Participant Guide - National Center for Mental Health and Juvenile

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Disclaimer
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© 2014 Policy Research Incorporated.
Models for Change
Models for Change is an effort to create successful and replicable models of juvenile justice reform through
targeted investments in key states, with core support from the John D. and Catherine T. MacArthur
Foundation. Models for Change seeks to accelerate progress toward a more effective, fair, and
developmentally sound juvenile justice system that holds young people accountable for their actions,
provides for their rehabilitation, protects them from harm, increases their life chances, and manages the risk
they pose to themselves and to the public. The initiative is underway in Illinois, Pennsylvania, Louisiana, and
Washington and, through action networks focusing on key issues, in California, Colorado, Connecticut,
Florida, Kansas, Maryland, Massachusetts, New Jersey, North Carolina, Ohio, Texas, and Wisconsin.
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Contents
Background & Overview of CIT for Youth .............................................................................................. v
Course Outline ...................................................................................................................................... ix
Acknowledgements ............................................................................................................................. xiii
Unit One – Introduction and Overview
Training Aids and Notes .................................................................................................................. 1
Unit Two – Understanding Adolescent Development
Training Aids and Notes .................................................................................................................. 5
Materials ........................................................................................................................................21
References .....................................................................................................................................27
Unit Three – Adolescent Psychiatric Disorders & Treatment
Training Aids and Notes ................................................................................................................29
Materials ........................................................................................................................................47
References .....................................................................................................................................51
Unit Four – Crisis Intervention & De-escalation
Training Aids and Notes ................................................................................................................53
Materials ........................................................................................................................................65
Unit Five – The Family Experience
Training Aids and Notes ................................................................................................................67
Unit Six – Legal Issues
Training Aids and Notes ................................................................................................................71
Materials ........................................................................................................................................76
Unit Seven – Connecting to Resources
Training Aids and Notes ................................................................................................................79
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Background & Overview of CIT for Youth
Introduction
Youth with mental health problems often come in
contact with law enforcement for disruptive or
delinquent behavior that manifests as a result of
an untreated or undetected mental health problem
(Skowyra & Cocozza, 2007). Law enforcement
officers responding to calls have latitude in
determining how best to respond to the situation,
and can decide whether the case proceeds into
the juvenile justice system or whether the youth
can be diverted (Office of Juvenile Justice and
Delinquency Prevention, 2004).
Law enforcement officers on a CIT team typically
undergo a 40-hour training in which they learn
about mental illness, how it affects people in crisis,
and how best to respond to crisis situations. This
intensive training is coupled with the development
of strong linkages with the mental health system to
ensure that mental health resources are available
to law enforcement officers when they respond to
an individual in mental health crisis or in need of
mental health services.
The response by law enforcement officers to a call
involving a youth in a mental health crisis, and the
immediate decisions that are made about how to
handle the case, can have a significant and
profound impact on a youth and his/her family. This
initial contact with law enforcement also represents
an opportunity to connect the youth with emergency
mental health services or refer the youth for mental
health screening and evaluation (Skowyra &
Cocozza, 2007). However, the ability of law
enforcement to respond in this way requires that
officers be appropriately trained to recognize the
signs and symptoms of mental disorders among
youth, and that resources be available so that
officers have a place to take youth for immediate
services.
Since 1988, the CIT approach has rapidly
proliferated across the country (Schwarzfeld,
Reuland & Plotkin, 2008). Currently, there are at
least 2,700 CIT programs in the nation (Cochran,
2014). Outcome studies of the CIT approach
suggest that CIT may result in positive outcomes
for both individuals with mental illness and the law
enforcement officers who respond to calls
involving those individuals, as well as for the larger
criminal justice system and the community. Some
studies have found that CIT decreased the need
for more intensive and costly law enforcement
responses, reduced officer injuries, and increased
referrals to emergency health care (Dupont &
Cochran, 2000). In addition, the partnerships that
are created between the mental health system and
law enforcement have been found to improve
access to mental health services (Teller et al.,
2006).
The CIT Approach
The CIT for Youth Training
In 1988, recognizing the potential benefits of
providing training about mental disorders and
response techniques to law enforcement, the first
Crisis Intervention Team (CIT) program was
developed in Memphis, Tennessee. CIT is a law
enforcement-based, crisis-response and diversion
strategy in which specialized law enforcement
officers who have received intensive training
respond to calls involving individuals with possible
mental health problems.
While law enforcement officers are called to
respond to incidents involving both adults and
youth, the standard CIT training that is offered to
most police officers focuses primarily on response
techniques for adults. While there are some
general similarities between adults and youth,
there are important and unique distinctions
between the two that require specialized
knowledge and training. Youth-focused crisis
training for law enforcement officers is especially
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important given the large numbers of youth in
contact with the juvenile justice system who have
mental health problems. A study by the National
Center for Mental Health and Juvenile Justice
(NCMHJJ) confirmed that 65 to 70 percent of youth
in contact with the juvenile justice system have a
diagnosable mental health disorder. For 27 percent
of justice-involved youth, their disorders are serious
enough to require immediate mental health services
(Shufelt & Cocozza, 2006).
Recognizing the need for specialized law
enforcement training that is focused exclusively on
youth, the Models for Change Mental Health/
Juvenile Justice (MH/JJ) Action Network, supported
by the John D. and Catherine T. MacArthur
Foundation, developed the Crisis Intervention
Training for Youth (CIT-Y) curriculum. CIT-Y trains
police officers on response techniques that are
appropriate for youth with mental health needs. It is
an eight-hour, supplemental training course for law
enforcement officials who have previously
undergone standard CIT training and who
understand the basic principles and concepts of CIT,
but who are looking for more specific information on
youth. The CIT-Y is designed to be administered by
a team of instructors with relevant subject matter
expertise, experience, and regional specific
knowledge.
CIT-Y was developed in conjunction with three states
participating in the MH/JJ Action Network: Colorado,
Louisiana, and Pennsylvania. The development was
overseen and coordinated by the NCMHJJ, in
conjunction with the Colorado Regional Community
Policing Institute.* The lead content developers
include Don Kamin, Ph.D.; Stephen Phillippi, Ph.D.,
LCSW ; and Robert Kinscherff, Ph.D., J.D.
*Additional advisors from Colorado include Sergeant Kevin
Armstrong, Judith Brodie, Commander Joe Cassa, Linda
Drager, Keri Fitzpatrick, John Patzman, and Elizabeth Sather,
PsyD.
