n general, studies to date have shown that a significant portion of incarcerated youth are suffering from some form of mental health disorder.

The Mental Health Services for At-Risk and Adjudicated Youth component is intended to improve the accessibility, quality, and efficiency of mental health services in communities and in juvenile facilities, with a particular focus on juvenile sex offenders. Mobile mental health units are an example of the type of enhanced services envisioned by OJJDP, although none of the demonstration sites have implemented such an approach to date. Other elements of this component include providing consultation and liaison services to law enforcement and justice system personnel who work with at-risk and delinquent juveniles, developing forensic case management systems for incarcerated mentally disordered youth, and providing training programs for mental health professionals who provide services to detained or confined juveniles and juvenile sex offenders. Services developed under this component are intended to include family participation and to be sensitive to ethnic and cultural backgrounds. Funding for this component is provided at a maximum of $150,000 per year to each SafeFutures site under Title II, Part C, of the JJDP Act of 1974, as amended.

Mental health problems in adolescents are reportedly widespread, with as many as 5 percent of adolescents suffering from serious emotional disturbances (Center for Mental Health Services, 1997). Although the link between mental health disorders and juvenile delinquency has not yet been firmly established, it has been shown that mental health disorders and delinquency co-occur (Elliott, Huizinga, and Menard, 1989). In general, studies to date have shown that a significant portion of incarcerated youth are suffering from some form of mental health disorder (Fagan, 1991; Hollender and Turner, 1985; McManus et al., 1984). Although the disorders experienced by the juvenile offender population are less severe than those of hospitalized youth, juvenile offenders nevertheless display a significantly higher prevalence of mental health disorders than the general youth population (Pumariega et al., 1995). Breda (1995, p. 210), for example, found that among youth with serious delinquency problems, more than 80 percent had “clinically significant psychopathology.” In addition, the study found that although there was only a moderate link between mental health disorders and delinquency, delinquent youth tended to have multiple mental health problems.

Juvenile sex offenders are responsible for a significant portion of sexual assaults, including an estimated 20 percent of rapes and 30 to 60 percent of child molestation cases (Brown, Flanagan, and McLeod, 1984). The number of juveniles arrested for sex offenses is growing steadily (Snyder and Sickmund, 1995). Furthermore, there is an established link between juvenile sex offending and adult sex offending: about half of adult sex offenders began offending as juveniles (Barbaree, Hudson, and Seto, in Barbaree, Marshall, and Hudson, 1993). Although the literature is sparse in this area, it does appear that cognitive-behavioral models used to treat adult sex offenders can be adapted to treat juvenile offenders. Some data suggest that effective therapies include reducing age-inappropriate sexual interests, improving sexual impulse control, enhancing social and assertiveness skills, cognitive restructuring, sex education, and relapse prevention (Becker and Kaplan, in Barbaree, Marshall, and Hudson, 1993). However, basic work remains to be done in this field. For instance, the Office of Justice Programs is currently working toward the development of a juvenile sex offender typology that would distinguish among juvenile sex offenders based on such factors as victim selection, level of aggression, and modus operandi. Such a typology could be used to assist judges and other court personnel in making appropriate disposition and placement decisions.

reatment plans are developed in concert with the family and are designed to intervene within families and between family members, peers, and other central social relationships.

In recent years, Multisystemic Therapy (MST) has attracted considerable attention as a viable approach to treating serious juvenile offenders and adolescent sexual offenders and their families (Henggeler et al., 1996; Sutphen, Thyer, and Kurtz, 1995). MST uses a family preservation model of service delivery to empower youth and families by supporting the development of resources and skills needed to deal with difficulties effectively. Treatment plans are developed in concert with the family and are designed to intervene within families and between family members, peers, and other central social relationships. Services are delivered in real-world settings (e.g., at home, in school).

Because of the complexity of developing mental health programs or services, there was a long lead time for implementation of this component in most sites. Only three sites provided direct mental health services as part of SafeFutures during year 1, although others engaged in planning efforts to devise strategic responses. The configuration of services provided under this component varies considerably across sites. Some (such as Contra Costa County and Fort Belknap) established new residential facilities for mental health services; others (such as Seattle and Imperial County) included mental health counseling as part of the menu of services offered by multifaceted programs.

Most sites focused their efforts on youth in the juvenile justice system, as illustrated by the following examples, which also reflect varying degrees of collaborative effort and/or systems reform.

Contra Costa County, CA. Contra Costa opened its Summit Center, which represents a collaborative effort, with funds or staff provided by SafeFutures, the County Probation Department, and the County Office of Education and California mental health funds matched by MediCal funds.⁹ Program staff (e.g., probation counselors and therapists) function as an integrated team, not in separate departments, and have been cross-trained.

Youth are identified for participation by the Summit Center’s director, who serves as a member of the Probation Department Screening Committee that meets weekly to review cases of youth recommended for placement other than custody (e.g., to group homes, residential facilities, etc.). Most youth in the Center have had treatment failures in prior residential placements; all have some kind of current or prior juvenile offense history.

