements. Overall, youth that completed diversion two to three years prior recidivated 30.2% of the time, which is consistent with a meta-analysis that found an average recidivism rate of 31.4% across 45 experiments with follow-up that ranged from 6 months to 36 months (Schwalbe et al., 2012). For youth who recidivated, on average that new law violation occurred almost a year post program completion. Our analysis revealed a range of effective diversion programs with variance by county. It is likely that outcomes for youth, including recidivism rates, are the result of programming and implementation quality. Throughout this report we included county-level results, so that programs can begin to analyze youth outcomes at the local level and work on strategies to improve program effectiveness. Perhaps the most important finding is that Nebraska youth who complete a diversion program successfully are significantly less likely to recidivate at both 1-2 and 2-3 years post program completion. Research has been mixed on the effectiveness of juvenile diversion programs on recidivism. One meta-analysis of 28 studies by Schwalbe and colleagues (2012) did not find a significant difference in average recidivism rates for diverted youth (31.4%) and non-diverted youth (36.3%). On the other hand, another meta-analysis by Wilson and Hoge (2013) did find a significant difference in average recidivism rates for diverted youth (31.5%) and non-diverted youth (41.3%). There is evidence, however, that certain strategies within diversion are more effective than others. In our sample, only 27% of the youth had diversion requirements and activities information entered in to the Juvenile Case Management System (JCMS). The data that was provided is critical because it indicates that particular activities were significantly related to lower rates of recidivism: youth assigned community service, administrative requirements, having an individual assignment, a parental involvement requirement, and whether a mental health or substance evaluation or therapy was required. Overall, juvenile diversion programs in Nebraska are statistically more likely to reduce recidivism for the youth who enrolled in the programs than youth who did not enroll in the program. Although this is a noteworthy finding, it should be noted that this finding does not indicate that diversion programming caused a reduction in recidivism. It could be that youth who were more likely to enroll and complete the program are youth who would be less likely to recidivate regardless of the intervention. We note this and other limitations to this study in the limitations section. Future directions may include comparing juvenile diversion recidivism rates in Nebraska to other juvenile justice systems and programs (e.g., probation, detention, youth rehabilitation treatment centers, or other community-based programs). Currently, however, calculating recidivism is a lengthy process because JUSTICE does not have a way to connect people across cases. There is a need for unique identifiers within systems and across systems. Future directions may also include a randomized study with a control group. This would require juvenile diversion programs who are willing to randomly assign kids to diversion programs and either traditional court processing or an alternative-type programming. Following this report, we recommend that programs begin to accurately report all fields available in the JCMS so we can continue to evaluate programs in Nebraska and better understand what individual-level and program-level variables predict outcomes. Programs should consistently enter information such as risk assessment scores and other assessment scores. All diversion activities that the youth participates in should also be indicated so that we can begin to see what programming may be working better than others. Our hope is that programs will use the information outlined in this report as a learning tool for improving their programs and that this report will create conversation between programs on what appears to be working best for juvenile diversion programs in Nebraska

Protein-Coding Variants Implicate Novel Genes Related to Lipid Homeostasis Contributing to Body Fat Distribution

Body fat distribution is a heritable risk factor for a range of adverse health consequences, including hyperlipidemia and type 2 diabetes. To identify protein-coding variants associated with body fat distribution, assessed by waist-to-hip ratio adjusted for body mass index, we analyzed 246,328 431 predicted coding and splice site variants available on exome arrays in up to 344,369 individuals from five major ancestries for discovery and 132,177 independent European-ancestry individuals for validation. We identified 15 common (minor allele frequency, MAF ≥ 5%) and 9 low frequency or rare (MAF < 5%) coding variants that have not been reported previously. Pathway/gene set enrichment analyses of all associated variants highlight lipid particle, adiponectin level, abnormal white adipose tissue physiology, and bone development and morphology as processes affecting fat distribution and body shape. Furthermore, the cross-trait associations and the analyses of variant and gene function highlight a strong connection to lipids, cardiovascular traits, and type 2 diabetes. In functional follow-up analyses, specifically in Drosophila RNAi-knockdown crosses, we observed a significant increase in the total body triglyceride levels for two genes (DNAH10 and PLXND1). By examining variants often poorly tagged or entirely missed by genome-wide association studies, we implicate novel genes in fat distribution, stressing the importance of interrogating low-frequency and protein-coding variants

Hall County Detention Utilization Study 2015-2020

Over the past twenty-five years, the Annie E. Casey Foundation’s Juvenile Detention Alternatives Initiative®, or JDAI, has worked closely with local jurisdictions to examine the appropriate use of juvenile detention. The University of Nebraska at Omaha’s Juvenile Justice Institute (JJI) has been in the forefront of juvenile justice reform and policy work since it was legislatively created in 2002. JJI staff and faculty have completed detention utilization studies in other Nebraska JDAI sites and play an active role in statewide JDAI committees and committees in local jurisdictions. The recommendations from this report are designed to help Hall County professionals decide the best use of detention and where changes can be made to better serve youth and possibly realize cost savings. This work aligns with the core values of JDAI by analyzing whether low risk youth are being detained, identifying opportunities to reduce length of stay, and by determining whether racial and ethnic disparities exist in detention