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About the Mental
Health/Juvenile Justice
Action Network
The Models for Change MH/JJ Action Network was
created through support from the John D. and
Catherine T. MacArthur Foundation. The primary
work of the Action Network occurred between years
2007 and 2011. It was a partnership of states
working together to develop and implement new
models and strategies for improving services and
policies for youth with mental health needs involved
with the juvenile justice system. Eight states
comprised the MH/JJ Action Network: Colorado,
Connecticut, Illinois, Louisiana, Ohio, Pennsylvania,
Texas, and Washington. For additional information
about the MH/JJ Action Network, visit www.
modelsforchange.net.
About the National Center
for Mental Health and
Juvenile Justice
The National Center for Mental Health and
Juvenile Justice, which coordinates the MH/JJ
Action Network, was established in 2001 to assist
the field in developing improved policies and
programs for youth with mental health disorders in
contact with the juvenile justice system, based on
the best available research and practice. The
NCMHJJ is operated by Policy Research
Associates, Inc. in Delmar, New York. For
additional information about the NCMHJJ, visit
www.ncmhjj.com.
About the Mental Health
and Juvenile Justice
Collaborative for Change
The NCMHJJ also coordinates the Mental Health
and Juvenile Justice Collaborative for Change
(Collaborative for Change), which is a resource
center dedicated to
 sharing the innovations and resources that
emerged from states involved with Models for
Change and the MH/JJ Action Network, and
 actively supporting the adaptation, replication,
and expansion of these innovations and
resources throughout the country.
The Collaborative for Change, which is supported
by the John D. and Catherine T. MacArthur
Foundation, aims to serve juvenile justice and
mental health system administrators, policy
makers, program directors, and direct care staff by
providing a wide array of information, technical
assistance, and support services on key mental
health and juvenile justice topics. For additional
information about the Collaborative for Change,
please visit: http://cfc.ncmhjj.com.
References
Cochran, S. (2014). University of Memphis CIT Center.
Personal Communication, June 16, 2014.
Dupont, R. & Cochran, S. (2000). Police response to
mental health emergencies – Barriers to change. J.
Am. Acad. Psychiatry Law, 28, 338-44.
Office of Juvenile Justice and Delinquency Prevention.
(2004). Statistical briefing book. Washington, D.C.:
U.S. Department of Justice, Office of Justice
Programs, Office of Juvenile Justice and
Delinquency Prevention.
Schwarzfeld, M., Reuland, M. & Plotkin, M. (2008).
Improving responses to people with mental
illnesses: The essential elements of a specialized
law enforcement-based program. Washington,
D.C.: U.S. Department of Justice, Office of Justice
Programs, Bureau of Justice Assistance.
Shufelt, J. & Cocozza, J. (2006). Youth with mental
health disorders in the juvenile justice system:
Results from a multi-state prevalence study.
Delmar, NY: National Center for Mental Health and
Juvenile Justice.
Skowyra, K. & Cocozza, J. (2007). Blueprint for change:
A comprehensive model for the identification and
treatment of youth with mental health needs in
contact with the juvenile justice system. Delmar,
NY: National Center for Mental Health and Juvenile
Justice.
Teller, J., Munetz, M., Gil, K. & Ritter, C. (2006). Crisis
intervention team training for police officers
responding to mental disturbance calls. Psych.
Services, 57(2), 232-37.
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Course Outline
Unit One – Introduction and Overview
I.
II.
III.
IV.
V.
Pre-course Assessment
Introduction
Objectives
Ground Rules
Overview of Day
a. Purpose
b. Goals
Unit Two – Understanding Adolescent Development
I. Objectives
II. Defining Adolescence
III. Adolescent Development
a. Cognitive Development
b. Moral Development
i. Case Study (Tony)
c. Social and Identity Development
d. Physical Development
i. Case Study (Henry)
e. Brain Development
IV. Differences between an Adolescent and an Adult
a. Self-Control
b. Short-Sightedness
c. Susceptibility to Peer Pressure
V. Important Considerations
VI. Disruptions in Normal Development
VII. Implications
a. Purpose of Criminal Punishment
b. Mitigation, Not Excuse
Unit Three – Adolescent Psychiatric Disorders & Treatment
I.
II.
III.
IV.
V.
VI.
Objectives
National Mental Health Prevalence Data
What are Mental Illnesses?
Myths and Facts
Signs of Mental Disorder in Youth
Mental Disorders and Symptoms
a. Disruptive Disorders
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i. Attention-Deficit/Hyperactivity Disorder
ii. Oppositional Defiant Disorder
iii. Conduct Disorder
b. Depressive (“Mood”) Disorders
i. Depression
1. Adolescent Suicide
2. Other Self-Harming Behaviors
ii. Bipolar Disorder
c. Anxiety Disorders
i. Generalized Anxiety Disorder
ii. Panic Disorder
iii. Separation Anxiety Disorder
d. Trauma and Stressor-Related Disorders
i. Posttraumatic Stress Disorder
e. Psychotic/Thought Disorders
f. Substance-Related Disorders
i. Co-occurring Disorders
g. Neurodevelopmental Disabilities
i. Intellectual Disorders
ii. Communication Disorders
iii. Autism Spectrum Disorder
VII. Treatment of Mental Disorders
Unit Four – Crisis Intervention & De-escalation
I.
II.
III.
IV.
V.
Objectives
Defining Crisis and Crisis Intervention
Triggers for Adolescents
Crisis State
General Communication Guidelines
a. Initial Approach
b. Introduction
c. Dialogue
d. Connection
e. Active Listening
f. Reflecting
g. Calming
VI. Family
VII. Additional Guidelines
VIII. Responding to Specific Emotions/Situations
a. Frustrated & Emotionally Distraught
b. Hostile/Aggressive Behavior
c. Substance-Induced Behavior
d. Suicidal Thoughts and/or Behavior
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IX. Mental Health Response Versus Criminal Arrest
X. Demonstration of De-escalation Techniques
Unit Five – The Family Experience
I.
II.
III.
IV.
V.
VI.
