An Evaluation of Ohio`s Behavioral Health/Juvenile Justice Initiative

Patrick Kanary, M.Ed. – Case Western Reserve University
Barbara Keen-Marsh, MSW, LISW-S, LICDC - South Community
Behavioral Healthcare
Jeff M. Kretschmar, Ph.D. - Case Western Reserve University
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Behavioral Health and Juvenile Justice Initiative
Brief history:
 1998: Response to judges who were concerned about
limited options for kids with serious mental health
disorders
 1998: Departments of Youth Services and Mental Health
created a joint committee to explore alternatives
 1999: Key recommendation was the implementation of
pilot sites at the local level
 Currently 6 BHJJ sites across the state
 2006-present: CWRU Evaluation
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Trends in Behavioral Health and Juvenile
Justice
• Decrease in juvenile crime overall
• Decrease in rates of incarceration
• More access to EBPs that can effectively divert youth
• Increase in assessment of youth with serious mental
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health disorders and co-occurring disorders in the juvenile
justice system
Focus on least restrictive settings
Shared system accountability for outcomes (at home, in
school and achieving, strengthened caregivers, reduced
substance use)
Attention to ‘cost effectiveness/cost avoidance/offset’
Family focus/strength based
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Common Elements of BHJJ Projects
• A partnership between the Juvenile Court and the Alcohol, Drug
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Addiction & Mental Health Services Board.
Effective models of assessment, treatment planning, and familyfocused community-based evidence-based practices.
The identification and diversion of high risk youth with behavioral
health from juvenile justice and DYS
The pursuit of first and third party reimbursement, including Medicaid.
Each community crafted its own project to reflect their strengths and
needs
Participation in an extensive evaluation by Case Western
Reserve University.
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SOUTH COMMUNITY BEHAVIORAL HEALTHCARE
LIFE Program
Learning Independence and Family Empowerment
Montgomery County
Dayton, Ohio
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LIFE Program
Learning Independence and Family
Empowerment
State and Federal Partners
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Why FFT?
Blueprints Model – Evidenced Based
Practice
•Well Documented
•Highly Successful Family Intervention Program for
Juvenile Offenders
Strength-based
• Consistent with local and state initiatives
• Focus on strengths and assists families to
recovery
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Goals:
 Significant and Long-Term Reduction in Youth
Re-Offending and Violent Behavior
 Low Drop-Out and High Completion Rates
 Positive Impacts On Family Conflict, Family
Communication, Parenting, and Youth Problem
Behavior
 Significant Reduction in Sibling Entry into HighRisk Behaviors
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LIFE PROGRAM STRUCTURE
Youth enters Juvenile Court Process or
Released from ODYS, Detention or Local
Corrections
Centralized Intake Completes Diagnostic
Assessment
LIFE Program is Recommended
Probation Officer or Other Court
Personnel Refer Family to The LIFE
Program
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LIFE PROGRAM STRUCTURE
Therapist Contacts Family Within 48 Hours
of Referral
Services Provided:
•Home Based Family
Therapy utilizing the FFT
Model
•Psychiatric Services
•Intensive Probation
Other Collaboration:
•Family
•Probation/parole Officer
•Intervention Center
•Natural Helper
•Child Welfare
•Other Systems
•Case Western Reserve
University
•Functional Family Therapy,
Inc.
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Macro Level
Key Concepts

Top Down Cooperation and Collaboration

Ongoing Problem Solving

Attention to Customer Service—the other
agencies are Our Customers too!!