The program serves 12- to 18-year-old males and can house 20 youth at a time. Youth in the Center are not in custody but are under general probation orders. Participation is voluntary; the youth and a parent or responsible adult must agree to participate in the program. Parental/adult involvement is required because family therapy is an integral part of the treatment; there are also multifamily groups led by a therapist and two parent support groups.

outh participate in individual, group, and family therapy, based on individual treatment plans.

Youth participate in individual, group, and family therapy, based on individual treatment plans. They attend school at the Center (in a class taught by a County Office of Education teacher and teacher’s aide), with individualized study plans to address their varying academic needs and status. The Center operates substance abuse groups (youth also may attend Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) meetings outside the Center) and groups addressing topics such as conflict resolution, anger management, and life skills. The program operates on a “level” system, with youth earning additional privileges as they move through four progressive levels of behavior and responsibility. Successfully completing (graduating from) the program takes approximately 6 months.

An aftercare component lasting approximately 1 year provides “wraparound” services using a model similar to multisystemic treatment. The approach emphasizes the use of family, system, and community resources (e.g., mental health or substance abuse resources). Wraparound teams are formed shortly after youth enter the Summit Center. Youth and families identify team members, which may include individuals such as parent(s), sibling(s), other relatives, a neighbor, a member of the youth’s church, the youth’s probation officer, and “outside” professionals, such as clinicians. The team is intended to help the family address issues/needs to assist in the youth’s transition back to the community. The Summit Center case manager assigned to the team serves as its facilitator while the youth is in the Center and for up to 1 year after Summit Center completion, although the team itself is intended to continue after that. The team meets biweekly or monthly while the youth is in the Center; after the youth graduates, team meetings are generally held once per month in the youth’s home or a community location.

Partly because of the perceived success and positive publicity associated with the Center, the county has developed a comparable facility for girls (modeled after the Summit Center), which became operational in late 1999. It serves 20 residential and 15 day-treatment clients.

St. Louis, MO. St. Louis SafeFutures provided support to the city’s Mental Health Board (MHB) to plan for this component.¹⁰ During the first 2 years of the initiative, MHB played a leading role in conducting a children’s mental health needs assessment, developing a strategic plan, and finding resources to initiate change. Systems change was perceived to have occurred even at this stage, in that the State mental health agency and the juvenile justice agencies had begun “talking to each other,” while in the past they had not had positive interaction. Funding for implementation of the plan is being provided by the Department of Mental Health, MHB, and SafeFutures, also illustrating collaboration.

he MST program uses a team of practitioners, home-based treatment, and family involvement to treat older youth.

The mental health services being implemented in year 3 focus on youth in the juvenile justice system. Two new programs are being funded: Child Conduct Programs and Multisystemic Therapy. The Child Conduct Programs target 7- to 11-year-olds who are starting to become out of control and their parents. The program focuses on effective parenting skills to avert delinquency. Services may include medication, assistance to parents in finding appropriate youth placement, special education, and other resources. The MST program uses a team of practitioners, home-based treatment, and family involvement to treat older youth. SafeFutures funds will support the service coordinator and the screening of SafeFutures youth and will likely assist staff training.

Youth receive an informal disposition (suspended interventions) pending participation in the program. Trained court intake staff, working with a mental health practitioner, use the Child/Adolescent Functional Assessment Scale (CAFAS) to determine individual risk levels. When CAFAS scoring indicates moderate or severe levels of impairment in a variety of domains (home, school, peer relations, substance abuse, thinking), youth are given a more comprehensive assessment. If mental health disorders are not substantiated, youth return to the court; otherwise, a treatment plan is devised. Services provided by the Department of Mental Health include psychological consultation, medication, and placement in a group home.

Seattle, WA. Seattle’s Sibling Support Program (SSP) focuses on youth in the juvenile justice system and their families.¹¹ SSP, which is a continuation of a project piloted by King County’s Department of Youth Services, represents a collaboration between SafeFutures, DYS, and the SSP provider (the Atlantic Street Center, a community-based nonprofit organization). SSP provides counseling and family therapy services to girls in the juvenile justice system, their siblings, and their parents. Key objectives include reducing recidivism and the likelihood that siblings will be offenders. Participation is voluntary; referrals typically come from probation officers, members of the Seattle Team for Youth, and judges. A credentialed therapist initiates the process by screening the parents and explaining the program’s requirements. A team (including some combination of probation officer, case manager, Child Protective Services professional, school officials, and relatives) is then assembled to monitor the offending youth’s and siblings’ progress and make treatment recommendations. Although there is no set course of treatment, the typical case progression appears to include making and keeping regular appointments, getting the child back into school or ensuring that the child remains in school, and getting the child and parent to acknowledge substance abuse problems and participate in therapy. Treatment for youth offenders may also include participation in other programs or in individual or group therapy.

Comprehensive Responses to Youth At Risk: Interim Findings From the SafeFutures Initiative

OJJDP Summary • November 2000