The Family Experience
a. What It’s Like
Causes of Mental Illness
Difficulties in Getting Help
Why the Police
A Parent’s Personal Experience
Supporting Families
Unit Six – Legal Issues
I. Objectives
II. Review of Federal Statutes
a. HIPAA
b. FERPA
c. 42CFR Chapter 2
III. Obtaining Assessment/Treatment
a. Voluntary
b. Involuntary
IV. Psychiatric Inpatient Admissions
V. Potential Collateral Legal Consequences
Unit Seven – Connecting to Resources
I. Objectives
II. Psychiatric Emergency Services
III. Other (Non-psychiatric) Emergency Services
IV. Outpatient Services
V. School-based Services
VI. Residential Treatment Facilities and Group Homes
VII. Other Child/Youth & Family Services
VIII. Mental Health Courts
IX. Support Groups
X. Responder Guide
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Acknowledgements
The CIT-Y training curriculum was developed with support from the John D. and Catherine T. MacArthur
Foundation and reflects the advice and contributions of many individuals:
Developers:
Don Kamin, Ph.D., Monroe County, New York, Office of Mental Health
Stephen Phillippi, Ph.D., LCSW, Louisiana State University Health Science Center
Robert Kinscherff, Ph.D., J.D., Massachusetts School of Professional Psychology
The Mental Health/Juvenile Justice Action Network states participating in the Front-End Diversion
Law Enforcement Workgroup, including:
Colorado (Sandy Sayre, Colorado Regional Community Policing Institute)
Louisiana (Sergeant Clifford Gatlin, Alexandria Police Department)
Pennsylvania (Kristen DeComo, Allegheny County Department of Human Services)
The National Center for Mental Health and Juvenile Justice, including:
Kathleen R. Skowyra, Associate Director
Joseph J. Cocozza, Director
Kay S. Peavey, Project Associate
Ashley Degnan, Project Assistant
Jennifer Deschamps, Senior Administrative Assistant
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Training Aids
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Materials
Case Study: Tony
Tony is a 16-year-old boy. His cousin robs a local convenience store and later asks Tony to hide him.
Tony agrees and is subsequently charged with “Accessory After the Fact.” He is offered a plea deal, but
only if he will testify against his cousin. Tony feels protective of his cousin. Tony also believes that the
convenience store has been a front for drug dealing, which he thinks at least some local police officers
know and have been “on the take” from the store owner.
Tony’s mother tells him to “do the right thing, tell the truth” and to testify. His lawyer tells him to take the
plea and let his cousin fend for himself. Tony’s older brother tells him to be loyal to his cousin and refuse
the plea agreement. Tony worries that if he is perceived as a “snitch,” people might hurt him or his family.
He resents that his cousin got him into this situation in the first place.
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Materials
Case Study: Henry
Henry is a 15-year-old white male who is small for his age. His mother and aunt refer to him as their “little
man.” Henry has few friends and has never played any type of organized sports or participated in
clubs/organizations at school or in the community. Teachers report that Henry has a history of being
aggressive toward other youth and teachers, and appears to be slower to understand school information
than his classmates.
Henry has been arrested in the past for theft and possession of marijuana. He’s on probation for those
delinquent acts. When Henry went through the local Juvenile Assessment Center, testing showed that
Henry had difficulty thinking about if-then and what-if situations. When asked about where he would like to
be in two or three years, Henry stated, “I’m not sure; maybe going to school.” Henry stated that he took
clothes from a local shopping mall because, “Everyone had jacked some really cool stuff and I was the only
one that didn’t have anything. They said I was a momma’s boy. The only problem was I was the one stupid
enough to get caught.” His response for smoking marijuana was, “I don’t know why everyone is freaking out
and making a big deal out of this with me. Everyone does it.”
Henry has very little contact with his father. His father has been in and out of jail since Henry was a year
old and is currently serving time in another state. Henry’s mother has been in and out of jail herself for
crimes such as possession of drugs and worthless check writing. Henry has lived with his grandmother,
his aunt and/or his uncle when his mom was in jail.
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Materials
MacArthur Foundation Research
Network on Adolescent
Development and Juvenile
Justice Issue Brief 3: Less Guilty
by Reason of Adolescence
In 2005, in a landmark decision, the U.S. Supreme Court outlawed the death penalty for offenders who
were younger than 18 when they committed their crimes. The ruling centered on the issue of culpability,
or criminal blameworthiness. Unlike competence, which concerns an individual’s ability to serve as a
defendant during trial or adjudication, culpability turns on the offender’s state of mind at the time of the
offense, including factors that would mitigate, or lessen, the degree of responsibility.
The Court’s ruling, which cited the Network’s work, ran counter to a nationwide trend toward harsher
sentences for juveniles. Over the preceding decade, as serious crime rose and public safety became a
focus of concern, legislators in virtually every state had enacted laws lowering the age at which juveniles
could be tried and punished as adults for a broad range of crimes. This and other changes have resulted
in the trial of more than 200,000 youth in the adult criminal system each year.1
Proponents of the tougher laws argue that youth who have committed violent crimes need more than a
slap on the wrist from a juvenile court. It is naïve, they say, to continue to rely on a juvenile system
designed for a simpler era, when youth were getting into fistfights in the schoolyard; drugs, guns, and
other serious crimes are adult offenses that demand adult punishment. Yet the premise of the juvenile
justice system is that adolescents are different from adults, in ways that make them potentially less
blameworthy than adults for their criminal acts.
The legal system has long held that criminal punishment should be based not only on the harm caused,
but also on the blameworthiness of the offender. How blameworthy a person is for a crime depends on
the circumstances of the crime and of the person committing it. Traditionally, the courts have considered
several categories of mitigating factors when determining a defendant’s culpability. These include:
• impaired decision-making capacity, usually due to mental illness or disability,
• the circumstances of the crime—for example, whether it was committed under duress, and
• the individual’s personal character, which may suggest a low risk of continuing crime.
Such factors don’t make a person exempt from punishment – rather, they indicate that the punishment
should be less than it would be for others committing similar crimes, but under different circumstances.
Should developmental immaturity be added to the list of mitigating factors? Should juveniles, in general,
be treated more leniently than adults? A major study by the Research Network on Adolescent
Development and Juvenile Justice now provides strong evidence that the answer is yes.
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The Network’s Study of Juvenile Culpability
The study of juvenile culpability was designed to provide scientific data on whether, in what ways, and at
what ages adolescents differ from adults.
Many studies have shown that by the age of sixteen, adolescents’ cognitive abilities – loosely, their
intelligence or ability to reason – closely mirror that of adults. But how people reason is only one influence
on how they make decisions. In the real world, especially in high-pressure crime situations, judgments are
made in the heat of the moment, often in the company of peers. In these situations, adolescents’ other
common traits – their short-sightedness, their impulsivity, their susceptibility to peer influence – can
quickly undermine their decision-making capacity.
The investigators looked at age differences in a
number of characteristics that are believed to
undergird decision-making and that are relevant to
mitigation, such as impulsivity and risk processing,
future orientation, sensation-seeking and resistance to
peer pressure. These characteristics are also thought
to change over the course of adolescence and to be
linked to brain maturation during this time. The
subjects – close to 1,000 individuals between the ages
of 10 and 30 – were drawn from the general population
in five regions. They were ethnically and
socioeconomically diverse.
The study’s findings showed several characteristics of adolescence that are relevant to determinations of
criminal culpability. As the accompanying figure indicates, although intellectual abilities stop maturing
around age 16, psychosocial capability continues to develop well into early adulthood.