Ongoing Needs Assessment

Planning for Sustainability from Day 1 and
adjusting Sustainability Plan as Program Grows
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Marketing
• A Site is Selling Two Things
• Service (Micro Level)
• Results (Macro Level)
• Expansion into FFT-CM
An Evaluation of Ohio’s
Behavioral Health/Juvenile
Justice Initiative: 2006-2011
Jeff Kretschmar
Begun Center for Violence Prevention Research and Education
Case Western Reserve University
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Our Role
• Responsible for the collection, cleaning, entry,
management, and analysis of all BHJJ data
• MH/BH data
• Juvenile court history/recidivism
• Attendance at local and state BHJJ meetings
• Report writing
• Research presentations
• Provide an evidence-base for the program
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Demographics
• From 2006 through June 2011, 1758 youth
enrolled
• average age at intake 15.6 years
• 55% male
• 54% Caucasian
• From July 2009 – June 2011
• 64% male
• 60% non-Caucasian
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Family Characteristics
• At intake, nearly 85% of youth lived with at least
one biological parent (58% with biological
mother).
• Nearly 80% of BHJJ caregivers had at least a
high school diploma or GED.
• Median household income for BHJJ families was
between $20000-$24999.
• Nearly 25% reported household income below
$10000
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Juvenile Court History
County
Youth with Felony Charges in the 12
Months prior to BHJJ Enrollment
Cuyahoga (Cleveland)
35/156 (22.4%)
Franklin (Columbus)
147/221 (66.5%)
Montgomery (Dayton)
124/634 (19.6%)
Hamilton (Cincinnati)
30/90 (33.3%)
Lucas (Toledo)
33/59 (55.9%)
Summit (Akron)
46/49 (93.9%)
Total
415/1209 (34.3%)
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OYAS Risk
• Ohio Youth Assessment System (OYAS)
• Criminogenic risk tool designed to assist juvenile court staff with
placement and treatment decisions
• Helps identify likelihood to re-offend
Risk Level
Low
Moderate
High
24% (n = 59)
48% (n = 118)
28% (n = 67)
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Youth Characteristics
Question
Has the child ever been physically abused?
Has the child ever been sexually abused?
Has the child ever had a problem with substance
abuse, including alcohol and/ or drugs?
Has the child ever talked about committing
suicide?
Has the child ever attempted suicide?
Has the child ever been exposed to domestic
violence or spousal abuse, of which the child was
not the direct target?
*p = .05, ** p < .01, *** p < .001
Females
Males
23.8%
(n=147)**
29.9%
(n = 206)***
46.3%
(n = 322)
49.1%
(n =343)***
15.8%
(n=135)
6.9%
(n = 58)
47.1%
(n = 397)
32.0%
(n = 273)
22.5%
(n = 155)***
46.2%
(n = 323)*
9.8%
(n = 82)
41.4%
(n = 355)
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Youth Characteristics
Question
Females
Males
Has anyone in the child’s biological family ever
been diagnosed with depression or shown
signs of depression?
66.8%
(n = 453)***
58.6%
(n = 490)
Has anyone in the child’s biological family had
a mental illness, other than depression?
45.8%
(n = 314)**
37.8%
(n = 311)
40.7%
(n = 277)
37.8%
(n = 314)
64.3%
(n = 439)**
57.2%
(n = 480)
Has the child ever lived in a household in
which someone was convicted of a crime?
Has anyone in the child’s biological family had
a drinking or drug problem?
*p = .05, ** p < .01, *** p < .001
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DSM Axis I Diagnoses
DSM-IV Axis I Diagnosis
Females
Males
Oppositional Defiant Disorder
43.4% (n = 305)
39.2% (n = 318)
Cannabis-related Disorders
33.0% (n = 232)
36.4% (n = 295)
Attention Deficit Hyperactivity Disorder
26.5% (n = 186)
44.0% (n = 357)***
Depressive Disorders
24.5% (n = 172)***
14.9% (n = 121)
Alcohol-related Disorders
17.7% (n = 124)***
11.6% (n = 94)
Bipolar Disorder
12.3% (n = 86)*
8.5% (n = 69)
Conduct Disorder
10.3% (n = 72)
25.5% (n = 207)***
Post-traumatic Stress Disorder
9.5% (n = 67)**
5.3% (n = 43)
Adjustment Disorder
9.3% (n = 65)
7.2% (n = 58)
Mood Disorder
9.0% (n = 63)
8.4% (n = 68)
Disruptive Behavior Disorder
8.0% (n = 56)
8.9% (n = 72)
*p < .05, ** p < .01, *** p < .001
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Trauma
TSCC Scores from Intake to Termination
10
9
8
Scale Scores
7
6
5
4
3
2
1
0
* all comparisons significant
between .30 Intake at the p < .01 level; effect sizes
