Grisso, Thomas

Vincent, Gina M.

English

eScholarship@UMMS

Recent events have brought the mentalhealth needs of youths involved in thejuvenile justice system to the forefrontof public health concerns. New research hasreported that around 70% of youths in deten-tion and correctional facilities meet criteria forat least one DSM diagnosis.1, 2 News reportsfrom various states have highlighted the poortreatment of juveniles' mental health needs.Finally, a congressional report discovered that,during FY 2001, more than 9,000 youths wereplaced in U.S. juvenile justice facilitiesbecause inpatient mental health services werenot available.3 The majority of theseyouths had not even been chargedwith a crime.Increasing demands to respond tomental health needs of youths incustody has been felt by virtuallyevery state over the past 10 years,when juvenile detention facilitiesbegan to report an influx of youths with mentaldisorders. A compelling explanation for thistrend is the legislation of more punitive lawsfor youthful offenders during the 1990s thatdecreased judicial discretion for divertingyouths with mental disorders to other services,and a concomitant nationwide deterioration ofchildren's mental health services that resultedin the use of detention facilities to deal with theunmet needs. Issue BriefDeveloping Mental Health Screening in Juvenile JusticeGina Vincent, Ph.D. and Thomas Grisso, Ph.D.disorders to the extent that they are associatedwith aggression. This is not to say that thejuvenile justice system should be expected toprovide treatment to the 70% of their populationestimated to have a diagnosis. Not all youths withdiagnoses have symptoms that are severe enoughto require psychiatric care. Moreover, in manyways juvenile justice programs are not the bestplaces to provide effective psychiatric treatment.But the system should develop ways to obtaintreatment-for example, from mental healthagencies-when it is needed. The first step toward managing the mental healthneeds of juveniles is to be ableto identify them. Mentalhealth screening is crucial foridentifying mental conditionsin need of immediateresponse, such as suicide risk,while also targeting youthsrequiring further assessment toformulate aggression managementand treatment strategies. Federal and stategovernmental agencies are encouraging theimplementation of routine mental healthscreening in public systems serving youth. InJuly 2003, the President's New FreedomCommission on Mental Health report called for"early mental health screening, assessment, andreferral to services" (p. 17) to become commonpractice. Bringing this goal to the juvenile justicesystem, both the Substance Abuse and MentalHealth Services Agency and the Office ofJuvenile Justice and Delinquency Preventionhave initiated block grant programs fundingstates to implement routine screening proceduresthroughout their juvenile facilities.  Considerations in the Implementation of aScreening and Assessment Process CMHSR faculty recently edited a book, MentalHealth Screening and Assessment for JuvenileJustice, to provide a resource for juvenilejustice officials seeking to adopt standardscreening and assessment procedures.5 TheCMHSRCenter for Mental Health Services ResearchUniversity of Massachusetts Medical SchoolThe Drive Toward Mental Health ScreeningJuvenile justice facilities have a legal andmoral obligation to care for the mental healthneeds of minors in their custody givenincarcerated youth are unable to seektreatment elsewhere.4 The juvenile justicesystem's obligation to protect public safetyalso requires attention to youths' mental© 2004 Center for Mental Health Services ResearchDepartment of Psychiatry University of Massachusetts Medical SchoolDecember 2004Vol 1, Issue 10.. .govermentalagencies are encour-aging implementationof routine mentalhealth screeningbook will be available in April 2005. It outlinesconsiderations for implementation and contains chaptersthat review the purpose and psychometric properties of manypsychological instruments available for screening andassessment in juvenile justice. To summarize the main points of this book, effectivescreening and assessment procedures require attentionto the quality of the instruments and the degree towhich they can function within the context of juvenilejustice settings, generally including initial intake orentry into juvenile detention or correctional facilities.How screening occurs, what facilitates its use, andwhat drives its purposes requires a consideration of thesystem's objectives, practical demands of juvenilefacilities, and capacities for response.  Objectives. Development of procedures must beginwith a clear view of the motivations for screening.Most screening tools will identify youth in need ofimmediate attention but will differ in their ability tomeet other objectives. Three objectives are particularlycommon. • Fulfilling Regulatory Requirements imposed by the law, state, county, or professional standards. Although these directives typically do not specify the mental health needs for screening, consensus dictates that tools need to indicate affective and anxiety symptoms, and the short-range likelihood for aggression, self-harm, and serious substance abuse at the minimum;• Improving Staff Decisions for managing youth. Appropriate tools will be highly structured, have clear training methods, and will produce scores that canbe translated into management decisions; and• Managing Resources to meet broader program objectives by providing data, such as prevalence rates, to project financial and other needs.  Costs and Feasibility. A screening process must fit thepractical demands of the facility.  Instruments favoredfor screening are those that require minimal resourcesto implement and administer, yet have known reliability andvalidity. Practical considerations for selecting a toolinclude the availability and need for collateral information,expertise required of staff for administration, efficiency ofadministration, and the cost of the test materials.Capacity for Response. Implementation of screeningalso requires administrators to determine when andhow they are going to respond to youths who score atsignificant levels on screening instruments. Often thisrequires development of relations with mental healthservices in the community, examining the research onwhat services are and are not effective, and assuring thatdecision rules for responding are clearly manualized forstaff. Policy RecommendationsIn light of the developments in practice for handlingmental health concerns in juvenile justice systems, werecommend that juvenile justice systems:• Develop mental health screening of emergency and other serious mental health needs during intake to pretrial and correctional facilities;• Select a mental health screening tool valid for juvenilejustice settings and commensurate with custodial obligations;• Design a structured and feasible policy for making decisions about response, referral and further assessment when youths manifest high needs in screening;• Develop interagency arrangements that will allow juvenile justice facilities to refer youth with emergentconditions to appropriate services; and• Pursue federal funding for these efforts to strengthen the ability to respond to the needs of youth.References1. Teplin, L. A., Abram, K. M., McClelland, G. M., Dulcan, M. K.,& Mericle, A. A.  (2002).  Psychiatric disorders in youth in juveniledetention.  Archives of General Psychiatry, 59, 1133-1143.2. Wasserman, G. A., McReynolds, L. S., Lucas, C. P., Fisher, P., &Santos, L.  (2002).  The Voice DISC-IV with incarcerated maleyouths:  Prevalence of disorder.  Journal of the American Academy ofChild and Adolescent Psychiatry, 41, 314-321.3. General Accounting Office (2003).  Child welfare and juvenilejustice:  Federal agencies could play a stronger role in helping statesreduce the number of children placed solely to obtain mental healthservices (GAO-03-397). Washington, DC:  U.S. General AccountingOffice.4. Grisso, T.  (2004).  Double Jeopardy: Adolescent Offenders withMental Disorders.  Chicago: University of Chicago Press. 5. Grisso, T., Vincent, G. M., & Seagrave, D.  [Eds.] (in press).Mental Health Screening and Assessment for Juvenile Justice.Guilford Press.  Visit us on-line at www.umassmed.edu/cmhsrOpinions expressed in this brief are those of the authors and not necessarily those of UMass Medical School or CMHSR.

Developing Mental Health Screening in Juvenile Justice

https://escholarship.umassmed.edu/cgi/viewcontent.cgi?article=1035&amp;context=pib

Developing Mental Health Screening in Juvenile Justice

Abstract

Similar works

Full text

Available Versions

eScholarship@UMMS