Short-Sighted Decision-Making
One important element of mature decision-making is a sense of the future consequences of an act. A variety
of studies in which adolescents and adults are asked to envision themselves in the future have found that
adults project their visions over a significantly longer time, suggesting much greater future orientation.
These findings are supported by data from the Network’s culpability study. Adolescents characterized
themselves as less likely to consider the future consequences of their actions than did adults. And when
subjects in the study were presented with various choices measuring their preference for smaller,
immediate rewards versus larger, longer-term rewards (for example, “Would you rather have $100 today
or $1,000 a year from now?”), adolescents had a lower “tipping point” – the amount of money they would
take to get it immediately as opposed to waiting.
How might these characteristics carry over into the real world? When weighing the long-term consequences
of a crime, adolescents may simply be unable to see far enough into the future to make a good decision.
Their lack of foresight, along with their tendency to pay more attention to immediate gratification than to
long-term consequences, are among the factors that may lead them to make bad decisions.
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Poor Impulse Control
The Network’s study also found that as individuals age, they become less impulsive and less likely to
seek thrills; in fact, gains in these aspects of self-control continue well into early adulthood. This was
evident in individuals’ descriptions of themselves and on tasks designed to measure impulse control. On
the “Tower of London” task, for example – where the goal is to solve a puzzle in as few moves as
possible, with a wrong move requiring extra moves to undo it – adolescents took less time to consider
their first move, jumping the gun before planning ahead.
Network research also suggests that adolescents are both less sensitive to risk and more sensitive to
rewards—an attitude than can lead to greater risk-taking. The new data confirm and expand on earlier
studies gauging attitudes toward risk, which found that adults spontaneously mention more potential risks
than teens. Juveniles’ tendency to pay more attention to the potential benefits of a risky decision than to
its likely costs may contribute to their impulsivity in crime situations.
Vulnerability to Peer Pressure
The law does not require exceptional bravery of citizens in the face of threats or other duress. A person
who robs a bank with a gun in his back is not as blameworthy as another who willingly robs a bank;
coercion and distress are mitigating factors. Adolescents, too, face coercion, but of a different sort.
Pressure from peers is keenly felt by teens. Peer influence can affect youth’s decisions directly, as when
adolescents are coerced to take risks they might otherwise avoid. More indirectly, youth’s desire for peer
approval, or their fear of rejection, may lead them to do things they might not otherwise do. In the
Network’s culpability study, individuals’ reports of their vulnerability to peer pressure declined over the
course of adolescence and young adulthood. Other Network research now underway is examining how
adolescent risk-taking is “activated” by the presence of peers or by emotional arousal. For example, an
earlier Network study, involving a computer car-driving task, showed that the mere presence of friends
increased risk-taking in adolescents and college undergraduates, though not adults.2
Although not every teen succumbs to peer pressures, some youth face more coercive situations than
others. Many of those in the juvenile justice system live in tough neighborhoods, where losing face can be
not only humiliating but dangerous. Capitulating in the face of a challenge can be a sign of weakness,
inviting attack and continued persecution. To the extent that coercion or duress is a mitigating factor, the
situations in which many juvenile crimes are committed should lessen their culpability.
Confirmation from Brain Studies
Recent findings from neuroscience line up well with the Network’s psychosocial research, showing that
brain maturation is a process that continues through adolescence and into early adulthood. For example,
there is good evidence that the brain systems that govern impulse control, planning, and thinking ahead
are still developing well beyond age 18. There are also several studies indicating that the systems
governing reward sensitivity are “amped up” at puberty, which would lead to an increase in sensationseeking and in valuing benefits over risks. And there is emerging evidence that the brain systems that
govern the processing of emotional and social information are affected by the hormonal changes of
puberty in ways that make people more sensitive to the reactions of those around them – and thus more
susceptible to the influence of peers.3
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Policy Implications: A Separate System for Young Offenders
The scientific arguments do not say that adolescents cannot distinguish right from wrong, nor that they
should be exempt from punishment. Rather, they point to the need to consider the developmental stage
of adolescence as a mitigating factor when juveniles are facing criminal prosecution. The same factors
that make youth ineligible to vote or to serve on a jury require us to treat them differently from adults
when they commit crimes.
Some have argued that courts ought to assess defendants’ maturity on a case-by-case basis, pointing to
the fact that older adolescents, in particular, vary in their capacity for mature decision-making. But the tools
needed to measure psychosocial maturity on an individual basis are not well developed, nor is it possible to
distinguish reliably between mature and immature adolescents on the basis of brain images. Consequently,
assessing maturity on an individual basis, as we do with other mitigating factors, is likely to produce many
errors. However, the maturing process follows a similar pattern across virtually all teenagers. Therefore it is
both logical and efficient to treat adolescents as a special legal category – and to refer the vast majority of
offenders under the age of 18 to juvenile court, where they will be treated as responsible but less
blameworthy, and where they will receive less punishment and more rehabilitation and treatment than
typical adult offenders. The juvenile system does not excuse youth of their crimes; rather, it acknowledges
the development stage and its role in the crimes committed, and punishes appropriately.
At the same time, any legal regime must pay attention to legitimate concerns about public safety. There
will always be some youth – such as older, violent recidivists – who have exhausted the resources and
patience of the juvenile justice system, and whose danger to the community warrants adjudication in
criminal court. But these represent only a very small percentage of juvenile offenders. Trying and
punishing youth as adults is an option that should be used sparingly.
Legislatures in several states have begun to reconsider the punitive laws enacted in recent decades.
They have already recognized that prosecuting and punishing juveniles as adults carries high costs, for
the youth and for their communities. Now we can offer lawmakers in all states a large body of research on
which to build a more just and effective juvenile justice system.
1
Allard, P., & Young, M. (2002). Prosecuting juveniles in adult court: Perspectives for policymakers and practitioners. Journal of
Forensic Psychology Practice, 6, 65-78.
2
Gardner, M., & Steinberg, L. (2005). Peer influence on risk-taking, risk preference, and risky decision-making in adolescence and
adulthood: An experimental study. Developmental Psychology, 41, 625-635.
3
Nelson, E., Leibenluft, E., McClure, E., & Pine, D. (2005). The social re-orientation of adolescence: A neuroscience perspective
on the process and its relation to psychopathology. Psychological Medicine, 35, 163-174.
For More Information
MacArthur Foundation Research Network on Adolescent Development and Juvenile Justice
Temple University, Department of Psychology
Philadelphia, PA 19122
www.adjj.org
The Research Network on Adolescent Development and Juvenile Justice is an interdisciplinary, multi-institutional program focused
on building a foundation of sound science and legal scholarship to support reform of the juvenile justice system. The network
conducts research, disseminates the resulting knowledge to professionals and the public, and works to improve decision-making
and to prepare the way for the next generation of juvenile justice reform.