Termination
.60.
Anxiety
Depression
Anger
Posttraumatic Stress
Dissociation
Sexual Concerns
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Ohio Scales
All comparisons significant at p < .01 level, effect sizes range between .66-.69.
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Ohio Scales
All comparisons significant at p < .01 level, effect sizes range between .41-.63.
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Substance Use
Males
Females
% Ever Used
Age of
First Use
% Ever Used
Age of
First Use
Alcohol
64.5% (n=546)
13.18
65.7% (n=447)
13.25
Cigarettes
59.7% (n=506)
12.31
64.8% (n=446)*
12.42
Chewing Tobacco
18.3% (n=154)**
13.74
6.0% (n=41)
13.76
Marijuana
68.2% (n=576)
13.04
64.8 (n=444)
13.24
Cocaine
6.3% (n=54)
14.68
12.1% (n=82)**
14.56
Pain Killers (use inconsistent with
15.3% (n=130)
14.05
17.4% (n=119)
14.24
Ritalin (use inconsistent with prescription)
7.9% (n=67)
12.85
9.7% (n=66)
13.91
Hallucinogens
6.9% (n=59)
14.38
6.9% (n=47)
14.36
Ecstasy
5.6% (n=47)
14.70
10.2% (n=69)**
14.58
prescription)
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Substance Use
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Substance Use
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Termination Information
Termination Reason
All Youth
Youth Enrolled from July
2009 through June 2011
Successfully Completed
Services
61.6% (n = 792)
62.2% (n = 253)
Client Did Not Return/Rejected
Services
8.1% (n = 103)
2.7% (n = 11)
Out of Home Placement
7.5% (n = 96)
8.4% (n = 34)
Client/Family Moved
3.7% (n = 48)
2.2% (n = 9)
Client Withdrawn
6.5% (n = 84)
11.5% (n = 47)
Client AWOL
2.4% (n = 31)
2.5% (n = 10)
Client Incarcerated
3.1% (n = 40)
5.7% (n = 23)
Other
7.1% (n = 91)
4.9% (n = 20)
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Termination Information
• 1285 youth terminated from BHJJ services (541 from Montgomery)
• ALOS = 217 days (150 days in Montgomery)
• 237 days successful completers
• 185 days for unsuccessful completers
• ALOS from July 2009 – June 2011 = 157 days (134 days in
Montgomery)
• 175 days for successful completers
• 126 days for unsuccessful completers
• At intake, 50% of youth were identified as at risk for out of
home placement
• At termination, 23% of youth were identified as at risk for out of
home placement
• 6% of successful completers
• 52% of unsuccessful completers
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Recidivism
• At termination, police contacts for 67% of youth had been
reduced
• Police contacts for 21% of youth remained the same
• One year after termination, 10% of successful completers
and 19% of unsuccessful completers had new felony
charges
• Thirty two (32) out of the 1665 youth (1.9%) enrolled in
BHJJ for whom we had recidivism data were sent to an
ODYS facility at any time following their enrollment in
BHJJ, including after a youth’s termination from BHJJ.
• 6/634 (0.9%) in Montgomery County
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Financial Considerations
• Using only the direct State contribution to BHJJ of
$8.4 million since 2006, the average cost per
youth enrolled in BHJJ was $4778. The FY11 per
diem to house a youth at an ODYS institution was
$442 and the average length of stay was 12.6
months. Based on these numbers, the estimated
cost of housing the average youth at an ODYS
facility in FY11 was $167,960.
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What We’ve Learned
• Possible and necessary for mental health and juvenile
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justice to be partners in achieving positive outcomes
Incentive funding creates the opportunity
Sustainability rests with stakeholders
Providers ready to serve very high risk youth and families
Critical use of data/outcomes in different venues
Stakeholders willing to share information and be candid
Multiple levels of accountability for performance and
improvement
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Implications:
Policy-Program-Evaluation
Challenges
Opportunities
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Contact Information
Jeff Kretschmar, PhD.
Begun Center for Violence Prevention Research and Education
Case Western Reserve University
[email protected]
Barbara Keen-Marsh, MSW, LISW-S, LICDC
South Community, Inc.
[email protected]
Patrick Kanary, M.Ed.
Begun Center for Violence Prevention, Research & Education/ Center
of Innovative Practices
[email protected]