26
References
Chedd-Angier Production Company. (2013). Peer influence and adolescent behavior. Brains on Trial with
Alan Alda: Deciding Punishment. Available at http://brainsontrial.com/watch-ideos/video/episode2-deciding-punishment/
Chedd-Angier Production Company. (2013). What fMRI scans tell us about the adolescent brain. Brains
on Trial with Alan Alda: Deciding Punishment. Available at http://brainsontrial.com/watchvideos/video/episode-2-deciding-punishment/
Craig, G. J. (1999). Human development. Upper Saddle River, NJ: Prentice Hall.
CSR, Inc. (1997). Understanding youth development: Promoting positive pathways of growth.
Washington, D.C.: Department of Health and Human Services, Administration for Children and
Families, Administration on Children, Youth and Families, Families and Youth Services Bureau.
Daeg de Mott, D. K. (1998). Moral development. Gale Encyclopedia of Childhood and Adolescence. Gale
Research.
Frontline. (2002). The wiring of the adolescent brain. Inside the Teenage Brain. Available at
http://www.pbs.org/wgbh/pages/frontline/video/flv/generic.html?s=frol02sfa9q392&continuous=1
Gardner, M. & Steinberg, L. (2005). Peer influence on risk-taking, risk preference, and risky decisionmaking in adolescence and adulthood: An experimental study. Developmental Psychology, 41, 625635.
MacArthur Foundation Research Network on Adolescent Development & Juvenile Justice (2006). Less
guilty by reason of adolescence. Issue Brief 3. Chicago, IL: John D. and Catherine T. MacArthur
Foundation.
Seifert, K. L. & Hoffnung, R. J. (1994). Child and adolescent development, Third Ed. Boston: Houghton
Mifflin Company.
Steinberg, L. (2007). Senate judiciary committee briefing. June 11, 2007. Washington, D.C.: U.S. Senate.
Steinberg, L. (2008). Development & criminal blameworthiness: Bringing research to policy & practice.
MacArthur Foundation Models for Change Annual Conference. December 9, 2008. Washington, D.C.
Steinberg, L. (2009). Should the science of adolescent brain development inform public policy? American
Psychologist, 64, 739-750.
Steinberg, L., Albert, D., Cauffman, E., Banich, M., Graham, S. & Woolard, J. (2008). Age differences in
sensation seeking and impulsivity as indexed by behavior and self-report: Evidence for a dual
systems model. Developmental Psychology, 44, 1764-1778.
Steinberg, L., Graham, S., O’Brien, L., Woolard, J., Cauffman, E. & Banich, M. (2009). Age differences in
future orientation and delay discounting. Child Development, 80, 28-44.
Steinberg, L. & Monahan, K. (2007). Age differences in resistance to peer influence. Developmental
Psychology, 43, 1531-1543.
27
Supreme Court of the United States. (2012). Miller v. Alabama. 567 U.S. ___
Van Hasselt, V. B. & Hersen, M. (1987). Handbook of adolescent psychology. New York: Pergamon
Press.
Vasta, R., Haith, M. M. & Miller, S. A. (1995). Child psychology: The modern science, Second Ed. New York:
John Wiley & Sons, Inc.
White, B. (1999). Understanding adolescent behavior: Knowledge, skills, & interventions. Trainer’s
Manual. Louisiana State University in Shreveport. Division of Continuing Education and Public
Service
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Materials
Myths & Facts
Myth 1: All youth in the juvenile justice system are mentally ill.
Facts:
• 65 percent to 70 percent of youth in juvenile correctional facilities have a mental health disorder.
• About 50 percent of youth in juvenile correctional facilities are in need of special education classes.
• Mental health disorders may be significantly different than behavioral disorders.
Myth 2: All mental health disorders cause criminal behavior.
Facts:
• Mental health disorders may or may not be associated with criminal/delinquent offenses. For
example, research shows that substance use introduces people to different types of crime, but
doesn’t necessarily cause the crime.
• Mental health disorders and delinquent behaviors may be related, but are not necessarily causative.
The disorder, if undetected or untreated, can manifest in behaviors that could bring a youth to the
attention of law enforcement.
• Mental health disorders may be genetic or environmental in nature.
Myth 3: Family members of youth with mental health disorders are resistant to treatment.
Facts:
• Family members often feel disconnected from treatment (or even blamed), especially in juvenile
detention and secure care settings.
• Many evidence-based practices focus on taking the blame off of any one person in a family and
refocus attention so that problems (mental illness included) are an issue for everyone in the family to
address and everyone can be part of the solution.
• Family members may assist in transitioning youth back into the community after an offense has been
committed (youth need support and resources to sustain change). For example, when there is a
smooth transition from detention or institutional care to the community, treatment is more effective
and can continue to help the child beyond confinement.
47
Myth 4: Mental health disorders and mental retardation are identical.
Facts:
• Mental retardation is a separate and distinct set of disorders affecting intelligence and educational
abilities.
• Mental health disorders are complex, affecting thinking, perception, mood and behaviors.
Myth 5: Mental health programming and treatment does not work with delinquent youth
who have mental health disorders.
Facts:
• Certain treatments have been shown to be effective.
• Interventions that are designed to work with youth in the context of their environment (family, home,
peer, school, work, neighborhood) have been found to be more effective than traditional office-based
or institutional interventions.
• Treatments that focus on teaching skills and reinforcing youth and family as they utilize those skills
in the “real world” are more effective than educational programs or interventions that only allow
youth to demonstrate skills in a controlled environment (e.g., office or institution).
Myth 6: Mental health screening should be provided to a limited number of youth who
enter the juvenile justice system.
Facts:
• All youth entering the juvenile justice system should be screened for mental health and other related
issues.
• Screening and assessing youth assist in developing effective treatment planning.
Myth 7: The Americans with Disabilities Act does not apply to mentally ill youth being
disciplined in juvenile justice settings for violating the law.
Facts:
• Accommodations must be made for youth with mental health disabilities.
• Youth need to be held accountable for their actions, but should not be punished for a symptom of
their mental illness (they should be treated).
48
Materials Medication Information Sheet
Brand
Generic Name
Indication
Common Side Effects
Abilify
Aripiprazole
Antipsychotic
Nausea, headache, dizziness, insomnia, anxiety
Adderall
Adderall XR
Dextroamphetamine/
amphetamine
Stimulant
(for ADHD)
Difficulty sleeping, feeling irritable or restless, dry mouth, dizziness,
loss of appetite, headache, feeling shaky, nausea
Ambien
Zolpidem
Sedative
Drowsiness, dizziness, difficulty with coordination, headache, nausea
Anafranil
Clomipramine
Antidepressant
Dry mouth, blurred vision, constipation, sedation, dizziness
Antabuse
Disulfiram
Alcoholism
Drowsiness, headache, “metallic” taste
Asendin
Amoxapine
Antidepressant
Dry mouth, blurred vision, constipation, sedation, dizziness, stiffness
Ativan
Lorazepam
Antianxiety
Drowsiness, dizziness, slurred speech, difficulty with coordination,
memory loss
BuSpar
Buspirone
Antianxiety
Drowsiness, dizziness, dry mouth, headache, nausea, fatigue
Catapres
Clonidine
Impulsive/aggressive
behaviors
Drowsiness, dizziness, dry mouth, headache, weakness, constipation
Campral
Acamprosate
Alcoholism
Dizziness, headache, nausea, tremor, diarrhea, insomnia, sweating
Celexa
Citalopram
Antidepressant
Nausea, nervousness, drowsiness, headache, change in appetite
Cymbalta
Duloxetine
Antidepressant
Nausea, dry mouth, constipation, dizziness, drowsiness
Clozapine
Clozapine
Antipsychotic
Sedation, increased salivation, constipation, increased appetite,
low blood pressure (Seizures may occur at high doses)
Dalmane
Flurazepam
Sedative
Drowsiness, dizziness, slurred speech, difficulty with coordination,
memory loss
Depakote
Depakene
Valproate, valproic acid,
divalproex
Mood Stabilizer
(Antimanic)
Nausea, vomiting, sedation, increased appetite
Desyrel
Trazodone
Antidepressant
Sedation, dizziness, dry mouth, blurred vision, headache
Dexedrine
Dextroamphetamine
Stimulant
(for ADHD)
Difficulty sleeping, feeling irritable or restless, dry mouth, dizziness,
loss of appetite, headache, feeling shaky, nausea
Effexor
Effexor XR
Venlafaxine
Antidepressant
Headache, dry mouth, nausea, constipation, drowsiness, nervousness,
trouble sleeping
Elavil
Amitriptyline
Antidepressant
Dry mouth, blurred vision, constipation, sedation, dizziness
Eskalith CR
Lithobid
Lithotab
Lithonate
Lithium Carbonate
Mood Stabilizer
(Antimanic)
Nausea, shakiness and tremor, dry mouth, diarrhea, drowsiness,
increased thirst, increased urination
With overdose: confusion, slurred speech, seizures, muscle twitching,
severe vomiting, coma and death
Geodon
Ziprasidone
Antipsychotic
Sedation, restlessness, dizziness, constipation, nausea, tremor
Halcion
Triazolam
Sedative
Drowsiness, dizziness, slurred speech, difficulty with coordination,
memory loss
Haldol
Haloperidol
Antipsychotic
Stiffness, shakiness, unusual muscle movements, sedation, dry mouth,
blurred vision
Invega
Paliperidone
Antipsychotic
Sedation, restlessness, dizziness, nausea, headache
Klonopin
Clonazepam
Antianxiety,
anti-seizure
Drowsiness, dizziness, slurred speech, difficulty with coordination, memory
loss
Lamictal
Lamotrigine
Mood Stabilizer,
anti-seizure
Dizziness, nausea, diarrhea, headache, blurred vision, drowsiness,
incoordination
Lexapro
Escitalopram
Antdepressant
Sedation, nausea, diarrhea, sweating, dizziness
Librium
Chlordiazepoxide
Antianxiety
Drowsiness, dizziness, slurred speech, difficulty with coordination,
memory loss
Loxitane
Loxapine
Antipsychotic
Stiffness, shakiness, unusual muscle movements, sedation, dry mouth,
blurred vision
Luvox
Fluvoxamine
Antidepressant
Nausea, nervousness, drowsiness, headache, change in appetite
Mellaril
Thioridazine
Antipsychotic
Stiffness, shakiness, unusual muscle movements, sedation, dry mouth,
blurred vision
49
Brand
Generic Name
Indication
Common Side Effects
Moban
Molindone
Antipsychotic
Stiffness, shakiness, unusual muscle movements, sedation, dry mouth,
blurred vision
Nardil
Phenelzine
Antidepressant
Dizziness, dry mouth, nausea, shakiness, blurred vision, increased appetite,
difficulty sleeping
Navane
Thiothixene
Antipsychotic
Stiffness, shakiness, unusual muscle movements, sedation, dry mouth,
blurred vision
Neurontin
Gabapentin
Antianxiety,
nerve pain
Dizziness, fatigue, incoordination, drowsiness, tremor
Norpramin
Desipramine
Antidepressant
Dry mouth, blurred vision, constipation, sedation, dizziness
Pamelor
Nortriptyline
Antidepressant
Dry mouth, blurred vision, constipation, sedation, dizziness
Paxil
Paroxetine
Antidepressant
Nausea, nervousness, drowsiness, headache, change in appetite
Prolixin
Fluphenazine
Antipsychotic
Stiffness, shakiness, unusual muscle movements, sedation, dry mouth,
blurred vision
Prozac
Fluoxetine
Antidepressant
Nausea, nervousness, drowsiness, headache, change in appetite
Remeron
Mirtazapine
Antidepressant
Sedation, increased appetite, dizziness, nausea, dry mouth, constipation,
impaired motor skills
Restoril
Temazepam
Sedative
Drowsiness, dizziness, slurred speech, difficulty with coordination,
memory loss
ReVia
Naltrexone
Alcoholism
Nausea, vomiting, nervousness, dizziness, anxiety, insomnia
Risperdal
Risperidone
Antipsychotic
Insomnia, anxiety, constipation, some stiffness at higher doses
Ritalin
Concerta
Methylphenidate
Stimulant
(for ADHD)
Difficulty sleeping, feeling irritable or restless, dry mouth, dizziness,
loss of appetite, headache, feeling shaky, nausea
Serax
Oxazepam
Antianxiety
Drowsiness, dizziness, slurred speech, difficulty with coordination,
memory loss
Seroquel
Quetiapine
Antipsychotic
Sedation, dizziness, constipation, dry mouth, low blood pressure
Serzone
Nefazodone
Antidepressant
Dizziness, drowsiness, dry mouth, nausea, constipation, weakness
Sinequan
Doxepin
Antidepressant
Dry mouth, blurred vision, constipation, sedation, dizziness
Strattera
Atomoxetine
For ADHD
Constipation or diarrhea, dizziness, dry mouth, headache, nausea
Stelazine
Trifluoperazine
Antipsychotic
Stiffness, shakiness, unusual muscle movements, sedation, dry mouth,
blurred vision
Symbyax
Fluoxetine/Olanzapine
Bipolar depression
Drowsiness, dizziness, headache, dry mouth, increased appetite
Tegretol
Carbamazepine
Mood Stabilizer
(Antimanic)
Dizziness or lightheadedness, clumsiness or unsteadiness, nausea,
weakness, blurred or double vision, drowsiness
Tenex
Guanfacine
Impulsive/aggressive
behaviors
Drowsiness, dizziness, dry mouth, headache, weakness, constipation
Thorazine
Chlorpromazine
Antipsychotic
Stiffness, shakiness, unusual muscle movements, sedation, dry mouth,
blurred vision
Tofranil
Imipramine
Antidepressant
Dry mouth, blurred vision, constipation, sedation, dizziness
Tranxene
Clorazepate
Antianxiety
Drowsiness, dizziness, slurred speech, difficulty with coordination,
memory loss
Trilafon
Perphenazine
Antipsychotic
Stiffness, shakiness, unusual muscle movements, sedation, dry mouth,
blurred vision
Trileptal
Oxcarbazepine
Mood stabilizer
Dizziness, nausea, tremor, headache, blurred vision, unsteady gait
Valium
Diazepam
Antianxiety
Drowsiness, dizziness, slurred speech, difficulty with coordination,
memory loss
Wellbutrin
SR/XL
Bupropion
Antidepressant
Anxiety, trouble sleeping, dry mouth, loss of appetite, headache,
constipation, shakiness
Xanax
Alprazolam
Antianxiety
Drowsiness, dizziness, slurred speech, difficulty with coordination,
memory loss
Zoloft
Sertraline
Antidepressant
Nausea, nervousness, drowsiness, headache, change in appetite
Zyprexa
Olanzapine
Antipsychotic
Sedation, constipation, increased appetite, dizziness, tremor
04/08 – Commonly Used Psychotropics, prepared by Sue Hahn, Pharm.D., Mental Health Center of Denver.
50
References
Abrantes, A.M., Hoffman, N.G., Anton, R. & Estroff, T.W. (2004). Identifying co-occurring disorders
among juvenile justice populations. Youth Violence and Juvenile Justice, 2(4), 329-341.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).
Arlington, VA: American Psychiatric Publishing.
Brown, S., Gleghorn, A., Schuckit, M. & Mott, M. (1996). Conduct disorder among adolescent alcohol
and drug abusers. Journal of Studies on Alcohol, 57(3), 314–324.
Grant, B., Stinson, F. & Harford T. (2001). Age at onset of alcohol use and DSM-IV alcohol abuse and
dependence: A 12-year follow-up. Journal of Substance Abuse, 13(4), 493-504.
McMahon, R.J., Wells, K.C. & Kotter, J.S. (2006). Conduct problems. In E.J. Marsh & R.A. Barkley
(Eds.), Treatment of childhood disorders (3rd ed., pp. 137-268). New York: Guilford Press.
National Action Alliance for Suicide Prevention: Youth in Contact with the Juvenile Justice System Task
Force. (2013). Need to know: A fact sheet series on juvenile suicide – Juvenile court judges and staff.
Washington, DC: Author.
Office of Juvenile Justice and Delinquency Prevention. (2014). Statistical briefing book. Available at
http://www.ojjdp.gov/ojstatbb/crime/qa05101.asp?qaDate=2011&text=
Saluja, G., Lachan, R., Scheidt, P. Overpeck, M., Sun, W. & Giedd, J. (2004). Prevalence of and risk
factors for depressive symptoms among young adolescents. Arch Pediatr Adolesc. 158: 760-765.
Shufelt, J. & Cocozza, J. (2006). Youth with mental health disorders in the juvenile justice system: Results
from a multi-state prevalence study. Delmar, NY: National Center for Mental Health and Justice.
Snyder, H.N. & Sickmund, M. (2006). Juvenile offenders and victims: 2006 national report. Washington,
DC: U.S. Department of Justice, Office of Justice Programs, Office of Juvenile Justice and
Delinquency Prevention.
Teplin, L., Abram, K., McClelland, G., Mericle, A., Dulcan, M. & Washburn, J.J. (2006). Psychiatric
disorders of youth in detention. Office of Juvenile Justice and Delinquency Prevention. Available at
http://www.ncjrs.gov/pdffiles1/ojjdp/210331.pdf
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Materials
Case Studies
.
Case Study #1
You are assigned to a school. You have been contacted by a student running down the hall who states
that the teacher is crying and Debra is out of control in the classroom. You respond to the classroom and
find the teacher sobbing at her desk while Debra, a 13-year-old student, is standing on the chair at her
desk screaming that the teacher was involved in a porn movie and that the students are all actors. Debra
screams that no one is real and they must all stop talking. Someone has broken the cubbies in the room
and papers, boots, and backpacks are strewn about the area. The kids in the classroom have mixed
reactions: some are fearful, some are laughing, and some are quietly watching. Two girls are trying to get
out of the room by sliding along the wall while Debra’s back is turned.
Useful Information
• Debra is known to be on some kind of medication.
• Debra has been transferred twice in the district due to disruptive behavior.
• Debra’s parents have filed a suit against the school, believing that their daughter has been
mistreated by school personnel and the School Resource Officer (SRO).
• The teacher has a history of depression which she shared with you during a disturbance in her class
last year.
• The principal has been notified and is expected to respond, however she has not arrived yet.
• The former SRO was criticized in the past by school staff and parents for being “too aggressive” in a
crisis situation which was investigated and founded. You are newly assigned to this school.
General Questions
1. What is your first priority?
2. How do you approach the room?
3. What kind of communication will be most effective with each of the identified parties?
4. What kind of resources might you offer?
(continued on next page)
65
Case Study #2
A call comes in through dispatch that a large group of kids is hanging out at a vacant convenience store
parking lot. The reporting party stated the kids are loud and that they are of all ages and all sizes. The
caller is sure they are doing drugs and other things that are horrible. The caller became upset when she
reported that she also heard someone, probably a girl, screaming. The caller is sure the girl was being
hurt – maybe even raped.
When you arrive on the scene, you observe a group of boys standing around a car and rocking it. They are
shouting or chanting and there is a trick bicycle lying on the ground near the car. You can’t see into the car, and
when you approach the scene, a girl on a bench starts screaming that you arrived too late.
One small boy watches you intently and seems to want to talk to you. Another female, perhaps age 14 or 15,
is walking in circles and asking for help from “my god.”
Useful Information
• This parking lot is known for drug sales and gang involvement. A local gang who engages in its own
interpretation of “voodoo” practices has recently been tagging the area.
• The girl praying has a history of running away; she has been found several times lying down on the
railroad tracks. One officer recognizes her upon arrival.
• The boy seems fearful and appears glued to the bench, yet his eyes follow you and he seems to be
mouthing something you can’t hear from your current position.
General Questions
1. What is your first priority?
2. How do you approach the car?
3. What kind of communication will be most effective with each of the identified parties?
4. What kind of resources might you offer?
5. What, if any, difference might it make in this crisis-response situation if the youth involved are of
recent Caribbean origin and have maintained a tradition of voodoo practice? What might an officer
want to know in advance about this tradition and practice or how the youth have implemented their
own “interpretation” of this traditional practice?
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Materials
U.S. Department of Justice
HIPAA Fact Sheet
What Law Enforcement Officers “Need To Know” about the Federal Medical Records Privacy Regulation
and Access to “Protected Health Information”
• Since April 14, 2003, a federal regulation gives federal privacy protections to medical records
(45 Code of Federal Regulations – Parts 160 & 164).
• The regulation places legal obligations on doctors, hospitals, pharmacies, insurance companies,
etc., governing their ability to disclose medical information about a suspect or victim and may, in
some situations, prevent them from giving such information.
• This FACT SHEET will help law enforcement officers understand how to obtain personal medical
evidence needed for investigations, within the bounds of federal law.
Health Insurance Portability and Accountability Act of 1996 (HIPAA): Standards for Confidentiality of
Individually Identifiable Health Information (HIPAA Privacy Rule)
• HIPAA’s “Standards for Confidentiality of Individually Identifiable Health Information” governs how
and when a “Covered Entity” can use or disclose “individually identifiable health (medical)
information (in whatever form) concerning an individual person (in HIPAA terminology: “protected
health information”).
• There are three types of Covered Entities under HIPAA: (1) health plans: group and individual health
insurance, HMOs, Medicare, Medicaid and other government health plans; (2) health care
clearinghouses: billing services and providers; (3) health care providers: doctors, nurses, paramedics
and other emergency services personnel; hospitals and clinics; pharmacies (see 45 CFR 160.103). A
fourth type of covered entity included Medicare prescription drug discount card sponsors.
• Protected health information is “individually identifiable health information” which is transmitted by
electronic media, or maintained in any electronic medium (defined at 45 CFR 162.103), or transmitted
or maintained in any other form or medium (essentially all health records identifiable by a patient name
or other personal identifier – such as a Social Security number – is protected health information).
• As a general rule, Covered Entities may not use or disclose protected health information unless
permitted by a provision of the rules, such as the:
•
•
•
•
patient provides written authorization (permission) for the disclosure, or
disclosure is for a health oversight purpose, or
disclosure is for a certain law enforcement purpose (see next page), or
disclosure is otherwise required by law, e.g., statute, subpoena, court order.
• The behavior of government agencies that are not covered entities (e.g., law enforcement) is not
regulated by the HIPAA Privacy Rule, but when law enforcement agencies seek protected health
information from covered entities, the rules will dictate how the covered entities respond to law
enforcement requests for protected health information.
76
The HIPAA Privacy Rule provides “law enforcement exceptions” to the requirement that patients
authorize a Covered Entity’s disclosure of their protected health information. So, if a Covered Entity or a
person speaking on behalf of a Covered Entity, says: “Sorry, officer, I can’t give you that information
because of the HIPAA privacy regulations...” or “the patient didn’t authorize this disclosure...”, you can
respond with one of the following responses, IF it applies...“Yes, [Covered Entity], you can give me the
information I need because [one of the following law enforcement exceptions applies]...”
1.
Required by law [45 CFR 164.512(f)(1)(i)]. “The laws of this State require reporting of [certain types of
wounds or other physical injuries...] to law enforcement agencies...”
2.
Court order, or warrant, subpoena or summons issued by a judicial officer [45 CFR 164.512(f)(1)(ii)(A)]. “I
am serving a court-ordered subpoena on you, so you can (and must) produce the medical records I am
seeking.”
3.
Grand jury subpoena [45 CFR 164.512(f)(1)(ii)(B)]. “I am serving a grand jury subpoena on you, so you can
(and must) produce the medical records that I seek.”
4.
Administrative subpoena or request, but only if three specific requirements are met [45 CFR
164.512(f)(1)(ii)(C)]. “Because I am serving an administrative subpoena on you, and I certify that the
subpoena meets the three-part test... (1) the information sought is material to a legitimate law enforcement
inquiry; (2) the request is specific and limited in scope to the purpose for which it is being sought; and (3)
de-identified information could not reasonably be used (i.e., without SSN or name, the information would
be useless as evidence).
5.
Locate or identify [45 CFR 164.512(f)(2). “I am trying to locate OR identify a suspect... fugitive...material
witness...OR a missing person.” This exception will permit access to eight types of individually identifiable
information (but excludes DNA, dental records, body fluid, or tissue, which would require a subpoena).
6.
Information about a victim of a crime [45 CFR 164.512(f)(3). “I need this information about this person, who
is or I suspect is a victim of a crime...or to determine if someone else committed a crime...that cannot be
delayed until the victim approves the disclosure...”
7.
Crime on premises [45 CFR 164.512(f)(5)]. “The [covered entity] believes that the information is evidence
of a crime that occurred on the premises” (e.g. a nursing home, hospital, etc.).
8.
Reporting crime in emergencies [45 CFR 164.512(f)(6)]. “You are an emergency health care worker who
responded to a medical emergency outside the hospital (etc.) and you can tell law enforcement about the
commission and nature of the crime; location of the crime and victims; the identity, description or location
of the perpetrator...”
9.
Victims of abuse, neglect, domestic violence [45 CFR 164.512(c)]. This exception is limited to four specific
scenarios; if possible, get a subpoena or the individual’s agreement to use his/her medical information
instead of relying on this exception.
10. Coroners [45 CFR 164.512(g)(1)]. “Because the coroner or medical examiner needs the information to
determine the cause of death or perform his other duties…”
11. To avert a serious threat to health/safety [45 CFR 164.512(j). “The disclosure is necessary to avert a
serious and imminent threat to a person’s safety or the public...; OR to identify or apprehend an individual
... because that individual admitted participating in a violent crime that may have caused serious physical
harm to the victim”; OR “to identify or apprehend someone who escaped from a correctional institution or
from lawful custody.”
12. Other important miscellaneous exceptions: National security and intelligence; protective services for the
President and others; jails, prisons, law enforcement custody to safeguard the person/s in custody or
corrections employees who are in proximity of the person/s in custody.
Remember to show your badge, that you need to satisfy only ONE of the law enforcement exceptions, AND that you also
must familiarize yourself with the requirements of your state’s medical records privacy laws. To stop a Covered Entity from
disclosing to patients that you have their medical information, (1) make an oral request that the entity not make a disclosure to the
patient and (2) follow up with a written request, on official letterhead, within 30 days.
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Materials
U.S. Department of Justice
HIPAA Card
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